# IP 2018

Title:
A Sandwich Technique (N&H Variation Technique) To ‎Reduce Blood Loss During Cesarean Delivery For ‎Complete Placenta Previa; Methodological And ‎Statistical Concerns


Title:
Combined Cabergoline and Metformin in Patients with Polycystic Ovarian Disease with Hyperprolactinemia: Methodological Concerns


Title:
Comments On Manuscript: Early Amniotomy After ‎Dinoprostone Insert Used For The Induction Of Labor


Title:
Comments On Manuscript: Lidocaine For Pain Control ‎During Intrauterine Device Insertion


Title:
Comments On Manuscript: Measurement Of The Fetal Occiput-Spine Angle During The First Stage Of Labor As Predictor Of The Progress And Outcome Of Labor


Title:
Comments On: Effect Of Subcutaneous Tissue Closure Technique In Cesarean Section On Postoperative Wound Complications In Obese Egyptian Women


Title:
Effect Of Female Genital Cutting Performed By Health Care Professionals On Labor Complications In Egyptian Women: Methodological Concerns

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


Title:
Evaluating The Effects Of Copper Supplement During ‎Pregnancy On Premature Rupture Of Membranes And ‎Pregnancy Outcome: Some Statistical Issues


Title:
Intravenous Lidocaine Before Caesarean Section

Author Info:
a Department of Obstetrics and Gynecology , Assiut University , Assiut , Egypt.


Authors:
Abbas AM(1), Abdelbadee SA(1), Alanwar A(2), Mostafa S(1).

Title:
Efficacy Of Ferrous Bis-Glycinate Versus Ferrous Glycine Sulfate In The Treatment Of Iron Deficiency Anemia With Pregnancy: A Randomized Double-Blind Clinical Trial.

Abstract:
OBJECTIVE:
The aim of this study is to compare the efficacy and tolerability of oral ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia (IDA) with pregnancy.

METHODS:
A randomized double-blind clinical trial (NCT02590224) conducted at a tertiary University Hospital in the period between (1) January 2016 and 31 July 2017 included pregnant women at 14-18 weeks of gestation with mild to moderate IDA. Patients were randomized into two groups: (Group I) received oral ferrous bis-glycinate tablets once daily for eight consecutive weeks and (Group II) received oral ferrous glycine sulfate capsules in the same dose and duration. The primary outcome of the study was the rate of increase of hemoglobin (HB) level after 8 weeks of iron treatment.

RESULTS:
The study included 187 women in the final analysis. The mean increase in HB level after 8 weeks of treatment in ferrous bis-glycinate group was 2.48 ± 0.12 g/dL versus 1.32 ± 0.18 g/dL in ferrous glycine sulfate group (p ≤ .0001). The percentage of women with HB level more than 11 g/dL after 8 weeks of treatment was 89.2% in ferrous bis-glycinate group versus 71.3% in ferrous glycine sulfate group (p < .0001). The rate of adverse effects was significantly higher in ferrous glycine sulfate group (p = .001).

CONCLUSIONS:
Pregnant women with second trimester IDA could be supplied with ferrous bis-glycinate which is more efficient in increasing HB level. Moreover, it has tolerable adverse effects and high compliance than ferrous glycine sulfate.

Author Info:
(1)
a Department of Obstetrics & Gynecology, Faculty of Medicine , Assiut University , Egypt.
2
b Department of Obstetrics & Gynecology, Faculty of Medicine , Ain Shams University , Egypt.


Title:
Lactoferrin For Treating Iron Deficiency Anemia In ‎Pregnancy: Statistical Concerns


Authors:
Abbas AM(1), A Shehata M(2), M Fathalla M(1)

Title:
Maternal And Perinatal Outcomes Of Uterine Rupture In ‎A Tertiary Care Hospital: A Cross-Sectional Study

Abstract:
OBJECTIVE:
The current study aims to evaluate the incidence, maternal and perinatal outcomes in cases presented with uterine rupture (UR) and to explore the differences in presentation, management and outcome of UR in patients with scarred versus unscarred uterus.

MATERIALS AND METHODS:
A cross-sectional study conducted in a tertiary care hospital over a period of 2 years. The study included all women diagnosed with UR and admitted to the emergency unit between January 20(1)6 and December 2017. A structured questionnaire was used to collect the preoperative demographic and clinical data. An observation checklist was used for intraoperative findings and management. Postoperative data were collected about maternal and fetal outcomes. Data were analyzed using SPSS software. Qualitative variables were compared between groups using chi-square test while quantitative variables were compared using the Mann-Whitney test.

RESULTS:
Sixty two women were diagnosed with uterine rupture (0.32% of all deliveries). The mean age of the included patients was 29.6 ± 5.6 years while the mean parity was 3.0 ± 1.8. Uterine repair was successful in 52 cases (83.9%). There were four (6.5%) maternal deaths and 42 (67.8%) perinatal deaths. Ten patients (16.1%) were transferred to the postoperative intensive care unit (ICU). Re-exploration was carried out in three cases. The most common complication of UR was disseminated intravascular coagulopathy (DIC) occurred in eight women (12.9%). Maternal and perinatal mortality were significantly higher in patients with unscarred uterus (p = .0001 and .026, respectively).

CONCLUSIONS:
The incidence of UR is 32/10,000 deliveries in our tertiary hospital. Rupture of unscarred uterus is associated with more maternal and fetal mortality. However, rupture of scarred uterus was more common due to the rising rate of cesarean sections.

Author Info:
(1)
a Department of Obstetrics and Gynecology , Woman's Health Hospital, Assiut University , Assiut , Egypt.
2
b Department of Obstetrics and Gynecology , Dairut Hospital , Assiut , Egypt.


Authors:
Abbas AM(1), Elzargha AM(2), Ahmed AGM(1), Mohamed II(1), Altraigey A(3), Abdelbadee AY(4)

Title:
Oral Diclofenac Potassium Versus Hyoscine-N-Butyl Bromide In Reducing Pain Perception During Office Hysteroscopy: A Randomized Double-Blind Placebo-Controlled Trial

Abstract:
STUDY OBJECTIVE:
To compare the efficacy of oral diclofenac potassium versus hyoscine-N-butyl bromide (HBB) in reducing pain perception in patients undergoing diagnostic office hysteroscopy (OH).

DESIGN:
Randomized double-blind placebo-controlled trial (Canadian Task Force I) SETTING: University Hospital.

INTERVENTION:
One-hundred twenty-nine patients were divided randomly into 3 groups (n=43 in each group); (group I) received 50 mg diclofenac potassium, group (II) received 20 mg HBB, and group (III) received placebo tablets. All tablets were taken orally (1) hour prior to OH. Primary outcome was the participant's self-rated pain perception using the 10-point Visual Analogue Scale (VAS) during the procedure. Secondary outcomes included the VAS score 30 minutes after OH, ease of OH assessment using a 10 cm scale, duration of OH and adverse effects of the study medications.

MEASUREMENTS AND MAIN RESULTS:
Both of diclofenac and HBB groups showed significant pain scores reduction compared with placebo group (p=0.001). The mean pain score in diclofenac group was significantly lower than HBB group (2.12±1.03 vs. 3.02±1.55 respectively, p=0.002). Pain scores in diclofenac and HBB groups immediately after OH were significantly lower than placebo group (p=0.001) and the mean pain score in diclofenac group was significantly lower than HBB group (1.23±0.57 vs. 1.56±0.73 respectively, p=0.024). The ease of procedure score was significantly lower in diclofenac and HBB groups than the placebo group (p=0.003 &0.005, respectively). The mean duration of the procedure was significantly less in the diclofenac group (p=0.01). Fourteen women (32.6%) in the HBB group experienced dizziness and two women (4.6%) had nausea while only four women (9.3%) in the diclofenac group had dizziness and two women (4.6%) had vomiting.

CONCLUSION:
Oral diclofenac potassium administration 1 hour prior to diagnostic OH reduces the procedure pain with subsequent easier and shorter OH duration. Oral HBB is less effective than diclofenac potassium with more adverse effects. The trial is registered at Clinicaltrials.gov on March 21, 2016 with number NCT02714699 and available at:https://clinicaltrials.gov/ct2/show/NCT02714699?term=NCT02714699&rank=1.

Author Info:
(1)
From the Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt.
2
Department of Obstetrics & Gynecology, Faculty of Medicine, Sirte University, Libya.
3
Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University, Egypt.
4
From the Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt. Electronic address: ahmedhefnawy2015@gmail.com.


Authors:
Abdalmageed OS(1), Farghaly TA(1), Abdelaleem AA(1), Abdelmagied AE(1), Ali MK(2), Abbas AM(2)

Title:
Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial

Abstract:
OBJECTIVES:
To evaluate the impact of metformin on in vitro fertilization (IVF) outcomes in overweight and obese women with polycystic ovary syndrome (PCOS).

METHODS:
This was a randomized double-blind placebo-controlled study ( ClinicalTrials.gov : NCT 029(1)0817) carried out in a University IVF Center. The study included 102 overweight and obese women (body mass index [BMI] >24 kg/m2) with PCOS who underwent their first fresh autologous IVF-embryo transfer cycle and agreed to participate in the study. The study participants were randomized into 2 groups: metformin group received metformin (1000 mg per day) at the start of controlled ovarian stimulation (COH) until the day of the pregnancy check, and placebo group received placebo tablets in the same duration. The primary outcome measure was the total number of retrieved oocytes.

RESULTS:
Both groups were homogenous in baseline demographic characteristics. Metformin group versus the placebo group demonstrated decrease in the mean number of the retrieved oocytes (9.06 ± 4.23 vs 16.86 ± 8.3, P < .01) and similar live birth rate (LBR; 25.5% vs 17.6%, P = .34). The number of fertilized oocytes was lower in the metformin group (5.65 ± 2.66 vs 9 ± 4.55, P < .01). However, the fertilization rate was similar in both groups (62.3% vs 53.4%, P = .10). There was no difference in the implantation rate (15.7% vs 11.8%, P = .32), multiple pregnancy rate (13.4% vs 3.9%, P = .08), or miscarriage rate (23.5% vs 35.7%, P = .46). No cases of ovarian hyperstimulation syndrome (OHSS) were observed in both groups.

CONCLUSION:
Short-term administration of metformin to overweight or obese women with PCOS undergoing IVF decreased number of the retrieved oocytes but did not improve the LBR. Synopsis Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.

Author Info:
(1)
1 Assiut IVF center, Assiut University, Assiut, Egypt.
2
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel-Ghaffar HS(1), Kamal SM(2), El Sherif FA(2), Mohamed SA(2)

Title:
Comparison Of Nebulised Dexmedetomidine, Ketamine, ‎Or Midazolam For Premedication In Preschool Children ‎Undergoing Bone Marrow Biopsy

Abstract:
BACKGROUND:
The aim of our study was to compare the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication administered by nebuliser 30 min before general anaesthesia in preschool children undergoing bone marrow biopsy and aspiration.

METHODS:
Ninety children aged 3-7 yr were randomly allocated into three equal groups to be premedicated with either nebulised ketamine 2 mg kg-(1) (Group K), dexmedetomidine 2 μg kg-1 (Group D), or midazolam 0.2 mg kg-1 (Group M). The primary endpoint was a five-point sedation score on arrival in the operating room 30 min after end of study drug administration. Secondary outcomes included: parental separation anxiety scale; medication and mask acceptance scales; haemodynamic variables; recovery time; postoperative face, legs, activity, cry, and consolability scale; emergence agitation scale; and adverse effects.

RESULTS:
The median (range) sedation score on arrival in the operating room was 3.5 (1-4), 2.0 (2-3) and 2.0 (1-3) in Groups M, D, and K, respectively (P=0.000). Subjects in Group D showed higher medication (P<0.03) and mask acceptance scores (P<0.015) and more satisfactory parental separation anxiety scale (P<0.044). The median (range) recovery time was significantly shorter in Group D [5.5 (4-8) min] compared with Group K [10.0 (5-15) min, P=0.000] and M [8.0 (6-15) min, P=0.000]. The incidence of emergence agitation was lower in Group D (P<0.008).

CONCLUSIONS:
Preschool children premedicated with nebulised dexmedetomidine had more satisfactory sedation, shorter recovery time, and less postoperative agitation than those who received nebulised ketamine or midazolam.

CLINICAL TRIAL REGISTRATION:
NCT02935959.

Author Info:
(1)
Anaesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: hallasaad@yahoo.com.
2
Anaesthesia, Intensive Care and Pain Management Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Title:
Prophylactic Granisetron For Post-Spinal Anesthesia ‎Shivering In Caesarean Section: A Randomized ‎Controlled Clinical Study

Abstract:
BACKGROUND:
The serotonergic system is known to be involved in control of post-anesthetic shivering. Our hypothesis was that prophylactic granisetrone (serotonin antagonist) might reduce incidence of post- spinal anesthesia shivering in cesarean section.

METHODS:
Parturient scheduled for elective Caesarean delivery under spinal anesthesia were allocated to receive 0.9% saline (Group I, n = 7(1)), 1 mg granisetron (Group II, n = 69), or 0.7 mg granisetron (Group III, n = 72) before the spinal block. Assessment parameters included; hemodynamics, tympanic membrane temperature, neonatal Apgar score, shivering score, patient satisfaction scores about shivering prophylaxis and adverse effects.

RESULTS:
Clinically significant shivering was recorded in 55/71 patients (77.5%) in group I, 11/69 (15.9%) in group II and 21/72 (29.2%) in group III (P = 0.000). The intensity of shivering was significantly lower in patients who received granisetron 1 mg compared with granisetron 0.7 mg or saline (P = 0.000). Patients who received prophylactic granisetron 1 mg reported lower mean intraoperative arterial pressure and heart rate values and consumed higher doses of iv ephedrine compared with 0.7 mg granisetron or saline placebo (P < 0.05). Pruritus significantly decreased from (22.5%) in control group to (0%) in granisetron groups (P = 0.000). Nausea was reported in 8 vs. 10 and 4 in group I, II, and III respectively (P < 0.03). Sixteen vs. eight and six patients vomited in group I, II, and III respectively (P < 0.03). Higher patient satisfaction scores were recorded in group II (9.83 ± 0.29, P < 0.03) and III (9.14 ± 1.04, P < 0.04), compared with control group (8.23 ± 1.14).

CONCLUSION:
Prophylactic granisetron effectively reduced incidence and severity of perioperative shivering in a dose-dependent manner, compared to placebo controls.

Author Info:
(1)
Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel-Ghaffar HS(1), Abdel-Aziz NGE(2), Mostafa MF(2), Osman AK(2), Thabet NM(2)

Title:
Ketamine As An Adjunct To Bupivacaine In Infra-Orbital ‎Nerve Block Analgesia After Cleft Lip Repair

Abstract:
OBJECTIVES:
We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries.

METHODS:
Sixty patients were randomly allocated into two groups (n=30), Group B received infra-orbital nerve block with 2mL of 0.25% Bupivacaine and Group BK received 0.5mg.kg-(1) Ketamine for each side added to 1mL of 0.5% Bupivacaine solution diluted up to 2mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects.

RESULTS:
Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p<0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p<0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67±45.67 vs. 240.0±0.0mg, p<0.04). The time to first oral intake was significantly reduced in Group BK (87.67±15.41 vs. 27.33±8.68min, p<0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45min (0.86±0.11 vs. 0.46±0.16, p<0.04) and in the first hour (h) postoperatively (1.40±0.17 vs. 0.67±0.14, p<0.003). Higher parent satisfaction scores were recorded in Group BK (p<0.04) without significant adverse effects.

CONCLUSIONS:
The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries

Author Info:
(1)
Assiut University, Faculty of Medicine, Pediatric Hospital, Assiut, Egito. Electronic address: hallasaad@yahoo.com.
2
Assiut University, Faculty of Medicine, Pediatric Hospital, Assiut, Egito.


Authors:
Abdel-Wahab N(1),(2), Talathi S(3), Lopez-Olivo MA(1), Suarez-Almazor ME(1).

Title:
Risk Of Developing Antiphospholipid Antibodies ‎Following Viral Infection: A Systematic Review And Meta-‎Analysis

Abstract:
Objective The objective of this paper is to conduct a systematic review and meta-analysis on the risk of developing elevated antiphospholipid (aPL) antibodies and related thromboembolic and/or pregnancy events following a viral infection. Method We searched Medline, EMBASE, Web of Science, PubMed ePubs, and Cochrane Central Register of Controlled Trials through June 20(1)6. Independent observational studies of elevated aPL antibodies in patients with a viral infection compared with controls or patients with lupus were included. Results We analyzed 73 publications for 60 studies. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) were most commonly reported. Compared with healthy controls, patients with HIV were more likely to develop elevated anticardiolipin (aCL) antibodies (risk ratio (RR) 10.5, 95% confidence interval (CI) 5.6-19.4), as were those with HCV (RR 6.3, 95% CI 3.9-10.1), hepatitis B virus (HBV) (RR 4.2, 95% CI 1.8-9.5), and Epstein-Barr virus (EBV) (RR 10.9 95% CI 5.4-22.2). The only statistically significant increased risk for anti-β2-glycoprotein I (anti-β2-GPI) antibodies was observed in patients with HCV (RR 4.8 95% CI 1.0-22.3). Compared with patients with lupus, patients with HIV were more likely to develop elevated aCL antibodies (RR 1.8, 95% CI 1.3-2.6), and those with EBV, elevated anti-β2-GPI antibodies (RR 2.2, 95% CI 1.3-3.9). Thromboembolic events were most prevalent in patients with elevated aPL antibodies who had HCV (9.1%, 95% CI 3.0-18.1), and HBV (5.9%, 95% CI 2.0-11.9) infections, and pregnancy events were most prevalent in those with parvovirus B19 (16.3%, 95% CI 0.78-45.7). However, compared to virus-infected patients with negative aPL antibodies, the only statistically significant increased risk was observed in those with HCV and positive aPL. Conclusions Viral infection can increase the risk of developing elevated aPL antibodies and associated thromboembolic events. Results are contingent on the reported information.

Author Info:
(1)
1 Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The 4002 University of Texas MD Anderson Cancer Center , Houston, TX, USA.
2
2 Rheumatology and Rehabilitation Department, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt.
3
3 2011 Lincoln Medical Center , Weill Cornell Medical College, Bronx, NY, USA.


Authors:
Abdel-Wahab R(1),(2), Varadhachary GR(1), Bhosale PR(3), Wang X(4), Fogelman DR(1), Shroff RT(1), Overman MJ(1), Wolff RA(1), Javle M5.

Title:
Randomized, Phase I/II Study Of Gemcitabine Plus IGF-‎‎(1)R Antagonist (MK-0646) Versus Gemcitabine Plus ‎Erlotinib With And Without MK-0646 For Advanced ‎Pancreatic Adenocarcinoma

Abstract:
BACKGROUND:
Binding of insulin-like growth factor-I (IGF-(1)) to its receptor (IGF-1R) initiates downstream signals that activate PI3K/Akt/mTOR and MEK/Erk pathways, which stimulate cancer cell proliferation and induce drug resistance. Cross talk between IGF-1R and epidermal growth factor receptor (EGFR) mediates resistance to anti-EGFR agents. We studied safety, tolerability, and outcomes of MK-0646, IGF-1 monoclonal antibody, in combination with gemcitabine (G) ± erlotinib (E) in metastatic pancreatic cancer.

METHODS:
Our study included a phase I dose escalation and phase II randomization and expansion cohorts. A 3 + 3 dose escalation protocol was used to determine MK-0646 maximum tolerable dose (MTD) in combination with G ± E standard doses. For phase II, patients were randomized to arm A (G + MK), arm B (G + MK + E), or arm C (G + E). Primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), disease control rate, toxicity, and correlation between OS and IGF-1 in patients treated with MK-0646.

RESULTS:
MK-0646 MTD was 10 mg/kg in combination with G and 5 mg/kg in combination with G + E. In randomization cohort, 15 patients were treated in each arm. Disease control rates were 50, 60, and 40% respectively. PFS was not different between the three arms. OS was significantly different between arm A (10.4 months) and C (5.7 months) (P = 0.02). However, addition of erlotinib in arm B yielded no OS benefit compared to arm A (P = 0.6). Plasma and tissue IGF-1 levels did not correlate with OS (P = 0.64, 0.87). Grade 3-4 toxicity during phase II cohorts were neutropenia (10/arm A, 14/arm B, 5/arm C), leukopenia (5/A, 5/B, 7/C), thrombocytopenia (8/A, 9/B, 2/C), hyponatremia (1/A, 3/B), and hyperglycemia (8/A, 1/B).

CONCLUSIONS:
MK-0646 was tolerable in combination with G and associated with improvement in OS but not PFS as compared with G + E. Tissue and serum IGF-1 did not correlate with clinical outcome.

TRIAL REGISTRATION:
This trial is registered in ClinicalTrial.gov under the Identifier NCT00769483 and registration date was October 9, 2008.

Author Info:
(1)
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 426, Houston, TX, 77030, USA.
2
Clinical Oncology Department, Assiut University Hospitals, Assiut, Egypt.
3
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 426, Houston, TX, 77030, USA. mjavle@mdanderson.org.


Authors:
Abdel-Zaher AO(1), Farghaly HSM(1), El-Refaiy AEM(2), Abd-Eldayem AM(1).

Title:
Protective Effect Of The Standardized Leaf Extract Of ‎Ginkgo Biloba (Egb76(1)) Against Hypertension-Induced ‎Renal Injury In Rats

Abstract:
BACKGROUND:
Ginkgo biloba leaves extract has been widely used worldwide to protect against oxidative stress-induced cell damage and improves blood circulation.

METHODS:
The potential protective role of the standardized leaf extract of Ginkgo biloba (EGb76(1)) on hypertension-induced renal injury was investigated in rats. Hypertension was induced in rats by L-NAME.

RESULT:
Repeated treatment with EGb761 produced progressive reductions in the systolic, diastolic and mean arterial blood pressure. Also, EGb761 increased the progressive reductions in blood pressure induced by losartan. Hypertension-induced marked elevation of renal malondialdehyde (MDA) and nitrite levels and reduction of reduced glutathione (GSH) level were inhibited by EGb761. In addition, hypertension-induced increases in tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β)) levels in renal tissues were inhibited by EGb761. Also, treatment with EGb761 inhibited hypertension-induced decrease in endothelial nitric oxide synthase (eNOS) protein expression and increase in the protein expressions of inducible NO synthase (iNOS), TNF-α, IL-6 and IL-1B in the kidney tissues. EGb761 enhanced losartan effects on renal tissues oxidative stress, nitrite, and inflammatory markers levels and on protein expressions of eNOS, iNOS, TNF-α, IL-6 and IL-1B. effects.

CONCLUSIONS:
These results indicate that EGb761 has the ability to protect against hypertension-induced renal injury.

Author Info:
(1)
a Pharmacology Department , Assiut University, Faculty of Medicine , Assiut , Egypt.
2
b Pathology Department , Assiut University, Faculty of Medicine , Assiut , Egypt.


Authors:
Abdelaleem AA(1), Abbas AM(1), Thabet AL(1), Badran E(1), El-Nashar IH(1).

Title:
The Effect Of Initiating Intravenous Oxytocin Infusion ‎Before Uterine Incision On The Blood Loss During ‎Elective Cesarean Section: A Randomized Clinical Trial

Abstract:
OBJECTIVE:
This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).

METHODS:
A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30 IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.

RESULTS:
The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p = .06 and 0.24 respectively) and hematocrit values (p = .(1)2 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7 ± 90.6 versus 588.9 ± 96.3 mL respectively, p = .001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p = .002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.

CONCLUSIONS:
Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.

Author Info:
(1)
a Department of Obstetrics & Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Abdelgawaad AS(1), Ezzati A(2), Govindasamy R(3), Krajnovic B(2), Elnady B(4), Said GZ4.

Title:
Kyphoplasty For Osteoporotic Vertebral Fractures With ‎Posterior Wall Injury

Abstract:
BACKGROUND CONTEXT:
Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers.

PURPOSE:
The primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated.

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

PATIENT SAMPLE:
Eighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 20(1)2 to 2016.

OUTCOME MEASURES:
The following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS).

METHODS:
All patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain X-ray images, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months.

RESULTS:
No cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day.

CONCLUSION:
Balloon kyphoplasty is a viable option for the treatment of osteoporotic vertebral fractures even with posterior wall involvement.

Author Info:
(1)
Spine Center, Helios Klinikum Erfurt, Erfurt, Germany; Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt. Electronic address: ahsh313@yahoo.com.
2
Spine Center, Helios Klinikum Erfurt, Erfurt, Germany.
3
Department of Orthopedics, PIMS Medical College, Pondicherry, India.
4
Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt.


Authors:
Abdelmoneim SS(1),(2), Ball CA(1), Mantovani F(1),(3), Hagen ME(1), Eifert-Rain S(1), Wilansky S(4), Castello R5, Pellikka PA(1), Best PJM6,7, Mulvagh SL(1),6,8.

Title:
Prognostic Utility of Stress Testing and Cardiac Biomarkers in Menopausal Women at Low to Intermediate Risk for Coronary ARTery Disease (SMART Study): 5-Year Outcome

Abstract:
BACKGROUND:
In women with low to intermediate risk of coronary artery disease (CAD), prognostic detection strategies have been controversial. We present the follow-up data of the SMART trial in peri/postmenopausal women at low to intermediate risk of CAD.

OBJECTIVES:
To determine the value of contrast stress echocardiography (CSE), stress electrocardiogram (sECG), and serum biomarkers for prediction of cardiovascular events (CE) in peri/postmenopausal women at low to intermediate risk of CAD.

MATERIALS AND METHODS:
From January 2004 to August 2007, 400 peri/postmenopausal women were prospectively enrolled. All women had detailed risk factor assessment, and underwent simultaneous CSE (Definity®, Lantheus Medical Imaging) and sECG. Laboratories included brain natriuretic peptide (BNP), atrial natriuretic peptide, endothelin, and high sensitivity C-reactive protein. Wall motion score index was based on a (1)6-segment model. Abnormal CSE was defined as new or worsening wall motion abnormality at stress, while abnormal sECG was ≥1 mm horizontal/downsloping ST segment depression/elevation (80 mseconds duration). Self-reported outcome data were collected from a mailed Women's Heart Clinic Questionnaire. CE outcomes included all-cause mortality, nonfatal myocardial infarction (MI), heart failure, chest pain hospitalization or development of typical angina (CP), and revascularization (REVASC). Adjusted Cox proportional hazard ratios (HR; 95% confidence intervals) were reported.

RESULTS:
A total of 366 women (54.4 ± 5.5 years, Framingham risk 6.5% ± 4.4%) completed simultaneous CSE and sECG. Forty-two (11.5%) had abnormal CSE, while sECG was abnormal in 22 (6%) women. Follow-up (4.4 ± 1.2 years) was available in 315/366 (86%) women (78% exercise-CSE, 22% dobutamine-CSE). In those who completed follow-up, CSE was abnormal in 33 women (10.5%) and sECG was abnormal in 21 (6.7%). In 33 women with abnormal CSE, sECG was abnormal in 7 (21.2%) and normal in 26 (79%), p = 0.0004. CE occurred in 27 (8.6%) women: 8 all-cause mortality, 2 nonfatal MI, 13 CP, and 4 REVASC. CE occurred in 21% versus 7% of women with abnormal versus normal CSE, p = 0.014 and 38% versus 6% of women with abnormal versus normal sECG, p < 0.0001. Rest BNP was higher in women with CE versus those without (p = 0.018). Abnormal sECG and abnormal CSE were associated with CE, while only abnormal sECG was an independent predictor of CE (adjusted HR 10.3 [1.9-61.4], p = 0.007). Of the laboratory results, only BNP was associated with CE (adjusted HR 2.9 [1.1-7.3], p = 0.028).

CONCLUSIONS:
sECG and rest BNP were independent predictors of subsequent CE within 5 years in peri/postmenopausal women at low to intermediate risk of CAD.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT00162370.

Author Info:
(1)
1 Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, Minnesota.
2
2 Division of Cardiovascular Diseases, Assiut University , Assuit, Egypt .
3
3 Arcispedale Santa Maria Nuova (IRCCS) , Reggio Emilia, Italy .
4
4 Department of Cardiovascular Medicine, Mayo Clinic , Scottsdale, Arizona.
5
5 Memorial Hospital , Jacksonville, Florida.
6
6 Women's Heart Clinic, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, Minnesota.
7
7 Cardiovascular Catheterization Laboratory, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, Minnesota.
8
8 Department of Medicine, Division of Cardiology, Dalhousie University , Halifax, Nova Scotia, Canada .


Authors:
Aboulhagag NA(1), El-Deek HEM(2), Sherif MF(2).

Title:
Expression Of Galectin-(1) And Galectin-3 In Renal Cell ‎Carcinoma; Immunohistochemical Study

Abstract:
BACKGROUND AND AIMS:
Galectins comprise a large family of calcium independent lectins. Galectin-(1) and galectin-3 contribute to neoplastic transformation, angiogenesis, and tumor metastasis in some cancers. This study aimed at studying the immunohistochemical expression of both galectin-1 and galectin-3 in renal cell carcinoma (RCC) variants and detecting the possible association of galectins with various clinicopathological parameters.

MATERIALS AND METHODS:
Sections from 67 formalin-fixed paraffin-embedded tissue blocks of RCC variants were stained with galectin-1 and galectin-3. Expression was assessed in tumor tissue and adjacent renal parenchyma and was correlated with clinicopathological criteria.

RESULTS:
In apparently normal renal parenchyma adjacent to tumor tissue, galectin-1 was expressed in 27 (40.2%) of specimens in renal tubules and glomeruli, while 34 (50.7%) of specimens showed galectin-3 expression in renal tubules sparing glomeruli. In tumor tissue, galectin-1 showed high expression in 47 (70.1%) and low expression in 20 (29.9%) of specimens. Galectin-3 had high expression in 15 (22.4%) and low expression in 52 (77.6%) of specimens. Significant association was detected between expression of galectin-1 and galectin-3 and the type of RCC (P = 0.032) and (P = 0.006), respectively. Significant inverse association was detected between the expression of galectin-3 and the presence of tumor haemorrhage and necrosis (P = 0.014) and (P = 0.039), respectively.

CONCLUSION:
Galectin-1 and galectin-3 are overexpressed in RCC with different percentage in different subtypes. Galactin-1expression is more in tumor tissue than surrounding renal parenchyma suggesting that it has a carcinogenic role. Galectin-1 and galectin-3 overexpression in chromophobe RCC suggests that they may have diagnostic role.

Author Info:
(1)
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: nohah@aun.edu.eg.
2
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Aboulhagag NAE(1), Torky RF(2), Fadel SA(3)

Title:
Folate Receptor Α Is Associated With Poor ‎Clinicopathological Perspectives In Breast Carcinoma

Abstract:
BACKGROUND:
Breast carcinoma is the commonest malignancy in females. Folate is required for the biosynthesis of nucleotide bases, amino acids, and other cellular methylation reactions in proteins and phospholipids. The high affinity folate receptor alpha (FRα) has been shown to be expressed in several kinds of human cancers.

METHODS:
In this descriptive-analytic study, sections from formalin-fixed paraffin-embedded tissue blocks of 50 cases of invasive ductal breast carcinoma (IDC) as well as (1)5 cases of non-neoplastic breast specimens were immunohistochemically stained with FRα antibody. Histopathological evaluation for various clinicopathological parameters was done and was correlated with FRα expression.

RESULTS:
Positive FRα expression was more frequently detected in IDC (64%) compared to non-neoplastic breast specimens (20%). In IDC, Positive FRα expression was significantly associated with high tumor grade (p = 0.007), large tumor size (p < 0.001), high lymph node stage (p = 0.004), presence of angiolymphatic emboli (p = 0.001), presence of perineural invasion (p = 0.001). Significant association between FRα positivity and negative hormone receptors (estrogen and progesterone) (p < 0.001) and triple negative cases (p = 0.0021).

CONCLUSION:
Our work demonstrates that FRα is over expressed in IDC compared to non-neoplastic breast tissue. Folate receptor α expression was associated with poor clinicopathological perspective. This work suggests that FRα may be an independent prognostic factor and supports the possibility of using FRα-targeted therapies of breast carcinoma. However, our work requires validation on larger cohort with correlation with survival data of patients.

Author Info:
(1)
Department of Pathology, Faculty of Medicine, Assiut University, 7111, Assiut, Egypt. Electronic address: nohah@aun.edu.eg.
2
Department of Pathology, Faculty of Medicine, Assiut University, 7111, Assiut, Egypt. Electronic address: rana-torky11@aun.edu.eg.
3
Department of Pathology, Faculty of Medicine, Assiut University, 7111, Assiut, Egypt. Electronic address: sabahahmed@aun.edu.eg.


Authors:
Abubeih H(1), Khaled M(2), Saleh WR(2), Said GZ(2).

Title:
Flexor Hallucis Longus Transfer Clinical Outcome ‎Through A Single Incision For Chronic Achilles Tendon ‎Rupture

Abstract:
PURPOSE:
The aim of this study is to evaluate the clinical outcome of single-incision flexor hallucis longus tendon transfer in chronic Achilles tendon rupture.

METHODS:
A prospective study of a series of cases of chronic Achilles tendon rupture that were treated with single-incision flexor hallucis longus tendon transfer, from April 20(1)5 to December 2016. The study included 21 patients (15 men and 6 women), with mean age 40.3 ± 17.5 years. The average follow-up time was 15 (12-24) months. Flexor hallucis longus transfer was fixed with a titanium interference screw in an intraosseous calcaneal tunnel.

RESULTS:
The average operative time was 52.9 ± 8.7 minutes. The AOFAS-hindfoot score was significantly improved from the mean pre-operative value of 57.4 ± 10.3 to mean value of 95.3 ± 4.4 (p value < 0.001). There was no effect on the big toe function. The complication recorded was one superficial wound infection which resolved by dressing and appropriate antibiotic coverage. All patients were satisfied with the results of surgery.

CONCLUSIONS:
Single-incision flexor hallucis longus transfer for chronic Achilles tendon ruptures is a simple method with minimal morbidity and complications. The technique resulted in great patients' satisfaction as well as excellent functional and clinical outcomes.

Author Info:
(1)
Orthopaedic Department, Assiut University Hospitals, PO box: 71526, Assiut, Egypt. hossamabubeih@hotmail.com.
2
Orthopaedic Department, Assiut University Hospitals, PO box: 71526, Assiut, Egypt.


Authors:
Abubeih HMA(1), Farouk O(1), Abdelnasser MK1, Eisa AA(1), Said GZ(1), El-Adly W(1).

Title:
Femoral Malalignment After Gamma Nail Insertion In The ‎Lateral Decubitus Position

Abstract:
INTRODUCTION:
Insertion of gamma nail with the patient in lateral decubitus position have the advantages of easier access to the entry point, easier fracture reduction and easier implant positioning. Our study described the incidence of femoral angular and rotational deformity following gamma nail insertion in lateral decubitus position.

METHODS:
In a prospective clinical case series, 3(1) patients (26 males and 5 females; the average age of 42.6 years) with 31 proximal femoral shaft fractures that were treated with gamma IMN were included in our study. Postoperatively, computerized tomography scans of the pelvis and both knees (injured and uninjured sides) were examined to measure anteversion angles on both sides. A scout film of the pelvis and upper both femurs was taken to compare the neck shaft angles on both sides.

RESULTS:
No angular malalignment was detected in our series; the mean angular malalignment angle was 1.6 ± 1.5°. There was a high incidence of true rotational malalignment of ≥10° in 16 out of 31 patients (51.6%); most of them were external rotational malalignment. Younger age group (≤40 years) had significantly more incidence of rotational malalignment (≥10°) than older age group (>40 years) (P-value 0.019).

DISCUSSION:
Gamma nail fixation in lateral decubitus position without the fracture table gives an accurate and easier access to the entry point, good implant positioning with no or minimal angular malalignment (varus -valgus) but poses high incidence of true rotational malalignment. Great care and awareness of rotation should be exercised during fixing proximal femoral fractures in lateral decubitus position.

Author Info:
(1)
Orthopaedic Department, Assiut University, Assiut, Egypt.


Authors:
Ahmadzadeh A(1), Larsen M(1),(2), Jacobsen N(1),(2), Soliman W(3).

Title:
Risk Of Pecking Injury Of The Eye When Children And ‎Chickens Roam Together

Author Info:
(1)
Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark.
2
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
3
Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt.


Authors:
Ahmed MA(1), Kamal HM(2), Taha AM(3), Abd-Allateef SF3.

Title:
Folic Acid Protects Against Experimental Prenatal ‎Nicotine-Induced Cardiac Injury By Decreasing ‎Inflammatory Changes, Serum TNF And COX-2 ‎Expression

Abstract:
Nicotine administration has been shown to increase the risk for cardiovascular diseases and death. The present study was designed to investigate the impact of nicotine administration on serum level tumor necrosis factor and cycloxygenase -2 (COX-2) expression mediated cardiac injury in rat off springs, and the possible protective effect of folic acid. Eighteen pregnant female rats were randomly divided into three groups, six animals each. Control group received the vehicle, nicotine group received a dose of nicotine 0.(1) mg/kg body weight, daily with subcutaneous injection from day 3 of gestation until weaning on postnatal day 21. Nicotine treated group received daily oral supplementation with folic acid 200 mg/kg body weight by intragastric tube prior to injection of nicotine. In serum of the pups, levels of tumor necrosis factor (TNF), nitric oxide (NO), total antioxidant capacity (TAC) and malondialdehyde (MDA) were measured. Histopathological studies of cardiac tissues using hematoxylin-eosin (H&E) were carried out. The expression of COX-2 was evaluated using immunohistochemistry. Serum TNF and MDA were significantly increased, while serum NO and TAC were significantly decreased in nicotine group. Moreover, nicotine-exposed rats showed complete lysis of cardiac myocytes, marked cytoplasmic vacuolation of myocytes, muscle fibers show loss of striation and increased COX-2 expression. Concomitant folic acid administration resulted in a significant alleviation of biochemical and structural alteration-induced by nicotine. In conclusion, folic acid has a protective role against nicotine induced cardiac injury by reduction of COX-2 expression, decreasing TNF production and lipid peroxidation mediated cell injury.

Author Info:
(1)
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: marwaahmed@aun.edu.eg.
2
Anatomy Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Physiology Department, Faculty of Medicine, Al-Azhar Univeristy, Assiut, Egypt.


Authors:
Al Johi RS(1), Seifeldein GS(1), Moeen AM(2), Aboulhagag NA(3), Moussa EM(1), Hameed DA(2), Imam HM(2).

Title:
Diffusion Weighted Magnetic Resonance Imaging In ‎Bladder Cancer, Is It Time To Replace Biopsy?‎

Abstract:
INTRODUCTION:
To assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC).

MATERIAL AND METHODS:
(1)02 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated.

RESULTS:
The cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1-pT2) and non-organ confined lesions (pT3-pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%).

CONCLUSIONS:
Adding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.

Author Info:
(1)
Department of Radiology, Assiut University, Assiut, Egypt.
2
Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Al-Hussaini TK(1), Abdelaleem AA(1), Elnashar I(1), Shabaan OM(1), Mostafa R(2), El-Baz MAH(3), El-Deek SEM3, Farghaly TA(4).

Title:
The Effect Of Follicullar Fluid Pesticides And ‎Polychlorinated Biphenyls Concentrations On ‎Intracytoplasmic Sperm Injection (ICSI) Embryological ‎And Clinical Outcome.‎

Abstract:
OBJECTIVES:
The present study evaluated the correlation between the concentrations of polychlorinated biphenyls (PCBs) and pesticides in the follicular fluid (FF) obtained during intracytoplasmic sperm injection (ICSI) with the ovarian response, endometrial thickness, and embryological and clinical outcomes.

DESIGN:
Cross-sectional observational study.

