# Internationally Published Papers 2016

Authors:
Awad, S.M.a,  Morsy, H.aEmail Author,  Abdel-Aal, A.M.b,  Ibrahim, A.K.c

Journal:
Journal of the Egyptian Women's Dermatologic Society

Title:
Effect of Narrowband Ultraviolet B Phototherapy on Serum Vitamin D ‎Levels in Patients with Vitiligo‎

Abstract:
Background Low vitamin D status has been associated with vitiligo. Narrowband ultraviolet B (NBUVB) therapy has improved vitamin D balance in psoriasis and atopic dermatitis; however, few data are available on such effect in vitiligo and the relationship of vitamin D levels with disease severity and repigmentation. Objective To investigate the influence of NB-UVB phototherapy on vitamin D status in vitiligo patients. Patients and methods The serum levels of 25-hydroxyvitamin D were assessed in 28 vitiligo patients before and after exposure to 24 sessions of NB-UVB treatment. Baseline vitamin D levels of patients were compared with those of 20 age and sex-matched healthy participants. Clinical response was evaluated using the vitiligo area scoring index (VASI) scoring system. Results Insufficient vitamin D levels (≤75 nmol/l) were found in 78.6% of vitiligo patients, compared with 15% of controls. The mean serum vitamin D value was significantly lower than that in controls (P≤0.001). After phototherapy, a significant increase in vitamin D was observed (P≤0.001). The increase in vitamin D was negatively correlated with baseline vitamin D levels. However, there was no significant correlation between vitamin D levels and vitiligo area severity index (VASI) score. Conclusion NB-UVB therapy improves low vitamin D levels in vitiligo patients, which may contribute to its therapeutic efficacy. © 2016 Egyptian Women's Dermatologic Society.

Author Info:
aDepartments of Dermatology, Assiut University Hospital, Assiut, 71526, Egypt
bDepartments of Clinical Pathology, Assiut University Hospital, Egypt
cDepartment of Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Bakry, R.a,  El-Sayed, M.I.bEmail Author,  Hamza, H.M.c,  Hassan, K.H.d

Date of Publishing:
Volume 11, Issue 1, January 2016, Pages 823-830

Title:
Pretreatment Levels of Serum Osteoprotegerin and P53 Protein and Urine ‎Telomerase as Prognostic Factors Affecting Survival in Egyptian Bladder ‎Cancer Patients‎

Abstract:
A non-invasive marker is required for the diagnosis and follow-up of patients with bladder cancer. The aim of the current study was to evaluate the potential prognostic significance of serum osteoprotegerin (OPG), p53 protein and urine telomerase in patients with bladder cancer. For all patients, serum levels of OPG and p53 protein were determined using enzyme-linked immunosorbent assay (ELISA), and urine telomerase was assessed using a polymerase chain reaction ELISA technique. Patients were assigned into group 1 (cystectomy and adjuvant radiotherapy) or group 2 (transurethral resection and chemoradiotherapy). The results revealed that serum OPG and p53, and urine telomerase levels were significantly higher in bladder cancer patients compared with in healthy individuals (P<0.0001). High serum OPG was associated with significantly lower overall survival and disease-free survival rates (both P=0.001), and was correlated with advanced tumor stages (P<0.0001), high tumor grades (P<0.0001) and the occurrence of disease relapse (P=0.001). Serum p53 and urine telomerase did not demonstrate prognostic significance. These findings indicate that serum OPG level may be used as a diagnostic tool and a prognostic variable for patients with muscle invasive bladder cancer. Future trials are required to elucidate its therapeutic role in such patients. © Spandidos Publications 2015. All rights reserved.

Author Info:
aDepartments of Clinical Pathology, Assiut University, Assiut, 71111, Egypt
bDepartments of Radiotherapy, Assiut University, Assiut, 71111, Egypt
cDepartments of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt
dDepartment of Biochemistry, Al-Azhar University, Cairo, 11566, Egypt


Authors:
Darwish, A.M.Email Author,  Hassanin, A.I.,  Aleem, M.A.A.,  Aboushama, I.H.,  Mohammad, I.I.