MATERIALS AND METHODS:
Women aged 20 to 38 years (300 infertile couples) presenting to a university-affiliated fertility center were approached to participate in the study. Only (1)50 couples that underwent ICSI for male factor infertility agreed to participate, and 94 of them had retrieved enough FF samples suitable for laboratory testing. The FF sample was obtained, centrifuged, and stored in liquid nitrogen. Two organochlorine pesticides (OCPs), Lindane and DDT;three organophosphates (OPs);chlorpyrifos;Diazinon; malathion; one Chloroacetanilide (Pretilachlor);two pyrethroids(Bioallethrin and β-cyfluthrin); and the concentrations of four PCBs, 28, 52, 138, 180, were estimated in the obtained FF samples by using gas chromatography/mass spectrometry. SPSS statistical analysis program (version 17) was used for analysis. Multiple regression analysis was used to correlate the PCBs and pesticides with ICSI outcomes.

RESULTS:
There were significant negative correlations between FF concentrations of the eight examined pesticides and the four PCBs on the endometrial thickness. However, Pretilachlor, chlorpyrifos, β-cyfluthrin, and Diazinon were the only toxic agents that negatively correlated with the number of the oocytes retrieved. Fertilization and early embryo cleavage rates were negatively correlated with Pretilachlor and β-cyfluthrin. Moreover, high concentrations of Lindane,DDT, Diazinon,and chlorpyrifos were significantly associated lower implantation rate. PCB 28 and 180 concentration in the FF was associated with a lower number of retrieved oocytes and fertilization rate, respectively. The number of implanted embryos was negatively correlated with PCB 52 FF concentration. However, the clinical pregnancy rate did not reach the level of significance.

CONCLUSION:
Higher concentrations of any studied PCBs and pesticides are associated with thinner endometrial thickness. The higher the level of Pretilachlor, β-cyfluthrin, PCB 28 and 180, the lower the retrieval, fertilization, and embryo cleavage rates. High PCB and pesticide concentrations in the FF adversely affected embryological ICSI outcomes. However, more data are needed to evaluate their effect on the clinical outcome.

Author Info:
(1)
Women's Health Hospital, Assiut University, Egypt.
2
Andrology Departments, Suez Canal University, Seuz, Egypt.
3
Biochemistry department, Assiut University, Egypt.
4
Women's Health Hospital, Assiut University, Egypt. Electronic address: tarekabdelradi@yahoo.com.


Authors:
Alassal M(1), Ibrahim BM(2), Elrakhawy HM(3), Hassenien M(4), Sayed S5, Elshazly M4, Elsadeck N6.

Title:
Total Correction of Tetralogy of Fallot at Early Age: A Study of 183 Cases

Abstract:
BACKGROUND:
Opinions regarding the optimal time for the repair of tetralogy of Fallot vary. A debate also exists about the timing of repair for the asymptomatic infant.

METHODS:
This study included (1)83 patients with tetralogy of Fallot. All patients were subjected to clinical examination with measurement of oxygen saturation, 12-lead ECG, plain chest x-ray, and complete laboratory investigation. Echocardiography and cardiac catheterisation were indicated if there was an inability to reach diagnosis by echocardiography, suspicion of coronary anomaly, evaluation of distal pulmonary arteries or suspicion of major aorto-pulmonary collaterals. Complete repair was done in all patients. Patients were divided into two groups for comparison. Group 1 (147 patients, 1-year-old or less), and Group 2 (36 patients older than 1 year).

RESULTS:
Three patients died in Group1 (2.04%) while there was no early mortality in Group 2 patients. Six patients in Group 1 (4.08%) were reoperated for significant residual or recurrent right ventricular outflow stenosis, three patients (2.04%) were reoperated for residual significant shunt, and three patients (2.04%) were reoperated for residual significant stenosis and residual significant shunt. That is in addition to three patients (2.04%) who had significant tricuspid regurgitation, three more patients (2.04%) who needed a permanent pacemaker implantation, and nine patients (6.1%) who had significant postoperative pulmonary valve regurgitation. On the other hand, for Group 2 patients, there were only three patients who were reoperated for postoperative restenosis and significant shunt, three patients who were reoperated for permanent pacemaker implantation, and another two patients who had insignificant restenosis to be followed up.

CONCLUSIONS:
Early complete tetralogy of Fallot repair can be accomplished with a low mortality.

Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Author Info:
(1)
Cardiothoracic Surgery Department, Benha University, Egypt; King Salman Heart Center, King Fahd Medical City (KFMC), Riyadh, Saudi Arabia; Prince Abdullah Bin Abdulaziz Bin Musaed Cardiac Center (PAAMCC), Arar, Saudi Arabia. Electronic address: dmohamedabdelwahab@gmail.com.
2
Cardiothoracic Surgery Department, Tanta University, Egypt.
3
Cardiothoracic Surgery Department, Benha University, Egypt; King Salman Heart Center, King Fahd Medical City (KFMC), Riyadh, Saudi Arabia.
4
Department of Cardio-thoracic Surgery, National Heart Institute, Egypt.
5
Cardiothoracic Surgery Department, Assiut University, Egypt.
6
Cardiothoracic Surgery Department, Zagazig University, Egypt.


Authors:
Alhussaini MA(1),(2), Banakis Hartl RM(1), Benichoux V(3), Tollin DJ(1),3, Jenkins HA(1), Greene NT(1).

Title:
Intracochlear Pressures in Simulated Otitis Media With Effusion: A Temporal Bone Study.

Abstract:
HYPOTHESIS:
Simulated otitis media with effusion reduces intracochlear pressures comparable to umbo velocity.

BACKGROUND:
Otitis media with effusion is a common cause of temporary hearing loss, particularly in children, producing deficits of 30 to 40 dB. Previous studies measured the effects of simulated effusion on ossicular mechanics; however, no studies have measured cochlear stimulation directly. Here, we compare pressures in the scala vestibuli and tympani to umbo velocity, before and after induction of simulated effusion in cadaveric human specimens.

METHODS:
Eight cadaveric, hemi-cephalic human heads were prepared with complete mastoidectomies. Intracochlear pressures were measured with fiber optic pressure probes, and umbo velocity measured via laser Doppler vibrometry (LDV). Stimuli were pure tones (0.(1)-14 kHz) presented in the ear canal via a custom speculum sealed with a glass cover slip. Effusion was simulated by filling the mastoid cavity and middle ear space with water.

RESULTS:
Acoustic stimulation with middle ear effusion resulted in decreased umbo velocity up to ∼26 dB, whereas differential pressure (PDiff) at the base of the cochlea decreased by only ∼16 dB.

CONCLUSION:
Simulating effusion leads to a frequency-dependent reduction in intracochlear sound pressure levels consistent with audiological presentation and prior reports. Results reveal that intracochlear pressure measurements (PSV and PST) decrease less than expected, and less than the decrease in PDiff. The observed decrease in umbo velocity is greater than in the differential intracochlear pressures, suggesting that umbo velocity overestimates the induced conductive hearing loss. These results suggest that an alternate sound conduction pathway transmits sound to the inner ear during effusion.

Author Info:
(1)
Department of Otolaryngology.
2
Department of Otolaryngology, Faculty of Medicine Assiut University, Egypt.
3
Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado.


Authors:
Abbas AM(1), Fikry EM(2), Mostafa TS(2), Shaltout AS(3), El-Baz MAH(2)

Title:
Prognostic Value Of Serum Soluble FMS-Like Tyrosine ‎Kinase (Sflt-(1)) Levels In Pre-Eclampsia And Eclampsia; A ‎Prospective Cohort Study.‎

Abstract:
OBJECTIVE:
To evaluate the levels of circulating sFlt-(1) in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications.

METHODS:
The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications.

RESULTS:
The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057-1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871-0.975.

CONCLUSIONS:
Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia.

Author Info:
(1)
a Department of Obstetrics and Gynecology , Woman's Health Hospital, Assiut University , Assiut , Egypt.
2
b Department of Medical Biochemistry, Faculty of Medicine , Assiut University , Assiut , Egypt.
3
c Department of Medical Microbiology & Immunology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Abbas AM(1), Michael A(1), Ali SS(1), Makhlouf AA(1), Ali MN(1), Khalifa MA(1)

Title:
Spontaneous Prelabour Recurrent Uterine Rupture After ‎Laparoscopic Myomectomy

Author Info:
(1)
a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Abbas AM(1), Abdel Hafiz HA(2), Abdelhafez AM(2), Michael A(1), Ismail AM(1)

Title:
Topical Lidocaine-Prilocaine Cream Versus Lidocaine ‎Infiltration For Pain Relief During Repair Of Perineal ‎Tears After Vaginal Delivery: Randomized Clinical Trial

Abstract:
OBJECTIVE:
The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery.

MATERIALS AND METHODS:
A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 20(1)6 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age >37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants' satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications.

RESULTS:
The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86 ± 1.59) than the lidocaine infiltration group (5.99 ± 1.47) [p = .001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37 ± 3.68 versus 8.17 ± 2.75 min, respectively, p = .001). The need for additional anesthesia was quite similar in both groups (p = .371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p = .000). No difference between side effects in both groups (p = .171) Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.

Author Info:
(1)
a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut, Egypt.
2
b Department of Obstetrics & Gynecological Nursing, Faculty of Nursing , Assiut University , Assiut, Egypt.


Title:
Ultrasound-Guided Intrauterine Device Insertion: A Step ‎Closer To Painless Insertion: A Randomised Control ‎Trial

Author Info:
a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Abbas MS(1), Mohamed KS(1), Ibraheim OA(1), Taha AM(2), Ibraheem TM(2), Fadel BA(2), Elawamy A(1), Abbas AM(3)

Title:
Effects Of Terlipressin Infusion On Blood Loss And ‎Transfusion Needs During Liver Resection: A ‎Randomised Trial

Abstract:
BACKGROUND:
Blood loss and perioperative blood transfusion requirements affect the long-term survival after liver resection for malignant tumours. Terlipressin is a synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction with subsequent reduction of blood loss during abdominal surgeries. We tried to examine the impact of terlipressin on blood loss and blood transfusion needs during liver resection.

METHODS:
In this randomised, double-blind placebo-controlled trial 84 patients scheduled for major liver resections were randomly assigned to receive either terlipressin at the onset of surgery as an initial bolus dose of ((1) mg over 30 minutes) followed by a continuous infusion of 2 μg/kg/h throughout the procedure (Terlipressin group) or the same volume and rate of 0.9% saline (Placebo group).The primary outcome was the amount of intra-operative blood loss.

RESULTS:
The mean (SD) of the amount of intra-operative blood loss was 1351 (887) in the terlipressin group versus 1892 (889) mL in the placebo group (P = 0.006). Thirteen (30%) patients received blood transfusion in the terlipressin group compared with t27 (64.2%) in the placebo group (P = 0.002) with a statistically significant difference in the median (range) number of the transfused units of packed RBCs [0 (0-5) units and 1 (0-6) units in the two groups respectively; P = 0.001].

CONCLUSION:
Terlipressin infusion during major liver resection was associated with less bleeding compared to placebo. More studies are required to confirm our results especially in patients with normal portal pressure.

Author Info:
(1)
Anesthesia and Intensive Care Department, Assiut University, Assiut, Egypt.
2
Unit of Hepatobiliary Surgery, General Surgery Department, Al Rajhi Liver Hospital, Assiut University, Assiut, Egypt.
3
Obstetrics and Gynaecology Department, Assiut University Hospital, Assiut University, Assiut, Egypt.


Title:
Melatonin Attenuates Chronic Immobilization Stress-‎Induced Muscle Atrophy In Rats: Influence On Lactate-‎To-Pyruvate Ratios And Na+/K+ Atpase Activity

Abstract:
This study assessed the protective effect of melatonin against muscle atrophy provoked by chronic immobilization stress (CIS). CIS was induced in rats by limiting their trunk movement for 90 min daily for 6 weeks. Rats subjected to the CIS procedure demonstrated a substantial decrease in body weight, an increase in serum corticosterone, muscle atrophy, and an increase in atrogin-(1) mRNA levels. An increase in the serum lactate-to-pyruvate ratio and the oxidative stress accompanied by a reduction of Na+/K+ ATPase activity could be responsible for these changes. Melatonin efficiently attenuated CIS-induced deleterious effects on the muscle by reducing corticosterone levels, the lactate-to-pyruvate ratio, and oxidative stress, thereby improving Na+/K+ ATPase activity and muscle condition. We conclude that melatonin can contribute to the prevention of CIS-induced muscle atrophy via its anti-stress, anti-oxidant properties and its effect on Na+/K+ ATPase activity.

Author Info:
(1)
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: eman_sayyed2@yahoo.com.
2
Medical Physiology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.


Authors:
Abd Ellah NH(1), Abouelmagd SA(2), Abbas AM(3), Shaaban OM3, Hassanein KMA(4)

Title:
Dual-Responsive Lidocaine In Situ Gel Reduces Pain Of ‎Intrauterine Device Insertion

Abstract:
The most effective and safe contraceptive method, intrauterine devices (IUDs), is still underutilized due to the pain barrier during IUD insertion. Lidocaine, a well-known local anesthetic, can be used to relieve IUD insertion pain. This study aimed at formulation, in vitro, in vivo and clinical evaluation of a novel lidocaine dual-responsive in situ gel. Pluronic and Gelrite® were used as thermosenstive and ion-activated polymers, respectively. In situ gels containing 2% lidocaine, pluronics and/or Gelrite® were prepared. The optimized dual-responsive formula (F5) was clear, with 95% drug content, free flowing at room temperature and gel at vaginal temperature (Tgel of 28 °C). This optimized dual-responsive in situ gel was found to be superior to single-responsive one due to presence of Gelrite®, imparting resistance to dilution effect of simulated vaginal fluids. DSC thermograms revealed no interaction between formulation components. Biocompatibility study showed no degeneration, necrosis or inflammation. Optimized dual-responsive in situ gel was further evaluated for pain reduction efficiency via a pilot randomized, double-blinded, placebo-controlled clinical trial showing ease of self-administeration by patients and significant pain reduction induced at all steps of IUD insertion. In conclusion, lidocaine dual-responsive in situ gel can be effectively used in prevention of pain during IUD insertion.

Author Info:
(1)
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt. Electronic address: nora.1512@aun.edu.eg.
2
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.
3
Department of Obstetrics and Gynecology, Assiut University, Egypt Women's Health Hospital, Assiut 71511, Egypt.
4
Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Egypt; Deanship of Scientific Research, Jazan University, Saudi Arabia


Authors:
Abd-Allah F(1), Khedr E(2), Oraby MI(3), Bedair AS(4), Georgy SS4, Moustafa RR4

Title:
Stroke Burden In Egypt: Data From Five Epidemiological ‎Studies

Abstract:
PURPOSE:
Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies.

METHOD:
A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between (1)990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea).

RESULTS:
The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000.

CONCLUSION:
The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo - the capital of Egypt.

Author Info:
(1)
a Department of Neurology , Cairo University , Cairo , Egypt.
2
b Department of Neurology , Assiut University , Assiut , Egypt.
3
c Department of Neurology , Beni-Suef University , Beni Suef , Egypt.
4
d Department of Neurology , Ain Shams University , Cairo , Egypt.


Authors:
Abd-Elhamid TH(1), Elgamal DA(2), Ali SS(2), Ali FEM(3), Hassanein EHM3, El-Shoura EAM3, Hemeida RAM3

Title:
Reno-Protective Effects Of Ursodeoxycholic Acid ‎Against Gentamicin-Induced Nephrotoxicity Through ‎Modulation Of NF-Κb, Enos And Caspase-3 Expressions‎

Abstract:
Gentamicin (GNT) is a potent aminoglycoside antibiotic widely used to treat life-threatening bacterial infections. We aim to investigate the potential protective effect of ursodeoxycholic acid (UDCA) against GNT-induced nephrotoxicity. In this study, 24 male Wistar rats were used and randomly divided into four groups of six animals each. Control group received 0.5% carboxymethyl cellulose orally for (1)5 days, GNT group received GNT 100 mg/kg/day i.p. for 8 days, UDCA group received UDCA orally for 15 consecutive days at a dose of 60 mg/kg/day suspended in 0.5% carboxymethyl cellulose and UDCA-pretreated group received UDCA orally for 7 days then co-administered with GNT i.p. for 8 days at the same fore-mentioned doses. Serum levels of kidney function parameters (urea, creatinine, uric acid and albumin) were measured. Renal tissues were used to evaluate oxidative stress markers; malonaldehyde (MDA), reduced glutathione (GSH) and the anti-oxidant enzyme superoxide dismutase (SOD) activities and nuclear factor kappa light-chain enhancer of activated B cells (NF-κB) and kidney injury molecule-1 (KIM-1) mRNA levels. Immunohistochemical expression of endothelial nitric oxide synthase (eNOS) and caspase-3 and histological and ultrastructural examination were performed. Treatment with GNT increased the serum levels of renal function parameters and renal MDA, NF-κB and KIM-1 mRNA levels, while it decreased GSH and SOD activities. Marked immunohistochemical expression of caspase-3 was observed after GNT administration while it decreased eNOS expression. Histological and ultrastructural alterations were also evident in renal corpuscles and tubules. In contrast, pretreatment with UDCA reversed changes caused by GNT administration. These results suggest that UDCA ameliorates GNT-induced kidney injury via inhibition of oxidative stress, inflammation and apoptosis.

Author Info:
Author information
(1)
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt. tabdelhamid@aun.edu.eg.
2
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pharmacology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.


Authors:
Abd-Elkareem M(1), Abou Khalil NS(2), Sayed AH(3)

Title:
Hepatotoxic Responses Of 4-Nonylphenol On African ‎Catfish (Clarias Gariepinus): Antixoidant And ‎Histochemical Biomarkers

Abstract:
4-Nonylphenol (NP) toxicity in fish attracts much attention due to its ability in targeting several organs; however, the researches regarding its potential hepatotoxicity are conflicting and still require further investigation. Therefore, the objective of this study is to focus on this issue from the histophysiological point of view using NP intoxicated African catfish (Clarias gariepinus) as a model of hepatotoxicity. Twelve adult fish (6 per group) were divided into two groups; the first was considered as a control and the second was exposed to NP dissolved in water at a dose of 0.(1) mg/kg BW for 3 weeks. A significant reduction in the hepatic alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase levels was observed in NP-exposed fish. Concerning the oxidant/antioxidant balance, a significant depletion in superoxide dismutase, catalase, and glutathione peroxidase was found along with a significant elevation in total peroxide and malondialdhyde. The histopathological examination of the hepatic tissues revealed that NP had marked hepatotoxic effects including hepatitis, centrilobular and focal hydropic and fatty degeneration, fatty change (steatosis), hepatic coagulative necrosis, and nuclear alterations in addition to apoptosis of hepatocytes and necrosis of endothelial cells. Depletion of the glycogen and increased in pigments (lipofuscin and hemosiderin) content in the hepatocytes were also recorded. Hemosiderosis and proliferation of the connective tissue around the blood vessels and branches of bile ducts and in the portal areas were also observed. In light of these findings, it was concluded that NP has a well-defined hepatotoxic impact paving the road towards other studies to investigate other detrimental cyto-physiological influences of this aquatic pollutant.

Author Info:
(1)
Anatomy, Histology and Embryology Department, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
2
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Zoology Department, Faculty of Science, Assiut University, Assiut, 71516, Egypt. alaasayed@aun.edu.eg.


Authors:
Abd-Ellatief RB(1), Mohamed HK(2), Kotb HI(3).

Title:
Reactive Astrogliosis in an Experimental Model of Fibromyalgia: Effect of Dexmedetomidine

Abstract:
To our knowledge, this is the first study which investigates the induction of neuroinflammation in rats using an acidic-saline model of fibromyalgia. It is well known that the hippocampus has a fundamental role in pain perception, and astrocytes play a crucial role in pain signaling. Our aim is to evaluate the ability of dexmedetomidine to attenuate the inflammatory responses induced in astrocytes. In a group of healthy rats, induction of chronic muscle pain by intramuscular injection of (1)00 µL of acidic saline on days 0 and 5 resulted in peripheral sensitization (measured using the von Frey test) and significant (p < 0.05) increases in IL-1β (160.2 ± 1.1 to 335.2 ± 1.8), IL-6 (100.1 ± 1.4 to 202.4 ± 1.1), and TNF-α (60.0 ± 0.7 to 115.5 ± 1). Light and electron microscopy revealed degenerative changes in the hippocampus and reactive astrogliosis. Immunohistochemistry showed increased expression of glial fibrillary acid protein and inducible nitric oxide synthase. Surprisingly, treatment with a single dose of an α2-adrenergic agonist, dexmedetomidine (5 µg/kg i.p.), attenuated these changes. This trial suggests that dexmedetomidine possibly directly acts on astrocytes, and a peripheral action is also suggested.

Author Info:
(1)
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Anatomy, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ali MAS(1), Khedr EMH(2), Ahmed FAH(2), Mohamed NNE(2).

Title:
Clinical Pharmacist Interventions In Managing Drug-‎Related Problems In Hospitalized Patients With ‎Neurological Diseases.

Abstract:
Background Drug-related problems (DRPs) are common in hospitalized patients with neurological diseases. Clinical pharmacy services could minimize drug-related harm and improve patient care. Objective To identify common DRPs in neurology and document clinical pharmacists' medication-related interventions. Setting The wards and intensive care unit of the Department of Neurology at Assiut University Hospital. Method Prospective study of clinical pharmacists' interventions during the routine care work of reviewing patients medical charts over a period of 6 months from January to June 20(1)7. Main outcome measure The frequency and severity of DRPs and clinical pharmacists' recommendations. Results Out of 1421 reviewed medications charts, a total of 414 DRPs were detected for 285 admitted patients. The most common DRPs were drug selection problems (36.7%) and dosing errors (27.5%). The majority of DRPs (71.7%) were categorized as causing no patient harm. Clinical pharmacists provided recommendations for the detected problems that ranged from drug monitoring to stop and starting new medicines. About 90% of pharmacists' interventions were accepted by physicians. Poisson regression of factors that may influence the frequency of DRPs revealed significant associations of patient age (p = 0.03) and the number of comorbid diseases (p = 0.01). Conclusions Prescribing errors in neurology inpatient are likely to occur. Clinical pharmacists' interventions assisted in early detection of drug problems and prevention of the consequent patient harms.

Author Info:
(1)
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt. mostafa.ali3@pharm.au.edu.eg.
2
Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, 71526 Assiut, Egypt.


Authors:
Ali ME(1), El-Badawy O(2), Afifi NA(3), Eldin AS(4), Hassan EA5, Halby HM6, El-Mokhtar MA7.

Title:
Role of T-Helper 9 Cells in Chronic Hepatitis C-Infected Patients

Abstract:
Hepatitis C virus is a hepatotropic virus that is transmitted parenterally. Viral infections are usually associated with modulations of the immune cells, leading to enhanced viral survival and spreading, and accordingly, life-threatening complications. Recently, it has been proposed that a new subset of T-helper, named T-helper 9, is involved in the pathogenesis of different immunopathological conditions, such as allergies, tumors, and viral infections. Some studies reported a protective role, and others described a pathogenic potential for the T-helper 9 cells. Here, we present evidence that T-helper 9 cells are dynamically increased with increasing the pathogenic strategy for hepatitis C virus (HCV). Furthermore, viral clearance is associated with a decrease in T-helper 9. The increase in T-helper 9 was paralleled with an increase in its receptor expression. Taken together, our data suggest that T-helper 9 cells play an important role in the pathogenesis of HCV, and is directly associated with HCV-related complications.

Author Info:
(1)
Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt. elkady4work@azhar.edu.eg.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. omniaalbadawy@aun.edu.eg.
3
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. noafifi2000@yahoo.com.
4
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. abeer.ahmed@aun.edu.eg.
5
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. elham.abdelhalem@aun.edu.eg.
6
Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt. hamadahalby@ymail.com.
7
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. ma_mokhtar@yahoo.com.


Title:
Foley's Catheter Balloon For Induction Of Mid-Trimester ‎Missed Abortion With Or Without Traction Applied: A ‎Randomized Controlled Trial

Abstract:
OBJECTIVE:
To determine whether the traction placed on a transcervical Foley catheter balloon inserted for the induction of mid-trimester missed abortion results in faster time of abortion.

STUDY DESIGN:
It was randomized clinical trial conducted at Assiut Woman's Health Hospital, Egypt, from September 20(1)6 to August 2017 on women with missed abortion in the mid-trimester. Participants were randomly assigned to transcervical Foley catheter balloon insertion with or without traction. The primary outcome of this study was insertion to abortion time. The secondary outcomes included insertion to catheter expulsion time, vaginal bleeding, and pain associated with insertion. The outcome variables were analyzed using Mann-Whitney U and chi-square tests. A logistic regression model was utilized to examine the association between patient's characteristics and the failure of Foley catheter balloon expulsion within 24 hours.

RESULTS:
Two hundred women were recruited (100 women in each group). The insertion to abortion time was significantly shorter in group I (traction group) than group II (no traction group) (16.49 ± 2.59 versus 18.24 ± 3.30 hours; p = .000). Insertion to balloon expulsion time in group I was also significantly short (7.92 ± 0.86 versus 9.12 ± 1.19 hours; p = .000). However, a significantly higher rate of vaginal bleeding and a higher degree of pain were reported by the women in group I (p = .008, p = .000; respectively). The nulliparity, longer interpregnancy interval (>22 months), smaller gestational age (<14 weeks) and lower Bishop Score before insertion (<2) were significantly associated with a higher likelihood of Foley catheter balloon expulsion failure within 24 hours.

CONCLUSION:
The small time advantage of traction does not compensate for the downsides of traction, mainly pain, analgesic use, and vaginal bleeding.

Author Info:
(1)
a Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine , Assiut University , Assiut , Egypt.
2
b Department of Obstetrics & Gynecology , El Eman Hospital for Woman and Child , Assiut , Egypt.


Authors:
Ali MK(1), Abbas AM(1), Yosef AH(1), Bahloul M(1).

Title:
The Effect Of Low-Dose Aspirin On Fetal Weight Of ‎Idiopathic Asymmetrically Intrauterine Growth Restricted ‎Fetuses With Abnormal Umbilical Artery Doppler Indices: ‎A Randomized Clinical Trial

Abstract:
OBJECTIVE:
To investigate the effect of aspirin on fetal weight in fetuses with idiopathic asymmetrical intrauterine growth restriction (IUGR) complicated by abnormal umbilical artery Doppler indices.

MATERIALS AND METHODS:
The study was a randomized controlled trial conducted at Woman's Health Hospital, Assiut, Egypt, between June 20(1)6 and the January 2017 included 60 pregnant women (28-30 weeks) with idiopathic asymmetrical IUGR associated with abnormal umbilical artery Doppler indices. Women were randomly assigned to group I (aspirin 75 mg) daily for four weeks or group II (no intervention). The primary outcome was the fetal weight after four weeks. Secondary outcomes included Doppler blood flow changes in the umbilical artery plus delivery and neonatal outcomes.

RESULTS:
The estimated fetal weight and umbilical artery blood flow increased significantly in aspirin group (p = .00) when compared with no intervention group. As regard neonatal outcomes; aspirin group showed better results and encouraging outcomes (p < .05).

CONCLUSIONS:
Aspirin improves fetal weight and umbilical artery blood flow in idiopathic asymmetrical IUGR fetuses complicated by abnormal umbilical artery Doppler blood flow.

Author Info:
a Department of Obstetrics & Gynecology , Woman's Health Hospital, Faculty of Medicine, Assiut University , Assiut , Egypt.


Authors:
Ali SH(1), El Sisi A(2), Raafat DM(3), Amry SE3, Mahamoud SED(4).

Title:
Short-Term Outcomes Of Transcatheter Closure Of ‎Secundum Atrial Septal Defect In Children And ‎Adolescents: An Experience Of Two Centers In Upper ‎Egypt

Abstract:
BACKGROUND:
The aim of this study was to evaluate the acute and short-term outcomes of transcatheter closure of secundum atrial septal defect (ASD) in children and adolescents in the first 4-year experience in two institutional centers in Upper Egypt.

METHODS:
This was a retrospective cohort study including (1)35 children and adolescents who underwent ASD closure between April 2012 and May 2016. A review of the acute and short-term outcomes and adverse events was performed.

RESULTS:
The patients had a median age of 5 years (interquartile range: 3-9 years), 71% of patients were ≤5 years, and median weight was 17 kg (interquartile range: 13-30 kg). Single defects were observed in 113 patients (84%). The remainder had multiple or multifenestrated defects that were closed by a single device. The mean defect size of single defects and the mean interatrial septum length were 15.24 ± 5.16 mm and 38.13 ± 6.3 mm, respectively. The ratio of device to TEE (Transoesophageal echocardiography) size of ASD was 1.19 ± 0.12. The devices were implanted successfully in 98.5% of patients. Six cases had concordant PS (Pulmonary stenosis), patent ductus arteriosus or perimembranous ventricular septal defect and were treated with balloon dilation, or closure. No residual flow was seen after device placement except in one patient with multiple fenestrations. There were five high-severity adverse events (3.7%) with no mortality. Device erosion was confirmed in one of two patients with massive haemopericardium; embolization of the device with retrieval in one patient; and heart block was detected in two cases. No cardiac perforation, device erosion, embolization, thrombus formation, or clinical evidence of bacterial endocarditis was observed during follow-up.

CONCLUSIONS:
Transcatheter closure of ASDs in children and adolescents was feasible and safe in the first 4 years experience in our centers, with good short-term outcome. Balloon sizing is not necessary for transcatheter closure of secundum ASD. Multiple defects can be safety closed by a single device.

Author Info:
(1)
Department of Pediatrics, Cath. Lab, Sohag University, Sohag, EgyptaEgypt.
2
Department of Pediatrics, Cairo University, Cairo, EgyptbEgypt.
3
Department of Pediatrics, Assiut University, Assiut, EgyptcEgypt.
4
Department of Internal Medicine, Sohag University, Sohag, EgyptdEgypt.


Authors:
Alsayed Hasanain AF(1), El-Maghraby KM(2), H Zayed AA(3), A Nafee AM(4), Abdel-Aal SM5, Bakkar SM6.

Title:
Latent Tuberculosis Infection Among Patients With ‎Coronary Artery Stenosis: A Case-Control Study

Abstract:
BACKGROUND:
The activation of the cell-mediated immune responses by Mycobacterium tuberculosis can promote atherogenesis.

AIMS:
The aim of this study is to determine the frequency of latent tuberculosis infection (LTBI) among patients with coronary artery stenosis (CAS) and to explore the association between LTBI and development of CAS. We conducted a case-control study which included (1)83 patients' who underwent percutaneous coronary angiography (121 patients with CAS and 62 patients without as a control group).

METHODS:
For all the study population, clinical evaluation, tuberculin skin test (TST), imaging studies (including chest radiography and echocardiography), laboratory investigations, and electrocardiography were carried out. Only for the patients with positive TST, QuantiFERON-TB Gold test was performed. Predictors of CAS were identified using univariate analyses (Yates' corrected Chi-square test or Fischer's exact test) followed by multivariate analysis (binary logistic regression).

RESULTS:
Among 29.5% of the study population, LTBI was detected, and among patients with CAS, 56.2% of patients had advanced CAS. After multivariate analysis, it was found that metabolic syndrome (MS) (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.5-22.6, P = 0.022) and LTBI (OR 2.5, 95% CI 1.2-17.3, P = 0.018) were the predictors of CAS among the study population, while only diabetes mellitus (DM) (OR 1.9, 95% CI 1.1-11.7, P = 0.031) was the predictor of advanced CAS.

CONCLUSION:
LTBI is associated with the development of CAS. In addition, MS is associated with CAS, while its related disorder, DM, is associated with advanced CAS.

Author Info:
(1)
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Asyut, Egypt.
2
Department of Cardiology, Faculty of Medicine, Assiut University, Asyut, Egypt.
3
Department of Chest Diseases, Faculty of Medicine, Assiut University, Asyut, Egypt.
4
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Asyut, Egypt.
5
Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Asyut, Egypt.
6
Department of Biochemistry, Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
Aly M(1), Ibrahim A(2), Farrag W(2), Abdelsalam K(2), Mohamed H(2), Tawfik A(2).

Title:
Pruritus After Intrathecal Morphine For Cesarean Delivery: Incidence, Severity And Its Relation To Serum Serotonin Level

Abstract:
BACKGROUND:
Pruritus is the most common side effect of intrathecal morphine, especially in parturients. The exact mechanism is not clear and many possible mechanisms have been suggested. Among these is the activation of the 5-hydroxytryptamine sub-type-3 receptors by intrathecal morphine.

METHODS:
Forty parturients who underwent elective cesarean delivery under spinal anesthesia were divided into two groups of 20 each in this prospective, randomized study. Both groups received an intrathecal injection of 0.5% (2-3 mL) hyperbaric bupivacaine in addition to (1)00 μg of morphine in group 1 (M100) and 200 μg of morphine in group 2 (M200). Two blood samples were taken from each patient for serotonin estimation, preoperatively and four hours later. Postoperatively, all patients were assessed for pruritus (incidence and severity), pain (visual analog pain scale), first request for analgesia, and total analgesic dose required within 24 hours.

RESULTS:
The serum serotonin level increased significantly postoperatively, by 283% versus 556% (P <0.05) in group M100 and M200, respectively. The incidence of pruritus was 55% in the M100 group, and 75% in the M200 group (P=0.32). Postoperative pruritus severity was significantly higher in group M200 than in group M100 (P <0.05) at six and eight hours; but not at other times. Postoperative analgesia, as well as analgesic consumption, was comparable between groups.

CONCLUSION:
The serum serotonin level increased significantly in the postoperative period in both groups, suggesting a role of serotonin in the genesis of intrathecal morphine-induced pruritus.

Author Info:
(1)
Anaesthesia Department, Assiut University, Faculty of Medicine, Assiut, Egypt. Electronic address: galam1967@aun.edu.eg.
2
Anaesthesia Department, Assiut University, Faculty of Medicine, Assiut, Egypt.


Authors:
Alzahrani SH(1), Bakarman MA(2), Alqahtani SM(3), Alqahtani MS3, Butt NS(2), Salawati EM(2), Alkatheri A(2), Malik AA(2), Saad K(4).

Title:
Awareness Of Diabetic Retinopathy Among People With Diabetes In Jeddah, Saudi Arabia.

Abstract:
BACKGROUND:
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the foremost cause of blindness. This study aimed to assess the level of awareness of DR and its related risk factors among patients with DM in Jeddah, Saudi Arabia.

METHODS:
A cross-sectional study was conducted among patients with DM attending primary health care centers at the Ministry of Health in Jeddah. A structured, pretested, self-administered questionnaire was used to collect information on the sociodemographic and DM- and DR-related characteristics of the patients.

RESULTS:
A total of 377 patients were enrolled. About 82.6% of the patients were aware that DM can affect their eyes, and they listed physicians, ophthalmologists, television, and family members as common sources of information on the topic. About 36% of the patients reported that their doctors had not advised them about it. More than half responded that they did not feel their vision to be affected by DM. More than 58% had never been diagnosed with DR. About 35% did not go to their eye checkups, even though around 59% thought that DR could lead to blindness. Of the 64% of patients whose DM was well controlled, (1)1% and 25% listed surgery and laser treatment, respectively, as available treatment options for DR. The following factors were found to be significant in relation to the subjects' awareness that DM can affect their eyes: the patients' perception of their doctors' advice about DR; the experience of having their vision affected by DM; the knowledge that DR may lead to blindness; the practice of going to eye checkups.

CONCLUSIONS:
Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.

Author Info:
(1)
Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, PO Box 80205, Jeddah 21589, Saudi Arabia.
2
Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
3
Public Health Administration, Ministry of Health, Jeddah, Saudi Arabia.


Authors:
Alzohiry MA(1), Abdelnasser MK(2), Moustafa M(1), Mahran M(1), Bakr H(1), Khalifa Y(1), Abelaal A(1), Atta H(3), Said GZ(1).

Title:
Accuracy Of Plain Antero-Posterior Radiographic-Based Methods For Measurement Of Acetabular Cup Version

Abstract:
INTRODUCTION:
Acetabular cup version is crucial for successful total hip arthroplasty (THA). Many methods have been described for measurement of cup version angle. The aim of this study is to assess the accuracy of five commonly used methods for measurement of acetabular cup version in plain antero-posterior views of the pelvis and hip.

MATERIAL AND METHODS:
Sixty primary THA cases were subjected postoperatively to plain A-P of the pelvis (AP-P), A-P view of the hip (AP-H), and computed tomography (CT) imaging. The acetabular cup version was measured in AP-P and AP-H by five methods (Lewinnek, Widmer, Hassan et al., Ackland et al., and Liaw et al.). These measurements were compared to the CT measurement.

RESULTS:
All plain X-ray methods showed no significant differences from the CT, except those of Hassan et al. in AP-H, and Widmer and Ackland et al. in AP-P.

CONCLUSIONS AND RECOMMENDATIONS:
For measurement of acetabular cup version angle, we recommend the use of Lewinnek and Liaw et al. methods both in AP-P and in AP-H, while Hassan et al.'s method is recommended in AP-P only, and Widmer and Ackland et al.'s methods in AP-H only.

Author Info:
(1)
Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
2
Orthopedic Department, Assiut University Hospital, Assiut, Egypt. m.kamal1@hotmail.com.
3
Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Ansari J(1), Ali M(1), Farrag A(2), Ali AM(3), Alhamad A(1).

Title:
Efficacy of Nivolumab in a Patient with Metastatic Renal Cell Carcinoma and End-Stage Renal Disease on Dialysis: Case Report and Literature Review

Abstract:
Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis poses a therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there is uncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity when using targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received prior antiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patient population, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCC and ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiological response, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and published retrospective case studies to review the management options for patients with mRCC and ESRD on dialysis.

Author Info:
1
Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
2
Clinical Oncology Department, Assiut University, Asyut, Egypt.
3
Medical Oncology Department, South Egypt Cancer Institute, Asyut, Egypt.


Title:
Which Is Better For Pain Reduction During Transrectal Ultrasound-Guided Biopsy Of The Prostate: Intravenous Diazepam, Local Periprostatic Nerve Block, Or Combination? Controlled Randomized Study

Abstract:
BACKGROUND:
Transrectal ultrasound-guided prostate biopsy (TRUSPB) is considered the procedure of choice for the diagnosis of prostate cancer. Men undergoing this biopsy experience high psychological stress. Different studies recommend techniques as sedation, lidocaine gel intrarectally, periprostatic nerve block alone, or nitrous oxide inhalation as effective methods of analgesia during procedural-related pain or discomfort. We evaluated three techniques for pain relief during TRUSPB and evaluated if there was any increase in the incidence of complications when employing either technique.

SETTING:
Assiut University Hospital, Assiut, Egypt.

METHODS:
Three hundred patients of age 43-92-year-old underwent TRUSPBs. Patients were allocated randomly into three equal groups to receive intravenous (IV) diazepam 5 mg slowly (Group I), bilateral periprostatic nerve block by 10 ml of 1% lidocaine solution injected under ultrasound guidance (Group II), or combined IV diazepam and the periprostatic nerve block (Group III).

RESULTS:
The mean pain score was 4.95 for patients in Group I, 4.15 for patients in Group II, and 2.18 for patients in Group III with statistically significant findings (F = 120.27, P < 0.001). TRUSPB under combined IV sedation and local anesthesia had no significant increase in the incidence of complications.

CONCLUSIONS:
Patients should have analgesia during TRUSPB to decrease the procedure pain and to improve tolerance permitting proper aiming for biopsy cores without increasing the patient distress. The combined IV sedation and local periprostatic nerve block are efficient in controlling and limiting pain better than employing each technique alone with no significant increase in complications incidence.

Author Info:
1
Department of Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt.
3
Department of Urology, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt.


Authors:
Awad SM(1), Morsy H(1), Sayed AA(2), Mohamed NA(2), Ezzat GM(2), Noaman MM(3).