Date of Publishing:
Volume 13, Issue 3, 1 August 2016, Pages 187-192

Title:
A Novel Use of Vaginoscopic Office Hysteroscopy for Prediction of Tubal ‎Patency and Peristalsis among Infertile Women: A Preliminary ‎Study‎

Abstract:
The objective of this study is to test whether vaginoscopic office hysteroscopy (OH) can predict proximal tubal patency as compared with hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and concomitantly tubal peristalsis in infertile women. This is a prospective cross sectional study. The setting is in the endoscopy unit of a tertiary hospital. A total of 85 infertile patients scheduled for laparoscopy are used as the sample of this study. The method used is the vaginoscopic OH in the outpatient infertility clinic to assess proximal tubal patency. The patency results will be compared to HSG and DL reports. Diagnostic accuracy of OH alone or in combination with HSG for assessment of proximal tubal patency in comparison to HSG and DL is the mean outcome measure. Office hysteroscopic bubble suction test was feasible in 78 cases (91.7 %). Patent tubes were diagnosed in 91 and 88.5, 92.3 and 91, and 93.6 and 93.6 % using OH, HSG, and DL on right and left sides, respectively. The percentage of agreement between OH and DL was 78 % while it was 84 % between HSG and DL regarding tubal patency testing. Diagnostic indices of OH were very close to those of HSG. Adding OH to HSG did not improve diagnostic accuracy. Positive osteal peristalsis was reported in 32 cases (42 %) and 28 cases (36.8 %) for right and left ostea, respectively. Hysteroscopic bubble suction test is a good initial screening test for tubal patency nearly comparable to HSG and DL. It should be attempted in every case of OH prior to referral for more invasive HSG or laparoscopic chromopertubation test. Hysteroscopic documentation of peristalsis of the proximal part of the tube is an interesting cofinding but requires more confirmatory studies. © 2016, Springer-Verlag Berlin Heidelberg.

Author Info:
Department of Obstetrics and Gynecology, Woman’s Health University Hospital, Assiut University, Assiut, 71111, Egypt


Authors:
Darwish, A.M.a,bEmail Author,  Metwally, A.B.a,  Shaaban, M.M.a,  Mohamed, S.a

Date of Publishing:
Volume 13, Issue 3, 1 August 2016, Pages 179-185

Title:
Monopolar Versus Bipolar Laparoscopic Ovarian Drilling in Clomiphene-‎Resistant Polycystic Ovaries (Pco): A Preliminary Study‎

Abstract:
The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged. © 2016, Springer-Verlag Berlin Heidelberg.

Author Info:
aWomen’s Health University Hospital, Assiut, Egypt
bDepartment of Obstetrics and Gynecology, Woman’s Health University Hospital, 71111 Assiut, P.O. Box: (1), Assiut, Egypt


Authors:
El-Ossily, N.A.A.a,  Yones, D.A.aEmail Author,  Monib, M.E.S.M.M.a,  Hassanin, A.S.A.b,  Khalifa, R.M.A.a

Title:
Sds-Page Protein Pattern and Antigenicity Cross Reaction of Human ‎Schistosomes‎

Abstract:
Schistosomiasis is one of the most important neglected tropical diseases. Its control depends on treatment with the available drug praziquantel. No vaccine exists despite the intense search for molecular candidates and adjuvant formulations over the last three decades. The present study aimed to compare the antigenic protein structures of Schistosoma mansoni, S. haematobium, Fasciola. hepatica and Echinococus granulosus hydatid cyst and to find out shared antigens among these species which could be recognized by S. mansoni antibodies. Antigenic protein structures were recognized through the use of Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) after Coomassie blue staining. Antigenic differences between the detected polypeptides and positive S. mansoni serum were performed using Western blotting. The SDS-PAGE profiles of the tested parasites revealed many polypeptides ranging from 15-206 kDa. Some of these proteins were shared between all the examined parasites e.g.: 52-47 and 15-25 kDa. Some ranged from 42-38 kDa were shared with both examined schistosomes and hydatid cyst fluid. Bands ranged from 58-55 kDa were common in S. mansoni, S. haematobium and F. hepatica. The protein bands of about 60 kDa crossly reacted with S. mansoni serum and detected in all used antigens. The detected immunoreactive proteins from other helminthes could be used to develop potential vaccine against schistosomiasis. © 2016 Nahed A.A. EL-Ossily, Doaa A. Yones, Mohamed El-Salahy M.M. Monib, Ahmed S.A. Hassanin and Refaat M.A. Khalifa.