Title:
Oxidative Stress And Psychiatric Morbidity In Patients With Facial Acne

Abstract:
BACKGROUND:
Acne vulgaris is a common cosmetic problem that is frequently associated with psychosocial disturbances as well as increased oxidative stress. However, oxidative stress and psychological aspects have been studied separately in acne.

OBJECTIVE:
To evaluate the relationships between oxidative stress, anxiety, depression, and quality of life in acne patients.

METHODS:
Sixty patients with facial acne and 40 age- and sex-matched healthy individuals were included in the study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) was measured by the Cardiff Acne Disability Index. Disease severity was assessed using the Combined Acne Severity Classification. The serum levels of zinc and malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured in patients and healthy subjects.

RESULTS:
The mean HADS scores for anxiety and depression were higher in patients than controls (P<.001 for both). Acne patients showed higher serum MDA and lower TAC and serum zinc levels compared with control subjects (P=.019, P<.001, and P=.028, respectively). Anxiety and depression scores did not correlate with oxidative stress parameters. Patients with moderate/severe acne had worse anxiety scores than mild acne (P=.048), and higher anxiety scores were associated with poorer quality of life (r=.436, P=.001).

CONCLUSION:
Our results indicate that the high levels of anxiety and depression in patients with facial acne were not related to oxidative stress. Anxiety was more common than depression and was directly related to QoL impairment.

Author Info:
1
Faculty of Medicine, Department of Dermatology and Venereology, Assiut University, Assiut, Egypt.
2
Faculty of Medicine, Department of Medical Biochemistry, Assiut University, Assiut, Egypt.
3
Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt.


Authors:
Awad SM(1), Attallah DA(1), Salama RH(2), Mahran AM(1), Abu El-Hamed E(3)

Title:
Serum Levels Of Psoriasin (S100A7) And Koebnerisin (S100A15) As Potential Markers Of Atherosclerosis In Patients With Psoriasis

Abstract:
BACKGROUND:
Psoriasin (S100A7) and koebnerisin (S100A15) are proinflammatory proteins upregulated in psoriasis, but their relation to atherosclerosis remains unclear.

AIM:
To evaluate the role of serum psoriasin and koebnerisin as possible markers for subclinical atherosclerosis in patients with psoriasis.

METHODS:
Serum levels of psoriasin and koebnerisin were measured by ELISA in 45 patients with psoriasis and in 45 healthy controls (HCs). Intima-media thickness (IMT) of the right and left common carotid arteries was measured to detect the presence of subclinical atherosclerosis. Clinical severity of psoriasis was estimated using the Psoriasis Area and Severity Index (PASI).

RESULTS:
Compared with HCs, patients with psoriasis had significantly higher levels of psoriasin (26.61 ± 22.45 ng/mL vs. 6.31 ± 1.68 ng/mL, P < 0.001) and koebnerisin (21.2 ± 13.12 ng/mL vs. 12.2 ± 4.67 ng/mL, P = 0.001), and significantly higher IMT values (1.07 ± 0.4 mm vs. 0.61 ± 0.1 mm, P < 0.001). A positive correlation was observed between IMT and PASI (r = 0.78, P < 0.001), serum psoriasin (r = 0.48, P > 0.01) and serum koebnerisin (r = 0.48, P < 0.01). Patients with psoriasis with subclinical atherosclerosis had higher serum levels of koebnerisin compared with patients without subclinical atherosclerosis (P = 0.04), which was not observed for psoriasin (P = 0.94).

CONCLUSION:
Serum psoriasin and koebnerisin correlate with IMT, underlining their value as a potential link between psoriasis and atherosclerosis. In particular, koebnerisin seems to be a useful marker of subclinical atherosclerosis in patients with psoriasis.

Author Info:
1
Department of Dermatology and Venereology, Assiut University Hospital, Assiut, Egypt.
2
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Diagnostic Radiology, Assiut University Hospital, Assiut, Egypt.


Authors:
Ayuob NN(1),(2), El Wahab MGA(3),(4),(5), Ali SS(6),(7), Abdel-Tawab HS(8).

Title:
Ocimum Basilicum Improve Chronic Stress-Induced Neurodegenerative Changes In Mice Hippocampus.

Abstract:
Alzheimer's disease (AD), one of the progressive neurodegenerative diseases might be associated with exposure to stress and altered living conditions. This study aimed to evaluate the effectiveness of Ocimum basilicum (OB) essential oils in improving the neurodegenerative-like changes induced in mice after exposed to chronic unpredictable mild stress (CUMS). Forty male Swiss albino mice divided into four groups (n = 10); the control, CUMS, CUMS + Fluoxetine, CUMS + OB were used. Behavioral tests, serum corticosterone level, hippocampus protein level of the glucocorticoid receptors (GRs) and brain-dreived neurotropic factor (BDNF) were determined after exposure to CUMS. Hippocampus was histopathologically examined. Data were analyzed using statistical package for the social sciences (SPSS) and P value of less than 0.05 was considered significant. OB diminished the depression manifestation as well as impaired short term memory observed in the mice after exposure to the CUMS as evidenced by the forced swimming and elevated plus maze test. OB also up-regulated the serum corticosterone level, hippocampal protein level of the glucocorticoid receptor and the brain-derived neurotropic factor and reduced the neurodegenerative and atrophic changes induced in the hippocampus after exposure to CUMS. Essential oils of OB alleviated the memory impairment and hippocampal neurodegenerative changes induced by exposure to the chronic unpredictable stress indicating that it is the time to test its effectiveness on patients suffering from Alzheimer disease.

Author Info:
1
Anatomy department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. nasraayuob@gmail.com.
2
Department of Histology, Faculty of Medicine, Mansoura University, Mansoura, Egypt. nasraayuob@gmail.com.
3
Department of Anatomy, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
4
Department of Basic Sciences, Nursing College, King Saud Bin Abd El Aziz University, National guard, Jeddah, Saudi Arabia.
5
Yousef Abdullatif Jameel, Chair of Prophetic Medical Applications (YAJCPMA), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
6
Anatomy department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
7
Histology Department, Faculty of Medicine, Assuit University, Assiut, Egypt.
8
Zoology Department, Faculty of Science, Assiut University, Assiut, Egypt.


Authors:
Aziz MM(1), Galal MAA(2), Elzohri MH(3), El-Nouby F(4), Leong KP(5)

Title:
Cross-Cultural Adaptation And Validation Of Systemic Lupus Erythematosus Quality Of Life Questionnaire Into Arabic

Abstract:
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of quality of life (QoL) of the patients. Comprehensive patient assessment should include QoL measures in addition to the objective clinical measures of the disease. There is no specific Arabic instrument for assessment of QoL of SLE patients. The objective of this study was to translate and cross culturally adapt the SLEQOL questionnaire into Arabic and test its reliability and validity. The SLEQOL questionnaire was translated into Arabic based on the Guidelines for Translation and Cross-cultural Adaptation into other languages. Reliability was assessed by interviewing patients three times: two interviews on the same day by different interviewers and the third interview 14 days later by one of the first interviewers. Validity was assessed by correlating SLEQOL scores of 91 patients with 36-item Short Form Health Survey (SF-36) scores and clinical parameters of the patients. We found that the Arabic version of SLEQOL has a Cronbach's alpha of 0.936, interobserver and intraobserver correlation coefficients of 0.809 and 0.886 respectively. Strong correlations were also found between SLEQOL scores and SF-36 Physical and Mental Component summaries. In conclusion, the Arabic version of SLEQOL is a reliable and valid instrument for measuring QoL of Egyptian SLE patients.

Author Info:
1
1 Department of Public Health and Community Medicine, 68797 Assiut University , Egypt.
2
2 Department of Rheumatology, Rehabilitation and Physical Medicine, 68797 Assiut University , Egypt.
3
3 Department of Internal Medicine and Rheumatology, 68797 Assiut University , Egypt.
4
4 Department of Rheumatology, Rehabilitation and Physical Medicine, 435387 Aswan University , Egypt.
5
5 Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.


Authors:
Aziz MM(1), El-Gazzar AF(1), Elgibaly O(1).

Title:
Factors Associated With First-Year Discontinuation Of Implanon In Upper Egypt: Clients' And Providers' Perspectives

Abstract:
BACKGROUND:
The etonogestrel implant Implanon is a favourable and cost-effective contraceptive method for women in developing countries, and expansion of its use represents a priority for the family planning (FP) programme in Egypt. We studied the factors affecting first-year Implanon discontinuation from clients' and providers' perspectives.

METHODS:
We used a mixed quantitative-qualitative methodology. We conducted a household survey of Implanon clients and three focus group discussions with FP physicians and directors.

RESULTS:
We found that 13.5% of Implanon users discontinued its use in the first year. Survival analysis found that clients who had previously used Implanon (HR 0.36, 95% CI 0.15 to 0.88) and whose husbands had secondary or a higher level of education (HR 0.36,95% CI 0.19 to 0.69) were less likely to discontinue Implanon use after the first year, while clients who experienced side effects of Implanon use were more likely to discontinue it (HR 3.6,95% CI 1.60 to 8.11). Other causes of discontinuation which emerged in the qualitative analysis were the unjustified advice for Implanon removal by non-gynaecologists, due to unrelated users' complaints, and deficient pre-insertion counselling.

CONCLUSIONS:
Implanon has a low first-year discontinuation rate as compared with other contraceptive methods. FP clients should be given sufficient pre-insertion counselling about side effects of Implanon and duration of protection. Physicians should offer Implanon mainly to clients seeking long-term contraception in order to decrease its discontinuation rate and increase its cost effectiveness.

Author Info:
1
Public Health and Community Medicine, Assiut University, Assiut, Egypt.


Authors:
Aziz MM(1), Abd El-Megeed HS(2), Abd Ellatif MAM(3).

Title:
Pre-Travel Health Seeking Practices Of Umrah Pilgrims Departing From Assiut International Airport, Egypt.

Abstract:
OBJECTIVES:
to assess the health seeking practices and their determinants among Umrah pilgrims departing from Assiut international Airport.

METHODS:
We interviewed 300 pilgrims departing from Assiut International Airport while they were in the departure lounge, using a semi-structured questionnaire.

RESULTS:
Only 60%, 46.3% and 46.3% of Umrah pilgrims believed in importance of pre-travel vaccination, seeking health information, and health examination, respectively. The most frequently practiced pre-travel health related behaviour was getting vaccinated (56.3%), as compared to much lower frequencies of seeking health information (24%) or having a clinical health examination (26.7%). Private clinics, internet and the tourism companies were the main sources of health information of the pilgrims. Positive attitude of pilgrims about health seeking practices, the perception of health risk of travelling to Hajj/Umrah and having a chronic disease were the predictors of pre-travel health practices.

CONCLUSION:
Raising awareness among Hajj/Umrah pilgrims about the importance of seeking professional pre-travel health advice and communicating the risk of exposure to travel-related diseases to pilgrims could be important strategies to improve the uptake of preventive measures. Training of general practitioners in the public health sector about the travel health information would promote the travel health services.

Author Info:
1
Department of Public Health & Community Medicine, Assiut University, Egypt. Electronic address: miretteaziz@aun.edu.eg.
2
Department of Public Health & Community Medicine, Assiut University, Egypt.
3
Assiut International Airport Clinic, Egypt.


Authors:
Badr G(1), Gul HI(2), Yamali C(3), Mohamed AAM(4), Badr BM(5), Gul M(6), Abo Markeb A(7), Abo El-Maali N(7).

Title:
Curcumin Analogue 1,5-Bis(4-Hydroxy-3-((4-Methylpiperazin-1-Yl)Methyl)Phenyl)Penta-1,4-Dien-3-One Mediates Growth Arrest And Apoptosis By Targeting The PI3K/AKT/Mtor And PKC-Theta Signaling Pathways In Human Breast Carcinoma Cells

Abstract:
Recent developments in the literature have demonstrated that curcumin exhibit antioxidant properties supporting its anti-inflammatory, chemopreventive and antitumoral activities against aggressive and recurrent cancers. Despite the valuable findings of curcumin against different cancer cells, the clinical use of curcumin in cancer treatment is limited due to its extremely low aqueous solubility and instability, which lead to poor in vivo bioavailability and limited therapeutic effects. We therefore focused in the present study to evaluate the anti-tumor potential of curcumin analogues on the human breast carcinoma cell lines MDA-MB-231 and MCF-7, as well as their effects on non-tumorigenic normal breast epithelial cells (MCF-10). The IC50 values of curcumin analogue J1 in these cancer cell lines were determined to be 5 ng/ml and 10 ng/ml, in MDA-MB-231 and MCF-7 cells respectively. Interestingly, at these concentrations, the J1 did not affect the viability of non-tumorigenic normal breast epithelial cells MCF-10. Furthermore, we found that J1 strongly induced growth arrest of these cancer cells by modulating the mitochondrial membrane potentials without significant effect on normal MCF-10 cells using JC-1 staining and flow cytometry analysis. Using annexin-V/PI double staining assay followed by flow cytometry analysis, we found that J1 robustly enhanced the induction of apoptosis by increasing the activity of caspases in MDA-MB-231 and MCF-7 cancer cells. In addition, treatment of breast cancer cells with J1 revealed that, in contrast to the expression of cyclin B1, this curcumin analogue vigorously decreased the expression of cyclin A, CDK2 and cyclin E and subsequently sensitized tumor cells to cell cycle arrest. Most importantly, the phosphorylation of AKT, mTOR and PKC-theta in J1-treated cancer cells was markedly decreased and hence affecting the survival of these cancer cells. Most interestingly, J1-treated cancer cells exhibited a significant inhibition in the activation of RhoA followed by reduction in actin polymerization and cytoskeletal rearrangement in response to CXCL12. Our data reveal the therapeutic potential of the curcumin analogue J1 and the underlying mechanisms to fight breast cancer cells.

Author Info:
1
Zoology Department, Faculty of Science, Assiut University, 71516 Assiut, Egypt; Laboratory of Immunology & Molecular Physiology, Zoology Department, Faculty of Science, Assiut University, 71516 Assiut, Egypt. Electronic address: http://www.aun.edu.eg/membercv.php?M_ID=393.
2
Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ataturk University, Erzurum, Turkey. Electronic address: incigul@atauni.edu.tr.
3
Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ataturk University, Erzurum, Turkey.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, 71526 Assiut, Egypt.
5
Radiation Biology Department, National Centre for Radiation Research and Technology (NCRRT), Cairo, Egypt.
6
Department of Physiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
7
Department of Chemistry, Faculty of Science, Assiut University, Assiut 71516, Egypt.


Authors:
Barakat A(1), Hamdy MM(2), Elbadr MM(2).

Title:
Uses Of Fluoxetine In Nociceptive Pain Management: A Literature Overview

Abstract:
Fluoxetine is one of the top ten prescribed antidepressants. Other therapeutic applications were approved for fluoxetine including, anxiety disorders, bulimia nervosa, and premature ejaculation. However, the role of fluoxetine in nociceptive pain management is still unclear. In this review, we discuss an overview of five possible roles of fluoxetine in pain management: intrinsic antinociceptive effect, enhancement of acute opioid analgesia, attenuation of tolerance development to opioid analgesia, attenuation of dependence development and abstinence syndrome, and attenuation of opioid induced hyperalgesia. Conflicting data were reported about fluoxetine intrinsic anti-nociceptive effect in preclinical and clinical studies except for inflammatory pain. Similar controversy was described in preclinical and clinical studies which explored the possible enhancement of opioid analgesia by fluoxetine co-administration. However, fluoxetine was found to have a promising effect on opioid tolerance and dependence in animal and human studies. Regarding opioid induced hyperalgesia, no studies examined fluoxetine effects in this regard. Our literature review revealed that, the most likely beneficial use of fluoxetine in nociceptive pain management is for alleviation of inflammatory pain and attenuation of opioid tolerance and dependence. Non-steroidal anti-inflammatory and corticosteroids carry many adverse effects and toxicities. Effective alleviation of opioid tolerance and dependence represents a huge health burden and growing unmet medical need. Moreover, most agents used to attenuate these phenomena are either experimental or poorly tolerable drugs which limit their transitional value. Fluoxetine offers an effective, safe, and tolerable alternative for management of both inflammatory pain and opioid tolerance and dependence presently available to clinicians.

Author Info:
1
Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt. Electronic address: ahmedbarakat@aun.edu.eg.
2
Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt.


Authors:
Bedaiwy MA(1), Abdel-Rahman MY(2), Tan J(1), AbdelHafez FF(3), Abdelkareem AO(2), Henry D(4), Lisonkova S(1), Hurd WW(5), Liu JH(4).

Title:
Clinical, Hormonal, and Metabolic Parameters in Women with Subclinical Hypothyroidism and Polycystic Ovary Syndrome: A Cross-Sectional Study

Abstract:
BACKGROUND:
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive age women, yet its clinical presentation shares similarities with several other endocrine disorders such as thyroid disease. Hence, the objective of this study was to further evaluate this association by investigating the clinical, hormonal, and metabolic parameters between subclinical hypothyroidism (SCH) and PCOS.

METHODS:
This is a cross-sectional study conducted in a tertiary care clinic at Cleveland, Ohio, USA. A total of 137 women diagnosed with PCOS by Rotterdam criteria were examined. SCH was defined as thyroid-stimulating hormone >2.5 mIU/L in the absence of symptoms of overt hypothyroidism. The mean age, body mass index (BMI), fasting plasma glucose (FPG), glucose tolerance test, hemoglobin A1c, fasting insulin, a 2 hours insulin level after 75 g glucose load, cholesterol, LDL, HDL, and homeostatic model assessment (HOMA) were compared between women with and without SCH. Logistic regression was used to adjust for age and BMI.

RESULTS:
Among 137 women with PCOS, 21.9% had SCH. Comparison groups were similar in both age and BMI and there was no difference in the mean values of all endocrine and metabolic parameters tested. However, abnormal FPG levels (OR 3.01; CI: 1.12-8.07. p = 0.03) and abnormal HOMA (OR 3.7; CI: 1.14-12.00. p = 0.03) were more likely in women who had SCH than in women without SCH independent of age and BMI.

CONCLUSIONS:
Women with PCOS and SCH are more likely to have impaired FPG values and impaired insulin sensitivity even after adjusting for age and BMI. Hence, close monitoring of PCOS patients for SCH may be beneficial.

Author Info:
1
1 Department of Obstetrics and Gynaecology, Faculty of Medicine, The University of British Columbia , Vancouver, Canada .
2
2 Department of Obstetrics and Gynaecology, Faculty of Medicine, Sohag University , Sohag, Egypt .
3
3 Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University , Assiut, Egypt .
4
4 Department of Obstetrics and Gynaecology, School of Medicine, Case Western Reserve University , Cleveland, Ohio.
5
5 Department of Obstetrics and Gynaecology, School of Medicine, Duke University , Durham, North Carolina.


Authors:
Bedaiwy MA(1),(2),(3), Yong PJ(1), Farghaly TA(3), Abdelhafez FF(3), Tan J(1), Pope R(2), Hurd WW(2), Liu JH(2), Zanotti K(2).

Title:
The Effect of Age and Body Mass Index on the Surgical Anatomy of Supraumbilical Port Insertion: Implications for Laparoscopic and Robotic Surgery

Abstract:
BACKGROUND:
Minimally invasive surgery is the preferred approach for performing many gynecologic procedures. Occasionally, supraumbilical port placement may be preferable to optimize visibility and maneuverability although the risks of complications are less well characterized compared to umbilical entry.

METHODS:
We conducted a retrospective review of computed tomograms from 92 patients to evaluate the anatomic considerations for umbilical and supraumbilical port entry based on patient age, body mass index (BMI), parity, abdominal wall thickness, and distance to the great vessels.

RESULTS:
Supraumbilical entry was not associated with differences in distance to the great vessels compared to the umbilicus. However, supraumbilical location and BMI were associated with greater abdominal wall thickness. Age and BMI were associated with greater distance to the great vessels, while age was associated with thinner abdominal wall. Multiple linear regression confirmed independent effects of age and BMI. No association between parity and distance to retroperitoneal vessels was observed.

CONCLUSION:
Younger patients may be at increased risk for great vessel injury and pre-peritoneal insufflation. Obese patients may be at risk for pre-peritoneal insufflation, while patients with BMI < 30, particularly with a skin-to-aorta distance < 7 cm, may be at an increased risk for great vessel injury. Surgeons should consider these factors when considering supraumbilical port entry.

Author Info:
1
Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology and Infertility, The University of British Columbia, Vancouver, British Columbia, Canada.
2
Department of Reproductive Biology, Case Western Reserve University, and Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
3
Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt.


Authors:
Bjørklund G(1), Kern JK(2), Urbina MA(3), Saad K(4), El-Houfey AA(5), Geier DA(6), Chirumbolo S(7), Geier MR(6), Mehta JA(8), Aaseth J(9).

Title:
Cerebral Hypoperfusion In Autism Spectrum Disorder

Abstract:
Cerebral hypoperfusion, or insufficient blood flow in the brain, occurs in many areas of the brain in patients diagnosed with autism spectrum disorder (ASD). Hypoperfusion was demonstrated in the brains of individuals with ASD when compared to normal healthy control brains either using positron emission tomography (PET) or single‑photon emission computed tomography (SPECT). The affected areas include, but are not limited to the: prefrontal, frontal, temporal, occipital, and parietal cortices; thalami; basal ganglia; cingulate cortex; caudate nucleus; the limbic system including the hippocampal area; putamen; substantia nigra; cerebellum; and associative cortices. Moreover, correlations between symptom scores and hypoperfusion in the brains of individuals diagnosed with an ASD were found indicating that the greater the autism symptom pathology, the more significant the cerebral hypoperfusion or vascular pathology in the brain. Evidence suggests that brain inflammation and vascular inflammation may explain a part of the hypoperfusion. There is also evidence of a lack of normal compensatory increase in blood flow when the subjects are challenged with a task. Some studies propose treatments that can address the hypoperfusion found among individuals diagnosed with an ASD, bringing symptom relief to some extent. This review will explore the evidence that indicates cerebral hypoperfusion in ASD, as well as the possible etiological aspects, complications, and treatments.


Authors:
Bjørklund G(1), Skalny AV(2), Rahman MM(3), Dadar M(4), Yassa HA(5), Aaseth J(6), Chirumbolo S(7), Skalnaya MG(8), Tinkov AA(9).

Title:
Toxic Metal(Loid)-Based Pollutants And Their Possible Role In Autism Spectrum Disorder

Abstract:
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction, verbal and non-verbal communication, and stereotypic behaviors. Many studies support a significant relationship between many different environmental factors in ASD etiology. These factors include increased daily exposure to various toxic metal-based environmental pollutants, which represent a cause for concern in public health. This article reviews the most relevant toxic metals, commonly found, environmental pollutants, i.e., lead (Pb), mercury (Hg), aluminum (Al), and the metalloid arsenic (As). Additionally, it discusses how pollutants can be a possible pathogenetic cause of ASD through various mechanisms including neuroinflammation in different regions of the brain, fundamentally occurring through elevation of the proinflammatory profile of cytokines and aberrant expression of nuclear factor kappa B (NF-κB). Due to the worldwide increase in toxic environmental pollution, studies on the role of pollutants in neurodevelopmental disorders, including direct effects on the developing brain and the subjects' genetic susceptibility and polymorphism, are of utmost importance to achieve the best therapeutic approach and preventive strategies.

Author Info:
1
Council for Nutritional and Environmental Medicine, Mo i Rana, Norway. Electronic address: bjorklund@conem.org.
2
Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; Yaroslavl State University, Yaroslavl, Russia; All-Russian Research Institute of Medicinal and Aromatic Plants, Moscow, Russia.
3
Department of Environmental Sciences, Jahangirnagar University, Dhaka, Bangladesh; Graduate School of Environmental Science, Hokkaido University, Japan.
4
Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran.
5
Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway; Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.
7
Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
8
Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
9
Peoples' Friendship University of Russia (RUDN University), Moscow, Russia; Yaroslavl State University, Yaroslavl, Russia.


Authors:
Buwenge M(1), Marinelli A(2), Deodato F(2), Macchia G(2), Wondemagegnhu T(3), Salah T(4), Cammelli S(1), Uddin AFMK(5), Sumon MA(5), Donati CM(1), Cilla S(6), Morganti AG(1).

Title:
Definition Of Fields Margins For Palliative Radiotherapy Of Pancreatic Carcinoma

Abstract:
The present study aimed to provide practical guidelines for palliative treatment of advanced carcinoma of the pancreas (CAP) with the 2D technique. Fifteen patients with locally advanced CAP consecutively treated with radiation therapy at the Radiation Oncology Center, Research and Care Foundation 'Giovanni Paolo II' (Campobasso, Italy) underwent computed tomography simulation in supine position. Definition of the clinical target volume (CTV) included the head and body of the pancreas, and the retropancreatic space. The planning target volume was defined by adding a margin of 14 mm to the CTV in the cranio-caudal direction and of 11 mm in radial direction. For each patient, 3 treatment plans were calculated using a cobalt source, 6 MV photons and 15 MV photons (box technique). Beams were drawn using the primary collimators without using multileaf collimators, and progressively optimized in order to respect the minimum dose (Dmin>90%) constraint. Once the final plan was achieved, distances of the fields edges from a set of reference points (bony or duodenal landmarks) were measured. Using this technique, 15 anterior-posterior and postero-anterior (AP-PA) beams and 15 pairs of lateral-lateral (LL) beams were defined for the different patients. Finally, the single minimal AP-PA and LL beams able to include the 15 sets of AP-PA and LL beams were defined. The results of this analysis are reported in tabular form. Guidelines are provided for treatment based on cobalt unit or Linear accelerator (both 6 and 15 MV photons). This study provides information regarding field size and position. A dosimetric study has been planned to identify the dose to be administered with this technique taking into account current dose-volume constraints.

Author Info:
1
Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy.
2
Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy.
3
Department of Radiation Oncology, Black Lion Hospital, Addis Ababa 9086, Ethiopia.
4
Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
5
Radiation Oncology Department, United Hospital Limited, Gulshan, Dhaka 1212, Bangladesh.
6
Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy.


Authors:
Chelban V(1),(2),(3), Wiethoff S(1),(4), Fabian-Jessing BK(5), Haridy NA(1),(6), Khan A(1), Efthymiou S(1), Becker EBE(7), O'Connor E(1), Hersheson J(1), Newland K(1), Hojland AT(5), Gregersen PA8, Lindquist SG(9),(1)0, Petersen MB(5), Nielsen JE(9), Niel

Title:
Genotype-Phenotype Correlations, Dystonia And Disease Progression In Spinocerebellar Ataxia Type 14

Abstract:
BACKGROUND:
Spinocerebellar ataxia type 14 is a rare form of autosomal dominant cerebellar ataxia caused by mutations in protein kinase Cγ gene. Clinically, it presents with a slowly progressive, mainly pure cerebellar ataxia.

METHODS:
Using next generation sequencing, we screened 194 families with autosomal dominant cerebellar ataxia and normal polyglutamine repeats. In-depth phenotyping was performed using validated clinical rating scales neuroimaging and electrophysiological investigations.

RESULTS:
We identified 25 individuals from 13 families carrying pathogenic mutations in protein kinase Cγ gene. A total of 10 unique protein kinase Cγ gene mutations have been confirmed of which 5 are novel and 5 were previously described. Our data suggest that the age at onset is highly variable; disease course is slowly progressive and rarely associated with severe disability. However, one third of patients presented with a complex ataxia comprising severe focal and/or task-induced dystonia, peripheral neuropathy, parkinsonism, myoclonus, and pyramidal syndrome. The most complex phenotype is related to a missense mutation in the catalytic domain in exon 11.

CONCLUSION:
We present one of the largest genetically confirmed spinocerebellar ataxia type 14 cohorts contributing novel variants and clinical characterisation. We show that although protein kinase Cγ gene mutations present mainly as slowly progressive pure ataxia, more than a third of cases had a complex phenotype. Overall, our case series extends the phenotype and suggests that protein kinase Cγ gene mutations should be considered in patients with slowly progressive autosomal dominant cerebellar ataxia, particularly when myoclonus, dystonia, or mild cognitive impairment are present in the absence of polyglutamine expansion. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Author Info:
1
Department of Molecular Neuroscience, University College London, Institute of Neurology, London, UK.
2
National Hospital for Neurology and Neurosurgery, London, UK.
3
Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova.
4
Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany.
5
Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.
6
Department of Neurology and Psychiatry, Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.
7
Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
8
Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
9
Danish Dementia Research Centre, Neurogenetics Clinic, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
10
Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
11
Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
12
Deparmtent of Molecular Neuroscience, Ataxia Centre UCL, Institute of Neurology, London, UK.


Title:
Response To "A Letter To The Editor" Concerning Oral Lactoferrin Plus Health Education For IDA.

Author Info:
1
a Woman's Health University Hospital , Assiut University , Asyut , Egypt.


Authors:
Darwish AM(1), Abdallah MM(1), Shaaban OM(1), Ali MK(1), Khalaf M(1), Sabra AMA(1)

Title:
Bakri Balloon Versus Condom-Loaded Foley's Catheter For Treatment Of Atonic Postpartum Hemorrhage Secondary To Vaginal Delivery: A Randomized Controlled Trial

Abstract:
OBJECTIVE:
To assess the efficacy and safety of condom-loaded Foley's catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery.

STUDY DESIGN:
This study was single blinded randomized controlled trial conducted at Assiut Woman's Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley's catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications.

RESULTS:
Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p = .199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09 min vs. 11.76 min, p = .042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion.

CONCLUSIONS:
Condom-loaded Foley's catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.


Authors:
Darwish AM(1), Fouly HA(2), Saied WH(2), Farah E(3).

Title:
Lactoferrin Plus Health Education Versus Total Dose Infusion (TDI) Of Low-Molecular Weight (LMW) Iron Dextran For Treating Iron Deficiency Anemia (IDA) In Pregnancy: A Randomized Controlled Trial

Abstract:
BACKGROUND:
Iron deficiency anemia (IDA) is one of the most common medical disorder disturbing pregnancies particularly in low resources countries, and contributes significantly to morbidities and mortalities. Thus, early diagnosis and prompt management of IDA is highly recommended.

AIM:
To Test the efficacy and safety of oral lactoferrin plus health education provided by a nurse versus total dose infusion (TDI) of low-molecular weight (LMW) iron dextran for treating IDA in the second and third trimester of pregnancy.

DESIGN:
A prospective interventional, randomized, parallel-group, single-center longitudinal study.

SETTING:
Woman's Health Assiut University Hospital, Assiut, Egypt, at the outpatient clinic and inpatient unit. It comprised 120 cases divided into two groups as pineapple flavored lactoferrin oral sachets 100 mg twice daily with health education (group A) and TDI of LMW iron dextran (group B).

MAIN OUTCOME MEASURES:
The primary efficacy parameter was clinical improvement and the amount of increase in hemoglobin concentration by 4 weeks after therapy, secondary outcome measures included measurement of the rest of RBC, and iron indices, the adverse effects related to iron therapy and the patient compliance to the treatment.

RESULTS:
There was insignificant difference between both groups regarding sociodemographic data, parity and mean gestational age. Both groups showed a significant clinical improvement of anemia 4 weeks post-therapy. There was no statistically significant difference in mean Hb level improvement in both groups after 1 month of therapy. However, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) improved significantly more in group B than A while iron indices (serum iron and serum ferritin) were significantly more in group A than group B.

CONCLUSIONS:
Pineapple flavored lactoferrin oral sachets plus health education can be widely used as an alternative to TDI iron dextran supplementation due to clinical as well as laboratory improvement of IDA during pregnancy after 1 month of treatment. Proper health education of the pregnant women with nurse recommendations of balanced diet containing good sources of iron would increase awareness of pregnant women and help eradicate IDA with its serious sequel during pregnancy.

Author Info:
1
a Department of Obstetrics and Gynecology, Faculty of Medicine , Woman's Health University Hospital , Assiut , Egypt.
2
b Faculty of Nursing , Assiut University , Assiut , Egypt.
3
c Department of Clinical Pathology , Faculty of Medicine, Aswan University , Assiut , Egypt.


Authors:
El Kassas M(1), Alboraie M(2), Mostafa A(3), Ezzat R(4), El Tahan A(5), Afify S(5), Sweedy A(5), Kabbash I(6), Esmat G(7).

Title:
After Successful Hepatitis C Virus Antiviral Therapy: It Looks That Normal Alanine Aminotransferase Level Is Not The Normal

Abstract:
BACKGROUND:
Normal serum alanine aminotransferase (ALT) levels differ with age, gender, and body mass index. Adjusting the upper limits of normal (ULN) for ALT needs further research in different populations. Aim of this work was to monitor the effect of successful chronic hepatitis C (CHC) treatment on the ALT levels in patients with normal pretreatment ALT.

METHODS:
Data of 1160 CHC patients with persistent pretreatment normal liver enzymes were retrospectively analyzed. Treatment response to direct acting antiviral agents (DAAs) therapy was recorded. Changes in ALT levels before and after treatment were analyzed by patients' demographic, laboratory, and radiologic characteristics. Areas under the receiver operating characteristic curve (AUROC) of ALT after treatment were used to generate a new ALT ULN.

RESULTS:
Males were 568 (49%) and females 592 (51%) with a mean age of 50.7 years. After treatment, mean (±SD) of ALT levels significantly decreased from (26.3±7.8) to (19.1±10.9). This reduction was more significant in interferon-free than interferon-based regimens. ROC curve analyses suggested a new ALT ULN cut off (26.4 IU/L) in the treated patients (sensitivity=78.6%, specificity=83.8%, AUROC=0.89. This cutoff dropped to 14.7 IU/L in cirrhotic patients (sensitivity=77.4%, specificity=44.7%, AUROC=0.612). The identified cutoffs were 16.3 IU/L (sensitivity=66.7%, specificity=47.5%, AUROC=0.499) and 15.5 IU/L (sensitivity=76.5%, specificity=51.3%, AUROC=0.576) in males and females, respectively.

CONCLUSION:
The current ALT ULN needs readjustment to identify new normal cutoffs in CHC patients. Posttreatment cutoffs differ according to gender, pretreatment liver affection, and treatment regimen.

Author Info:
1
Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
2
Internal Medicine Department, Al-Azhar University, Cairo, Egypt.
3
Community, Environmental, and Occupational Health Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
New Cairo Viral Hepatitis Treatment Unit, Cairo, Egypt.
6
Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
7
Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.


Authors:
El Toony LF(1), Hamad DA(2), Omar OM(3).

Title:
Outcome Of Focused Pre-Ramadan Education On Metabolic And Glycaemic Parameters In Patients With Type 2 Diabetes Mellitus

Abstract:
BACKGROUND:
Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting.

OBJECTIVES:
To evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus.

METHODS:
A prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes.

RESULTS:
Fasting blood glucose decreased significantly during, and after Ramadan in both groups (P < 0.001). Hypoglycaemia during fasting occurred in 4.1% of patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c < 7% increased statistically significantly in the intervention group (from 20.8% of patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups.

CONCLUSION:
There was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan.

Author Info:
1
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt. Electronic address: leltoni@aun.edu.eg.
2
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt. Electronic address: dinaalihamad@yahoo.com.
3
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt. Electronic address: herdan4@aun.edu.eg.


Authors:
El-Hakeim EH(1), Elawamy A(2), Kamel EZ(3), Goma SH(1), Gamal RM(1), Ghandour AM(1), Osman AM(4), Morsy KM(4).

Title:
Fluoroscopic Guided Radiofrequency of Genicular Nerves for Pain Alleviation in Chronic Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial

Abstract:
BACKGROUND:
Nowadays, pain and disability due to chronic knee arthritis is a very common problem in middle aged people. A lot of modalities for management are available, including conservative analgesics and up to surgical interventions. Radiofrequency ablation of genicular nerves is assumed to be an effective less invasive and safe pain alleviation modality.

OBJECTIVES:
To evaluate the efficacy of fluoroscopic guided radiofrequency neurotomy of the genicular nerves for alleviation of chronic pain and improvement of function in patients with knee osteoarthritis.

STUDY DESIGN:
A single-blind randomized controlled trial.

SETTING:
Pain management unit, and Rheumatology and Rehabilitation clinics of Assiut University hospitals, Assiut, Egypt.

METHODS:
This study involved 60 patients with chronic knee osteoarthritis. Radiofrequency neurotomy of the genicular nerves was done for 30 patients (Group A) while the other 30 patients (Group C) received conventional analgesics only. The outcome measures included visual analog scale (VAS), Western Ontario and McMaster Universities Index (WOMAC), and Likert scale for patient satisfaction in the 2nd week,3rd, and 6th months.

RESULTS:
There were significant differences regarding the VAS in the 2nd week, 3rd, and 6th months between the 2 groups, and a significant difference in total WOMAC index in the 6th month only. There were significant changes when comparing pretreatment values with the values during the whole follow-up period with regard to the VAS and total WOMAC index in both groups.

LIMITATIONS:
No diagnostic block was done prior to radiofrequency. We recommend the use of such a technique on a larger number of OA patients, with a longer follow-up period.

CONCLUSION:
RF can ameliorate pain and disability in chronic knee osteoarthritis in a safe and effective manner.

Author Info:
1
Department of Rheumatology, Rehabilitation, and Physical Medicine, Assiut University Hospital, Assiut, Egypt.
2
Department of Anesthesia, Assiut University, Assiut, Egypt.
3
Assiut University, Assiut, Egypt.
4
Assiut University, Faculty of Medicine, Egypt.


Title:
Ambulance Vehicles As A Source Of Multidrug-Resistant Infections: A Multicenter Study In Assiut City, Egypt

Abstract:
BACKGROUND:
Ambulances may represent a potential source of infection to patients, patients' relatives, and paramedical staffs. In this study, we analyzed the extent of bacterial contamination in ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens.

MATERIALS AND METHODS:
Twenty-five vehicles were included and 16 sampling points were swabbed in each vehicle. Then the swabs were immediately transferred to the laboratory to identify bacterial contaminants utilizing standard microbiological procedures and API® systems. Antibiotic susceptibility testing and screening for methicillin-resistant staphylococci and extended spectrum β-lactamases (ESBLs)-producing Gram-negative rods were carried out.

RESULTS:
A total of 400 samples were collected, 589 bacteria were isolated and 286 (48.6%) of the isolates were potentially pathogenic. The highest contamination rate with pathogenic bacteria was detected in suction devices (75.8%) and stethoscopes (67.7%). Staphylococci were the most frequently detected microorganisms (n=184) followed by Klebsiella spp. (49), Escherichia coli (40), Citrobacter spp. (7), and Proteus spp. (6). Staphylococci were mostly sensitive to vancomycin, whereas Gram-negative bacteria were sensitive to imipenem. Overall, 46.1% of Staphylococcus aureus were methicillin resistant, whereas 20.4% of the coagulase-negative staphylococci were methicillin resistant. Moreover, 36.7% of Klebsiella spp. and 27.5% of E. coli were ESBL producers.

CONCLUSION:
Our study provides evidence that ambulances represent a source of prehospital multidrug-resistant infections.

Author Info:
1
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
#
Contributed equally


Authors:
El-Mokhtar MA(1),(2), Bauer A(1), Madela J(1), Voigt S(3),(4).

Title:
Cellular Distribution Of CD200 Receptor In Rats And Its Interaction With Cytomegalovirus E127 Protein

Abstract:
CD200 is a membrane protein that interacts with CD200R on the surface of immune cells and delivers an inhibitory signal. In this study, we characterized the distribution of inhibitory CD200R in rats. In addition, we investigated if e127, a homologue of rat CD200 expressed by rat cytomegalovirus (RCMV), can suppress immune functions in vitro. RT-PCR analysis was carried out to test the expression of CD200R in different rat tissues and flow cytometry was performed to characterize CD200R at the cellular level. To test the inhibitory functions of e127, a co-culture system was utilized in which immune cells were incubated with e127-expressing cells. The strongest CD200R expression was detected in lymphoid organs such as bone marrow and spleen. Flow cytometry analyses showed that CD200R+ cells were mainly CD4- dendritic cells (DC) and CD4+ T cells in the spleen. In blood, nearly all monocytes and granulocytes expressed CD200R and in bone marrow the NKRP1low subset of natural killer cells highly expressed CD200R. In addition, both peritoneal macrophages and the NR8383 macrophage cell line carried CD200R. At the functional level, viral e127 conferred an inhibitory signal on TNFα and IL6 cytokine release from IFNγ-stimulated macrophages. However, e127 did not affect the cytotoxic activity of DC. CD200R in the rat is mainly expressed on myeloid cells but also on non-myeloid cell subsets, and RCMV e127 can deliver inhibitory signals to immune cells by engaging CD200R. The RCMV model provides a useful tool to study potential immune evasion mechanisms of the herpesviridae and opens new avenues for understanding and controlling herpesvirus infections.

Author Info:
1
Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany. sebastian.voigt@charite.de.
4
Department of Pediatric Oncology/Hematology/SCT, Charité-Universitätsmedizin, Berlin, Germany. sebastian.voigt@charite.de.


Authors:
El-Nagar MKS(1), Abdu-Allah HHM(1), Salem OIA(2), Kafafy AN(1), Farghaly HSM(3).

Title:
Novel N-Substituted 5-Aminosalicylamides As Dual Inhibitors Of Cyclooxygenase And 5-Lipoxygenase Enzymes: Synthesis, Biological Evaluation And Docking Study

Abstract:
Three new series of 5-aminosalicylic acid derivatives; series I (14, 16-18), series II (19-30) and series III (31-41) were synthesized as potential dual COX-2/5-LOX inhibitors. Their chemical structures were confirmed using spectroscopic tools including IR, 1H NMR, 13C NMR, mass spectroscopy and elemental analyses. The anti-inflammatory activity for all target compounds was evaluated in vivo using carrageenan-induced paw edema. Compound 36 showed the highest anti-inflammatory activity (114.12%) relative to reference drug indomethacin at 4 h interval. Selected derivatives were evaluated in vitro to inhibit ovine COX-1, human recombinant COX-2 and 5-LOX enzymes. Compounds 34 &35 exhibited significant COX-2 inhibition (IC50 = 0.10 µM) with significant COX-2 selectivity indices (SI = 135 & 145 respectively) approximate to celecoxib (IC50 = 0.049 µM, SI = 308.16) and exceeding indomethacin (IC50 = 0.51 µM, SI = 0.08). Interestingly, all compounds showed superior 5-LOX inhibitory activity about 2-5 times relative to zileuton. Compound 16 was the superlative 5-LOX inhibitor that revealed (IC50 = 3.41 µM) relative to zileuton (IC50 = 15.6 µM). Compounds 34, 35, 36 and 41 showed significant dual COX-2/5-LOX inhibitions. The gastric ulcerogenic effect of compound 36 was examined on gastric mucosa of albino rats and they showed superior GI safety profile compared with indomethacin. Molecular docking studies of the compounds into the binding sites of COX-1, COX-2 and 5-LOX allowed us to shed light on the binding mode of these novels dual COX and 5-LOX inhibitors.

Author Info:
1
Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.
2
Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt. Electronic address: ola.salim@pharm.au.edu.eg.
3
Pharmacology Department, Faculty of Medicine, Assiut University, Assiut 71111, Egypt.


Authors:
El-Sherbiny YM(1),(2),(3), Psarras A(1),(3), Yusof MYM(1),(3), Hensor EMA(1),(3), Tooze R(4), Doody G(4), Mohamed AAA(1),(5),(3), McGonagle D(1),(3), Wittmann M(1),(3), Emery P(1),(3), Vital EM(6),(7).

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

Abstract:
Measurement of type I interferon (IFN-I) has potential to diagnose and stratify autoimmune diseases, but existing results have been inconsistent. Interferon-stimulated-gene (ISG) based methods may be affected by the modularity of the ISG transcriptome, cell-specific expression, response to IFN-subtypes and bimodality of expression. We developed and clinically validated a 2-score system (IFN-Score-A and -B) using Factor Analysis of 31 ISGs measured by TaqMan selected from 3-IFN-annotated modules. We evaluated these scores using in-vitro IFN stimulation as well as in sorted cells then clinically validated in a cohort of 328 autoimmune disease patients and healthy controls. ISGs varied in response to IFN-subtypes and both scores varied between cell subsets. IFN-Score-A differentiated Systemic Lupus Erythematosus (SLE) from both Rheumatoid Arthritis (RA) and Healthy Controls (HC) (both p < 0.001), while IFN-Score-B differentiated SLE and RA from HC (both p < 0.001). In SLE, both scores were associated with cutaneous and hematological (all p < 0.05) but not musculoskeletal disease activity. Comparing with bimodal (IFN-high/low) classification, significant differences in IFN-scores were found between diagnostic groups within the IFN-high group. Our continuous 2-score system is more clinically relevant than a simple bimodal classification of IFN status. This system should allow improvement in diagnosis, stratification, and therapy in IFN-mediated autoimmunity.

Author Info:
1
National Institute of Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
2
Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
3
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
4
Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
5
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Asyut, Egypt.
6
National Institute of Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. e.m.j.vital@leeds.ac.uk.
7
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. e.m.j.vital@leeds.ac.uk.


Authors:
Elawamy A(1), Kamel EZ(2), Hassanien M(3), Wahba OM(2), Amin SE(4).

Title:
Implication of Two Different Doses of Intradiscal Ozone-Oxygen Injection upon the Pain Alleviation in Patients with Low Back Pain: A Randomized, Single-Blind Study

Abstract:
BACKGROUND:
Low back pain (LBP) is mostly induced by disc herniation (DH) or degeneration and has a burden upon social activity and economical aspects of life. An abundance of medical and surgical interventions have evolved to resolve this problem, but one of the newly introduced techniques, which is the minimally invasive, low cost ozone-oxygen mixture (O₃-O₂) intradiscal injection, offers a rapid onset amelioration of symptoms with a sustained duration of pain relief.

OBJECTIVE:
We aim to evaluate the quality of pain alleviation using 2 different doses of intradiscal injections of O₃-O₂ mixture.

STUDY DESIGN:
A prospectively randomized, single-blind study.

SETTING:
Pain clinic, anesthesia, intensive care, and pain department in Assiut University Hospitals.

METHODS:
Sixty patients with symptomatizing single lumbar DH were subjected to O₃-O₂ intradiscal injection and randomly allocated into one of 2 groups; group A: received 10 mL, 40 µg/mL of O₃-O₂ and group B: received 10 mL, 30 µg/mL of O₃-O₂. Pain score and functional ability of the patients using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated after 1, 6, and 12 months and compared to the basal values. Patient satisfaction and reduction of DH were evaluated after the sixth month.

RESULTS:
There were no significant differences between the 2 groups regarding the clinical outcome; however both the ODI and VAS evaluations showed highly significant improvement (decreased) (P < 0.01) after injection and during the entire follow-up period. There were highly significant negative correlations between the DH reduction percentage and both the VAS and ODI scores after 6 months in both of the groups.

LIMITATIONS:
This study was limited by a small sample size; it was also an active control trial, which may explain the insignificant difference in between the groups, in addition to being a single-blind trial.

CONCLUSION:
Intradiscal injection of O₃-O₂ mixture is a very valuable maneuver in the reduction of DH size and improvement of pain quality, with either ozone concentrations of 40 µg/mL or 30 µg/mL.

Author Info:
1
Department of Anesthesia, Assiut University, Assiut, Egypt.
2
Assiut University, Assiut, Egypt.
3
1Assiut University, Assiut, Egypt.
4
South Egypt Cancer Institute, Assiut University, Egypt.


Authors:
Elbadawy A(1), Ali H(2), Saleh M(2), Hasaballah A(2).

Title:
Editor's Choice - A Prospective Study to Evaluate ‎Complete Wound Healing and Limb Salvage Rates After ‎Angiosome Targeted Infrapopliteal Balloon Angioplasty ‎in Patients with Critical Limb Ischaemia

Abstract:
OBJECTIVE/BACKGROUND:
To evaluate complete wound healing and limb salvage rates in patients with critical limb ischaemia (CLI) with concurrent foot ulceration/gangrene who underwent angiosome targeted infrapopliteal balloon angioplasty.

METHODS:
This was a prospective observational study. In total, 212 patients who underwent successful infrapopliteal balloon angioplasty to assist wound healing and achieve limb salvage were included from June 2014 to March 2016. Propensity score matching was developed to compare complete wound healing, 1 year amputation free survival (AFS), and limb salvage rates between the two study groups (direct revascularisation [DR] and indirect revascularisation [IR]).

RESULTS:
Direct flow to the foot wounds based on the angiosome principle was achieved in 117 legs (55.2%) versus 95 legs (44.8%) that represented the IR group. Seventy-three matched pairs were obtained to minimise intergroup differences in baseline characteristics. Twelve months after angioplasty, the complete wound healing rates were 80.8% and 63.0% (p = .02), AFS rates were 72.6% and 61.6% (p = .164), and limb salvage rates were 90.4% and 82.2% (p = .148) in the DR and IR groups, respectively.

CONCLUSION:
This study suggests that the complete wound healing rate is better when the target foot lesion receives direct perfusion following the angiosome concept, whereas limb salvage and AFS rates were not significantly different among the DR and IR groups.

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


Authors:
ElBadre HM(1), El-Mahdy RI(2), Mohamed NA(1), Zakhary MM(1), Maximous DW(3).

Title:
Tissue Indices of Telomere Length and p53 in Patients with Different Gastrointestinal Tumors: Correlation with Clinicopathological Status.

Abstract:
Telomere length dysfunction is involved in the generation of genomic rearrangements that drive progression to malignancy. A set of serological markers for telomere dysfunction, namely chitinase and N-acetylglucosaminidase (NAG), DNA damage, and tissue alteration of p53 have been identified. The probability that genomic damage, accumulation of reactive oxygen species, and shorter telomeres may be related to the onset and advancement of gastrointestinal (GI) tumors. A total of 40 patients with GI tumors and 20 healthy controls with matched age and sex were included. Estimation of serum chitinase, NAG, lipid peroxide (LPER), glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase by colorimetric methods, and p53 by ELISA were assessed. Related clinicopathological features were determined. Serological chitinase, NO, LPER, and p53 were significantly increased, SOD was significantly decreased (p ˂ 0.001 for each) in GI tumor patients compared with controls and correlated significantly with age. There was a significant correlation between telomere dysfunction indices, p53, oxidative stress indices, and malignant stages of GI cancer patients. Moreover, a significant difference in the mean serum levels of indices between control, malignant, and benign subjects was found. Accordingly, these biomarkers play an important role in the pathogenesis of GI cancer and their estimation may predict the GI tumor behavior.

Author Info:
1
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. rehamibrahimelmahdy@gmail.com.
3
Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Elgayar SAM(1), Abdel-Hafez AAM(1), Gomaa AMS(1), Elsherif R(1)

Title:
Vulnerability Of Glia And Vessels Of Rat Substantia Nigra ‎In Rotenone Parkinson Model

Abstract:
BACKGROUND:
Astrocytes have been implicated as potentially exerting both neurotoxic and neuroprotective activities in Parkinson's disease (PD). Whether glial cells negatively impact the neuron integrity remains to be determined. We aimed to assess the vulnerability of glia and vessels in rat substantia nigra in a rotenone PD model.

MATERIAL AND METHODS:
Twenty adult male albino rats were divided into two equal groups: vehicle-control group (received dimethylsulfoxide + polyethylene glycol (PEG)-300, 1:1 v/v) and rotenone-treated group (received six doses of rotenone, 1.5 mg/kg/48 h s.c.). Using histological, ultrastructural, biochemical, and morphometric techniques, astrocytes, microglia, vessels, and total antioxidant capacity have been assessed.

RESULTS:
The rotenone-treated group revealed an increase in the number of astrocytes compared to the control, conformational changes of the immature form, disruption of the outer mitochondrial membrane, and no increase in glial filaments. Dark microglia appeared in close vicinity of blood capillaries. The blood capillaries displayed an increase in number compared to the control, degenerated apoptotic endothelium, and pericytes and an increase in string vessels. The total antioxidant level significantly increased in rotenone-treated group (p < 0.001) compared to the control group.

CONCLUSION:
Our results demonstrated that oxidative stress and mitochondrial dysfunction involved nigral cellular elements other than dopaminergic neurons. These included astrocytes, microglia, vascular endothelial cells, and pericytes, which might result in promoting damage to the neurons.

Author Info:
1
a Histology & Medical Physiology Departments, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Elgendy SG(1), Abdel Hameed MR(2), El-Mokhtar MA(1).

Title:
Tigecycline Resistance Among Klebsiella Pneumoniae ‎Isolated From Febrile Neutropenic Patients

Abstract:
Febrile neutropenic patients are at a high risk of life-threatening bacterial infections. Tigecycline was developed to treat multidrug-resistant isolates, however resistance to tigecycline in Klebsiella pneumoniae has been reported. Here, we investigated tigecycline resistance among K. pneumoniae isolated from febrile neutropenic patients admitted to Hematology ICU, Egypt. Out of 75 enrolled febrile neutropenic patients, 48 cases showed bacteriologically confirmed infection. The majority of cases were infected with K. pneumoniae, of which nine were tigecycline non-susceptible. Expression levels of the efflux pump genes acrB and oqxB and their regulatory genes ramA and rarA were analysed. Six isolates had overexpression of the four efflux-related genes while one showed baseline expression. This study emphasizes the importance of growing tigecycline resistance in K. pneumoniae infecting febrile neutropenic patients. Concerning the mechanism of resistance, it was clear that the ramA gene plays the major role, although alternative resistance mechanisms may also exist

Author Info:
1
1​Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt.
2
2​Internal Medicine and Hematology Unit, Assiut University Hospitals, Assiut University, Egypt.


Authors:
Elmorsy SA(1), Soliman GF(2), Rashed LA(3), Elgendy H(4).

Title:
Dexmedetomidine And Propofol Sedation Requirements ‎In An Autistic Rat Model

Abstract:
BACKGROUND:
Autism is a challenging neurodevelopmental disorder. Previous clinical observations suggest altered sedation requirements for autistic children. Our study aimed to test this observation experimentally with an animal model and, to explore its possible mechanisms.

METHODS:
Eight adult pregnant female Sprague Dawley rats were randomly selected into two groups. Four were injected with intraperitoneal sodium valproate on the gestational day 12 and four were injected with normal saline. On post-natal day 28 the newborn male rats were subjected to an open field test to confirm autistic features. Each rat was injected intraperitoneally with a single dose of propofol (50 mg/kg) or dexmedetomidine (0.2 mg/kg). Times to Loss of Righting Reflex (LORR) and to Return of Righting Reflex (RORR) were recorded. On the next day, all rats were re-sedated and their EEGs were recorded. The rats were sacrificed and hippocampal GABAA and glutamate NMDA receptor gene expression were assessed.

RESULTS:
Autistic rats showed significantly longer time to LORR and a shorter time to RORR compared to controls (Median time to LORR: 12.0 versus 5.0 for dexmedetomidine and 22.0 and 8.0 for propofol; p < 0.05). EEG showed a low frequency, high amplitude wave pattern two minutes after LORR in control rats. Autistic rats showed a high frequency, low amplitude awake pattern. Hippocampal GABAA receptor gene expression was significantly less in autistic rats and NMDA gene expression was greater.

CONCLUSIONS:
This study in rat supports the clinical observations of increased anesthetic sedative requirements in autistic children and proposes a mechanism for it.

Author Info:
1
Associate Professor of Medical Pharmacology, Faculty of Medicine, Cairo University.
2
Lecturer of Medical Pharmacology, Faculty of Medicine, Cairo University.
3
Professor of Medical Biochemistry, Faculty of Medicine, Cairo University.
4
Associate Professor of Anesthesia, Assiut University Hospitals, Egypt & Anesthesia Dept., HAMAD Medical Corporation, Doha, Qatar & Clinical Ass. Prof. Weill Cornell Medicine Qatar.


Authors:
Elrakhawy HM(1),(2), Alassal MA(1),(3), Shaalan AM(1),(4), Awad AA(5), Sayed S(6), Saffan MM(1).

Title:
Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes

Abstract:
BACKGROUND:
Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period is documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia, particularly atrial fibrillation, is common after pulmonary resection. RV assessment can be done by non-invasive methods and/or invasive approaches such as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permits continuous measurements of cardiac output, right ventricular ejection fraction, and right ventricular end-diastolic volume. It can also be used for right atrial and right ventricular pacing, and for measuring right-sided pressures, including pulmonary capillary wedge pressure.

METHODS:
This study included 178 patients who underwent major pulmonary resections, 36 who underwent pneumonectomy assigned as group (I) and 142 who underwent lobectomy assigned as group (II). The study was conducted at the cardiothoracic surgery department of Benha University hospital in Egypt; patients enrolled were operated on from February 2012 to February 2016. A rapid response thermistor pulmonary artery catheter was inserted via the right internal jugular vein. Preoperatively the following was recorded: central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, right ventricular ejection fraction and volumes. The same parameters were collected in fixed time intervals after 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively.

RESULTS:
For group (I): There were no statistically significant changes between the preoperative and postoperative records in the central venous pressure and mean arterial pressure; there were no statistically significant changes in the preoperative and 12, 24, and 48 hour postoperative records for cardiac index; 3 and 6 hours postoperative showed significant changes. There were statistically significant changes between the preoperative and postoperative records for heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index, in all postoperative records. For group (II): There were no statistically significant changes between the preoperative and all postoperative records for the central venous pressure, mean arterial pressure and cardiac index. There were statistically significant changes between the preoperative and postoperative records for heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index in all postoperative records. There were statistically significant changes between the two groups in all postoperative records for heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index.

CONCLUSION:
There is right ventricular dysfunction early after major pulmonary resection caused by increased right ventricular afterload. This dysfunction is more present in pneumonectomy than in lobectomy. Heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction, and right ventricular end diastolic volume index are significantly affected by pulmonary resection.

Author Info:
1
Cardiothoracic Surgery Department, Benha University, Benha, Egypt.
2
Prince Mutaib Bin Abdul-Aziz Hospital, Sakaka, Al-Jouf, Saudi Arabia.
3
King Fahd Medical City, Riyadh, Saudi Arabia.
4
Dallah Hospital, Cardiac Center, Riyadh, Saudi Arabia.
5
Dallah Hospital, Endocrinology Center, Riyadh, Saudi Arabia.
6
Cardiothoracic Surgery Department, Assiut University, Assiut, Egypt.


Authors:
Elshafay A(1), Truong DH(2), AboElnas MM(3), Idrees H(4), Metwali HG(5), Vuong NL(6),(7), Saad OA(3), Hirayama K(8), Huy NT(9),(10)

Title:
The Effect of Endothelin Receptor Antagonists in Patients with Eisenmenger Syndrome: A Systematic Review

Abstract:
INTRODUCTION:
The efficacy of endothelin receptor antagonists (ERAs) in the management of Eisenmenger syndrome (ES) remains controversial. The aim of this study is to systemically review the safety and effects of ERAs in improving the quality of life and basic cardiac functions of these patients.

METHODS:
Twelve databases were searched, including PubMed, Web of Science, Scopus, Virtual Health Library, World Health Organization (WHO) Global Health Library, Google Scholar, POPLINE, Systems for Information of Grey Literature in Europe, New York Academy of Medicine, ClinicalTrials.gov, metaRegister of Controlled Trials and the WHO International Clinical Trials Registry Platform, through August 2016. We included randomized clinical trials addressing the effect of ERAs on cardiac functions in patients with ES. The quality of studies was assessed using the Cochrane Collaboration tool.

RESULTS:
We included two trials represented by four papers, of which three papers reported the efficacy of bosentan against placebo and one paper reported the results of a combination of bosentan and sildenafil versus placebo and bosentan. One trial showed a significant effect of bosentan treatment over placebo on indexed pulmonary vascular resistance and mean pulmonary artery pressure, but a non-significant increase in 6-min walk distance and a non-significant effect on systemic pulse oximetry. The other trial reported the safe but non-significant effect of combination therapy of bosentan and sildenafil compared with bosentan and placebo.

CONCLUSIONS:
This study demonstrated safety and improved hemodynamic effects of bosentan in ES, with a controversial effect on exercise capacity. Further randomized controlled trials with longer follow-up duration are needed to confirm these results.

Author Info:
1
Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt.
2
Quang Binh pharmaceutical joint-stock company, Quang Binh, 510000, Vietnam.
3
Faculty of Medicine, Cairo University, 11562, Cairo, Egypt.
4
Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
5
Faculty of Pharmacy, Assiut University, Assiut, 83511, Egypt.
6
Department of Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, 80000, Vietnam.
7
Department of Medical statistic and Informatics, Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, 80000, Vietnam.
8
Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
9
Evidence Based Medicine Research Group and Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 80000, Vietnam. nguyentienhuy@tdt.edu.vn.
10
Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan. nguyentienhuy@tdt.edu.vn.


Authors:
Elsherbiny NM(1), Ali IM(2), Hassanein KM(3), Ahmed MT(2)

Title:
Extended-Spectrum Β-Lactamase (ESBL)-Producing ‎Serratia Marcescens Causing Healthcare-Associated ‎Infections In Assiut University Hospitals, Egypt

Author Info:
1
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, P.O. 71515, Assiut, Egypt. Electronic address: nahlaelsherbiny@aun.edu.eg.
2
Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Egypt.
3
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, P.O. 71515, Assiut, Egypt.


Authors:
Farghaly HSM(1), Ashry IEM(2), Hareedy MS(2).

Title:
High Doses Of Digoxin Increase The Myocardial Nuclear ‎Factor-Kb And Cav1.2 Channels In Healthy Mice. A ‎Possible Mechanism Of Digitalis Toxicity

Abstract:
BACKGROUND:
Toxic effects of digoxin may occur with normal therapeutic serum level. However, the underlying mechanisms are not fully understood. Nuclear factor kappa-B (NF-kB) is an important transcription factor in most organ systems and is often implicated in the harmful effects of cardiac injury. NF-kB promotes inflammatory responses, mediates adverse cardiac remodeling and has a function correlation with calcium. The voltage-gated L-type calcium channel CaV1.2 mediates the influx of Ca+2 into the cell in response to membrane depolarization. Our aim was to characterize the role of NF-kB during digoxin toxicity and to assess its correlation with Cav 1.2 in healthy mice in vivo.

METHODS:
To address these questions, digoxin was administered in doses of 0.1, 1 or 5 mg/kg orally daily for seven days to the animals. Serum digoxin, serum calcium, atrial and ventricular calcium levels were measured. We, also, looked for NF-kB and CaV1.2 channel expression in cardiac muscle of mice.

RESULTS:
Digoxin at a dose of 0.1 mg/kg did not enhance serum, atrial, and ventricular Ca+2 levels, but were increased when digoxin dose of 1 and 5 mg/kg were administered. Histologically, myocardial necrosis and cellular infiltration on day 7 were significantly more severe in the 5 mg/kg/day digoxin group. Immunohistochemical studies showed more expression of both NF-kB and CaV1.2 in 1 and 5 mg/kg/day digoxin groups.

CONCLUSIONS:
These data suggest that NF-kB may be responsible for digoxin toxicity, at least partially via modulation of CaV1.2 and intracellular calcium homeostasis in the myocardium

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt. Electronic address: hanan.farghali@med.au.edu.eg.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.


Authors:
Farrag A(1),(2), Ansari J(1), Ali M(1), Sunbuli G(3), Kassem H(4), Al Hamad AA(1).

Title:
Intracranial Meningioma As Primary Presentation For An ‎Undiagnosed Collision Metastatic Breast Cancer: Case ‎Report And Literature Review

Abstract:
Intracranial metastasis from breast cancer is a relatively common finding, however, the appearance of breast cancer metastasis in a meningioma is very rare. Several cases of tumor-to-tumor metastasis and collision tumors have been reported previously, with meningioma being implicated as the most common benign intracranial neoplasm to harbour the metastasis. Occasionally, the discovery of a tumor-to-meningioma metastasis may herald the diagnosis of an occult primary malignancy. Careful histopathological assessment of the resected meningioma specimen is pivotal to the management of these patients, as this will alter the treatment plan and prognosis considerably. Intracranial meningioma with collision breast cancer as primary presentation of an undiagnosed metastatic breast cancer is extremely rare. The current study presents a case of intracranial meningioma with collision breast cancer as a primary presentation, and reviews the available evidence for this unusual disease entity.

Author Info:
1
Department of Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh 11159, Kingdom of Saudi Arabia.
2
Clinical Oncology Department, Assiut University Hospitals, Assiut, Assiut 71515, Kingdom of Saudi Arabia.
3
Department of Pathology, Prince Sultan Military Medical City, Riyadh, Riyadh 11159, Kingdom of Saudi Arabia.
4
Department of Radiology, Prince Sultan Military Medical City, Riyadh, Riyadh 11159, Kingdom of Saudi Arabia.


Authors:
Farrag MA(1), Oraby MI(2), Ghali AA(3), Ragab OA(3), Nasreldein A(4), Shehata GA(4), Elfar E(5), Abd-Allah F(6).

Title:
Public Stroke Knowledge, Awareness, And Response To ‎Acute Stroke: Multi-Center Study From 4 Egyptian ‎Governorates

Abstract:
BACKGROUND AND PURPOSE:
Acute stroke treatment has significantly improved over the years in Egypt. However, there is often notable delay in pre-hospital and in-hospital management of acute stroke patients. The delay may be largely attributed to poor stroke knowledge and awareness of the general public and this study was aimed at the evaluation of the abovementioned factors.

METHODS:
Descriptive cross-sectional study involving 1154 participants from 4 governorates using a questionnaire in Arabic, collecting sociodemographic data, participants' risk factors, and knowledge and stroke awareness (risk factors, symptoms, prevention, treatment and prognosis, action in response to acute stroke). Data were collected during the World stroke day October 29, 2015.

RESULTS:
Study participants were found to have a low level of awareness of stroke with median percent score of 35.7% and interquartile range (IQR) of 17.86. Higher income, level of education, having risk factors and knowing someone with stroke were significant predictors of a higher level of stroke awareness.

CONCLUSION:
In general, low public stroke awareness has been detected among Egyptians, and this is a call for healthcare authorities to invest in public education programmes among the Egyptian population.

Author Info:
1
Neurology Department, Faculty of Medicine, Cairo University, Egypt. Electronic address: mohammadfarrag@kasralainy.edu.eg.
2
Neurology Department, Faculty of Medicine, Beni-Suef University, Egypt.
3
Neurology Department, Faculty of Medicine, Tanta University, Egypt.
4
Neurology Department, Faculty of Medicine, Assiut University, Egypt.
5
Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt.
6
Neurology Department, Faculty of Medicine, Cairo University, Egypt.


Authors:
Fathi HA(1), Allam A(2), Elsabahy M(3), Fetih G(4), El-Badry M(4).

Title:
Nanostructured Lipid Carriers For Improved Oral ‎Delivery And Prolonged Antihyperlipidemic Effect Of ‎Simvastatin

Abstract:
The purpose of the current study is to develop nanostructured lipid carriers (NLCs) for the delivery of the antihyperlipidemic drug simvastatin (SIM) to increase its extremely low oral bioavailability (<5%) and prolong its antihyperlipidemic effect. NLCs were prepared via emulsification-solvent evaporation technique followed by ultrasonication, and the effect of composition of the nanocarriers on the particle size, size distribution, surface charge, entrapment efficiency, drug release kinetics and physical stability was extensively studied. NLCs exhibited nanosized (<200nm) spherical morphologies with narrow size distribution and high drug entrapment efficiency (>75%), sustained drug release pattern, and negative surface charge (zeta potential of -35-40mV) that imparts sufficient electrostatic physical stability. When tested in vivo, SIM-NLCs of the optimal composition demonstrated improved and prolonged reduction in the total cholesterol and non-high density lipoprotein cholesterol levels, as compared to the drug suspension. After oral administration of a single dose of SIM-NLC, 4-fold increase in bioavailability was observed, as compared to the SIM suspension. Hence, NLCs might provide efficient nanodevices for the management of hyperlipidemia and promising drug delivery systems to enhance SIM oral bioavailability

Author Info:
1
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut 71515, Egypt.
2
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt.
3
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut 71515, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA; Misr University for Science and Technology, 6th of October City, Egypt. Electronic address: mahmoud.elsabahy@chem.tamu.edu.
4
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut 71515, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt.


Authors:
Fawzy M(1), Emad M(1), Mahran A(2), Sabry M(3), Fetih AN(4), Abdelghafar H(3), Rasheed S(3).

Title:
Artificial Oocyte Activation With Srcl2 Or Calcimycin ‎After ICSI Improves Clinical And Embryological ‎Outcomes Compared With ICSI Alone: Results Of A ‎Randomized Clinical Trial

Abstract:
STUDY QUESTION:
Are pregnancy and birth rates affected by artificial oocyte activation (AOA) with SrCl2 or calcimycin after ICSI for couples with male-factor infertility linked to abnormal sperm morphology or for couples with previous ICSI cycles of unexplained low fertilization or inadequate fertilization associated with impaired oocyte morphology?

SUMMARY ANSWER:
AOA with either SrCl2 or calcimycin can improve the rates of clinical pregnancy, ongoing pregnancy and live birth compared with ICSI alone, and the two agents have diverse effects for different subgroups of patients.

WHAT IS KNOWN ALREADY:
ICSI is a successful treatment for infertility, but not in all individuals. AOA has potential to overcome inadequate fertilization in ICSI. Calcimycin and SrCl2 are candidate agents for AOA, but their effectiveness remains to be compared.

STUDY DESIGN, SIZE, DURATION:
This study was a randomized, open-label, three-arm, parallel-group, double-centre, superiority trial conducted between April 2015 and January 2016. The study evaluated the effects of AOA with calcimycin or SrCl2 for clinical pregnancy rates after ICSI and included 343 couples divided into three groups.

PARTICIPANTS/MATERIALS, SETTING, METHODS:
Couples were included if they had two previous ICSI cycles of no or low fertilization (0-30%) with unknown causes or impaired oocyte morphology. Male-factor infertility cycles (frozen-thawed sperm, surgically retrieved sperm or ejaculates contained <10 millions spermatozoa/ml) undergoing their first ICSI attempt were also included if they had 100% abnormal sperm morphology (including globozoospermia and tapered-head). Couples were randomized to undergo ICSI with SrCl2 AOA, ICSI with calcimycin AOA or ICSI alone, with clinical pregnancy as the primary endpoint. Effect sizes were summarized as absolute rate differences (ARDs) and odds ratios (ORs), with precision evaluated by 95% CIs.

MAIN RESULTS AND THE ROLE OF CHANCE:
Both SrCl2 and calcimycin AOA improved clinical pregnancy rates compared to ICSI alone (49, 42 and 27%; ARD 22, 95% CI: 9-33; P = 0.0007 and ARD 16, 95% CI: 3-27; P = 0.014). SrCl2 and calcimycin AOA were also superior to ICSI alone on the rates of ongoing pregnancy (42, 36 and 23%; P = 0.0019 and P = 0.023) and live birth (40, 33 and 18%; P = 0.0002 and P = 0.012). Among couples with previous ICSI cycles of low fertilization, AOA with SrCl2 (but not with calcimycin) was superior to ICSI alone for rates of clinical pregnancy (ARD 35 percentage points (pp), P = 0.0007), ongoing pregnancy (ARD 27 pp, P = 0.009) and live birth (ARD 37 pp, P = 0.002). Among couples affected by male-factor infertility, AOA with calcimycin (but not with SrCl2) was superior to ICSI alone for rates of clinical pregnancy (ARD 22 pp, P = 0.006), ongoing pregnancy (ARD 19 pp, P = 0.013) and live birth (ARD 17 pp, P = 0.02).

LIMITATIONS, REASONS FOR CAUTION:
This study was an open-label trial, and this design might have introduced bias, although randomization methods were used. The study did not include a longitudinal follow-up, so further evidence is required to demonstrate the safety of AOA.

WIDER IMPLICATIONS OF THE FINDINGS:
The decision to use SrCl2 or calcimycin for AOA after ICSI may depend on whether the activation failure originates in the oocyte or the sperm.

STUDY FUNDING/COMPETING INTEREST(S):
The study received no funding and the authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER:
NCT02424214.

TRIAL REGISTRATION DATE:
22 April 2015.

DATE OF FIRST PATIENT’S ENROLMENT:
27 April 2015.

Author Info:
1
IbnSina IVF Centre, IbnSina Hospital, Sohag 15322, Egypt.
2
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, AG 71515, Egypt.
3
Department of Obstetrics and Gynecology, Sohag University, Sohag 82524, Egypt.
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, AG 71515, Egypt.


Authors:
Fawzy M(1), Emad M(2), Gad MA(2), Sabry M(3), Kasem H(2), Mahmoud M(2), Bedaiwy MA(4).

Title:
Comparing 36.5°C With 37°C For Human Embryo Culture: ‎A Prospective Randomized Controlled Trial

Abstract:
This prospective, double-blind, randomized controlled trial was designed to evaluate the efficacy of a culture temperature of 36.5°C versus 37°C on human embryo development in vitro. A total of 412 women undergoing IVF were randomized to two groups: the oocytes and embryos of the intervention group were cultured at 36.5°C; those of the control group were cultured at 37°C. Although no significant effect of culture temperature was observed on pregnancy or implantation rates, differences were found in embryo development. Embryo culture at 36.5°C was associated with a significantly higher cleavage rate (OR 1.6, 95% CI 1.03 to 2.51), but a lower fertilization rate, fewer high-quality embryos on day 3, a lower blastocyst formation rate on day 5, and fewer high-quality and cryopreserved blastocysts (OR 0.87, 95% CI 0.78 to 0.98), (OR 0.60, 95% CI 0.53 to 0.69), (OR 0.85, 95% CI 0.75 to 0.97), (OR 0.5, 95% CI 0.44 to 0.56) and (OR 0.77, 95% CI 0.68 to 0.88), respectively, compared with 37°C. On the basis of these results, and in the absence of data on the optimal temperature for each stage of embryo development in vitro, we recommend continuation of the use of 37°C for human embryo culture.

Author Info:
1
IbnSina IVF Center, IbnSina Hospital, 146 El Aref Square, Sohag, Egypt, Egypt. Electronic address: drfawzy001@me.com.
2
IbnSina IVF Center, IbnSina Hospital, 146 El Aref Square, Sohag, Egypt, Egypt.
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt.
4
Department of Obstetrics and Gynecology, Assiut University, Egypt; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of British Columbia, Canada.


Authors:
Fouly H(1), Abdou FA(2), Abbas AM(3), Omar AM(4).

Title:
Audit For Quality Of Care And Fate Of Maternal Critical ‎Cases At Women's Health Hospital

Abstract:
Maternal deaths remain high, numbers at the facility level are relatively low.

AIM:
To evaluate effect of management guidelines on occurrence of maternal near miss in Women's Health Hospital.

DESIGN:
A cross-sectional study.

SETTING:
ICU of Women's Health Hospital's at Assiut Main University Hospital and Al-fayoum University Hospital.

SUBJECTS:
Convenient sample of 93 maternal near-miss cases including (Pregnancy or postpartum complications). TOOL: audit the applied critical care for severe condition related to obstetric complications and consist of three parts: Patient's demographic data, Audit of critical care and "Maternal near-miss" Fate. Data collected during a period of 1/3/2015 to 30/8/2015 for management guidelines and maternal outcomes.

RESULTS:
A statistical significant differences between the medical management and occurrence of sever maternal complications such as (severe postpartum hemorrhage, severe pre-eclampsia, Sepsis or severe systemic infection, uterine hemorrhage, ruptured uterus) (P=0.000, P=0.031, P=0.036, P=0.052, P=0.012 respectively).

CONCLUSIONS:
The maternal management guidelines was a successful tool in recording the gap between the current received management and standards management guidelines in ICU. Also they measure the effect of current management in ICU on maternal mortality and morbidity.

Author Info:
1
Obstetric and Gynecology of Nursing, Assiut University, Egypt. Electronic address: hoida.elfouly@aun.edu.eg.
2
Critical Care Nursing, Faculty of Nursing, Assiut University, Egypt.
3
Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt.
4
Maternity and neonatal health nursing, Al-fayoum University, Egypt.


Authors:
Gadalla MA(1),(2), Huang S(2),(3), Wang R(2), Norman RJ(2), Abdullah SA(1), El Saman AM(1), Ismail AM(1), van Wely M(4), Mol BWJ(2),(5)

Title:
Effect Of Clomiphene Citrate On Endometrial Thickness, ‎Ovulation, Pregnancy And Live Birth In Anovulatory ‎Women: Systematic Review And Meta-Analysis

Abstract:
OBJECTIVES:
To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders.

METHODS:
We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates).

RESULTS:
We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, -1.39; 95% CI, -2.27 to -0.51; I2  = 100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90-1.04; I2  = 47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63-0.95; I2  = 43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49-0.98; I2  = 35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, -0.23; 95% CI, -0.92 to 0.45; I2  = 78%; RR, 0.84; 95% CI, 0.67-1.06; I2  = 0%; and RR, 0.79; 95% CI, 0.33-1.87; I2  = 0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, -1.51; 95% CI, -1.98 to -1.04; I2  = 45%). In two studies that compared CC with CC + nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, -1.75; 95% CI, -2.08 to -1.41; I2  = 0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, -1.34; 95% CI, -2.70 to 0.01; I2  = 96%) with comparable ovulation and pregnancy rates.

CONCLUSIONS:
In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low.

Author Info:
1
Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
2
Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
3
Reproductive Medicine Centre, Peking University Third Hospital, Beijing, China.
4
Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
5
South Australian Health and Medical Research Institute, Adelaide, Australia.


Authors:
Gadalla MA(1),(2), Wang R(2), van Wely M(3), Mol BWJ(2),(4).

Title:
How Should We Report Outcomes In Reproductive ‎Medicine?‎

Author Info:
1
Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
2
Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
3
Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
4
South Australian Health and Medical Research Institute, Adelaide, Australia.


Title:
Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 1. Urological Wrong-Surgery Catastrophes and Disabling Complications.

Abstract:
INTRODUCTION:
Surgical never events are preventable harmful non-intentional human errors. Urology is a common surgical specialty for their occurrence.

PATIENTS AND METHODS:
A retrospective search of our center's data was done during the period 2006-2016 for surgical never events. Each included case was studied for the primary diagnosis, procedure, and subspecialty, never event type and timing, needed extra-interventions, urologist/procedure proportioning, outcomes, and possible underlying causes of the event.

RESULTS:
Of more than 55,000 different urological interventions, 61 patients were involved in never events. Wrong procedures represented 75% of the never events, and endourology and urolithiasis subspecialties were more often involved. The main detectable underlying factor was the disproportion between the levels of the procedure class and the qualification of the urologist (41%). Thirty-four cases had extra-procedures. The short-term harm effect represented the final outcome in 42% of all events. Death, permanent organ loss, and long-term harm represented 20, 15, and 23%, respectively.

CONCLUSION:
Urological surgical never events are rare, but their final outcomes could be catastrophic, even leading to death.

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


Title:
Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 2. Intracorporeally-Retained Urological Surgical Items.

Abstract:
OBJECTIVE:
Presentation of our center's experience in the management of intracorporeally-retained urological surgical items.

MATERIALS AND METHODS:
Retrospective search of our center's data for cases of retained surgical items during the period July 2006 to June 2016. Each case was studied for the demographic and clinical variables including types, presentation, and management.

RESULTS:
Out of more than 55,000 different urological interventions, only 39 cases (28 males and 11 females) had retained surgical items. Urolithiasis-related urological subspecialties were more involved than others. Forgotten items and technically-retained items occurred in 38.5 and 61.5% of cases, respectively, and were immediately discovered or discovered up to 10 years later. Material types were textiles, biosynthetics, and metallics in 31, 51, and 18%, respectively. Possible predisposing factors included complex surgeries, emergent intraoperative events, and extra approaches. Occurrences of retained surgical items before and after implemented corrective actions were 74.6 and 25.4%, respectively. All the final outcomes were either short- or long-term harm without deaths, organ losses, or permanent disabilities.