Author Info:
aDepartment of Medical Parasitology, Assiut University, Assiut, 71526, Egypt
bDepartment of Microbiology and Immunology, Assiut University, Assiut, 71526, Egypt


Authors:
El-Tallawy, H.N.a,  Farghaly, W.M.A.a,  Shehata, G.A.aEmail Author,  Badry, R.a,  Hassan, M.b,  Hamed, M.A.a,  Sayed, M.A.M.c,  Abdulghani, K.O.d,  Sayed, S.S.e,  Rageh, T.A.a,  Metwally, N.A.b,  Mohamed, K.O.a,  Tohamy, A.M.a

Journal:
Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Date of Publishing:
Volume 53, Issue 2, April-June 2016, Pages 70-73

Title:
Incidence and Clinical Predictors of Outcome of Bell’s Palsy, Al-Quseir City, ‎Red Sea Governorate, Egypt‎

Abstract:
Background Bell’s palsy (BP) is one of the most common causes of acute-onset unilateral facial weakness. Through this study we aimed to estimate the incidence of BP in Al-Quseir City, Red Sea Governorate, Egypt. Patients and methods A project was undertaken to assess the epidemiology of major neurological disorders. A total of 33 285 eligible patients were screened through a door-to-door survey (every door) by three specialists in neurology and 15 social workers. All patients were subjected to detailed history taking and a meticulous neurological examination by means of a specific questionnaire designed for this study. Results Within 1 year, 27 patients were diagnosed with BP. This yielded an incidence rate of 98.9/100000 population (aged 9 years and older). The incidence was higher in the male population than in the female population (116.4 and 81.2/100 000, respectively). Age-specific incidence of BP showed that its peak was between the ages of 18 and 60 years. About 78% of patients with BP recovered completely within 6 months after onset. There was no significant difference between male and female patients. Conclusion The incidence rate for BP was 98.9/100 000 among those aged 9 years and older. Most affected cases were older than 18 and less than 60 years. © 2016 The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.

Author Info:
aDepartment of Neurology, Assiut University, Egypt
bDepartment of Neurology, Al-Azhar University (Assiut Branch), Egypt
cDepartment of Neurology, Sohag University, Egypt
dDepartment of Neurology, Helwan University, Egypt
eDepartment of Neurology, Fayoum University, Egypt


Authors:
Elbadawy, A.aEmail Author,  HaSSaBaLLa, A.a,  Osman, M.b,  ALi, H.a,  SaLEh, M.a

Date of Publishing:
Volume 29, Issue 4, August 2016, Pages 107-113

Title:
Endovascular Approaches in the Management of Extremity Vascular ‎Trauma‎

Abstract:
BACKGROUND: The aim of this study was to understand the role and best indications of endovascular interventions and techniques in management of extremity vascular trauma. METHODS: A retrospective study. We included patients presented with extremity vascular injuries and managed with either transcatheter embolization of bleeding arteries, balloon vascular control or covered stents. Data recorded for each patient were demographics, mechanism of injury, clinical presentation, location of injured vessel, type of endovascular approach in management, complications, need for reinterventions and the outcome. Primary outcomes were freedom from rebleeding, freedom from reinterventions, complete exclusion of pseudoaneurysm or arteriovenous istula (AVF) and limb salvage. Descriptive statistics were used for analysis of retrieved data. RESULTS: Sixteen cases (9.5%) were included in current series. The mean age was 35.2 years (range 20: 65 years). The clinical presentations were: Acute bleeding in 4 cases (25%), pseudoaneurysm (N.=7, 43.7%) and AVF (N.=5, 31.3%). Transcatheter embolization of bleeding vessel using NBCA glue was performed in 10 patients (62.5%). Covered stent grafts were deployed in 2 cases (12.5%). Balloon vascular control was deemed necessary in 4 trauma patients (25%). Primary technical success was 93.7% (15 cases). Reintervention was needed in a single case. Immediate and 6 month follow up survival rate and limb salvage rate in the current series were 100%. CONCLUSIONS: Endovascular approaches could provide deinite management of extremity vascular trauma or pave the way for deinite surgical treatment in situations needed to avoid aggressive surgical exposures associated with higher morbidity in such young trauma population. © 2015 EDiZiONi MiNErVa MEDiCa.