CONCLUSION:
Retained urological surgical items are surgical never events that result from forgetfulness or technical surgical human errors. Their sequels can be potentially fatal, but they are preventable and can be significantly reduced.


Authors:
Gadelkareem RA(1), Moeen AM(1), Reda A(1), Azoz NM(2), Elhadad AF(3), Taha TM(1), Mohammed N(1),(4), Taha MI(1).

Title:
Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. III. Psychourological Events: 1. Psychic Anuria

Abstract:
INTRODUCTION:
Psychic anuria is an old term, referring to a very rare psycho-urological event that has scarcely been studied so far.

MATERIALS AND METHODS:
A retrospective study of the patients with psychic anuria presented to Assiut Urology and Nephrology Hospital during the period July 1991-June 2016 was done. Psychic anuria was defined, and the demographic and clinical characteristics including the methods of diagnosis and management were studied.

RESULTS:
Of more than 3,800 cases of anuria, 9 female patients (0.24%) experienced psychic anuria in the age range of 17-43 years. Cardinal clinical findings included anuria for 36-72 h with absence of organic causes and normal renal function tests. Psychosocial risk factors were reported in the 9 cases. Anuria was documented by reliable history (56%) or observable urine collection (44%). Diagnosis was done by exclusion, where the investigations revealed no organic causes. Seven cases responded to the placebo intervention and 2 cases were self-limiting and resolved spontaneously.

CONCLUSIONS:
Psychic anuria is an extremely rare urological emergency that presents, mainly, in young adult females with unknown mechanisms. Renal vasoconstriction following psychosocial stressors is suggested. It is diagnosed by exclusion and resolves spontaneously or responds to placebo intervention as a mental distraction technique.

Author Info:
1
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine-Nephrology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Neuropsychiatry, Faculty of Medicine, Al-Azhar University-Assiut Branch, Assiut, Egypt.
4
Department of Urology, Martin-Luther University, Halle, Germany.


Authors:
Gadelkareem RA(1), Elqady AA(1), Abd-Elshafy SK(2), Imam H(3), Abolella HA(1).

Title:
Isolated Renal Hydatid Cyst Misdiagnosed and Operated as a Cystic Renal Tumor

Abstract:
OBJECTIVE:
The aim of this work is the presentation of a case of isolated renal hydatid cyst with novel findings and an unusual surgical scenario.

CLINICAL PRESENTATION AND INTERVENTION:
A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a well-demarcated left renal cystic lesion with a double-layer wall. Radical nephrectomy was performed due to the possibility of malignancy. On retrograde revision, the double-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology.

CONCLUSION:
Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

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.
3
Department of Diagnostic Radiology, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Galal El-Shemi A(1),(2), Mohammed Ashshi A(1), Oh E(3), Jung BK(3), Basalamah M(1),(4), Alsaegh A(1), Yun CO(3).

Title:
Efficacy Of Combining ING4 And TRAIL Genes In ‎Cancer-Targeting Gene Virotherapy Strategy: First ‎Evidence In Preclinical Hepatocellular Carcinoma

Abstract:
Current treatments of hepatocellular carcinoma (HCC) are ineffective and unsatisfactory in many aspects. Cancer-targeting gene virotherapy using oncolytic adenoviruses (OAds) armed with anticancer genes has shown efficacy and safety in clinical trials. Nowadays, both inhibitor of growth 4 (ING4), as a multimodal tumor suppressor gene, and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), as a potent apoptosis-inducing gene, are experiencing a renaissance in cancer gene therapy. Herein we investigated the antitumor activity and safety of mono- and combined therapy with OAds armed with ING4 (Ad-ΔB/ING4) and TRAIL (Ad-ΔB/TRAIL) gene, respectively, on preclinical models of human HCC. OAd-mediated expression of ING4 or TRAIL transgene was confirmed. Ad-ΔB/TRAIL and/or Ad-ΔB/ING4 exhibited potent killing effect on human HCC cells (HuH7 and Hep3B) but not on normal liver cells. Most importantly, systemic therapy with Ad-ΔB/ING4 plus Ad-ΔB/TRAIL elicited more eradicative effect on an orthotopic mouse model of human HCC than their monotherapy, without causing obvious overlapping toxicity. Mechanistically, Ad-ΔB/ING4 and Ad-ΔB/TRAIL were remarkably cooperated to induce antitumor apoptosis and immune response, and to repress tumor angiogenesis. This is the first study showing that concomitant therapy with Ad-ΔB/ING4 and Ad-ΔB/TRAIL may provide a potential strategy for HCC therapy and merits further investigations to realize its possible clinical translation.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Bioengineering, College of Engineering, Hanyang University, Seoul, Korea.
4
Department of Pathology, Faculty of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.


Authors:
Ghanem MK(1), Makhlouf HA(1), Hasan AA(1), Alkarn AA(1).

Title:
Acute Pulmonary Thromboembolism In Emergency ‎Room: Gray-Scale Versus Color Doppler Ultrasound ‎Evaluation

Abstract:
BACKGROUND:
Pulmonary thromboembolism (PTE) remains under-diagnosed fatal disease at emergency units suggesting the need for alternative, easy, and noninvasive bedside diagnostic approaches.

OBJECTIVES:
To determine the diagnostic role of gray-scale and color Doppler transthoracic ultrasonography (TUS) in patients with PTE.

PATIENTS AND METHODS:
Blinded to 64 multi-detectors CT pulmonary angiography (MDCTPA) examination as a gold standard, 60 patients with clinically suspected PTE underwent gray-scale and then color Doppler TUS examination. Results were compared and diagnostic accuracy of TUS was assessed.

RESULTS:
Forty patients proved to have PTE by MDCTPA. TUS showed typical lesions in 33 patients with the mean of 2 lesions per patient. Most lesions were hypoechoic, wedge- shaped, and pleural- based and the majority (80%) was located in the lower lobes. Consolidation with little perfusion was detected by Color Doppler ultrasound in 97% of lesions. Isolated central PTE was significantly higher in TUS negative patients. For gray -scale TUS, sensitivity, specificity, positive and negative predictive values and accuracy were 82%, 90%, 94%, 72%, and 85%. Meanwhile the sensitivity, specificity, positive and negative predictive values and accuracy of color Doppler TUS were 80%, 95%, 97%, 70% and 87%, respectively.

CONCLUSION:
TUS is a reliable diagnostic bedside test for PTE in critically ill and immobile patients. Adding color Doppler to gray-scale TUS increases the specificity and accuracy and consequently the confidence in the diagnosis of peripheral pulmonary infarctions and differentiates them from other pulmonary lesions that allow initiation of anticoagulants.

Author Info:
1
Chest Department, Assiut University Hospital, Egypt.


Title:
Characteristics Of Children Admitted To Intensive Care ‎With Acute Bronchiolitis

Abstract:
To assess factors associated with outcome in children admitted to paediatric intensive care (PIC) with bronchiolitis. A retrospective study of children admitted to the PICU at St Mary's Hospital, London with bronchiolitis over a 6-year period (2011-2016). All bronchiolitis admissions < 2 years were included. Data collected particularly noted risk factors for severity, demographics, microbiology and outcome. We compared respiratory syncytial virus (RSV) with non-RSV status. Multivariate analysis was performed. Two hundred seventy-four patients were identified. Median age was 60 days (IQR 28-150 days), 63% were male, 90% were invasively ventilated and 42% were previously healthy. Pre-existing co-morbidities were present in 38%. The most frequently isolated pathogens were RSV (60%) and rhinovirus (26%). Co-infection was present in 45%, most commonly with RSV, rhinovirus and bacterial pathogens. Median length of stay (LOS) was 6 days (IQR 4.75-10). Younger age, prematurity, RSV, co-infection and co-morbidity were identified as significant risk factors for prolonged LOS. Six children died. Five of these had documented co-morbidities.

CONCLUSION:
RSV causes more severe bronchiolitis than other viruses. Nearly half of children admitted to PICU with RSV were previously healthy. Current guidelines for immunoprophylaxis of RSV bronchiolitis should be re-considered. What is Known: • Bronchiolitis is one of the most common reasons for unplanned PICU admission. The most common virus causing bronchiolitis is RSV • Bronchiolitis severe enough to require admission to PICU is associated with frequent morbidity but has low mortality. What is New: • RSV causes more severe bronchiolitis than other viruses. • Nearly half of all children admitted to PICU with RSV were previously healthy.

Author Info:
1
Paediatric Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W21NY, UK.
2
Pediatric Department, Assuit University Hospital, Assuit University, Assiut, Egypt.
3
Paediatric Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W21NY, UK. s.nadel@imperial.ac.uk.
4
Imperial College London, London, UK. s.nadel@imperial.ac.uk.


Authors:
Gheita TA(1), Abaza NM(2), Hammam N(3),(4), Mohamed AAA(3), El-Gazzar II(1), Eissa AH(5).

Title:
Anti-Dsdna Titre In Female Systemic Lupus ‎Erythematosus Patients: Relation To Disease ‎Manifestations, Damage And Antiphospholipid ‎Antibodies

Abstract:
Background Attempts are ongoing to unveil unresolved queries about anti-double-stranded deoxyribonucleic acid (anti-dsDNA), their precise pathogenic effects and to what extent blocking them would be a useful therapeutic goal. Objectives The aim of the present study was to determine the anti-dsDNA antibodies titre in systemic lupus erythematosus (SLE) patients and investigate their relation to the disease characteristics, activity, damage and antiphospholipid autoantibodies (aPL). Methods Seventy female SLE patients and 35 age- and sex-matched controls were included. The anti-dsDNA level and aPL were measured. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) were assessed. Results The mean age of the patients was 27.5 ± 5.1 years, disease duration 7.7 ± 5.4 years, and SLEDAI and SLICC/ACR-DI scores were 6.8 ± 8.04 and 1.2 ± 1.3, respectively. Anti-dsDNA was positive in 61.4% of the patients and the titre (133.2 ± 100.5 IU/ml) was significantly higher compared to controls (22.03 ± 17.2 IU/ml) ( p < 0.0001). The anti-dsDNA level was significantly increased in those with musculoskeletal manifestations ( p = 0.007) and positive anti-β2 glycoprotein (anti-β2GP) ( p = 0.037) and decreased in those with neuropsychiatric manifestations ( p = 0.004) and those receiving cyclophosphamide (CYC) ( p = 0.013). The anti-dsDNA level tended to be higher in active patients. The anti-dsDNA titre significantly correlated with the erythrocyte sedimentation rate ( p = 0.001), anticardiolipin IgG and IgA antibodies ( p = 0.008) and anti-β2GP IgG ( p = 0.03) and IgA ( p = 0.002) and inversely with the total leucocytic count ( p < 0.0001) and SLICC/ACR-DI ( p = 0.001). Conclusion Anti-dsDNA is remarkably increased in SLE patients especially those with musculoskeletal manifestations and aPL. A protective role seems likely in those with neuropsychiatric manifestations and those receiving CYC and may form a shield against disease tissue damage.

Author Info:
1
1 Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
2
2 Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3
3 Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt.
4
4 Faculty of Rehabilitation, University of Alberta, Edmonton, Alberta, Canada.
5
5 Clinical Pathology (Immunology) Department, Faculty of Medicine, Cairo University, Cairo, Egypt.


Authors:
Gheita TA(1), Sayed S(1), Azkalany GS(1), Abaza N(2), Hammam N(3),(4), Eissa AH(5).

Title:
Toll-Like Receptor 9 In Systemic Sclerosis Patients: ‎Relation To Modified Rodnan Skin Score, Disease ‎Severity, And Functional Status.‎

Abstract:
The objective of this study is to assess toll-like receptor-9 (TLR9) expression in CD3-positive T lymphocytes and CD19-positive B lymphocytes in systemic sclerosis (SSc) patients and to study their relation to the extent of skin fibrosis, disease characteristics, and severity as well as the functional status. Fifty-five female SSc patients and 30 matched controls were included. Skin thickness was scored according to the modified Rodnan skin score (mRss). The severity of major organ involvement was assessed using the Medsger severity score (MSS). Scleroderma health assessment questionnaire (SHAQ) was measured to evaluate patients' functional status. Expression of TLR9 in CD3-positive T lymphocytes and CD19-positive B lymphocytes was studied using flow cytometry. The mean age of the patients was 40.5 ± 9.1 years, and their disease duration was 6.7 ± 3.3 years. There were 21 (38.2%) with diffuse (dcSSc) and 34 (61.8%) with limited cutaneous (lcSSc) subtypes. There was a significant increase in the expression of TLR9/CD3 and TLR9/CD19 in the SSc patients (44.9 ± 18.1 and 24.1 ± 9.6) compared to that in the control (1.4 ± 0.97 and 1.3 ± 0.94; p < 0.0001 for both, respectively) being higher in those with dcSSc. TLR9/CD3 expression was significantly increased in SSc patients with arthralgia/arthritis and digital resorption compared to those without. The TLR9/CD3 significantly correlated with the mRss and MSS (r = 0.37, p = 0.006 and r = 0.31, p = 0.02; respectively). Both the TLR9/CD3 and TLR9/CD19 expressions were significantly correlating (r = 0.53, p < 0.0001). On regression analysis, only TLR9/CD3 was a significant risk factor of the mRss and MSS (β = 0.43, p = 0.009 and β = 0.33, p = 0.015, respectively). TLR9, especially TLR9/CD3, is highly expressed in SSc patients particularly those with dcSSc subtype and could form a potential marker for skin fibrosis and disease severity.

Author Info:
1
Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
2
Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Asyut, Egypt. hammam@ualberta.ca.
4
University of Alberta, Corbett Hall, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada. hammam@ualberta.ca.
5
Clinical and Chemical Pathology Department (Immunology), Faculty of Medicine, Helwan University, Helwan, Egypt.


Authors:
Gomaa AA(1), Farghaly HSM(2), El-Sers DA(3), Farrag MM(2), Al-Zokeim NI(2).

Title:
Inhibition Of Adiposity And Related Metabolic ‎Disturbances By Polyphenol-Rich Extract Of Boswellia ‎Serrata Gum Through Alteration Of Adipo/Cytokine ‎Profiles

Abstract:
BACKGROUND:
The role of proinflammatory cytokines in adiposity is well established. The anti-inflammatory and antihyperglycemia effects of Boswellia serrata (B. Serrata) gum have been demonstrated by many investigators. The present study aimed to investigate the anti-obesity potential of B. serrata extract.

METHODS:
The effects of B. serrata extract on lipase activity and acute food intake were investigated. The present study aimed to investigate the anti-obesity potential of B. serrata extract. The effects on lipase activity and acute food intake were investigated. Body weight changes, biochemical and histopathological markers were demonstrated in rats fed a high-fat diet.

RESULTS:
Boswellia serrata extract inhibited alterations in pancreatic lipase activity, but orlistat was more efficacious. B. serrata and ephidrene, but not orlistat, significantly suppressed cumulative food intake in mice. In obese rats, B. serrata or orlistat significantly decreased weight gain and weight of visceral white adipose tissue. B. serrata-treated animals exhibited a significant reduction in serum glucose, TC, TG, LDL-C, FFA, IL-1β, TNF-α, insulin and leptin levels of obese rat groups while HDL-C and adiponectin levels were significantly increased by orlistat or B. serrata extract. Histopathological examination of the liver revealed that B. serrata was more effective than orlistat in alleviating steatosis and adipocyte hypertrophy shown in obese control rats.

CONCLUSIONS:
Boswellia serrata is as effective as orlistat in preventing obesity, hyperlipidemia, steatosis and insulin resistance. These actions may be mediated by suppression of food intake and decrease levels of TNF-α, IL-1β and leptin resistance along with increasing adiponectin.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. a.gomma@aun.edu.eg.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Gomaa AMS(1), Abd El-Mottaleb NA(2), Aamer HA(3).

Title:
Antioxidant And Anti-Inflammatory Activities Of Alpha ‎Lipoic Acid Protect Against Indomethacin-Induced ‎Gastric Ulcer In Rats

Abstract:
Little is known about the role of tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor-1 (PAI-1), and inducible nitric oxide synthase (iNOS) in the gastric ulcer and the effect of alpha lipoic acid (ALA) in their modulation. Hence, this experimental study was designed to assess the possible protective effect of ALA against indomethacin (IND)-induced gastric ulcer in rats, as well as to determine the possible underlying mechanisms with a special focus on TNF-α, PAI-1, and iNOS. Adult male rats (n = 28) were divided into four equal groups: the control group received distilled water, the vehicle group received 0.5% carboxymethylcellulose, the ulcer group received a single oral dose of IND (50 mg/kg) and the ALA-treated group received ALA (100 mg/kg) orally for 3 days before ulcer induction. Four hours after IND administration, all rats were sacrificed. The ulcer index, and gastric tissue homogenate contents of total antioxidant capacity (TAC), malondialdehyde (MDA), TNF-α, and PAI-1 were evaluated. Immunohistochemical evaluation of iNOS protein expression and histopathological examination of gastric tissue were investigated. The results revealed that ALA pretreatment significantly decreased the ulcer index, the gastric levels of MDA, TNF-α, PAI-1, and iNOS protein expression while increased the gastric levels of TAC as well as improved the histopathological appearance of gastric tissues. In conclusion, ALA ameliorated the IND-induced gastric ulceration. This could be attributed to its antioxidant and anti-inflammatory activities via suppression of TNF-α-induced elevation of both PAI-1 level and iNOS expression in the gastric tissue.

Author Info:
1
Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: asmaasayed@aun.edu.eg.
2
Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Animal, Poultry and Environment Hygiene, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt.


Authors:
Gomaa AMS(1), Abdelhafez AT(2), Aamer HA(3).

Title:
Garlic (Allium Sativum) Exhibits A Cardioprotective ‎Effect In Experimental Chronic Renal Failure Rat Model ‎By Reducing Oxidative Stress And Controlling Cardiac ‎Na+/K+-Atpase Activity And Ca2+Levels.‎

Abstract:
Gentamicin (GNT)-induced nephrotoxicity culminates into renal failure with a possible cardiovascular impact. Garlic extract (GE) is a cardiovascular protectant with limited mechanistic data. Therefore, we assessed the disturbance in specific cardiac parameters and the potential protective effect of GE supplementation against them in a rat model of GNT-induced chronic renal failure (CRF). Adult male rats (n = 24) were randomly assigned into four groups (n = 6 each): normal controls (CON), garlic extract controls (GE; 250 mg kg-1, orally), GNT-induced CRF (GNT; 100 mg kg-1, i.p.), and GNT + GE (GNT and GE in the same previous doses) groups. GNT and GE were given daily for 3 weeks. Animals co-treated with GNT and GE exhibited improved renal functions, body weight (BW), and heart weight (HW)/BW ratio; declined blood pressure; lowered plasma levels of lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), and total peroxides (TP); and elevated total antioxidant capacity (TAC) levels. Moreover, the heart tissue contained raised levels of TAC and Na+/K+-ATPase activity and lowered levels of TP and Ca2+. Findings provide evidence that administration of GE in experimental CRF model helped protect the heart through reducing oxidative stress and controlling cardiac Na+/K+-ATPase activity and Ca2+ levels.

Author Info:
1
Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt. asmaagom3a@yahoo.com.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Animal, Poultry and Environment Hygiene, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt.


Authors:
Greene NT(1), Alhussaini MA(2), Easter JR(3), Argo TF (4)th(4), Walilko T(4), Tollin DJ(5).

Title:
Intracochlear Pressure Measurements During Acoustic ‎Shock Wave Exposure

Abstract:
INTRODUCTION:
Injuries to the peripheral auditory system are among the most common results of high intensity impulsive acoustic exposure. Prior studies of high intensity sound transmission by the ossicular chain have relied upon measurements in animal models, measurements at more moderate sound levels (i.e. < 130 dB SPL), and/or measured responses to steady-state noise. Here, we directly measure intracochlear pressure in human cadaveric temporal bones, with fiber optic pressure sensors placed in scala vestibuli (SV) and tympani (ST), during exposure to shock waves with peak positive pressures between ∼7 and 83 kPa.

METHODS:
Eight full-cephalic human cadaver heads were exposed, face-on, to acoustic shock waves in a 45 cm diameter shock tube. Specimens were exposed to impulses with nominal peak overpressures of 7, 28, 55, & 83 kPa (171, 183, 189, & 192 dB pSPL), measured in the free field adjacent to the forehead. Specimens were prepared bilaterally by mastoidectomy and extended facial recess to expose the ossicular chain. Ear canal (EAC), middle ear, and intracochlear sound pressure levels were measured with fiber-optic pressure sensors. Surface-mounted sensors measured SPL and skull strain near the opening of each EAC and at the forehead.

RESULTS:
Measurements on the forehead showed incident peak pressures approximately twice that measured by adjacent free-field and EAC entrance sensors, as expected based on the sensor orientation (normal vs tangential to the shock wave propagation). At 7 kPa, EAC pressure showed gain, calculated from the frequency spectra, consistent with the ear canal resonance, and gain in the intracochlear pressures (normalized to the EAC pressure) were consistent with (though somewhat lower than) previously reported middle ear transfer functions. Responses to higher intensity impulses tended to show lower intracochlear gain relative to EAC, suggesting sound transmission efficiency along the ossicular chain is reduced at high intensities. Tympanic membrane (TM) rupture was observed following nearly every exposure 55 kPa or higher.

CONCLUSIONS:
Intracochlear pressures reveal lower middle-ear transfer function magnitudes (i.e. reduced gain relative to the ear canal) for high sound pressure levels, thus revealing lower than expected cochlear exposure based on extrapolation from cochlear pressures measured at more moderate sound levels. These results are consistent with lowered transmissivity of the ossicular chain at high intensities, and are consistent with our prior report measuring middle ear transfer functions in human cadaveric temporal bones with high intensity tone pips.

Author Info:
1
Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Nathaniel.Greene@ucdenver.edu.
2
Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Cochlear Boulder LLC, Boulder, CO, USA.
4
Applied Research Associates, Inc., Littleton, CO, USA.
5
Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA.


Authors:
Guerrero C(1), Garay A(1), Ariza-Solé A(2), Formiga F(1), Raposeiras-Roubín S(3), Abu-Assi E(3), D'Ascenzo F(4), Kinnaird T(5), Manzano-Fernández S(6), Alegre O(1), Sánchez-Salado JC(1), Lorente V(1), Templin C(7), Velicki L(8), Xanthopoulou I(9), Cerrato

Title:
Anemia In Patients With Acute Coronary Syndromes ‎Treated With Prasugrel Or Ticagrelor: Insights From The ‎RENAMI Registry

Abstract:
INTRODUCTION:
Ticagrelor and prasugrel are recommended as first line therapy in patients with acute coronary syndromes (ACS). However, patients with anemia are commonly treated with clopidogrel in routine clinical practice. The RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction) included ACS patients treated with prasugrel or ticagrelor at hospital discharge. The aim of this study was to analyze the prevalence of anemia and characteristics and outcomes of these patients according to anemia status.

METHODS:
Consecutive patients with ACS from 11 centers were included. All patients underwent percutaneous coronary intervention (PCI). Anemia was defined as hemoglobin <130 g/L in men and <120 g/L in women. The incidence of ischemic and bleeding events and all-cause mortality were assessed at one year.

RESULTS:
From 4424 patients included, 405 (9.2%) fulfilled criteria of anemia. Patients with anemia were significantly older, had a higher prevalence of peripheral artery disease, previous bleeding and renal disfunction and higher bleeding risk (PRECISE-DAPT score ≥ 25: 37.3% vs 18.8%, p < 0.001) The incidence of BARC 3/5 bleeding was moderately higher in patients with anemia (5.4% vs 1.5%, p = 0.001). The incidence of stent thrombosis or reinfarction was not significantly different according to anemia status. Anemia was independently associated with mortality (HR 1.73; 95% CI 1.03-2.91, p = 0.022).

CONCLUSIONS:
A not negligible proportion of patients treated with ticagrelor or prasugrel met criteria for anemia. Anemia was an independent predictor of mortality. Despite their higher bleeding risk profile, patients with anemia had an acceptable rate of bleeding.

Author Info:
1
Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
2
Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: aariza@bellvitgehospital.cat.
3
Hospital Álvaro Cunqueiro, Vigo, Spain.
4
Department of Cardiology, Department of Medical Sciences, University of Torino, Italy.
5
University Hospital of Wales, Cardiff, United Kingdom.
6
Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
7
University Heart Center, University Hospital Zurich, Switzerland.
8
Medical faculty, University of Novi Sad, Novi Sad, 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:
Hadiya S(1), Liu X(2), Abd El-Hammed W(3), Elsabahy M(1),(4),(5),(6), Aly SA(3).

Title:
Levofloxacin-Loaded Nanoparticles Decrease Emergence of Fluoroquinolone Resistance in Escherichia coli

Abstract:
Antimicrobial resistance is a major global health problem that is developed upon exposure of bacteria to antimicrobial agents, and, thus, reducing or eliminating the ability of the currently available antibacterial drugs to eradicate bacterial infections. The aim of the current study was to encapsulate levofloxacin (third generation fluoroquinolones) into chitosan (CS) nanoparticles, to evaluate the antibacterial potency of the nanosized drug, and to characterize the major genetic mutations associated with the exposure of bacteria to the levofloxacin-loaded nanoparticle versus free levofloxacin. Three consecutive mutants were selected by stepwise exposure of one reference and two clinical Escherichia coli isolates to a series of progressively increasing concentrations of levofloxacin and the levofloxacin-loaded nanoparticles. Mutations in quinolone resistance determining region (QRDR) of gyrA and parC and regulators of AcrAB efflux pump (soxR, soxS and acrR) for all the selected-mutants were determined using polymerase chain reaction and sequencing. Mutants developed upon exposure to the nanosized drug had higher sensitivity to levofloxacin, compared with the levofloxacin-selected mutants. In addition, mutations in gyrA were observed in the levofloxacin first mutants, but in the nanosized levofloxacin second mutants. In the third mutants, an additional mutation in parC and mutations in the regulators were found only in levofloxacin-selected mutants. Loading of levofloxacin into the CS nanoparticles could increase the antibacterial activity of the drug and decrease the emergence of resistant mutants. To the best of our knowledge, this is the first study to explore the role of antimicrobial-loaded nanoparticles in the reduction of emergence of bacterial resistance.

Author Info:
1
1 Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University , Assiut, Egypt .
2
2 College of Veterinary Medicine, Northwest A&F University , Yangling, China .
3
3 Department of Microbiology and Immunology, Faculty of Medicine, Assiut University , Assiut, Egypt .
4
4 Department of Pharmaceutics, Faculty of Pharmacy, Assiut University , Assiut, Egypt .
5
5 Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University , College Station, Texas.
6
6 Misr University for Science and Technology , 6th of October City, Egypt .


Authors:
Hakyemez IN(1), Erdem H(2),(3), Beraud G(4), Lurdes M(5), Silva-Pinto A(5), Alexandru C(6), Bishop B(7), Mangani F(8), Argemi X(9), Poinot M(10), Hasbun R(11), Sunbul M(12), Akcaer M(13), Alp S(14), Demirdal T(15), Angamuthu K(16), Amer F(17), Ragab E(18)

Title:
Correction To: Prediction Of Unfavorable Outcomes In ‎Cryptococcal Meningitis: Results Of The Multicenter ‎Infectious Diseases International Research Initiative (ID-‎IRI) Cryptococcal Meningitis Study

Abstract:
Abstract
In the original version of this article, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.

Author Info:
1
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
2
Infectious Diseases International Research Initiative (ID-IRI), Ankara, Turkey. hakanerdem1969@yahoo.com.
3
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey. hakanerdem1969@yahoo.com.
4
Department of Infectious Diseases, Poitiers University Hospital, Poitiers, France.
5
Department of Infectious Diseases, Centro Hospitalar S. João and Faculty of Medicine of University of Porto, Porto, Portugal.
6
Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
7
Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel.
8
Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Verona, Italy.
9
Department of Infectious Diseases, Nouvel Hôpital Civil, Strasbourg, France.
10
Department of Infectious and Tropical Diseases, University Hospital of Pontchaillou, Rennes, France.
11
Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
12
Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
13
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
14
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
15
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
16
Department of Clinical Microbiology, Almana General Hospital, Dammam, Saudi Arabia.
17
Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
18
Diagnostic Microbiology Lab of Alexandria University Hospital, Alexandria, Egypt.
19
Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
20
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
21
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Okan University, Istanbul, Turkey.
22
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
23
Department of Infectious Diseases, Bern University Hospital and Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
24
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
25
Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
26
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
27
Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey.
28
Department of Infectious Diseases and Clinical Microbiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
29
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.


Title:
Prediction Of Unfavorable Outcomes In Cryptococcal ‎Meningitis: Results Of The Multicenter Infectious ‎Diseases International Research Initiative (ID-IRI) ‎Cryptococcal Meningitis Study.‎

Abstract:
Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.


Authors:
Hamdy MM(1), Elbadr MM(1), Barakat A(2).

Title:
Bupropion Attenuates Morphine Tolerance And ‎Dependence: Possible Role Of Glutamate, ‎Norepinephrine, Inflammation, And Oxidative Stress

Abstract:
BACKGROUND:
Morphine - the main pillar of nociceptive pain management - systemic use is associated with development of tolerance and dependence. Tolerance and dependence lay a heavy burden in clinical pain management settings. An added weight to this dilemma is that effective, safe, and tolerable solution to this problem is still beyond reach. Antidepressants were reported as possible alleviators of opioid tolerance and dependence. One of the increasingly used antidepressant in clinical practice is bupropion given its high safety and tolerability profile.

METHODS:
The study was performed on male Balb-c mice weighing 20-30 g. Hot plate test was used for assessment of bupropion (5 mg/kg, ip) possible analgesic activity and enhancement of morphine acute analgesia (1 and 5 mg/kg, sc). Repeated morphine (5 mg/kg, sc) administration for 9 days developed tolerance and dependence, bupropion (5 mg/kg, ip) was concurrently administered to evaluate its potential to modulate these processes. We also biochemically analyzed bupropion effect on these phenomena through modulation of neurotransmitters (glutamate and norepinephrine), inflammatory status (nitric oxide), and pro-antioxidant balance (malondialdehyde and reduced glutathione).

RESULTS:
Bupropion was devoid of intrinsic analgesic activity and did not enhance morphine acute analgesia. However, bupropion significantly attenuated morphine tolerance and dependence development and abstinence syndrome with corresponding suppression of morphine induced changes in glutamate, norepinephrine, inflammatory status, and prooxidant-antioxidant balance.

CONCLUSION:
Bupropion efficacy in attenuation of morphine tolerance and dependence with its high safety and tolerability profile provide an alternative option to conventional agents e.g., ketamine and clonidine to modulate these phenomena.

Author Info:
1
Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: ahmedbarakat@aun.edu.eg


Authors:
Hamdy MM(1), Elbadr MM(1), Barakat A(1).

Title:
Fluoxetine Uses In Nociceptive Pain Management: A ‎Promising Adjuvant To Opioid Analgesics‎

Abstract:
Fluoxetine, a commonly prescribed antidepressant, use in nociceptive pain management represents one of the unsettled issues of fluoxetine therapeutics. By reviewing the literature about fluoxetine's possible roles in this setting, those could be solitary antinociceptive effect, enhancement of acute morphine analgesia, blocking morphine tolerance development, and blocking dependence development and associated abstinence syndrome. In this study, we examined those four alleged roles of fluoxetine. Moreover, as effective alleviation of morphine tolerance, dependence, and abstinence syndrome represents one of the most challenging medical needs, we biochemically analyzed fluoxetine effect on these phenomena. Fluoxetine (10 mg/kg, IP) was examined in hot plate test for assessment of possible analgesic activity and enhancement of morphine acute analgesia (1 and 5 mg/kg, SC). Repeated morphine (5 mg/kg, SC) administration for 9 days developed tolerance and dependence; fluoxetine was co-administered to evaluate its potential to modulate these processes. We also determined concomitant changes in neurotransmitters (glutamate and noradrenaline), inflammatory status, and prooxidant-antioxidant balance. Our results indicated that fluoxetine did not possess significant analgesia solely and did not enhance acute morphine analgesia. However, fluoxetine administration with morphine significantly attenuated tolerance and dependence development and abstinence syndrome with corresponding suppression of morphine-induced changes in neurotransmitters (glutamate and noradrenaline), inflammatory status, and prooxidant-antioxidant balance. These biochemical results may reflect both direct and indirect effects of fluoxetine. Our conclusion is that despite fluoxetine possesses low - if any - analgesic activity, it significantly adds to opioids not via enhancing analgesic activity but through modulation of tolerance and dependence development.

Author Info:
Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, 71526, Egypt.


Title:
Cochlear Function in Adults with Epilepsy and Treated with Carbamazepine

Abstract:
BACKGROUND:
Epilepsy is a chronic medical disease and is associated with comorbid adverse somatic conditions due to epilepsy itself or its long-term treatment.

OBJECTIVES:
This study evaluated cochlear function in patients with idiopathic epilepsy and treated with carbamazepine (CBZ).

PATIENTS AND METHODS:
Included were 47 patients (mean age = 34.56 ± 7.11 years and duration of illness = 17.84 ± 7.21 years) and 40 healthy subjects. They underwent pure-tone audiometry and transient evoked otoacoustic emission (TEOAE) analyses.

RESULTS:
Hearing loss (mainly bilateral mild) was reported in one third of patients. Compared to controls, patients had lower TEOAE amplitudes at 1.0-4.0 kHz particularly at high frequencies (3 and 4 kHz). Significant correlations were identified between TEOAE amplitudes with CBZ dose (at 3 kHz: r = -0.554, p = 0.008; at 4 kHz: r = -0.347, p = 0.01), its serum level (at 4 kHz: r = -0.280, p = 0.045) and duration of treatment (at 3 kHz: r = -0.392, p = 0.008; at 4 kHz: r = -0.542, p = 0.001).

CONCLUSIONS:
Long-term CBZ treatment may result in cochlear dysfunction and auditory deficits

Author Info:
1
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
2
Audiology Unit, Department of ENT, Assiut University Hospital, Assiut, Egypt.


Authors:
Hamed SA(1), Metwalley KA(2), Farghaly HS(3).

Title:
Cognitive Function In Children With Classic Congenital ‎Adrenal Hyperplasia

Abstract:
Studies of cognitive function in patients with congenital adrenal hyperplasia (CAH) are few and controversial. This study aimed to investigate general intelligence and specific cognitive functions in children with salt wasting (SW) form of CAH and their relationship to demographic, clinical, and laboratory variables. This study included 36 children with classic 21 hydroxylase deficiency SW type of CAH (males = 12; females = 24; mean age = 15.6 ± 2.3 years). Intelligence quotient (IQ) and cognition were assessed using Wechsler Intelligence Scale for Children 3rd edition (WISC-III) and Stanford Binet Subsets Test version 4 (SBST4). Compared to controls, patients had lower mean full-scale (FS) IQ (P = 0.01) score, particularly performance IQ score (P = 0.001), and comprehension, pattern analysis, quantitation, bead memory, and memory for sentences of SBST4 (P = 0.05, P = 0.014, P = 0.001, P = 0.002, and P = 0.05, respectively). Lower IQ was observed in poorly controlled compared with well-controlled patients on medical treatment. Significant correlations were observed between FSIQ with age (r = - 0.810; P = 0.001), duration of treatment (r = - 0.887; P = 0.01), dose of glucocorticoids (r = - 0.463; P = 0.01), 17-OHP (r = - 0.543; P = 0.01) and testosterone (r = - 0.462; P = - 0.006) levels, and number of hyponatremic episodes (r = - 0.350; P = 0.05). In multivariate analysis, the independent risks of low FSIQ were the dose of glucocorticoids (OR = 1.14; 95% CI = 1.08-1.23, P = 0.0001), 17-OHP levels (OR = 2.25; 95% CI = 1.19-2.85, P = 0.01), and number of hyponatremic episodes (OR = 4.34; 95% CI = 2.05-5.15, P = 0.01).

CONCLUSION:
Patients with SW form of CAH may have lower IQ and cognitive deficits which may be related to the dose of glucocorticoids, androgen excess, and number of hyponatremic episodes. What is Known: • Congenital adrenal hyperplasia (CAH) is a group of inherited impairment of cortisol biosynthesis. • Studies of cognitive function in patients with congenital adrenal hyperplasia (CAH) are few and controversial. What is New: • Children with CAH may have lower intelligent quotient (IQ) and cognitive deficits. • Early hyponatremic episodes, overtreatment with glucocorticoids, and high androgen levels may be possible causative factors for the cognitive deficits.

Author Info:
1
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O. 71111, Assiut, Egypt. kotb72@gmail.com.
3
Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O. 71111, Assiut, Egypt.


Authors:
Hamed SA(1), Rageh TA(1), Mohamad AO(2), Abou Elnour SM(1).

Title:
Renal Dysfunctions/Injury In Adult Epilepsy Patients ‎Treated With Carbamazepine Or Valproate

Abstract:
OBJECTIVES:
Clinical and subclinical laboratory evidence of renal proximal tubular dysfunction had been reported in children with epilepsy as an adverse effect of some antiepileptic drugs (AEDs). This study aimed to determine kidney function in adult patients with monosymptomatic epilepsy of unknown etiology and treated with valproate (VPA) or carbamazepine (CBZ).

METHODS:
This study included 60 patients [mean age of 33.97 ± 6.70 years and treated with VPA (n = 24) or CBZ (n = 36) for mean duration of treatment of 6.03 ± 2.81years. Measurements of serum creatinine (sCr), urinary creatinine, creatinine clearance (CrCl) and serum kidney injury molecule 1 (KIM-1), markers of renal dysfunction/injury were done.

RESULTS:
Compared to controls, patients had higher sCr, KIM-1 and lower CrCl levels. Compared to patients on VPA, those on CBZ had relatively higher KIM-1 and lower CrCl levels. We reported only significant correlations between KIM-1 with sCr (r = 0.324, p = 0.001) and duration of treatment with AEDs (r = 0.301, p = 0.02).

CONCLUSION:
Chronic VPA and CBZ therapy may be associated with subclinical renal glomerular and/or proximal tubular dysfunctions or injuries. The treating neurologist have to consider this while selection of AED on start treating patients or modifying the AED for patients at high risk of kidney injury.

Author Info:
1
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.
2
b Department of Biochemistry , Assiut University Hospital , Assiut , Egypt.


Title:
Sexual Dysfunctions Induced by Pregabalin.

Abstract:
OBJECTIVES:
Pregabalin (PGB) is a gabapentinoid (ie, GABA analog), which has been Food and Drug Administration-approved for treatment of partial epilepsy in adults and neuropathic pain. It also has off-label uses for the treatment of generalized anxiety disorders, fibromyalgia, and tension headache and prevention of migraine. Few cases were reported with sexual dysfunctions (SDs) as adverse effects of PGB and gabapentin, and the majority were dose related (≥900 mg/d for gabapentin). This study aimed to determine the frequency and types of SDs induced by PGB and the temporal relation to its use.

METHODS:
We presented case series of patients (n = 75) treated with PGB for different indications (sciatica, atypical facial pain, chronic tension headache, transformed migraine, fibromyalgia, and generalized anxiety disorder and developed different aspects of SDs).

RESULTS AND CONCLUSIONS:
In this case series, SDs were noticed with PGB in 41.33% (n = 31) (men, 13 [50%]; women, 18 [36.73%]), which included erectile dysfunction (n = 16, 51.61%), anorgasmia (n = 10, 32.26%), and loss of libido (n = 11, 35.48%). Sexual dysfunctions occurred within weeks after the use of PGB and were not dose related. They occurred with low therapeutic PGB doses (50-100 mg/d). Discontinuation of PGB resulted in improvement of SDs within weeks. To conclude, SDs are not infrequent adverse effects of PGB therapy. Pregabalin can induce erectile dysfunction, loss of libido, and anorgasmia. Sexual dysfunctions induced by PGB are not dose related. It is important for the clinician to acknowledge and encourage discussion regarding sexual function with patients and inquire about the impact of PGB on sexual function.

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


Authors:
Hameed DA(1), Yassa HA(2), Agban MN(3), Hanna RT(4), Elderwy AM(1), Zwaita MA(1)

Title:
Correction To: Genetic Aberrations Of The K-Ras Proto-‎Oncogene In Bladder Cancer In Relation To Pesticide ‎Exposure

Abstract:
The original publication of this paper contains a mistake. Line 6 in the abstract, line should read "One hundred patients were diagnosed with bladder cancer and two hundred controls attended the outpatient clinic;"

Author Info:
1
Urology Department, Assiut University, Assiut, Egypt.
2
Forensic Medicine and Clinical Toxicology Department, Assiut University, Assiut, Egypt. hebayassa@aun.edu.
3
Microbiology Department, Assiut University, Assiut, Egypt.
4
Biochemistry Department, Assiut University, Assiut, Egypt.


Authors:
Hameed DA(1), Yassa HA(2), Agban MN(3), Hanna RT(4), Elderwy AM(1), Zwaita MA(1).

Title:
Genetic Aberrations Of The K-Ras Proto-Oncogene In ‎Bladder Cancer In Relation To Pesticide Exposure‎

Abstract:
In Egypt, bladder cancer is one of the most popular cancers, accounting for 31% of all cancer cases. It ranks first in males about 16.2% of male cancer. The incidence in rural areas among males is near 32 per 100,000. The exact etiology of bladder cancer is still unknown; K-ras gene is known as a critical DNA target for chemical carcinogens such as pesticide. Some occupational hazard exposure is thought to be directly genotoxic, while others might enhance the mutagenicity and carcinogenicity of directly acting genotoxic agents. Analysis of the relationship between pesticide exposure and mutation in the K-ras gene in human bladder cancer. One hundred patients were diagnosed with bladder cancer and two hundred controls attended the outpatient clinic; after taking consent and filling a questionnaire for age, sex, occupation and pesticide exposure, surgically resected specimens were collected and the samples were used to determine the k-ras mutation. Blood samples were taken to analyze the level of acetylcholinesterase enzyme and level of P53. The present study indicated that pesticide exposure may play a great role in malignant transformation of the bladder cells through mutation in the K-ras gene; there was a significant correlation between the acetylcholinesterase enzyme level and k-ras mutation (p < 0.001). The results revealed that the level of P53 was significantly high in comparison with the control group (p < 0.001). These findings give an alarm to decrease the amount of pesticides used in our area; also, p53 may be used as an indicator to bladder cancer.


Authors:
Hammam N(1),(2), Rashad SM(3), Mohamed AAA(4).

Title:
Metabolic Syndrome In Systemic Lupus Erythematosus ‎Patients : Relationship To Disease Activity And ‎Neuropsychiatric Lupus

Abstract:
OBJECTIVE:
The study aims to evaluate the presence of metabolic syndrome (MetS) among Egyptian systemic lupus erythematosus (SLE) patients. Additionally, we intended to determine the association of MetS with disease activity, clinical and laboratory features.

PATIENTS AND METHODS:
This cross-sectional study included adult SLE patients diagnosed and followed in rheumatology outpatient clinics. The demographic data, clinical and laboratory parameters were assessed for all patients. Disease activity was measured using SLE Disease Activity Index (SLEDAI-2k). Patients were diagnosed to have MetS according to The National Cholesterol Education Program Adult Treatment Panel III (NCEP). The characteristics of SLE patients and their disease status were compared between those with and without MetS.

RESULTS:
A total of 74 SLE patients were included; mean age was 32.1 ± 10.9 years and 87.8% were females. Twenty-five (33.8%) SLE patients had neuropsychiatric lupus (NPSLE), with headache the most common manifestation. MetS was diagnosed in 45.9% of the SLE group. Patients with MetS had significantly older age, delayed age of diagnosis and higher SLEDAI-2k scores (p = 0.015, p = 0.014 and p = 0.019, respectively) compared to those without MetS. NPSLE was significantly correlated with MetS (r = 0.32, p = 0.006) and in particular with higher central obesity (r = 0.43, p < 0.001). In the multivariate analysis, NPSLE remained independently associated with MetS (OR = 4.9, p = 0.004, 95% CI = 1.7-14.4).

CONCLUSION:
Metabolic syndrome is present in a significant proportion of Egyptian patients with adult SLE. Delayed disease diagnosis and higher disease activity are SLE-related factors that may contribute to increase the risk of MetS. Data suggest that neuropsychiatric lupus may underlie some of the increased risk for MetS and central obesity.

Author Info:
1
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt. hammam@ualberta.ca.
2
University of Alberta, Corbett Hall, 8205 114 Street, T6G2G4, Edmonton, Alberta, Canada. hammam@ualberta.ca.
3
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez University, Suez, Egypt.
4
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt.


Authors:
Hammam N(1),(2), E Ezeugwu V(1), J Manns P(1), Pritchard-Wiart L(1).

Title:
Relationships Between Sedentary Behaviour, Physical ‎Activity Levels And Red Blood Cell Distribution Width In ‎Children And Adolescents

Abstract:
Background: Red blood cell distribution width (RDW) is a biomarker for cardiovascular disease(CVD). RDW is associated with sedentary behavior (SB) and physical activity (PA) in adults.To date, no study has evaluated this association in children. The purpose of this study was to evaluate the association between RDW and SB and PA levels of children and adolescents. Methods: This observational study included data from participants aged 12-20 years in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). SB and PA were measured using accelerometers. Activity levels were classified into intensity categories. Sex specific multivariable regression analyses (adjusted for covariates) were used to explore the associations between SB, PA and RDW. Results: The study included 2143 children and adolescents (1080 boys and 1063 girls). In the fully adjusted regression model for boys, SB was positively associated with RDW (β =0.116,P=0.004) while moderate PA was negatively associated with RDW (β =-0.082, P=0.048). In girls, there were no significant associations between activity levels and RDW. Conclusion: This study provides preliminary evidence of the association between SB, moderate intensity PA and RDW in boys, but not in girls. Further research to determine the mechanisms associated with this relationship and underlying sex differences is warranted.

Author Info:
1
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
2
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Abstract


Authors:
Hardin JS(1), Gauldin DW(1), Soliman MK(2),(3), Chu CJ(4), Yang YC(5),(6), Sallam AB(1),(7).

Title:
Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane

Abstract:
IMPORTANCE:
Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting.

OBJECTIVE:
To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM.

DESIGN, SETTING, AND PARTICIPANTS:
In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed.

MAIN OUTCOMES AND MEASURES:
We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery.

RESULTS:
The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (≥3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes.

CONCLUSIONS AND RELEVANCE:
On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Author Info:
1
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock.
2
Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada.
4
School of Clinical Sciences, University of Bristol and Bristol Eye Hospital, Bristol, United Kingdom.
5
Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals National Health Service Trust, New Cross, Wolverhampton, United Kingdom.
6
Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom.
7
Ophthalmology Department, Gloucestershire Hospitals National Health Service Trust, Cheltenham, United Kingdom.


Authors:
Hasan GM(1),(2), Al-Eyadhy AA(1), Temsah MA(1), Al-Haboob AA(1), Alkhateeb MA(1), Al-Sohime F(1).

Title:
Feasibility And Efficacy Of Sepsis Management ‎Guidelines In A Pediatric Intensive Care Unit In Saudi ‎Arabia: A Quality Improvement Initiative‎

Abstract:
OBJECTIVES:
Evaluation of feasibility and effectiveness of Surviving Sepsis Campaign (SSC) Guidelines implementation at a Pediatric Intensive Care Unit (PICU) in Saudi Arabia to reduce severe sepsis associated mortality.

DESIGN:
Retrospective data analysis for a prospective quality improvement (QI) initiative.

SETTINGS:
PICU at King Saud University Medical City, Saudi Arabia.

PARTICIPANTS:
Children ≤14 years of age admitted to the PICU from July 2010 to March 2011 with suspected or proven sepsis. Comparisons were made to a previously admitted group of patients with sepsis from October 2009 to June 2010.

INTERVENTIONS:
Adaptation and implementation of the Surviving Sepsis Campaign-Clinical Practice Guidelines (SSC-CPGs) through AGREE instrument and ADAPTE process.

MAIN OUTCOME MEASURES:
We reported pre- and post-implementation outcome of interest for this QI initiative, annual sepsis-related mortality rate. Furthermore, we reported follow-up of annual mortality rate until December 2016.

RESULTS:
Sixty-five patients was included in the study (42 in post-guidelines implementation group and 23 in pre-guidelines implementation group). Mortality was insignificantly lower in the post-implementation group (26.2% vs. 47.8%; P = 0.079). However, when adjusted for severity, identified by number of failing organs in the multivariate regression analysis, the mortality difference was favorable for the post-implementation group (P = 0.006). The lower sepsis-related mortality rate was also sustained, with an average mortality rate of 15.11% for the subsequent years (2012-16).

CONCLUSIONS:
Adaptation and implementation of SSC Guidelines in our setting support its feasibility and potential benefits. However, a larger study is recommended to explore detailed compliance rates.

Author Info:
1
Intensive Care Unit, Department of Pediatrics, King Khalid University Hospital and College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
2
Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Assiut University Children Hospital, Assiut University, Assiut, Egypt.


Authors:
Hasanain AFA(1), Mahran AMA(2), Safwat AS(3), Nafee AMA(4), Zayed AAH(5), Abdel-Aal SM(6), Bakkar SM(7), Abonnoor AEI(3).

Title:
Latent Tuberculosis Infection Among Patients With ‎Erectile Dysfunction

Abstract:
No previous studies have investigated the prevalence of latent tuberculosis infection (LTBI) among patients with erectile dysfunction (ED) or its contribution to the development of high-grade ED through a process of chronic inflammation-induced atherosclerosis. The aim of this study was to determine the frequency of LTBI among patients with erectile dysfunction and to explore the contribution of LTBI to high-grade ED. For all the study sample, clinical evaluation, imaging studies, and laboratory investigations were provided. Evaluation included, but was not confined to, scrotal ultrasonography, tuberculin skin test, and QuantiFERON-TB Gold test. The study sample mean ± SD age was 47.9 ± 13.6 years. Approximately 30% of the patients had LTBI and 43% had high-grade ED. After a multivariate analysis, it was found that older age (≥40 years) (OR, 5.2; 95% CI, 1.9-54.6; p 0.004), metabolic syndrome (MS) (OR, 3.4; 95% CI, 1.3-48.2; p 0.016), and LTBI (OR, 4.1; 95% CI, 1.7-61.3; p 0.021) were significantly, independently associated with high-grade ED as opposed to low-grade ED. In conclusion, the prevalence of LTBI among patients with high-grade ED is higher than among those with low-grade ED. In addition to LTBI, older age and MS are associated with high-grade ED as opposed to low-grade ED.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Asyut, Egypt. af.hasanain@outlook.com.
2
Department of Dermatology and Andrology (Andrology Unit), Faculty of Medicine, Assiut University, Asyut, Egypt.
3
Department of Urology, Faculty of Medicine, Assiut University, Asyut, Egypt.
4
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Asyut, Egypt.
5
Department of Chest Diseases, Faculty of Medicine, Assiut University, Asyut, Egypt.
6
Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Asyut, Egypt.
7
Department of Biochemistry, Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
Hassan EA(1), Elsherbiny NM(2), Abd El-Rehim AS(3), Soliman AMA(4), Ahmed AO(5)

Title:
Health Care-Associated Infections In Pre-Transplant ‎Liver Intensive Care Unit: Perspectives And Challenges

Abstract:
BACKGROUND:
Health care-associated infections (HAIs) threaten patient's safety worldwide especially in the intensive care units (ICU). In end-stage liver disease (ESLD), the condition is much more complicated. Data regarding HAIs among ESLD patients is lacking. We aimed to assess the incidence of HAIs, risk factors, causative micro-organisms, antimicrobial susceptibilities and mortality rates among patients with end-stage liver disease (ESLD) admitted to pre-transplant liver intensive care unit (LICU).

METHOD:
This prospective observational study included 337 ESLD patients admitted to LICU, Al-Rajhi liver center, Assiut University Hospital, Assiut, Egypt between January 2016 and June 2016 and they were followed up for the development of HAI manifestations. The medical history, physical examination and severity of underlying disease were determined. Clinical samples were taken from patients who developed HAIs for microbiological diagnosis and antimicrobial susceptibility testing.

RESULTS:
A total of 57 (16.9%) ESLD patients developed HAIs with the incidence density of 26.8 per 1000 patient-days. Blood stream infection was the most common (49.1%). Escherichia coli (21.1%) followed by methicillin-resistant Staphylococcus aureus (MRSA) (15.8%) were the commonest bacteria. Multidrug resistant organisms were reported in 52.6% of the isolates. Fungal causes were 15.8% with Candida species dominance. Sphingomonas paucimobilis and Achromobacter dentrificans were reported for the first time as pathogens for HAIs in LICU. Prolonged hospital stay, intravenous line duration, prolonged use of proton pump inhibitors and paracentesis were predictors for HAIs. No significant difference between ESLD patients with and without HAIs regarding mortality (36.8% vs. 48.6%, P=0.2).

CONCLUSION:
High HAI rate among ESLD patients is a matter of worry. Effective surveillance program, active infection control measures and national antibiotic policies are necessary to reduce the burden of HAIs.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: mam_elham75@yahoo.com.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hassan SS(1), Trenado C(2), Elben S(2), Schnitzler A(2), Groiss SJ(3).

Title:
Alteration Of Cortical Excitability And Its Modulation By ‎Miglustat In Niemann-Pick Disease Type C.‎

Abstract:
Niemann-Pick type C (NP-C) is a rare, neurodegenerative, lysosomal storage disease. Cortical excitability using different transcranial magnetic stimulation (TMS) protocols together with clinical and neuropsychological testing was longitudinally assessed in a patient with NP-C. Cerebellar inhibition, a measure for the integrity of the cerebello-thalamo-cortical network, was impaired. Short-latency afferent inhibition, a measure for cholinergic transmission, and cognitive functions were also impaired and improved under Miglustat treatment. Short interval intracortical facilitation, a marker for glutamatergic neurotransmission, was absent initially but increased after treatment with Miglustat. Our results provide new insights into pathophysiological mechanisms of NP-C and the response to Miglustat treatment.

Author Info:
1
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurology, Assiut University Hospital, Assiut, Egypt.
2
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
3
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. Electronic address: groiss-js@umin.net.


Authors:
Hosny G(1), Ismail W(2), Makboul R(3), Badary FAM(4), Sotouhy TMM(5)

Title:
Increased Glomerular Bax/Bcl2 Ratio Is Positively ‎Correlated With Glomerular Sclerosis In Lupus Nephritis

Abstract:
INTRODUCTION:
The role of intrinsic pathway of apoptosis in pathogenesis of lupus nephritis (LN) is still not clear. We investigated the relation between the expression of two major proteins of the intrinsic pathway of apoptosis; bcl2 as an antiapoptotic protein and bax as a proapoptotic one; in renal tissue of LN.

METHODS:
The study included fifty paraffin embedded renal tissue obtained from renal biopsy specimens of LN patients (8 cases class II, 10 cases class III, 21 cases class IV and 11 cases class V) and five paraffin embedded apparently normal renal tissue obtained from nephrectomy specimens due to renal neoplasms as a control group. Immunohistochemical staining for bcl2 and bax antibodies was done. Ki67 immunohistochemical staining was done for class III and IV to assess the degree of proliferation. The number of intraglomerular bcl2, bax and ki67 positive cells per glomerular cross section was evaluated for each case. The results were analysed in different LN classes and correlated to different glomerular lesions.

RESULTS:
The expression of bax and bcl2 proteins was higher in LN glomeruli compared to normal. The expression of bcl2 was significantly higher in class IV and was correlated to the degree of endocapillary hypercellularity. The bax to bcl2 ratio was significantly correlated to the percentage and degree of glomerular sclerosis.

CONCLUSION:
The intrinsic pathway of apoptosis interfere in the pathogenesis of lupus glomerulonephritis. The balance between bax and bcl2 proteins might have a role in regulating the progression of glomeruli from proliferative to sclerotic state.

Author Info:
1
Pathology Department, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt. Electronic address: ghada_h@aun.edu.eg.
2
Pathology Department, Faculty of Medicine, Beni Suef University, Beni suef, 71111, Egypt. Electronic address: wesam.ismail@med.bsu.edu.eg.
3
Pathology Department, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt. Electronic address: raniamakboul@aun.edu.eg.
4
Pathology Department, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt. Electronic address: fatbadary@aun.edu.eg.
5
Pathology Department, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt. Electronic address: thanaa53@aun.edu.eg.


Authors:
Hussein A(1), Saad K(1), Askar E(1), Zahran AM(2), Farghaly H(1), Metwalley K(1), Elderwy AA(3).

Title:
Functional Variants In Intercellular Adhesion Molecule-1 ‎And Toll-Like Receptor-4 Genes Are More Frequent In ‎Children With Febrile Urinary Tract Infection With Renal ‎Parenchymal Involvement

Abstract:
AIM:
We studied the functional polymorphisms of intercellular adhesion molecule-1 (ICAM-1) and toll-like receptor-4 (TLR-4) genes and risk of acute pyelonephritis (APN) in children attending Assiut University Children's Hospitals, Egypt, from 2011 to 2015.

METHODS:
Urinary tract infections (UTIs) were diagnosed in 380 children: 98 had APN and 282 had lower UTIs. Four single-nucleotide polymorphisms in ICAM-1 and TLR-4 genes were genotyped in all subjects: ICAM-1 rs1799969 Gly241Arg, ICAM-1 rs5498 Glu469Lys, TLR-4 rs4896791 Thr399Ile and TLR-4 rs4896790 Asp299Gly.

RESULTS:
Patients with APN were significantly more likely to have AA genotype of the ICAM-1 rs5498 (1462 A/G) polymorphism (p = 0.04) than children with lower UTIs and the TLR-4 Asp299Gly GG genotype (p = 0.002) and G allele (p = 0.006) than healthy controls. The association with the ICAM-1 Glu469Lys (1462A/G) was less evident. The GG genotype was associated with a modest relative risk of 1.4 (p = 0.1) of developing APN, but was not an independent odds ratio, at 1.2 (p = 0.48).

CONCLUSION:
Functional variants in ICAM-1 and TLR-4 genes were increasingly common in children with febrile UTIs with renal parenchymal involvement, but the ICAM-1 Glu469Lys (1462A/G) association was less evident. TLR4 Asp299Gly might independently increase renal parenchymal infection rather than renal scarring.

Author Info:
1
Children Hospital, Assiut University, Assiut, Egypt.
2
Clinical Pathology, SECI, Assiut University, Assiut, Egypt.
3
Pediatric Urology, Assiut University, Assiut, Egypt.


Title:
Non-Hodgkin's Lymphoma Of The Oral Cavity And ‎Maxillofacial Region: A Pathologist Viewpoint

Abstract:
Non-Hodgkin lymphomas of the oral and maxillofacial regions are uncommon malignancies. They usually have progressive course and dismal outcome. Areas covered: This review provides an update about the clinicopathologic, immunophenotypic, and molecular features of these lymphomas. Some relevant case reports are presented. Expert commentary: The lymphomas of the oral and maxillofacial regions involve the tongue, gingiva, hard palate, maxilla, mandible, Waldeyer's ring, palatine, and lingual tonsils. They include diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma, Burkitt lymphoma (BL), natural killer/T-cell lymphoma (NKTCL), marginal zone lymphoma, plasmablastic lymphoma (PBL), mantle cell lymphoma, and lymphoblastic lymphoma. They are more common in males than in females. They commonly present as mass lesions covered by an intact or ulcerated mucosa. Some lymphomas are associated with viral infections (Epstein-Barr virus or HIV) and specific genetic alterations. Each subtype has its specific clinicopathologic features and the most common subtypes include DLBCL, BL, NKTCL, and PBL. DLBCL is the most common oral lymphoma. BL is a rapidly proliferating mature B cell neoplasm almost always presenting in extranodal sites. Nasal-type NKTCL presents as a locally destructive, midfacial necrotizing lesion. PBL is a rare, highly aggressive disease that is commonly associated with immunodeficiency conditions.

Author Info:
1
a Department of Pathology , Assiut University Hospitals , Assiut , Egypt.


Authors:
Hussein OA(1), Abdel-Hafez AMM(1), Abd El Kareim A(1).

Title:
Rat Hippocampal CA3 Neuronal Injury Induced By Limb ‎Ischemia/Reperfusion: A Possible Restorative Effect Of ‎Alpha Lipoic Acid

Abstract:
Limb ischemia reperfusion (I/R) injury is associated with serious local and systemic effects. Reperfusion may augment tissue injury in excess of that produced by ischemia alone. The hippocampus has been reported to be vulnerable to I/R injury. Alpha lipoic acid (ALA) is an endogenous antioxidant with a powerful antioxidative, anti-inflammatory, and antiapoptotic properties. We studied the probable restorative effect of ALA on limb I/R-induced structural damage of rat hippocampus. Forty adult male albino rats were divided equally into four groups: group I (sham); group II (I/R-1 day) has undergone bilateral femoral arteries occlusion (3 h), then reperfusion for 1 day; group III (I/R-7 days) has undergone reperfusion for seven days; group IV (I/R-ALA) has undergone I/R as group III and received an intraperitoneal injection of ALA (100 mg/kg) for 7 days. I/R groups revealed degenerative changes in the pyramidal neuronal perikarya of CA3 field in the form of dark-stained cytoplasm, dilated RER cisternae, mitochondrial alterations, and dense bodies' accumulation. Their dendrites showed disorganized microtubules. Astrogliosis is featured by an increased number and increased immunoreactivity of astrocytes for glial fibrillary acid protein. Morphometric data revealed significant reduction of light neurons, surface area of neurons, and thickness of the CA3 layer. Most blood capillaries exhibited narrow lumen and irregular basal lamina. ALA ameliorated the neuronal damage. Pyramidal neurons revealed preservation of normal structure. Significant increase in the thickness of pyramidal layer in CA3 field and surface area and number of light neurons was observed but astrogliosis persisted. Limb I/R had a deleterious remote effect on the hippocampus aggravated with longer period of reperfusion. This work may encourage the use of ALA in the critical clinical settings with I/R injury.

Author Info:
a Histology and Cell biology Department, Faculty of Medicine , Assiut University , Assiut , Egypt.


Title:
Effect Of Intravenous Lidocaine Infusion On Long-Term ‎Postoperative Pain After Spinal Fusion Surgery

Abstract:
BACKGROUND:
Intravenous lidocaine infusion is known to reduce postoperative pain for days or weeks beyond the infusion time, and plasma half-life in several types of surgical procedures.

OBJECTIVES:
To evaluate the effect of intravenous (IV) lidocaine infusion on long term postoperative pain intensity for 3 months in patients undergoing spinal fusion surgery.

STUDY DESIGN:
Prospective randomized, double-blinded study.

SETTING:
Assiut University Hospital, Assiut, Egypt.

METHODS:
Forty patients undergoing spinal fusion surgery were randomized into 2 equal groups (n = 20 in each). Patients in the lidocaine group received IV lidocaine at a dosage of 2.0 mg/kg slowly before induction of anesthesia, followed by lidocaine IV infusion at a rate of 3.0 mg/kg/h until the end of surgery. Patients in the control group received an equal volume of normal saline. The following data were assessed: pain by Visual Analog Score (VAS) at 1 hour, 6 hours, 12 hours, 24 hours, 48 hours, at discharge time, and at 1 month, 2 months, and 3 months post-operation, time to first request for additional analgesia, and total morphine consumption in 24 hours.

RESULTS:
Lidocaine significantly reduced the postoperative pain score (VAS) for up to 3 months (P < .05), and significantly reduced morphine consumption (4.5 mg vs. 19.85 mg) in the 1st 24 hours postoperative. Lidocaine also significantly, prolonged (P < .05) the time to first request for additional analgesia (9.56 ± 2.06 hours vs 1.82 ± 0.91 hours).

CONCLUSION:
Intra-operative lidocaine, when given intravenously as a bolus followed by an infusion, significantly decreased long term postoperative back pain intensity in patients undergoing spinal fusion surgery.

Author Info:
1
Assiut University Hospital, Faculty of Medicine, Assiut, Egypt - aradys2000@yahoo.com.
2
Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.


Authors:
Ibrahim AS(1), Aly MG(2), Thabet ME(2), Abdelaziz MR(2).

Title:
Effect Of Adding Nalbuphine To Intrathecal Bupivacaine ‎With Morphine On Postoperative Nausea And Vomiting ‎And Pruritus After Elective Cesarean Delivery: A ‎Randomized Double Blinded Study

Abstract:
BACKGROUND:
The use of intrathecal morphine may result in serious side effects in parturients undergoing cesarean delivery. Nalbuphine, is a mu receptor antagonist and a ĸappa receptor agonist. Combinations of opioid agonist and agonist antagonist can decrease the incidence of opioid related side effects. We aimed to investigate the effect of adding nalbuphine, to intrathecal morphine on postoperative nausea and vomiting and pruritus after a cesarean delivery.

METHODS:
Eighty parturient undergoing elective cesarean delivery under spinal anesthesia was randomized into two similar groups. Group I: received 10 mg of 0.5% hyperbaric bupivacaine with 0.2 mg morphine. Group II: received as a group I plus 0.5 mg nalbuphine, with total volume 2.5 ml in both groups.

MEASUREMENTS:
Data on the severity of nausea and vomiting were collected using a numerical Rating scale and visual analogue scale was used to quantify pruritus. Onset and duration of sensory blockade, Visual analog scale for pain, the first time to ask for rescue analgesia and total rescue analgesic consumption were recorded.

RESULTS:
Nausea and vomiting and pruritus severity scores and number of patients developed nausea and vomiting and pruritus were significantly lower (p< 0.001) in group II. Onset and duration of sensory block, time to first request for rescue analgesia, Visual analog scale for pain and paracetamol consumption showed no statistically differences between both groups (p>0.05).

CONCLUSIONS:
We concluded that the addition of nalbuphine to intrathecal bupivacaine plus morphine significantly reduced the incidence and severity of postoperative nausea and vomiting and pruritus without affecting analgesic potency.


Authors:
Ibrahim AS(1), Aly MG(2), Abdel-Rahman KA(2), Mohamed MA(3), Mehany MM(3), Aziz EM(3).

Title:
Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study

Abstract:
BACKGROUND:
Between 25 and 40% of extubated patients with traumatic brain injury (TBI) in the intensive care unit at our hospital (Assiut University Hospital-Assiut-Egypt) require reintubation. This reflects the importance of developing better criteria for predicting successful extubation in TBI. We evaluated the accuracy of semi-quantitative cough strength score (SCSS) and Glasgow coma scale (GCS) in predicting extubation outcomes in TBI.

METHODS:
This prospective observational study included patients (18-65 years), with TBI on mechanical ventilation more than 24 h who were ready to be weaned off. Three tools were used. Tool I: Patient assessment sheet, this tool used to assess socio-demographic and clinical data of patients. Tool II: Semi-quantitative cough strength score (0-5). Tool III: Factors affecting successful extubation, this tool used to confirm the presence or absence of factors that can interfere with the results of extubation outcomes. After extubation, patient was followed up for 72 h to check for extubation success. Multivariate logistic binary regression test was used to calculate odds ratio for different clinical data collected before extubation as independent factors and successful extubation as a dependent factor.

RESULTS:
Among 80 patients of mean age 40.6 (± 16.1), 34% were female, median admission GCS was 8 (4-13), extubation occurred on mean post-injury day 6.5 (± 4), and 46.3% required reintubation. Successfully extubated patients had higher semi-quantitative cough scores and GCS. 81.3% patients with SCSS 5 were successfully extubated, while all patients with SCSS 0 were reintubated. All patients with GCS 15 were successfully extubated, and all patients with GCS < 12 required intubation.

CONCLUSION:
SCSS has shown promise in predicting successful extubation in TBI.

Author Info:
1
Anaesthesia and ICU Department, Faculty of Medicine, Assiut University Hospital, Assiut City, 7111, Egypt. aradys2000@yahoo.com.
2
Anaesthesia and ICU Department, Faculty of Medicine, Assiut University Hospital, Assiut City, 7111, Egypt.
3
Critical Care and Emergency Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt.


Authors:
Ibrahim AS(1), Aly MG(1), Farrag WS(1), Gad El-Rab NA(1), Said HG(2), Saad AH(1)

Title:
Ultrasound-Guided Adductor Canal Block After ‎Arthroscopic Anterior Cruciate Ligament ‎Reconstruction: Effect Of Adding Dexamethasone To ‎Bupivacaine, A Randomized Controlled Trial

Abstract:
BACKGROUND:
Dexamethasone improves the quality and duration of peripheral nerve block when used as an adjuvant to local anaesthetic. We evaluated the effect of adding dexamethasone to bupivacaine on the duration of postoperative analgesia in patients undergoing knee arthroscopy using ultrasound-guided adductor canal block.

METHODS:
The study was a randomized, double-blinded trial. Sixty patients scheduled for arthroscopic anterior cruciate ligament reconstruction were randomly allocated into two groups to receive adductor canal block. The control group received 20 mL bupivacaine 0.5% + 2 mL normal saline, and the dexamethasone group received 20 mL bupivacaine 0.5% + 2 mL dexamethasone (8 mg). Measurements included onset and duration of sensory blockade, visual analog score, time to first analgesic requirement, analgesic consumption, satisfaction score and assessment of quadriceps strength.

RESULTS:
Duration of sensory block was significantly longer in the dexamethasone group (17.42 ± 5.24 h) than the control group (12.52 ± 1.16 h), p < 0.001. The visual analog score was significantly lower (p < 0.05) in the dexamethasone group. Time to first analgesic requirement was significantly longer in the dexamethasone group (13.37 ± 3.68 h) compared with the control group (10.57 ± 0.93 h), p < 0.001. Ketorolac dose as a rescue analgesic was significantly higher in the control group (p < 0.001), whereas patients' satisfaction score was significantly higher in the dexamethasone group (p < 0.001).

CONCLUSION:
The addition of dexamethasone to bupivacaine in adductor canal block provides prolonged postoperative analgesia and less postoperative analgesic consumption than bupivacaine alone in anterior cruciate ligament arthroscopic surgery.

SIGNIFICANCE:
Adding dexamethasone to bupivacaine in adductor canal block significantly increases the duration of sensory block, time to first analgesic requirement and patients' satisfaction score in anterior cruciate ligament arthroscopic surgery.

Author Info:
1
Anesthesia Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Orthopedic Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ibrahim NM(1), Abdelhameed KM(1), Kamal SMM(2), Khedr EMH(3), Kotb HIM(1).

Title:
Effect of Transcranial Direct Current Stimulation of the Motor Cortex on Visceral Pain in Patients with Hepatocellular Carcinoma

Abstract:
OBJECTIVE:
Hepatocellular carcinoma (HCC) is frequently associated with visceral pain. Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain; however, its effectiveness in malignant visceral pain is unknown. This study aimed to investigate the effects of tDCS in patients with visceral pain due to HCC.

DESIGN:
This is a randomized, sham-controlled, double-blind, prospective study. Forty patients with visceral pain due to HCC were enrolled and randomly assigned into two groups: a real and a sham group; tDCS was applied over the primary motor area (M1) for 10 consecutive days (2 mA, 30 minutes). Patient's pain was evaluated by visual analog scale (VAS) and verbal descriptor scale (VDS) and for depression by Hamilton rating scale (HAM-D). Evaluation was done at prestimulation, after the first, fifth, and 10th sessions, and one month after the end of stimulation sessions.

RESULTS:
Real tDCS showed a reduction of VDS (P = 0.001, F = 4.01) and VAS (P = 0.001, F = 6.817) for HAM-D (P = 0.012, F = 5,077); the effect started from the fifth session and continued to one month after stimulation, while in the sham group the effect persisted for five days only. Percentage reduction in all scales in the real group after the 10th session was as follows: VDS P = 0.008, VAS P = 0.001, HAM-D = 0.001; for one month after the end of stimulation, it was as follows: VDS P = 0.001, VAS P = 0.037, HAM-D = 0.002.

CONCLUSIONS:
tDCS proved to be an effective and clinically relevant therapeutic strategy for visceral pain due to HCC.

Author Info:
1
Faculty of Medicine, Anesthesia, Intensive Care and Pain Management, Assiut Universiy, Assiut, Egypt.
2
Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Faculty of Medicine, Neurology department, Assiut University, Assiut, Egypt.


Authors:
Ibrahim WH(1), Ahmad AB(2), Sayed NG(3).

Title:
Association Of Serum Fibroblast Growth Factor-23 With ‎Doppler Pulse Wave Velocity In Hemodialysis Patients

Abstract:
Association Of Serum Fibroblast Growth Factor-23 With ‎Doppler Pulse Wave Velocity In Hemodialysis Patients

Author Info:
1
Department of Internal Medicine, Nephrology Unit, Assiut University Hospital, Assiut, Egypt.
2
Department of Internal Medicine, Cardiology and Critical Care Unit, Assiut University Hospital, Assiut, Egypt.
3
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Authors:
Iews M(1), Tan J(2), Taskin O(2), Alfaraj S(2), AbdelHafez FF(3), Abdellah AH(4), Bedaiwy MA(5).

Title:
Does Preimplantation Genetic Diagnosis Improve ‎Reproductive Outcome In Couples With Recurrent ‎Pregnancy Loss Owing To Structural Chromosomal ‎Rearrangement? A Systematic Review

Abstract:
Recurrent pregnancy loss (RPL) is a common, yet elusive, complication of pregnancy. Among couples at high risk of RPL, such as those carrying a structural chromosomal rearrangement, preimplantation genetic diagnosis (PGD) has been proposed as a tool to improve live birth rates and reduce the incidence of miscarriage; however, no clear consensus has been reached on its benefits in this population. This systematic review summarizes existing published research on the effect of PGD on pregnancy outcomes among carriers of chromosomal abnormalities with RPL. A comprehensive search of common databases was conducted, which yielded 20 studies. Meta-analysis was precluded owing to significant heterogeneity between studies. The primary outcome of interest was live birth rate (LBR), and a pooled total of 847 couples who conceived naturally had a LBR ranging from 25-71% compared with 26.7-87% among 562 couples who underwent IVF and PGD. Limitations of the study include lack of large comparative or randomized control studies. Patients experiencing RPL with structural chromosomal rearrangement should be counselled that good reproductive outcomes can be achieved through natural conception, and that IVF-PGD should not be offered first-line, given the unproven benefits, additional cost and potential complications associated with assisted reproductive technology.

Author Info:
1
Department of Obstetrics and Gynecology, The University of British Columbia, D415A-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; Department of Obstetrics and Gynecology, South Valley University, 83523 Qena, Egypt.
2
Department of Obstetrics and Gynecology, The University of British Columbia, D415A-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
3
Department of Obstetrics and Gynecology, Assiut University, Kornish Al Ibrahimeya, Al Walideyah Al Qebleyah, Qesm Than Asyut, Assiut Governorate, Egypt.
4
Department of Obstetrics and Gynecology, South Valley University, 83523 Qena, Egypt.
5
Department of Obstetrics and Gynecology, The University of British Columbia, D415A-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. Electronic address: mohamed.bedaiwy@cw.bc.ca.


Authors:
Ismail AM(1), Abbas AM(1), Ali MK(1), Amin AF(1)

Title:
Peri-Conceptional Progesterone Treatment In Women With Unexplained Recurrent Miscarriage: A Randomized Double-Blind Placebo-Controlled Trial

Abstract:
OBJECTIVE:
The current study aims to evaluate the effect of peri-conceptional progesterone started early in the luteal phase before confirmation of pregnancy in preventing miscarriage in women with history of unexplained recurrent miscarriage (RM).

MATERIALS AND METHODS:
The current study was a randomized double-blind controlled trial (NCT01608347) conducted at Assiut Women's Health Hospital from 2012 through 2015 included patients of unexplained RM. Participants were randomly assigned to receive either 400 mg progesterone pessaries or placebo twice daily, started in the luteal phase and continued after a positive pregnancy test till 28 weeks of gestation. The main study outcome was the miscarriage rate.

RESULTS:
Seven hundred women were enrolled (n = 350 in each group). The miscarriage rate was significantly lower in progesterone group (12.4 versus 23.3% in the placebo group, p = 0.001). There was significant improvement in rate of pregnancy continuation beyond 20 weeks as well as the live birth rate in the progesterone group in comparison to placebo group (87.6 versus 76.7% and 91.6 versus 77.4%, respectively, p < 0.05).

CONCLUSIONS:
Progesterone is more effective than placebo in reducing the risk of miscarriage if administered in the luteal phase of the cycle, before confirmation of pregnancy in women with history of unexplained RM.

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


Authors:
Jia F(1), Shan L(1), Wang B(1), Li H(1), Miao C(1), Xu Z(2), Lin CP(3), Saad K(4).

Title:
Bench To Bedside Review: Possible Role Of Vitamin D In Autism Spectrum Disorder

Abstract:
Autism spectrum disorder (ASD) is a group of dysfunctions in social interaction, communication, and behaviors. Studies have demonstrated that vitamin D deficiency during pregnancy and in individuals increased the risk of ASD. A genetic polymorphism study has pinpointed that genotype AA/A-allele of GC rs4588 in children is associated with ASD, which encodes the vitamin D binding protein. Translating the mentioned points into clinical practice, several clinical trials have demonstrated that vitamin D supplementation can improve the core symptoms in children with ASD. One paper also showed that possible prophylactic effect for the reoccurrence of ASD by vitamin D supplement during pregnancy and early childhood. Herein, this review aims to address the recent advances in this field and to clarify the possible role of vitamin D in ASD.

Author Info:
1
Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, China.
2
Department of Psychiatry, University Medical Center Utrecht, Netherlands.
3
Neurological Research Center of First Hospital of Jilin University, Changchun, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
4
Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, China; Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: ksaad8@yahoo.com.


Title:
Fluctuations In Clinical Symptoms With Changes In Serum 25(OH) Vitamin D Levels In Autistic Children: Three Cases Report

Abstract:
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complicated interactions between genetic and environmental factors. Clinical trials, including case reports, case-control studies, and a double-blinded randomized clinical study, have suggested that high-dose vitamin D3 regimens may ameliorate the core symptoms of ASD. Vitamin D3 supplementation was effective in about three-quarters of children with ASD. To further investigate the relationship between vitamin D and ASD symptoms in vitamin D-responsive autistic children, changes in symptoms were assessed in three children with ASD who were given vitamin D3 supplementation followed by a long interruption. The core symptoms of ASD were remarkably improved during the vitamin D3 supplementation period when serum 25-hydroxyvitamin D [25(OH)]D levels reached over 40.0 ng/mL. However, symptoms reappeared after the supplementation was stopped, when serum 25(OH)D levels fell below 30.0 ng/mL but were again improved with re-administration of vitamin D3 after the interruption, when serum 25(OH)D levels exceeded 40.0 ng/mL. Overall, these results showed that the core symptoms of ASD fluctuated in severity with changes in serum 25(OH)D levels in children, indicating that maintaining a responsive 25(OH)D level is important for treating ASD. Maintaining a serum 25(OH)D level between 40.0 and 100.0 ng/ml may be optimal for producing therapeutic effects in vitamin D-responsive individuals with ASD.

Author Info:
1
a Department of Developmental and Behavioral Pediatrics , The First Hospital of Jilin University , Changchun 130021 , People's Republic of China.
2
b Institute of Pediatrics of First Hospital of Jilin University , Changchun 130021 , People's Republic of China.
3
c Neurological Research Center of First Hospital of Jilin University , Changchun 130021 , People's Republic of China.
4
d Department of Psychiatry , University Medical Center Utrecht , Netherlands.
5
e Pediatric Department, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Kamel AM(1), Gameel A(2), Ebid GTA(2), Radwan ER(3), Mohammed Saleh MF(4), Abdelfattah R(5).

Title:
The Impact Of Cytokine Gene Polymorphisms On The Outcome Of HLA Matched Sibling Hematopoietic Stem Cell Transplantation

Abstract:
Graft-versus-host disease (GVHD) is the major complication of allogeneic hematopoietic stem cell transplantation (HSCT); cytokines are recognized as important mediators in its pathogenesis. In this study we investigated the role of cytokine gene polymorphisms on HSCT outcome. A total of 106 patient and 98 donors were genotyped by polymerase chain reaction sequence specific primers (PCR-SSP) based assay for tumor necrosis factor-α-308 (TNFα -308), interleukin (IL)-6-174, IL-10-1082, -819, -592, Interferon-γ+874 (IFN-γ+874), and transforming growth factor-β1 (TGF-β1) codon10 and 25 polymorphisms. Except one in each category, all patients and donors were TNFα -308 high producers and the majority were IL-6-174 high producers (93.3% and 90.8% respectively); a pattern that would alleviate any potential biological impact. Patient's IFN-γ+874 showed significant association with the development of chronic GVHD. Patients with IFN-γ +874 high producer showed an 8 folds likelihood to develop chronic GVHD as compared to those with IFN-γ+874 low producer predicted phenotype (95% CI: 1.59-40.2, p = 0.01). Patient's TGFβ1-codon 10 and 25 high/intermediate producers showed a lower incidence of acute GVHD though it did not achieve statistical significance (p = 0.065) on account of the low frequency of this genotype in our patients and donors (11.4 and 8.2% respectively). Other factors contributing to risk of GVHD included older age for both acute and chronic (p = 0.01 and 0.02 respectively) with age 24 as the best discriminating cutoff; CD34+ cell dose for chronic GVHD (p = 0.045) with a dose of 8 × 106/kg as the best discriminating cutoff; and conditioning regimen with Flu/Bu associated with the lowest incidence of acute GVHD (p = 0.003) and no impact on chronic GVHD. In conclusion the current study further indicates a potential role of some cytokine gene polymorphisms in the development of GVHD. The relative distribution of high and low producer genotypes in different ethnic groups contributes to their biological impact in different populations.

Author Info:
1
Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. Electronic address: Azza.kamel@nci.cu.edu.eg.
2
Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
3
Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
4
Clinical Hematology Unit, Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt; Bone Marrow Transplantation Unit, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt.


Authors:
Kamel EZ(1), Abd-Elshafy SK(1), Sayed JA(1), Mostafa MM(2), Seddik MI(3).

Title:
Pain Alleviation In Patients Undergoing Cardiac Surgery; Presternal Local Anesthetic And Magnesium Infiltration Versus Conventional Intravenous Analgesia: A Randomized Double-Blind Study

Abstract:
BACKGROUND:
Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery.

METHODS:
Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain.

RESULTS:
VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3.

CONCLUSIONS:
Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Author Info:
1
Department of Anesthesia, ICU, and Pain, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Cardiothoracic, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khaleel EF(1),(2), Abdel-Aleem GA(3),(4), Mostafa DG(2),(5).

Title:
Resveratrol Improves High-Fat Diet Induced Fatty Liver And Insulin Resistance By Concomitantly Inhibiting Proteolytic Cleavage Of Sterol Regulatory Element-Binding Proteins, Free Fatty Acid Oxidation, And Intestinal Triglyceride Absorption

Abstract:
Resveratrol (RES) has the ability to ameliorate nonalcoholic fatty liver disease (NAFLD) and the mechanism remains unclear. Hence, using high-fat diet (HFD) obese rat model, we investigated the effect of a low dose of RES (20 mg/kg) on the hepatic sterol regulatory element-binding protein (SREBPs) - lipogenesis pathway, enzymes involved in β-oxidation and activity of pancreatic lipase. Four groups of rats (n = 8) of control (12% of calories as fat) and HFD (40% of calories as fat) were administered orally with either normal saline as a vehicle or RES as a concomitant treatment for 8 weeks on a daily basis. Then, various biochemical, histological, and molecular experiments were carried out. RES prevented the development and progression of NAFLD and significantly improved insulin sensitivity through (1) inhibiting the proteolytic cleavage of SREBPs-1 and SREBPs-2 without affecting their precursor mRNA or protein levels, (2) inhibiting free fatty acid β-oxidation and generation of reactive oxygen species through significant inhibition of CPT-1 and UCP-2, and (3) decreasing activity of pancreatic lipase in vivo and in vitro. In conclusion, our findings are the first in the literature to show new mechanisms of the hepatoprotective effect of RES against HFD induced NAFLD in rats.

Author Info:
1
a Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
2
b Department of Medical Physiology, College of Medicine, King Khalid University, P.O. Box 3340, Abha 61421, Saudi Arabia.
3
c Department of Medical Biochemistry, Faculty of Medicine, Tanta University, Tanta, Egypt.
4
d Department of Medical Biochemistry, College of Medicine, King Khalid University, P.O. Box 3340, Abha 61421, Saudi Arabia.
5
e Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khedr EM(1), Abo El-Fetoh N(2), El-Hammady DH(3), Ghandour AM(4), Osama K(2), Zaki AF(5), Gamea A(5).

Title:
Prognostic Role Of Neurophysiological Testing 3-7 Days After Onset Of Acute Unilateral Bell's Palsy

Abstract:
OBJECTIVE:
Recovery from acute Bell's palsy (BP) is variable and there are few predictors of response. We evaluated the usefulness of a range of neurophysiological parameters to predict outcome in BP.

METHODS:
Fifty-nine patients (age: 33.7±15.4 years) with acute unilateral BP were recruited within 3-7 days of onset. They were evaluated with electroneurography, facial nerve excitability, and the blink reflex. House-Brackmann (HB) clinical scores were obtained at the same time and three months later. All patients received prednisolone treatment and regular rehabilitation.

RESULTS:
At three months, 41 patients (69.5%) had good recovery, while 18 patients (30.5%) had poor recovery according to the HB scale. The facial nerve excitability threshold and threshold difference between sides were significantly lower in patients with good recovery than those with poor recovery (P values=0.022 and 0.006 respectively). Facial nerve degeneration rate (1 - affected/unaffected amplitude of CMAP of muscle ×100%) recorded in frontalis (P=0.002) and orbicularis oris (P=0.038) were also smaller in good recovery than poor recovery patients. There were no differences in latency and amplitude of CMAPs recorded from frontalis or orbicularis oris muscle, nor in latencies of the components of the blink reflex. ROC analysis showed that patients who had a threshold side difference <13mA (35 cases), had a higher chance of good recovery (85.7% versus 14.3% poor recovery). Patients who had a degeneration rate<50% (38 cases) also had a higher chance of good recovery (78.9%) versus 21.1% who had poor recovery, while patients with a degeneration rate>50% (21 cases) had a 47.8% chance of good recovery versus 52.2% poor recovery (P=0.004). Logistic regression analysis showed that the most significant predictive indicator of BP recovery was the facial nerve degeneration rate of frontalis muscle (P=0.011).

CONCLUSION:
Facial nerve degeneration rate of frontalis muscle provides the most sensitive prognostic indicator of recovery from acute BP and may provide useful management strategies.

Author Info:
1
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Helwan University, Cairo, Egypt.
4
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Neuropsychiatry, Faculty of Medicine, South Valley University, Egypt.


Authors:
Khojah HM(1), Ahmed S(2),(3), Abdel-Rahman MS(4), Elhakeim EH(5).

Title:
Resveratrol As An Effective Adjuvant Therapy In The Management Of Rheumatoid Arthritis: A Clinical Study

Abstract:
Resveratrol (RSV), a naturally occurring polyphenol, has been found to have potent antioxidant, anti-inflammatory, and anticancer effects. Recently, RSV was reported as a new potential agent to suppress inflammation of collagen-induced arthritis in a mouse model. Nevertheless, the clinical benefits of RSV in the management of rheumatoid arthritis (RA) were not studied. This randomized controlled clinical trial aims to shed some light on the therapeutic benefits of RSV in the treatment of RA in patients with different stages of the disease activity. In this randomized controlled clinical trial, 100 RA patients (68 female, 32 male) were enrolled randomly and divided into two groups, each of 50 patients: an RSV-treated group that received a daily RSV capsule of 1 g with the conventional treatment for 3 months and a control group that just received the regular treatment. The clinical and biochemical markers of RA in both groups were assessed. It was found that the clinical markers (i.e., the 28-joint count for swelling and tenderness) and the disease activity score assessment for 28 joints were significantly lowered in the RSV-treated group. Moreover, serum levels of certain biochemical markers (i.e., C-reactive protein, erythrocyte sedimentation rate, undercarboxylated osteocalcin, matrix metalloproteinase-3, tumor necrosis factor alpha, and interleukin-6) were also significantly decreased in RSV-treated patients. The current study suggests the addition of RSV as an adjuvant to the conventional antirheumatic drugs.

Author Info:
1
Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Medina, Saudi Arabia. hkhojah@taibahu.edu.sa.
2
Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Medina, Saudi Arabia.
3
Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
4
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Kotb AM(1), Abd-Elkareem M(2), Abou Khalil NS(3), Sayed AEH(4).

Title:
Protective Effect Of Nigella Sativa On 4-Nonylphenol-Induced Nephrotoxicity In Clarias Gariepinus (Burchell, 1822)

Abstract:
The aim of this study was to examine the protective effects of Nigella sativa (N. sativa) on 4-Nonylphenol-induced nephrotoxicity in Clarias gariepinus. 30 fishes were divided into five groups: control, 4-nonylphenol-treated, 1% N. sativa treated, 2.5% N. sativa treated, and 5% N. sativa treated. N. sativa and 4-Nonylphenol were given for 3weeks. 4-NP and 4-NP-N. sativa treated fishes were compared with the control group. Kidney histology, immunochemistry, and electron microscope were assessed after 4-NP exposure. In the African catfish, 4-NP is mainly excreted through the kidney causing nephrotoxicity. Our results showed that 4-NP administration significantly disturbed the kidney structure and function. 4-NP treated fishes showed dilated glomerular vessels, fewer glomerular cells content, decreased expressions of glomerular proteins, and increased level of autophagy compared to control group (P<0.05). As N. sativa has different immunological and pharmacological effects such as anti-apoptotic and anti-oxidant, therefore, the administration of N. sativa with 4-Nonylphenol significantly minimize the nephrotoxic effect of 4-NP and maintain the normal kidney structure and function. Our novel study demonstrated for the first time that N. sativa could protect the kidney against 4-NP induced-nephrotoxicity.

Author Info:
1
Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, 71516 Assiut, Egypt; Institute of Anatomy and Cell Biology, University Medicine Greifswald, 17489 Greifswald, Germany.
2
Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, 71516 Assiut, Egypt.
3
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Zoology department, Faculty of Science, Assiut University, 71516 Assiut, Egypt; Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277-8562, Japan. Electronic address: alaasayed@aun.edu.eg.


Authors:
Lu Y(1),(2), Kamel-El Sayed SA(1),(3),(4), Wang K(1), Tiede-Lewis LM(1), Grillo MA(1), Veno PA(1), Dusevich V(1), Phillips CL(5), Bonewald LF(1),(6), Dallas SL(1).

Title:
Live Imaging of Type I Collagen Assembly Dynamics in Osteoblasts Stably Expressing GFP and mCherry-Tagged Collagen Constructs

Abstract:
Type I collagen is the most abundant extracellular matrix protein in bone and other connective tissues and plays key roles in normal and pathological bone formation as well as in connective tissue disorders and fibrosis. Although much is known about the collagen biosynthetic pathway and its regulatory steps, the mechanisms by which it is assembled extracellularly are less clear. We have generated GFPtpz and mCherry-tagged collagen fusion constructs for live imaging of type I collagen assembly by replacing the α2(I)-procollagen N-terminal propeptide with GFPtpz or mCherry. These novel imaging probes were stably transfected into MLO-A5 osteoblast-like cells and fibronectin-null mouse embryonic fibroblasts (FN-null-MEFs) and used for imaging type I collagen assembly dynamics and its dependence on fibronectin. Both fusion proteins co-precipitated with α1(I)-collagen and remained intracellular without ascorbate but were assembled into α1(I) collagen-containing extracellular fibrils in the presence of ascorbate. Immunogold-EM confirmed their ultrastuctural localization in banded collagen fibrils. Live cell imaging in stably transfected MLO-A5 cells revealed the highly dynamic nature of collagen assembly and showed that during assembly the fibril networks are continually stretched and contracted due to the underlying cell motion. We also observed that cell-generated forces can physically reshape the collagen fibrils. Using co-cultures of mCherry- and GFPtpz-collagen expressing cells, we show that multiple cells contribute collagen to form collagen fiber bundles. Immuno-EM further showed that individual collagen fibrils can receive contributions of collagen from more than one cell. Live cell imaging in FN-null-MEFs expressing GFPtpz-collagen showed that collagen assembly was both dependent upon and dynamically integrated with fibronectin assembly. These GFP-collagen fusion constructs provide a powerful tool for imaging collagen in living cells and have revealed novel and fundamental insights into the dynamic mechanisms for the extracellular assembly of collagen.

Author Info:
1
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, Kansas City, Kansas City, MO, USA.
2
Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX, USA.
3
Biomedical Sciences Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
4
Medical Physiology Department, Assiut University School of Medicine, Asyut, Egypt.
5
Departments of Biochemistry and Child Health, University of Missouri, Columbia, Columbia, MO, USA.
6
Departments of Anatomy and Cell Biology and Orthopaedic Surgery, Indiana University, Indianapolis, IN, USA.


Authors:
Lunsford KE(1), Javle M(2), Heyne K(3), Shroff RT(2), Abdel-Wahab R(4), Gupta N(5), Mobley CM(1), Saharia A(1), Victor DW(1), Nguyen DT(6), Graviss EA(6), Kaseb AO(2), McFadden RS(1), Aloia TA(7), Conrad C(7), Li XC1, Monsour HP(1), Gaber AO1, Vauthey JN(

Title:
Liver Transplantation For Locally Advanced Intrahepatic Cholangiocarcinoma Treated With Neoadjuvant Therapy: A Prospective Case-Series

Abstract:
BACKGROUND:
At present, intrahepatic cholangiocarcinoma is a contraindication for liver transplantation. However, previous studies in this field did not preselect patients on the basis of chemosensitivity or disease trajectory after neoadjuvant therapy. Experience with hilar cholangiocarcinoma has indicated that neoadjuvant therapy followed by liver transplantation in patients without disease progression results in a long-term survival benefit. We aimed to establish the potential efficacy of liver transplantation in patients with biologically responsive intrahepatic cholangiocarcinoma who have had sustained tumour stability or regression with neoadjuvant therapy.

METHODS:
In this prospective case-series, patients with locally advanced, unresectable intrahepatic cholangiocarcinoma, without extrahepatic disease or vascular involvement, were treated at a single liver transplant centre according to a non-randomised, centre-approved clinical management protocol with neoadjuvant chemotherapy followed by liver transplantation. Neoadjuvant therapy consisted of gemcitabine-based chemotherapy, such as gemcitabine-cisplatin or gemcitabine-capecitabine, with second-line or third-line therapies given per institutional standards. Patients with a minimum of 6 months of radiographic response or stability were listed for liver transplantation. The primary endpoints were overall survival and recurrence-free survival after liver transplantation, assessed with Kaplan-Meier analysis. This report includes interim data from the initial case-series treated under this ongoing clinical management protocol, censored on Dec 1, 2017.

FINDINGS:
Between Jan 1, 2010, and Dec 1, 2017, 21 patients were referred for evaluation and 12 patients were accepted, of whom six patients have undergone liver transplantation for intrahepatic cholangiocarcinoma. Three patients received livers from extended criteria deceased donors that would otherwise have been discarded, two from domino living donors, and one from a standard criteria liver donor. Median duration from diagnosis to transplantation was 26 months (IQR 17-33) and median follow-up from transplantation was 36 months (29-51). All patients received neoadjuvant chemotherapy while awaiting liver transplantation. Overall survival was 100% (95% CI 100-100) at 1 year, 83·3% (27·3-97·5) at 3 years, and 83·3% (27·3-97·5) at 5 years. Three patients developed recurrent disease at a median of 7·6 months (IQR 5·8-8·6) after transplantation, with 50% (95% CI 11·1-80·4) recurrence-free survival at 1, 3, and 5 years. Adverse events after liver transplantation included one patient with postoperative ileus (grade 3) and one patient with acute kidney injury requiring temporary dialysis (grade 4).

INTERPRETATION:
Selected patients with locally advanced intrahepatic cholangiocarcinoma who show pre-transplant disease stability on neoadjuvant therapy might benefit from liver transplantation.

FUNDING:
None.

Author Info:
1
J C Walter Jr Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston Methodist Hospital and Research Institute, Houston, TX, USA.
2
Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
3
Department of Oncology, Houston Methodist Hospital, Houston, TX, USA.
4
Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology, Assiut University, Assiut, Egypt.
5
Department of Radiology, Houston Methodist Hospital, Houston, TX, USA.
6
Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Research Institute, Houston, TX, USA.
7
Hepato-Pancreato-Biliary Section, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
8
J C Walter Jr Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston Methodist Hospital and Research Institute, Houston, TX, USA. Electronic address: rmghobrial@houstonmethodist.org


Authors:
Mahmoud O(1), Vikatmaa P(2), Räsänen J(3), Peltola E(4), Sihvo E(5), Vikatmaa L(6), Lappalainen K(4), Venermo M(7).

Title:
Catheter-Directed Thrombolysis Versus Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: A Cost-Effectiveness Analysis

Abstract:
BACKGROUND:
Upper extremity deep vein thrombosis represents (UEDVT) 2-3% of all deep vein thrombosis. Catheter directed thrombolysis (CDT) was replaced largely by pharmacomechanical thrombolysis (PMT) in our institution. In this study we compared the immediate and 1-year results as well as the total hospital costs between CDT and PMT in the treatment of UEDVT.

METHODS:
From 2006 to 2013, 55 patients with UEDVT were treated with either CDT or PMT at Helsinki University Hospital. Of them, 43 underwent thoracoscopic rib resection later to relieve phlebography-confirmed vein compression. This patient cohort was prospectively followed up with repeated phlebographies. CDT was performed to 24 patients, and 19 had PMT with a Trellis™ device. Clinical evaluation and vein patency assessment were performed with either phlebography or ultrasound 1 year after the thrombolysis. Primary outcomes were immediate technical success, 1-year vein patency, and costs of the initial treatment.

RESULTS:
The immediate overall technical success rate, defined as recanalization of the occluded vein and removal of the fresh thrombus, was 91.7% in the CDT group and 100% in the PMT group (n.s.). The median thrombolytic time was significantly longer in CDT patients than that in PMT patients (21.1 vs. 0.33 hr, P < 0.00001). There were no procedure-related complications. The 1-year primary assisted patency rate was similar in both the groups (91.7% and 94.7%). There were no recurrences of clinical DVT. The hospital costs for the acute period were significantly lower in the PMT group than those in the CDT group (medians: 11,476 € and 5,975 € in the CDT and PMT groups, respectively [P < 0.00001]).

CONCLUSIONS:
The clinical results of the treatment of UEDVT with CDT or PMT were similar. However, PMT required shorter hospital stay and less intensive surveillance, leading to lower total costs.

Author Info:
1
Department of Vascular Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Vascular Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Vascular Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
3
Department of General Thoracic and Esophageal Surgery, Heart and Lung Centre, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
4
Department of Radiology, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Finland.
5
Department of Surgery, Central Finland Central Hospital, Finland and University of Helsinki, Jyväskylä, Finland.
6
Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
7
Department of Vascular Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: maarit.venermo@hus.fi.


Authors:
Mahmoud O(1), Sihvo E(2), Räsänen J(3), Vikatmaa L(4), Vikatmaa P(5), Venermo M(6)

Title:
Treatment Of Paget-Schroetter Syndrome With A Three-Stage Approach Including Thoracoscopic Rib Resection At The Second Stage

Abstract:
OBJECTIVE:
Young, active persons may suffer lifelong consequences of subclavian vein thrombosis, but the best treatment options remain unclear. On introduction of more active pharmacomechanical thrombus removal and thoracoscopic rib resection in our institution, we planned a diagnostic and treatment protocol and aimed to analyze the early, midterm, and intermediate-term results.

METHODS:
The study included 72 patients who were diagnosed with an upper limb deep venous thrombosis and underwent phlebography between 2006 and 2013. After the initial treatment, control phlebography was performed and a thoracoscopic first rib resection was considered. Postoperative balloon angioplasty was performed when appropriate, and 1-year follow-up phlebography was carried out.

RESULTS:
After the initial thrombus removal, 60 patients were treated with thoracoscopic first rib resection and subsequent phlebography with or without balloon angioplasty. The median time from symptom to surgery was 124 days, and six (10%) patients had a reocclusion before surgery. Ten (16.7%) patients experienced complications, which were treated mainly with a chest tube (n = 3) or thoracoscopic re-exploration (n = 4). Three months after surgery, 98.3% (59/60) experienced an overall relief of symptoms. No recurrence of clinical thrombosis or residual compression due to incomplete rib resection was seen, and 96.6% (56/58) of the patients reported an overall improvement of symptoms at 13 months. Two patients (3.4%) were treated for chronic pain and had electroneuromyography-verified nerve plexus damage. In both cases, the pain was relieved in the long run.

CONCLUSIONS:
A combination of early thrombus removal, thoracoscopic first rib resection, and postoperative venous balloon angioplasty seems to yield acceptable intermediate-term results after Paget-Schroetter thrombosis.

Author Info:
1
Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Vascular Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
3
Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
4
Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
5
Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
6
Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: maarit.venermo@hus.fi.


Authors:
Mahran A(1), Turk A(2), Buzzy C(3), Wang M(4), Yang J(2), Neudecker M(5), Jaeger I(3), Ponsky LE(6).

Title:
Younger Men with Prostate Cancer have Lower Risk of Upgrading while on Active Surveillance: A Meta-analysis and Systematic Review of the Literature

Abstract:
Active surveillance (AS) has become a popular option for patients with low risk prostate cancer. Our objective was to examine the correlation between age and the risk of Gleason upgrading and biopsy progression. A systematic search was conducted. Eight studies met our eligibility criteria including 6,522 patients with median age of 65.8 (41-86) years. Per decade decrease in age, the pooled OR and HR (CI 95%) for Gleason upgrading were 0.83 (0.73-0.94) and 0.87 (0.82-0.92), and for biopsy progression were 0.80 (0.74-0.86) and 0.88 (0.79-0.99), respectively. Overall, younger patients have a lower risk of GS upgrading and biopsy progression.

Author Info:
1
Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Urology, Assiut University, Egypt.
2
Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
3
Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
4
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
5
Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
6
Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: Lee.ponsky@uhhospitals.org.


Authors:
Makhlouf HA(1), Sadek SH(1), Nafady AAH(2).

Title:
Platelet Function In Diabetic And Nondiabetic Patients With Chronic Obstructive Pulmonary Disease: A Case Control Study

Abstract:
BACKGROUND:
The effect of association between chronic obstructive pulmonary disease (COPD) and diabetes (DM) on platelet function has not been studied before.

OBJECTIVES:
To evaluate the effect of the association between COPD and DM on platelet function and C reactive protein (CRP).

PATIENTS AND METHODS:
This case control study was carried out on 110 stable COPD patients who were classified into diabetic and nondiabetic groups. In addition, 40 apparently healthy, age and sex-matched individuals were included in this study as a control group. Chest X-ray, pulmonary function testing and arterial blood gases were done for COPD patients. CRP and complete blood count (CBC) were measured in both patient and control groups.

RESULTS:
Mean platelet volume (MPV), platelet distribution width (PDW), platelet crit (PCT) and CRP were significantly higher in COPD patients either nondiabetic or diabetic compared to control group. Moreover, MPV and CRP markers were significantly higher in COPD diabetic patients compared to nondiabetic. There was no significant difference in various laboratory data among different stages of COPD either diabetic or nondiabetic (P > 0.05). In COPD patients, MPV was a significantly positively correlated with CRP and PDW (r = 0.346, P < 0.001; r = 0.510, P < 0.001, respectively) and negatively correlated with PLT count (r = -0.294, P = 0.002).

CONCLUSION:
MPV, PDW, PCT and CRP were significantly higher in COPD patients either nondiabetic or diabetic. Platelet function may be modified by the systemic inflammation that associated with COPD. Platelet activation as a prothrombotic sequence of this disease may be used as novel therapeutic target.

Author Info:
1
Department of Chest, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
2
Department of Clinical Pathology, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.


Authors:
Makhlouf NA(1), Abdel-Monem SA(1),(2), Farghaly AM(1), Helmy A(1),(3).

Title:
Attitude of Upper Egypt Health-Care Professionals Toward Living Liver Donation and Transplantation

Abstract:
BACKGROUND:
In Egypt, there is no legislation for deceased donor transplant; therefore, programs provide living donation only. One possible barrier against living liver donation may be the attitude of the health-care professional. This study aimed to (1) assess the level of knowledge and attitude toward liver donation and transplantation among health-care professional in an University Hospital in Upper Egypt and (2) analyze the variables that affect such an attitude.

MATERIALS AND METHODS:
This was a cross-sectional survey study with 300 health-care professionals.

RESULTS:
The mean (standard deviation) age was 27.4 (5.3) years. Two hundred (66.7%) were females, and 257 (85.7%) were Muslims. A total of 222 (74%) were residents in University Hospitals. Of the sample, 104 (34.7%) would donate a living liver part, 122 (40.7%) discussed the matter of organ donation and transplantation with their family, and 134 (44.7%) did not discuss this issue with their family. About 40% knew the attitude of their religion toward organ donation. Most (94.7%) health professionals were <40 years and did not know the attitude of their religion toward this issue. Single persons had more correct information regarding living organ donation and transplantation. More Muslims know the attitude of their religion toward living organ donation and transplantation.

CONCLUSIONS:
Independent predictors of accepting living liver donation are being younger, knowledge of religion attitude, and media coverage satisfaction ( P = 0.006, odd ratio [OR] = 0.2; P = 0.000, OR = 0.39; and P = 0.016; OR = 0.38).

Author Info:
1
1 Faculty of Medicine, Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
2
2 Faculty of Medicine, South Valley University, Qena, Egypt.
3
3 Department of Internal Medicine, College of Medicine, Aljouf University, Aljouf, Saudi Arabia.


Authors:
Mann DG(1), Nassr AA(2),(3), Whitehead WE(4), Espinoza J(2), Belfort MA(2), Shamshirsaz AA(2).

Title:
Fetal Bradycardia Associated With Maternal Hypothermia After Fetoscopic Repair Of Neural Tube Defect

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


Authors:
Mekky MA(1), Riad AR(2), Gaber MA(3), Abdel-Malek MO(2), Swifee YM(2).

Title:
Rifaximin Versus Metronidazole In Management Of Acute Episode Of Hepatic Encephalopathy: An Open Labeled Randomized Clinical Trial

Abstract:
BACKGROUND AND STUDY AIMS:
Many regimens are tried in managing overt hepatic encephalopathy (HE). We investigated the efficacy of rifaximin versus metronidazole in management of an acute episode of HE on top of cirrhosis.

PATIENTS AND METHODS:
An open label prospective controlled trial was conducted on patients with an acute episode of HE on top of cirrhosis who were randomly divided into metronidazole-group (M-group) and rifaximin-group (R-group) with 60 patients in each. The main outcome measure was the clinical improvement of HE, duration of hospital stay and the changes in the level of serum ammonia after 3 days of starting therapy.

RESULTS:
Both M-group and R-group were comparable as regards age and sex (mean age 51 ± 11 years and 49 ± 12; male/female ratio 45:15 and 50:10, respectively). Forty-six patients (76.7%) in M-group compared with forty-five (75%) in R-group showed clinical improvement (p = 0.412). Hospital stays were comparable between both group; 4.2 ± 2.1 and 3.9 ± 1.7 for M-group and R-group; respectively (p = 0.435). There was no significant difference of venous ammonia levels (Mean of delta 160.77 ± 185.34 µg/dL and 207.95 ± 218.43 µg/dL with p 0.664 and 0.974 in M-group and R-group, respectively). No adverse events were reported throughout the whole study.

CONCLUSION:
Rifaximin and metronidazole are equally effective in management of acute episode of overt HE, therefore, re-auditing of treatment protocols of HE are warranted especially in limited resource settings.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515 Egypt. Electronic address: mmekky75@yahoo.com.
2
Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515 Egypt.
3
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut 71515 Egypt.


Authors:
Mekky MA(1), Salama RH(2), Abdel-Aal MF(1), Ghaliony MA(1), Zaky S(1).

Title:
Studying The Frequency Of Aberrant DNA Methylation Of APC, P14, And E-Cadherin Genes In HCV-Related Hepatocarcinogenesis

Abstract:
BACKGROUND:
Data about the molecular pathogenesis of hepatitis C-related hepatocellular carcinoma (HCC) are still challenging.

OBJECTIVES:
Therefore, we tried to investigate the epigenetic study of three nominated genes (APC, P14, and E-cadherin) in the pathogenesis of HCV-related HCC in Egyptian.

METHODS:
Between March 2016 and March 2017, the DNA methylation, and quantification using (epigenetic ELISA kit) for E-cadherin, APC, and P14 genes were studied in three groups of patients: HCV related liver cirrhosis without HCC group (LC-group; n= 20), HCC on top of HCV-related cirrhosis (HCC-group; n= 20), and a third apparently healthy control group (control-group; n= 10).

RESULTS:
E-cad methylation showed non-significant differences between groups. P14 methylation was occurred only in HCC-group (45%). APC methylation was the highest in HCC group (70%). Methylation level was high in HCC group in comparison to both LC and control groups (P< 0.001). DNA methylation at a cutoff point > 2.9 ng/ml predicts HCC in LC-group with 90% sensitivity and 80% specificity and at level > 2.3 ng/ml had 95% sensitivity and 90% specificity in control-group. The pooled sensitivity, specificity, positive and negative predictive values and accuracy were 90%, 60%, 69.2, 85.7 and 75% respectively.

CONCLUSION:
Aberrant DNA methylation of multiple genes is associated with disease progression in HCV related cirrhosis. Moreover, early detection of promotor methylation of these may sever as good biomarker for early detection and therapeutic targets in high risk patients.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Metwalley KA(1), Hamed SA(2), Farghaly HS(3).

Title:
Cardiac Autonomic Function In Children With Type 1 Diabetes

Abstract:
Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D). This study aimed to evaluate cardiac autonomic nervous system (ANS) function in children with T1D and its relation to different demographic, clinical and laboratory variable. This cross-sectional study included 60 children with T1D (mean age = 15.1 ± 3.3 years; duration of diabetes = 7.95 ± 3.83 years). The following 8 non-invasive autonomic testing were used for evaluation: heart rate at rest and in response to active standing (30:15 ratio), deep breathing and Valsalva maneuver (indicating parasympathetic function); blood pressure response to standing (orthostatic hypotension or OH), sustained handgrip and cold; and heart rate response to standing or positional orthostatic tachycardia syndrome or POTs (indicating sympathetic function). None had clinically manifest CAN. Compared to healthy children (5%), 36.67% of children with T1D had ≥ 2 abnormal tests (i.e., CAN) (P = 0.0001) which included significantly abnormal heart rate response to standing (POTs) (P = 0.052), active standing (30:15 ratio) (P = 0.0001) and Valsalva maneuver (P = 0.0001), indicating parasympathetic autonomic dysfunction, and blood pressure response to cold (P = 0.01), indicating sympathetic autonomic dysfunction. 54.55, 27.27 and 18.18% had early, definite and severe dysfunction of ANS. All patients had sensorimotor peripheral neuropathy. The longer duration of diabetes (> 5 years), presence of diabetic complications and worse glycemic control were significantly associated with CAN.

CONCLUSIONS:
The study concluded that both parasympathetic and sympathetic autonomic dysfunctions are common in children with T1D particularly with longer duration of diabetes and presence of microvascular complications. What is Known: • Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D). • Limited studies evaluated CAN in children with T1D. What is New: • CAN is common in children with T1D. • Cardiac autonomic functions should be assessed in children with T1D particularly in presence of microvascular complications.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. hekmafarghly73@gmail.com.


Authors:
Metwalley KA(1), Farghaly HS(2), Abdelhamid A(3).

Title:
Left Ventricular Functions In Children With Newly Diagnosed Graves' Disease. A Single-Center Study From Upper Egypt

Abstract:
This study aimed to evaluate the left ventricular (LV) functions in a cohort of children with Graves' disease (GD). This is a cross-sectional case-control study. It included 36 children with GD and 36 healthy children matched for age and gender. Thyroid hormones (TSH, FT4, and FT3) and anti-thyroid autoantibodies [anti-thyroid peroxidase (anti-TPO), thyrotropin receptor (TRAbs), and thyroglobulin antibodies] were measured. Conventional and tissue Doppler imaging (TDI) echocardiographies were used to assess left ventricular systolic and diastolic functions. LV mass index (LVMI) and myocardial performance index (MPI) were also measured. Compared to healthy children, conventional echocardiography of patients with GD revealed higher LVMI (P = 0.001) indicating LV hypertrophy but normal LV functions while TDI revealed lower Em/Am ratio indicating LV diastolic dysfunction (P = 0.001). Significant correlations were reported between FT4 with LVMI (P = 0.05), Em/Am (P = 0.01), and MPI (P = 0.01). In multivariate analysis, a positive correlation was identified between FT4 with MPI (OR = 1.17; 95% CI = 1.09-1.15; P = 0.001).

CONCLUSIONS:
Children with newly diagnosed GD may have significant subclinical changes in LV structure and function (diastolic and global). TDI is more sensitive than conventional Doppler in detecting LV dysfunction. These findings highlight the importance of early monitoring of children with GD for left ventricular mass index and diastolic function. What is Known: • There is an increased risk for cardiac abnormalities in children with Graves' disease (GD). • Limited studies assessed left ventricular function in patients with GD. What is New: • Children with newly diagnosed GD may have significant subclinical changes in left ventricular structure and functions. • Children with newly diagnosed GD should be monitored for left ventricular mass index and diastolic function.

Author Info:
1
Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Assiut University, Assiut, B.O 71111, Egypt. kotb72@gmail.com.
2
Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Assiut University, Assiut, B.O 71111, Egypt.
3
Department of Clinical Pathology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.


Authors:
Metwalley KA(1), Farghaly HS(2), Sherief T(3).

Title:
Plasma Adrenomedullin Level In Children With Obesity: Relationship To Left Ventricular Function

Abstract:
BACKGROUND:
Obese children are at increased risk for abnormal cardiac structure and function. Little is known about adrenomedullin (AM), a cytokine produced in various organs and tissues, as a biomarker of cardiac hypertrophy in obese children. This study aimed to assess the plasma AM levels in a cohort of obese children and its relationship to left ventricular (LV) functions.

METHODS:
The study included 60 obese children and 60 non-obese children matched for age and gender as control group. Blood pressure, serum lipid profile, fasting glucose, insulin and plasma AM and the homeostatic model assessment of insulin resistance (HOMA-IR) were measured. Cardiac dimensions and LV functions were assessed using conventional echocardiography.

RESULTS:
Compared to control subjects, obese children had higher blood pressure (P = 0.01), insulin (P = 0.001), HOMA-IR (P = 0.001), and AM (P = 0.001). Moreover, obese children had higher LV mass index (LVMI) (P = 0.001), indicating LV hypertrophy; prolonged isovolumic relaxation times (P = 0.01), prolonged mitral deceleration time (DcT) (P = 0.01) and reduced ratio of mitral E-to-mitral A-wave peak velocity (P = 0.01), indicating LV diastolic dysfunction. Laboratory abnormalities were only present in children with LV hypertrophy. In multivariate analysis in obese children with LV hypertrophy, AM levels were positively correlated with LVMI [odds ratio (OR) 1.14, 95% confidence interval (Cl) 1.08-1.13, P = 0.0001] and mitral DcT (OR 2.25, 95% CI 1.15-2.05, P = 0.01) in the presence of higher blood pressure and HOMA-IR. A cut-off value of AM at 52 pg/mL could differentiate obese children with and without left ventricular hypertrophy at a sensitivity of 94.32% and specificity of 92.45%.

CONCLUSIONS:
Plasma AM levels may be elevated in obese children particularly those with LV hypertrophy and is correlated with higher blood pressure and insulin resistance. Measurement of plasma AM levels in obese children may help to identify those at high risk of developing LV hypertrophy and dysfunction.

Author Info:
1
Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O, Assiut, 71111, Egypt. kotb72@gmail.com.
2
Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O, Assiut, 71111, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Mmari K(1), Moreau C(1), Gibbs SE(1), De Meyer S(2), Michielsen K(2), Kabiru CW(3), Bello B(4), Fatusi A(4), Lou C(5), Zuo X(5), Yu C(5), Al-Attar GST(6), El-Gibaly O(6).

Title:
'Yeah, I've Grown; I Can't Go Out Anymore': Differences In Perceived Risks Between Girls And Boys Entering Adolescence

Abstract:
This analysis is based on data from the Global Early Adolescent Study, which aims to understand the factors that predispose young people aged 10-14 years to positive or negative health trajectories. Specifically, interview transcripts from 202 adolescents and 191 parents across six diverse urban sites (Baltimore, Ghent, Nairobi, Ile Ife, Assuit and Shanghai) were analysed to compare the perceived risks associated with entering adolescence and how these risks differed by gender. Findings reveal that in all sites except Ghent, both young people and their parents perceived that girls face greater risks related to their sexual and reproductive health, and because of their sexual development, were perceived to require more protection. In contrast, when boys grow up, they and their parents recognised that their independence broadened, and parents felt that boys were strong enough to protect themselves. This has negative consequences as well, as boys were perceived to be more prone to risks associated with street violence and peer pressure. These differences in perceptions of vulnerability and related mobility are markers of a gender system that separates young women and men's roles, responsibilities and behaviours in ways that widen gender power imbalance with lifelong social and health consequences for people of both sexes.

Author Info:
1
a Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
2
b International Centre for Reproductive Health (ICRH), Faculty of Medicine and Health Sciences , Ghent , Belgium.
3
c African Population and Health Research Center, APHRC Campus , Nairobi , Kenya.
4
d Population and Reproductive Health Programme, College of Health Sciences , Obafemi Awolowo University , Osun State , Nigeria.
5
e Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD , Fudan University , Shanghai , China.
6
f Public Health and Community Medicine Department , Assiut University , Assiut , Egypt.


Authors:
Moeen AM(1), Safwat AS(2), Gadelmoula MM(1), Moeen SM(3), Behnsawy HM(1), Shahat AA(1), Gadelkareem RA(1), Hameed DA(1), Hammouda HM(1).

Title:
Does The Site Of The Orthotopic Neobladder Outlet Matter? A Prospective Randomized Comparative Study

Abstract:
BACKGROUND:
To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution.

METHODS:
From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis.

RESULTS:
There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571).

CONCLUSION:
The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.

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


Authors:
Moeen SM(1), Thabet AF(1), Hasan HA(2), Saleh MA(3).

Title:
Lower Transcranial Doppler Flow Velocities in Sickle Cell Anemia Patients on Hydroxyurea: Myth or Fact.

Abstract:
Transcranial Doppler (TCD) detects stroke risk in patients with sickle cell anemia (SCA). Hydroxyurea therapy has the ability to induce increased levels of fetal hemoglobin in sickle cells thus decreasing tendency for red cell sickling. This study aimed to evaluate TCD findings in SCA patients on hydroxyurea and correlate the time-averaged mean velocity (TAMV) with their hematological parameters. Forty SCA patients of both sexes, aged 16-22 years with no history of stroke were screened with TCD for an elevated TAMV, divided into: Group T (20 patients on blood transfusion); and Group H (20 patients on daily hydroxyurea). For all, full medical history, clinical examination, hemoglobin, hematocrit, leukocytes, platelets, fetal hemoglobin and sickling test, in addition TCD to describe the pattern of cerebral blood flow abnormalities were done. TAMV in all cerebral arteries were significantly higher in Group T than Group H, the highest TAMV (147.5 ± 57.09 cm/s) was found in the right middle cerebral artery and correlated negatively with hematocrit in Groups H (P < 0.001). There were 2 (10%) abnormal TAMV results and 5 (25%) conditional in Group T, while all results were normal in Group H. Hydroxyurea therapy may lower TCD velocities and prevent the risk of primary stroke in SCA patients.

Author Info:
1
1Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
2Department of Radio-diagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
3Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Mohamed HAH(1), Salem MA(2), Elnaggar MS(3), Gabr A(4), Abdelrheem AM(5).

Title:
Trimodalities For Bladder Cancer In Elderly: Transurethral Resection, Hypofractionated Radiotherapy And Gemcitabine

Abstract:
PURPOSE:
A prospective phase II study carried out to evaluate hypofractionated radiotherapy with concurrent gemcitabine for bladder preservation in the elderly patient with bladder cancer.

PATIENTS AND METHODS:
Thirty-one patients were enrolled, age ≥65years, diagnosed with transitional cell carcinoma of the urinary bladder, after a maximum safe transurethral resection of a bladder tumour. They received 52.5Gy in 20 fractions using 3D conformal radiotherapy with concurrent 100mg/m2 gemcitabine weekly as a radiosensitizer.

RESULTS:
All patients completed their radiation therapy course, while seven patients received their chemotherapy irregularly due to grade 3 toxicities. Twenty-five patients (80.6%) achieved a complete response. At 2-years, overall survival was 94.4% and disease-free survival was 72.6%. T3 and residual after transurethral resection are factors that adversely affect disease-free survival.

CONCLUSION:
Hypofractionated radiotherapy and gemcitabine as a radiosensitizer in elderly as organ preservation for transitional cell carcinoma bladder cancer have acceptable toxicity profile with good response rate and disease-free survival, keeping salvage cystectomy for persistence or recurrence of invasive cancer.

Author Info:
1
Radiation Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Electronic address: hamza_assiut@yahoo.com.
2
Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt. Electronic address: abouelmagd1972@gmail.com.
3
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: maha_elnaggar@yahoo.com.
4
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Electronic address: adelgabre@yahoo.com.
5
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt.


Authors:
Mohamed TA(1), Soliman W(1), Fathalla AM(1), El Refaie A(2).

Title:
Effect Of Single Subconjunctival Injection Of Bevacizumab On Primary Pterygium: Clinical, Histopathological And Immunohistochemical Study

Abstract:
AIM:
To evaluate the effect (clinically, histopathologically and immunohistochemically) and safety of a single intra-pterygium injection of bevacizumab.

METHODS:
Prospective interventional study comprised 40 eyes of 40 patients with primary fleshy pterygia who attended the Outpatient Clinic of Department of Ophthalmology, Assiut University Hospitals, Egypt from May 2015 to May 2016. Patients were randomly classified into 2 groups: the first group received a single intralesional injection of bevacizumab (Avastin; Genentech, San Francisco, CA, USA); the second group comprised patients who did not receive subconjunctival bevacizumab. Excision of pterygium and conjunctival auto graft was done in both groups. The excised pterygium tissues were subjected to histopathological and immunohistochemical evaluation.

RESULTS:
The study comprised 40 eyes of 40 patients (33 men, 7 women) of age range from 31-58y. The study group included 22 eyes. The control group included 18 eyes. A decrease in the vascularity of the pterygium was noted in all injected cases. The mean vessel count was higher in non-injected pterygia than that in injected pterygia and the difference was statistically significant (P=0.001). Also, the mean vessel count in both groups was significantly higher than normal conjunctive (P=0.005 and 0.001). A statistically significant difference in vascular endothelial growth factor (VEGF) expression between injected and non-injected cases was detected in the epithelial, stromal and endothelial cells (P=0.0001, 0.016, 0.014). No serious intraoperative complications occurred in both groups.

CONCLUSION:
The use of single intra lesional injection of Avastin in pterygium decreased vascularity and decreased VEGF expression in injected pterygium after one month. Our study proved the effect of single intra lesional injection of Avastin on pterygium. Further studies may enable limiting the need for surgery and improve quality of life for patients with pterygia.

Author Info:
1
Department of Ophthalmology, Assiut University Hospital, Assiut 71111, Egypt.
2
Department of Pathology, Faculty of Medicine, Assiut University, Assiut 71111, Egypt.


Authors:
Mohamed-Hussein AA(1), Makhlouf HA(1), Selim ZI(2), Gamaleldin Saleh W(3).

Title:
Association Between Hand Grip Strength With Weaning ‎And Intensive Care Outcomes In COPD Patients: A Pilot ‎Study

Abstract:
BACKGROUND:
In COPD weight loss and muscle wasting contribute significantly to morbidity, disability and handicap. Dominant-handgrip strength for evaluation of muscle strength has not been tested as a parameter to predict outcome of weaning from mechanical ventilation (MV).

OBJECTIVES:
to evaluate the association between handgrip strength and the duration and success of weaning and extubation outcome.

PATIENTS AND METHODS:
This prospective study included 34 COPD patients requiring MV for at least 48 hours. Recovery from sedation and muscle relaxants was assessed before recruitment. Serial meseaurment of handgrip strength were assessed by trained personnel.

RESULTS:
There was a significant negative correlation between baseline hand grip and duration of MV (P= 0.047, r= -0.343). The mean day 5 hand grip was significantly lower in person who died compared to survivors (5.7±5.5 vs. 18.2±14.5, P= 0.044).The mean day 5 hand grip was significantly lower in patients who needed re-intubation compared to those in patients who did not need re-intubation (2.8±2 vs. 17.2±13.9, P= 0.029). There was no significant difference in the mean baseline, day 2, day 3, day 4 and day 5 hand grip in weaning success compared to those in failure (P>0.05).

CONCLUSION:
Handgrip strength may be good predictor for duration of MV, extubation outcome, ICU mortality and prognosis.

Author Info:
1
Professor of Pulmonology, Chest Department, Assiut University Hospitals, Assiut, 71515, Egypt.
2
Associate Professor of Rheumatology, Assiut University Hospitals, Assiut, 71515, Egypt.
3
Associate lecturer of Pulmonology, Chest Department, Assiut University Hospitals, Assiut, 71515, Egypt.


Authors:
Mohamed-Hussein AA(1), Makhlouf HA(1), Hashem SM(2)

Title:
Catastrophic Antiphospholipid Lung Syndrome In Young ‎Female With Repeated Abortions

Author Info:
1
Department of Chest, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
2
Department of Chest, Assiut University Hospitals, Assiut, Egypt.


Authors:
Montpellier C(1), Wychowski C(2), Sayed IM(3), Meunier JC(4), Saliou JM(1), Ankavay M(1), Bull A(4), Pillez A(1), Abravanel F(5), Helle F(6), Brochot E(6), Drobecq H(7), Farhat R(1), Aliouat-Denis CM(1), Haddad JG1, Izopet J(5), Meuleman P(8), Goffard A(1

Title:
Hepatitis E Virus Lifecycle and Identification of 3 Forms of the ORF2 Capsid Protein

Abstract:
BACKGROUND & AIMS:
Hepatitis E virus (HEV) infection is a major cause of acute hepatitis worldwide. Approximately 2 billion people live in areas endemic for HEV and are at risk of infection. The HEV genome encodes 3 proteins, including the ORF2 capsid protein. Detailed analyses of the HEV life cycle has been hampered by the lack of an efficient viral culture system.

METHODS:
We performed studies with gt3 HEV cell culture-produced particles and patient blood and stool samples. Samples were fractionated on iodixanol gradients and cushions. Infectivity assays were performed in vitro and in human liver chimeric mice. Proteins were analyzed by biochemical and proteomic approaches. Infectious particles were analyzed by transmission electron microscopy. HEV antigen levels were measured with the Wantaï enzyme-linked immunosorbent assay.

RESULTS:
We developed an efficient cell culture system and isolated HEV particles that were infectious in vitro and in vivo. Using transmission electron microscopy, we defined the ultrastructure of HEV cell culture-produced particles and particles from patient sera and stool samples. We also identified the precise sequence of the infectious particle-associated ORF2 capsid protein. In cultured cells and in samples from patients, HEV produced 3 forms of the ORF2 capsid protein: infectious/intracellular ORF2 (ORF2i), glycosylated ORF2 (ORF2g), and cleaved ORF2 (ORF2c). The ORF2i protein associated with infectious particles, whereas the ORF2g and ORF2c proteins were massively secreted glycoproteins not associated with infectious particles. ORF2g and ORF2c were the most abundant antigens detected in sera from patients.

CONCLUSIONS:
We developed a cell culture system and characterized HEV particles; we identified 3 ORF2 capsid proteins (ORF2i, ORF2g, and ORFc). These findings will advance our understanding of the HEV life cycle and improve diagnosis.

Author Info:
1
University of Lille, CNRS, INSERM, CHU Lille, Pasteur Institute of Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, Lille, France.
2
University of Lille, CNRS, INSERM, CHU Lille, Pasteur Institute of Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, Lille, France. Electronic address: czeslaw.wychowski@ibl.cnrs.fr.
3
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium; Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Inserm-U966, University F. Rabelais, Tours, France.
5
CHU Toulouse, Hôpital Purpan, Laboratoire de virologie, National Reference Center for Hepatitis E, Toulouse, France.
6
EA4294, Laboratoire de Virologie, Centre Universitaire de Recherche en Santé, Centre Hospitalier Universitaire et Université de Picardie Jules Verne, Amiens, France.
7
University of Lille, CNRS, Institut Pasteur de Lille, UMR 8161-M3T-Mechanisms of Tumorigenesis and Target Therapies, Lille, France.
8
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
9
University of Lille, CNRS, INSERM, CHU Lille, Pasteur Institute of Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, Lille, France. Electronic address: laurence.cocquerel@ibl.cnrs.fr.


Authors:
Morsi NG(1), Ali SM(1), Elsonbaty SS(1), Afifi AA(1), Hamad MA(2), Gao H(3), Elsabahy M(1),(4),(5),(6).

Title:
Poly(Glycerol Methacrylate)-Based Degradable ‎Nanoparticles For Delivery Of Small Interfering RNA.‎

Abstract:
Nucleic acids therapeutic efficiency is generally limited by their low stability and intracellular bioavailability, and by the toxicity of the carriers used to deliver them to the target sites. Aminated poly(glycerol methacrylate) polymers are biodegradable and pH-sensitive polymers that have been used previously to deliver antisense oligonucleotide and show high transfection efficiency. The purpose of this study is to compare the efficiency and toxicity of aminated linear poly(glycerol methacrylate) (ALT) biodegradable polymer to the most commonly used cationic degradable (i.e. chitosan) and non-degradable (i.e. polyethylenimine (PEI)) polymers for delivery of short interfering RNA (siRNA). ALT, PEI and chitosan polymers were able to form nanosized particles with siRNA. Size, size-distribution and zeta-potential were measured over a wide range of nitrogen-to-phosphate (N/P) ratios, and the stability of the formed nanoparticles in saline and upon freeze-drying was also assessed. No significant cytotoxicity at the range of the tested concentrations of ALT and chitosan nanoparticles was observed, whereas the non-degradable PEI showed significant toxicity in huh-7 hepatocyte-derived carcinoma cell line. The safety profiles of the degradable polymers (ALT and chitosan) over non-degradable PEI were demonstrated in vitro and in vivo. In addition, ALT nanoparticles were able to deliver siRNA in vivo with significantly higher efficiency than chitosan nanoparticles. The results in the present study give evidence of the great implications of ALT nanoparticles in biomedical applications due to their biocompatibility, low cytotoxicity, high stability and simple preparation method.

Author Info:
1
a Assiut International Center of Nanomedicine , Al-Rajhy Liver Hospital, Assiut University , Assiut , Egypt.
2
b Department of Surgery, Faculty of Medicine , Assiut University , Assiut , Egypt.
3
c School of Chemistry and Chemical Engineering , Tianjin University of Technology , Tianjin , China.
4
d Laboratory for Synthetic-Biologic Interactions, Department of Chemistry , Texas A&M University , College Station , TX , USA.
5
e Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt.
6
f Misr University for Science and Technology , 6th of October City , Egypt.


Title:
Correlation Between Serum IL-17A Level And SALT ‎Score In Patients With Alopecia Areata Before And After ‎NB-UVB Therapy

Abstract:
BACKGROUND:
There is strong evidence that alopecia areata is of immunological background; Interleukin-17 (IL-17) is a Th17 pro-inflammatory cytokine that has been allied to the pathogenesis of different autoimmune and inflammatory diseases.

OBJECTIVE:
This study aimed to measure serum IL-17A in patients with alopecia areata, and to study associations between IL-17A levels and disease severity before and after Narrowband-Ultraviolet B (NB-UVB), patient gender and age.

METHODS:
Twenty patients with AA of the scalp were treated with (NB-UVB), and 15 healthy subjects' age and sex matched were enrolled as controls. Patients were assessed clinically by SALT score. Assay of serum levels of IL-17A by ELISA was done in patients and controls.

RESULTS:
The mean level of IL-17A was (15.63 Â ± 10.89 Pg/mL) in AA patient group, and (16.50 Â ± 5.02 Pg/mL) in control group. No statistically significant correlation was detected between SALT score and IL-17A level before (NB-UVB) treatment while a significant negative correlation between SALT score and IL-17A level was observed after treatment (r = -.448, P = .047). Mean SALT score for patients was (14.03 Â ± 13.48), and correlated positively with age (r = .446, P = .049).

CONCLUSION:
Although (NB-UVB) is an immune-modulatory type of treatment for alopecia areata of mild efficacy especially if it's used alone, it has shown significant decrease in serum IL-17A level among patients, and correlation to disease severity.

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


Authors:
Morsy M(1), Sur YJ(2), Akdag O(3), Eisa A(4), El-Gammal TA(4), Lachman N(5), Moran SL(6).

Title:
Anatomic And High-Resolution Computed Tomographic ‎Angiography Study Of The Lateral Femoral Condyle Flap: ‎Implications For Surgical Dissection

Abstract:
BACKGROUND:
The lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin of this flap to allow for a safe and effective harvest.

MATERIALS AND METHODS:
Twenty-three lower extremities were injected with latex or a mixture of latex and barium sulfate. The SLGA was identified and dissected, documenting the course, diameter, anatomical relations, length, and branches. In the mixture group, high-resolution CT scanning was performed prior to dissection. Two additional specimens were dissected to illustrate the harvest technique.

RESULTS:
The SLGA originated from the popliteal artery at an average of 44.3 mm proximal to the knee joint line. The SLGA had an average diameter of 1.9 mm at origin and length of 56 mm. It coursed posterior to the femur, reaching the lateral intermuscular septum (IMS), dividing into superficial (patellar) and deep (condylar) branches, which coursed toward and gave branches to the patella and the LFC, respectively. At least one (average 1.4) septocutaneous skin perforator >5 mm emerged and ran posterior to the IMS. 3D reconstructions of the CT scans were used to confirm anatomic findings and describe a standard harvest technique.

CONCLUSIONS:
The SLGA has consistent anatomy, adequate length, suitable diameter at origin for microvascular anastomosis, and constant perforators to bone and skin. The LFC flap provides a useful alternative to flaps from the medial knee or iliac crest.

Author Info:
1
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
2
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
3
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey.
4
Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
5
Department of Anatomy, Mayo Clinic, Rochester, MN, USA.
6
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: moran.steven@mayo.edu.


Authors:
Mostafa MF(1), Herdan R(1), Elshazly M(2).

Title:
Comparative Study Of Levobupivacaine And ‎Bupivacaine For Bilateral Maxillary Nerve Block During ‎Pediatric Primary Cleft Palate Surgery: A Randomized ‎Double-Blind Controlled Study

Abstract:
BACKGROUND:
Cleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia.

METHODS:
Sixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine.

RESULTS:
Face, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications.

CONCLUSIONS:
Levobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

Author Info:
1
Department of Anesthesia and Intensive Care, Assiut University Faculty of Medicine, Assiut, Egypt.
2
Department of Plastic Surgery, Assiut University Faculty of Medicine, Assiut, Egypt.


Authors:
Nafady A(1),(2), Nafady-Hego H(3), Abdelwahab NM(1), Eltellawy RHN(1), Abu Faddan NH(4).

Title:
Peripheral Lymphocytes Analyses In Children With ‎Chronic Hepatitis C Virus Infection

Abstract:
BACKGROUND:
Hepatitis C virus (HCV)-specific immune response is believed to play a crucial role in viral clearance. There is, nevertheless, no reliable parameter to monitor this immune response or predict chronic HCV infection development.

METHOD:
An observational case-control study was performed to identify such parameters, peripheral blood mononuclear cells from 57 children with chronic HCV were systemically phenotyped, and the serum level of Interferon gamma and interleukin (IL) -17 was measured. The data were compared with 37 age-matched healthy volunteers (controls).

RESULTS:
Children with chronic HCV infection had a lower frequency of natural killer cells (NK) cells, CD56Dim NK cells and expansion of CD56Bright NK cells compared with controls (P = 0.001, P < 0.0001 and P < 0.0001 respectively). Increased CD56Dim NK cells were negatively correlated with the higher viral load, R2  = 0.29, P = 0.05, while, increased NK T cells were positively correlated with high viral load, R2  = 0.17, P = 0.011. T helper cells, naive T cells, CD127 negative T cells, and HLA-DR-positive T cells significantly increased in patients than in controls. The frequency of CD4+CD25high+ T regulatory (Treg) cells increased in HCV-infected patients, compared with those in control, and FOXP3 was upregulated within them. Treg cells' increase was positively correlated with high viral load, R2  = 0.45, P = 0.004. The level of IL-17 was higher in HCV patients than that in control, P < 0.0001.

CONCLUSION:
Although the contribution of those markers to the chronic HCV establishment in children remains elusive, the results may provide important clues for reliable indicators of HCV infection.

Author Info:
1
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical and Chemical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt.
3
Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Pediatrics, children hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Nashaat D(1), Elsabahy M(1),(2),(3), El-Sherif T(4), Hamad MA(5), El-Gindy GA(1), Ibrahim EH(1).

Title:
Development And In Vivo Evaluation Of Chitosan ‎Nanoparticles For The Oral Delivery Of Albumin.

Abstract:
Albumin is used as a plasma expander in critically ill patients and for several other clinical applications mainly via intravenous infusion. Oral administration of albumin can improve patient compliance although limited oral bioavailability of proteins is still a major challenge. Although nanomaterials have been extensively utilized for improving oral delivery of proteins, albumin has been utilized only as either a model drug or as a carrier for drug delivery. In the current study, for the first time, chitosan nanoparticles have been developed and extensively optimized to improve oral bioavailability of albumin as a therapeutic protein. Several characterizations have been performed for the albumin-loaded nanoparticles (e.g. drug encapsulation efficiency, DSC, FTIR, particle size, zeta potential, morphology, release kinetics, and enzymatic stability). Nanosized spherical particles were prepared and demonstrated high stability over three months either in a powdered form or as suspensions. Sustained release of albumin over time and high enzymatic stability as compared to the free albumin were observed. In vivo, higher serum concentrations of albumin in normal rabbits and cirrhotic rats were attained following oral and intraperitoneal administrations of the albumin-loaded nanoparticles as compared to the free albumin. The nanoparticles developed in the current study might provide efficient nanovehicles for oral administration of therapeutic albumin.

Author Info:
1
a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt.
2
b Laboratory for Synthetic-Biologic Interactions, Department of Chemistry , Texas A&M University College Station , TX , USA.
3
c Misr University for Science and Technology , 6th of October City , Egypt.
4
d Department of Clinical Pathology, Faculty of Medicine , Assiut University , Assiut , Egypt.
5
e Department of Surgery, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Nassr AA(1), Shazly SA(2), Trinidad MC(3), El-Nashar SA(4), Marroquin AM(3), Brost BC(5).

Title:
Body Fat Index: A Novel Alternative To Body Mass Index ‎For Prediction Of Gestational Diabetes And Hypertensive ‎Disorders In Pregnancy

Abstract:
OBJECTIVES:
To evaluate the association of ultrasound measurement of maternal abdominal subcutaneous and pre-peritoneal fat thickness in relation to the subsequent diagnosis of gestational diabetes (GDM), and to assess the association of body fat index (BFI), compared to conventional body mass index (BMI), with respect to the development of some obstetric related complications.

STUDY DESIGN:
A prospective study included non-diabetic pregnant women who were scheduled for fetal anatomic survey. Women underwent fat measurements and BFI (pre-peritoneal fat x subcutaneous fat/height) was calculated. They underwent routine glucose screening and diagnostic tests for GDM. Obstetric complications, mode of delivery, and delivery related events were reported. Multivariable logistic regression was used to test potential predictors for development of obesity-related complications. Primary outcome was development of GDM. Secondary outcomes included development of hypertensive disorders during pregnancy and need for cesarean delivery due to labor dystocia. The optimal cut-off points for continuous variables were obtained using a receiver operating characteristic (ROC) curve analyses.

RESULTS:
389 women met study criteria. Median gestational age at time of ultrasound evaluation was 19.1 weeks. Positive family history of diabetes (adjusted odds ratio "OR" 2.30, 95% CI 1.35-3.92), history of GDM (adjusted OR 6.87, 95% CI 3.03-15.61), subcutaneous fat≥13 mm (adjusted OR 4.63, 95% CI 1.60-13.38) and pre-peritoneal fat≥12 mm (adjusted OR 3.32, 95% CI 1.06-10.42) were significant predictors for development of GDM. ROC analysis demonstrated that a BFI > 0.5 was statistically superior to a BMI > 25 or 30 as a predictor of gestational diabetes (adjusted OR 6.24, 95% CI 1.86-20.96). A Similar ROC analysis demonstrated that a BFI > 0.8 was associated with a higher risk for the development of hypertensive disorders of pregnancy (adjusted OR 2.70 [95% CI 1.60-4.55]), and need for cesarean delivery (adjusted OR 2.01[95% CI 1.23-3.28]) than a BMI > 25 or 30.

CONCLUSION:
Values obtained by ultrasound measurement of subcutaneous and pre-peritoneal fat are associated with development of GDM and hypertensive disorders in pregnancy. Our data suggest that BFI was a better predictor than BMI for development of GDM and hypertensive disorders in pregnancy and should be studied further.

Author Info:
1
Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt; Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA. Electronic address: Ahmed.nassr@bcm.edu.
2
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
4
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
5
Division of Maternal Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.


Authors:
Omar H(1), El Akel W(1), Elbaz T(1), El Kassas M(2), Elsaeed K(3), El Shazly H(4), Said M(1), Yousif M(5), Gomaa AA(6), Nasr A(7), AbdAllah M(8), Korany M(9), Ismail SA(10), Shaker MK(3), Doss W(1), Esmat G(1), Waked I(4), El Shazly Y(3).

Title:
Generic Daclatasvir Plus Sofosbuvir, With Or Without ‎Ribavirin, In Treatment Of Chronic Hepatitis C: Real-‎World Results From 18 378 Patients In Egypt

Abstract:
BACKGROUND:
Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment.

AIM:
To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting.

METHODS:
Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored.

RESULTS:
During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group.

CONCLUSIONS:
Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

Author Info:
1
Faculty of Medicine, Cairo University, Cairo, Egypt.
2
Faculty of Medicine, Helwan University, Cairo, Egypt.
3
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4
National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt.
5
Faculty of Medicine, Zagazig University, Zagazig, Egypt.
6
Faculty of Medicine, Fayoum University, Fayoum, Egypt.
7
Faculty of Medicine, Assiut University, Assiut, Egypt.
8
National Research Center, Cairo, Egypt.
9
National Committee for Control of Viral Hepatitis, Cairo, Egypt.
10
National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.


Authors:
Omran GA(1), Gaber HD(2), Mostafa NAM(3), Abdel-Gaber RM(2), Salah EA(4).

Title:
Potential Hazards Of Bisphenol A Exposure To Semen ‎Quality And Sperm DNA Integrity Among Infertile Men

Abstract:
Bisphenol A (BPA) is an endocrine disruptor that is widely produced as a by-product in the plastics industry. The aim of the current study was to identify any association between urinary BPA levels and infertility related factors in patients who presented to the andrology clinic of a university hospital in Upper Egypt. In this case-control study, urinary BPA levels in 50 infertile patients and 50 matched controls were measured by high-performance liquid chromatography. Semen quality (sperm concentration, morphology, and motility) and oxidative stress (total antioxidant activity and malondialdehyde levels) were determined along with sperm DNA damage via alkaline comet assays. BPA concentrations were similarly high in urine samples from all infertile patients and fertile controls, with median values of 24.2 μg/l and 20.9 μg/l, respectively. Total BPA levels were negatively associated with semen quality and antioxidant levels, and positively correlated with DNA damage, especially with multiple semen profile defects, alongside seminal-plasma lipid peroxidation.

Author Info:
1
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: ghada.omran@aun.edu.eg.
2
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Histology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Urology Department, Faculty of Medicine, Al Azhar University, Assiut Branch, Egypt.


Authors:
Osman HA(1), Aly SS(2), Salah-Eldin EM(3), El-Masry MA(4), Hassan MH(5)

Title:
Diagnostic Validity Of Flow Cytometry Vs Manual ‎Counting Of Polymorphonuclear Leukocytes In ‎Spontaneous Bacterial Peritonitis.‎

Abstract:
BACKGROUND:
Spontaneous bacterial peritonitis (SBP) is frequently occurring infection among patients with liver cirrhosis, defined by polymorphonuclear (PMN) leukocytic count ≥250 cell/mm3 with or without a positive ascitic fluid (AF) bacterial culture. So, this study aimed to investigate the diagnostic value of flow cytometry versus manual counting of ascitic fluid PMNL in cirrhotic patients, with clinical suspicion of SBP.

METHODS:
A hospital-based cross-sectional study was carried out on 320 cirrhotic patients with clinical suspicion of SBP. Abdominal paracentesis was performed in all cases for microscopic manual and flow cytometry counting of PMNL. Anti-HLA-DR, anti-CD15, anti-CD16, and anti-CD45 monoclonal antibodies were used for flow cytometry method.

RESULTS:
Flow cytometric PMNL count had 100% sensitivity and specificity, while manual PMNL count had a sensitivity of 65.52% and specificity of 90% with significant difference (P value < .05).

CONCLUSION:
Flow cytometry is more reliable rapid method for PMNL counting, than the manual method that is less accurate and time-consuming in diagnosing clinically suspected SBP.

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


Authors:
Othman ER(1),(2), Meligy FY(3), Sayed AA(4), El-Mokhtar MA(5), Refaiy AM(6).

Title:
Stem Cell Markers Describe a Transition From Somatic to Pluripotent Cell States in a Rat Model of Endometriosis

Abstract:
OBJECTIVE:
To study Thy1 as a fibroblast marker, SSEA1 as a marker of intermediate pluripotency, and Oct4 as a marker of established pluripotency in rat model of endometriosis.

DESIGN:
In vivo animal study.

MATERIALS AND METHODS:
Endometriosis was induced in 20 albino female rats through autologous transplantation of one uterine horn to mesentery of intestine. Other 20 rats had their horn removed without transplantation (controls). Rats were sacrificed 4 weeks after induction surgery. Ectopic, eutopic, and control endometria were harvested from endometriosis and control animals respectively. Quantitative syber green based RT-PCR was used to detect expression of Thy-1 (CD90), FUT4 (SSEA1), and POU5F1 (Oct4) genes in tissues. Relative expression was normalized to that of β actin. Thy1, SSEA1, and Oct4 protein expression were detected by immunohistochemistry.

RESULTS:
Ectopic endometrium expressed significantly higher mRNA of Oct4 and SSEA1 as compared to control endometrium. Expression levels of Oct4 and SSEA1 were comparable between ectopic and eutopic endometria and between eutopic and control endometria. Thy1 (CD90) gene expression level was comparable among ectopic, eutopic, and control endometria. Oct4 immunoscore were significantly higher in ectopic (6.6±0.91) than eutopic (2.5±0.78) or control endometrium (3.7±0.1) (P value 0.02). Thy1 and SSEA1 immunoscores were comparable among all three types of endometria.

CONCLUSIONS:
Using rat model of endometriosis, ectopic endometrium showed significantly higher Oct4, and SSEA1, but similar Thy1 gene expression to that of control endometrium. This indicates increased transition from somatic to pluripotent cell states in ectopic endometrium which may play a role in endometriosis pathogenesis.

Author Info:
1
1 OB-GYN Department, Assiut University, Egypt.
2
2 Center of Excellence of Stem Cells and Regenerative Medicine (CESCRM), Assiut University, Egypt.
3
3 Histology Department, Assiut University, Egypt.
4
4 Medical Biochemistry Department, Assiut University, Egypt.
5
5 Medical Microbiology and Immunology, Assiut University, Egypt.
6
6 Pathology Department, Assiut University, Egypt.


Authors:
Oweira H(1), Lahdou I(2), Opelz G(3), Daniel V(4), Terness P(5), Schmidt J(6), Mehrabi A(7), Fusch G(8), Schefold J(9), Zidan A(10), Sadeghi M(11).

Title:
Association Of Pre- And Early Post-Transplant Serum ‎Amino Acids And Metabolites Of Amino Acids And Liver ‎Transplant Outcome

Abstract:
The aim of the present study was to investigate association of serum amino (AA) acids and metabolites of AAs with post-transplant outcome in liver transplant recipients. Eighty-nine patients with end-stage liver diseases and available pre- and early post-transplant serum were characterised as patients with (GI) and without one-year mortality (GII) and patients with and without early graft dysfunction (EAD). A panel of pre- and early post-transplant serum levels of AAs and early and metabolites of tryptophan were measured using tandem mass spectrometry. Patient groups had significantly higher pre-transplant serum levels of phenylalanine, tryptophan, and tryptophan metabolites than healthy controls (for all p<0.001). Pre-transplant serum levels of all these parameters were significantly higher in GI than in GII (for all p<0.001). GI had a higher MELD score and re-transplantation number than GII (p≤0.005 for both investigations). Serum bilirubin on day 5 and serum phenylalanine on day 10 post-transplant were associated parameters of mortality, whereas day 1post-transplant phenylalanine and kynurenine and female gender were associated parameters of EAD. Our results indicate that pre- and early post-transplant levels of phenylalanine, tryptophan and metabolites of tryptophan are increased in patients and are associated with EAD and one-year mortality in liver transplant recipients.

Author Info:
1
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany; General and Visceral Surgery, Hirslanden Private Hospital, Zurich, Switzerland. Electronic address: Hani.Oweira@hirslanden.ch.
2
Transplantation-Immunology, University of Heidelberg, Germany.
3
Transplantation-Immunology, University of Heidelberg, Germany. Electronic address: Gerhard.opelz@med.uni-heidelberg.de.
4
Transplantation-Immunology, University of Heidelberg, Germany. Electronic address: Volker.daniel@med.uni-heidelberg.de.
5
Transplantation-Immunology, University of Heidelberg, Germany. Electronic address: esa.germany@gmx.org.
6
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany; General and Visceral Surgery, Hirslanden Private Hospital, Zurich, Switzerland. Electronic address: Jan.schmidt@hirslanden.ch.
7
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: Arianeb.mehrabi@med.uni-heidelberg.de.
8
Department of Paediatrics, McMaster University, Hamilton, Canada. Electronic address: Gefusch@mcmaster.ca.
9
Department of Intensive Care Medicine Inselspital, Bern University Hospital, Freiburgstrasse 18, CH-3012 Bern, Switzerland. Electronic address: joerg.schefold@insel.ch.
10
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany; Department of HPB and liver transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt. Electronic address: ahmed.zidan@med.au.edu.eg.
11
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany; Transplantation-Immunology, University of Heidelberg, Germany. Electronic address: Mahmoud.sadeghi@med.uni-heidelberg.de.


Authors:
Oweira H(1),(2), Sadeghi M(3), Volker D(4), Mieth M(3), Zidan A(5), Khajeh E(3), Ghamarnejad O(3), Fonouni H(3), Weiss KH(6), Schmidt J(1),(2), Lahdou I(4), Mehrabi A(3).

Title:
Serum Caspase-Cleaved Cytokeratin (M30) Indicates Severity of Liver Dysfunction and Predicts Liver Outcome

Abstract:
BACKGROUND The Model for End-Stage Liver Disease (MELD) score is a well-established tool for assessing hepatic failure. The present retrospective study investigated whether serum keratin 18 (M65) and caspase-cleaved cytokeratin (M30) were associated with liver dysfunction and post-transplant graft failure. MATERIAL AND METHODS A total of 147 patients with liver cirrhosis were categorized into 2 groups according to their baseline MELD score (group I: MELD score <20, n=87, and group II: MELD score ≥20, n=60). Serum M65 and M30 levels were measured by ELISA. RESULTS Cirrhotic patients had significantly higher serum M65 and M30 levels than healthy controls (p<0.0001). Serum M65 was correlated with the MELD score and serum bilirubin (p≤0.007) and serum M30 was correlated with the MELD score, international normalized ratio, and serum bilirubin (p≤0.001). Group II had significantly higher serum M65 and M30 levels than group I (M65, p=0.025 and M30, p<0.001). Patients who lost the allograft during the first post-transplant year had significantly higher serum M30 levels than patients with a graft survival of >1 year (p=0.004). In the regression analysis, serum M30 was associated with the MELD score (odds ratio [OR]=2.545, p=0.005), serum bilirubin (OR=2.605, p=0.005) and 1-year graft loss (OR=3.61, p=0.006). CONCLUSIONS Our data indicate that serum M30 levels reflect the degree of liver dysfunction and can predict 1-year graft loss.

Author Info:
1
Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Switzerland.
2
Surgical Center Zürich, Hirslanden Hospital, Zürich, Switzerland.
3
Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
4
Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany.
5
Department of Hepato-Pancreato-Biliary (HPB) and Liver Transplantation Surgery, Rajhy Liver Hospital, Assiut University Hospital, Assuit, Egypt.
6
Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany.


Authors:
Patel B(1),(2), Peters GA(3), Skomorovska-Prokvolit Y(3), Yi L(3), Tan H(3), Yousef A(1),(4), Wang J(3), Mesiano S(1),(3).

Title:
Control of Progesterone Receptor-A Transrepressive Activity in Myometrial Cells: Implications for the Control of Human Parturition

Abstract:
Uterine quiescence during pregnancy is maintained by progesterone primarily via signaling mediated by the type-B progesterone receptor (PR-B) in myometrial cells. Withdrawal of PR-B-mediated progesterone activity is a principal trigger for labor. One mechanism for PR-B withdrawal is by inhibition of its activity by the type-A PR (PR-A) isoform in myometrial cells. We hypothesized that human parturition involves hormonal interactions that induce the capacity for PR-A to inhibit PR-B in myometrial cells and that pro-inflammatory cytokines are major regulators of this process. We tested this hypothesis in an immortalized human myometrial cell line, hTERT-HMA/B, in which levels of PR-A and PR-B can be experimentally controlled. We found that the capacity for PR-A to repress PR-B, assessed by activity of a transiently transfected reporter DNA controlled by the progesterone response element, and expression of FK506 binding protein 5 ( FKBP5) an endogenous PR-B responsive gene, was increased by serum supplementation and interleukin-1β. In pregnant uterus, FKBP5 was detected exclusively in myometrial cells and its expression decreased with advancing gestation and in association with the onset of labor at term. These findings suggest that in myometrial cells the repressive activity of PR-A on PR-B increases with advancing gestation and is induced by pro-inflammatory cytokines. This may be a key mechanism linking inflammation with the onset of labor.

Author Info:
1
1 Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, OH, USA.
2
2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
3
3 Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA.
4
4 Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Pope RJ(1), Abdelbadee AY(2), Armstrong AJ(3), Ganesh PR(4), Bedaiwy MA(5), Zanotti KM(3).

Title:
Standardization of Laparoscopic Operative Reporting: Improving Gynaecological Surgeon Communication

Abstract:
OBJECTIVE:
No standardization of quality of operative reporting currently exists, and this represents a missed opportunity for communication among health care providers. This study proposed a method to improve operative notes by structuring the findings by six anatomical zones of the pelvis. Objective I was to validate the method of documenting six zones of the pelvis by using intraoperative photography. Objective II was to compare this method with dictations from operative reports created before introducing this method.

METHODS:
This retrospective cohort study evaluated pre- and post-intervention results of using six zones to guide operative reporting. Reports were collected from participating surgeons and were scored using a validated scoring tool. Each participant was taught to photograph six zones and use the zones in the operative report. Pre- and post-intervention cases were compared using generalized linear mixed models.

RESULTS:
Scores of study participants using the zones were significantly higher than those without (P <0.0001). Surgeons showed an ability to improve their reporting. The detail illustrated in the cases was qualitatively richer, and the anatomy within the six zones was referenced more frequently.

CONCLUSION:
Compared with reports without the technique, incorporating the six zones greatly enhances operative reporting and likely would improve communication among care providers. More reliable communication of intraoperative findings has the potential to enhance the value of laparoscopy greatly as a diagnostic tool across gynaecological subspecialties.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: rachel.pope@gmail.com.
2
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Egypt; Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University, Cleveland, OH.
3
Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University, Cleveland, OH.
4
Department of Family Medicine and Community Health, University Hospitals, Case Western Reserve University, Cleveland, OH.
5
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.


Authors:
Raposeiras-Roubín S(1), Abu-Assi E(2), D'Ascenzo F(3), Fernández-Barbeira S(1), Kinnaird T(4), Ariza-Solé A(5), Manzano-Fernández S(6), Templin C(7), Velicki L(8), Xanthopoulou I(9), Cerrato E(10), Quadri G(11), Rognoni A1(2), Boccuzzi G1(3), Montabone A1

Title:
Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel

Abstract:
INTRODUCTION AND OBJECTIVES:
There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel.

METHODS:
We used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event.

RESULTS:
A total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54).

CONCLUSIONS:
Stent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine

Author Info:
1
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
2
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain. Electronic address: eabuassi@gmail.com.
3
Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy.
4
Cardiology Department, University Hospital of Wales, Cardiff, Wales, United Kingdom.
5
Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
6
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
7
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
8
Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia.
9
University Patras Hospital, Atenas, Rion, Patras, Greece.
10
Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
11
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
12
Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy.
13
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy.
14
Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt.
15
Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy.
16
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
17
Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.


Authors:
Raposeiras-Roubín S(1), Caneiro Queija B(1), D'Ascenzo F(2), Kinnaird T(3), Ariza-Solé A(4), Manzano-Fernández S(5), Templin C(6), Velicki L(7), Xanthopoulou I(8), Cerrato E(9), Quadri G(10), Rognoni A(11), Boccuzzi G1(2), Montabone A1(2), Taha S1(3), Dur

Title:
Usefulness of the PARIS Score to Evaluate the Ischemic-hemorrhagic Net Benefit With Ticagrelor and Prasugrel After an Acute Coronary Syndrome

Abstract:
INTRODUCTION AND OBJECTIVES:
The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry.

METHODS:
Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARISischemic and PARIShemorrhagic). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events.

RESULTS:
During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARISischemic and PARIShemorrhagic scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk.

CONCLUSIONS:
In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.

Author Info:
1
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
2
Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy.
3
Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom.
4
Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
5
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
6
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
7
Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia.
8
Department of Cardiology, Patras University Hospital, Rion, Patras, Greece.
9
Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
10
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
11
Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy.
12
Department of Cardiology, S.G. Bosco Hospital, Torino, Italy.
13
Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt.
14
Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy.
15
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
16
Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
17
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain. Electronic address: eabuassi@gmail.com.