Author Info:
aDepartment of Vascular and Endovascular Surgery, Assiut University Hospital, Assiut, 71515, Egypt
bDepartment of Interventional Radiology, Assiut University Hospital, Assiut, Egypt


Date of Publishing:
Volume 42, Issue 3, 1 May 2016, Pages 394-401

Title:
Assessment of the Needs of Mothers and Primary Healthcare Providers to ‎Support Early Childhood Development in Egypt: A Qualitative Study‎

Abstract:
Background: The early childhood period is considered the most important developmental phase in an individual's lifespan. However, it is not addressed in the Egyptian health system. We aimed to explore mothers' and healthcare providers' perceptions about early childhood development (ECD) and identify their needs to support ECD in Egypt. Methods: Focus group discussions with 79 mothers of children younger than 2years old from different socio-economic backgrounds and residing in urban and rural areas and 26 primary healthcare providers were used to collect data. Emerging themes and subthemes were identified from the data analysis. Results: Urban and rural mothers in Egypt of all educational levels are not well prepared to support their children's early development, especially the cognitive and emotional aspects. Limited sources of information about ECD, the large families of rural women and an absence of developmental health services and family support were the most important factors that led to a neglect of mother-child communication and stimulation. Conclusion: Raising community awareness and training primary healthcare providers to counsel mothers about ECD are important prerequisites for supporting ECD in Egypt. Rural and first-time mothers would be the most valuable starting point. © 2016 John Wiley & Sons Ltd.

Author Info:
Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt


Authors:
Elkablawy, M.A.a,cEmail Author,  Albasri, A.M.a,  Mohammed, R.A.a,d,  Hussainy, A.S.a,  Nouh, M.M.a,e,  Alhujaily, A.S.b

Date of Publishing:
Volume 37, Issue 2, February 2016, Pages 137-141

Title:
Ki67 Expression in Breast Cancer: Correlation with Prognostic Markers and ‎Clinicopathological Parameters in Saudi Patients‎

Abstract:
Objectives: To evaluate Ki67 immunoexpression pattern in Saudi breast cancer (BC) patients and investigate any possible predictive or prognostic value for Ki67. Methods: This is a retrospective study designed to quantitatively assess the Ki67 proliferative index (PI) in retrieved paraffin blocks of 115 Saudi BC patients diagnosed between January 2005 and March 2015 at the Department of Pathology, King Fahd Hospital, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. The Ki67 PI was correlated with individual and combined immunoprofile data of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2/neu) with their clinicopathological parameters. Results: Ki67 immunoreactivity was highly expressed (>25% of the tumor cells were positive) in 85 (73.9%) patients. The Ki67 PI was significantly associated with poor prognostic clinicopathological parameters including old age (p<0.02), high tumor grade (p<0.01), lymph node metastasis (p<0.001), and Her-2/neu positivity (p<0.009). However, the association with ER positivity, PR positivity, tumor size, and lymphovascular invasion were not statistically significant. The Ki67 PI was significantly associated with BC molecular subtypes that were Her2/neu positive (luminal B and HER-2) subtypes compared with the Her2/neu negative (luminal A) subtype (p<0.04). Conclusion: The Ki67 PI is significantly higher in Saudi BC patients comparing with the reported literature. Ki67 PI was highest in the HER-2 and luminal-B molecular subtypes. Along with other prognostic indicators, Ki67 PI may be useful in predicting prognosis and management of Saudi BC patients. © 2016, Saudi Arabian Armed Forces Hospital. All rights reserved.

Author Info:
aDepartment of Pathology, King Fahd Hospital, Al Munawarah, Al Madinah, Saudi Arabia
bTaibah University, Department of Pathology, King Fahd Hospital, Al Munawarah, Al Madinah, Saudi Arabia
cDepartment of Pathology, Menoufia University, Menoufia, Egypt
dDepartment of Pathology, Asiut University, Assiut, Egypt
eDepartment of Pathology, Benha University, Benha, Egypt


Authors:
Elwasify, M.a,  Barakat, D.H.bEmail Author,  Fawzy, M.c,  Elwasify, M.a,  Rashed, I.a,  Radwan, D.N.b

Date of Publishing:
Volume 23, Issue 4, 1 October 2016, Pages 200-207

Title:
Quality of Sleep in a Sample of Egyptian Medical Students‎

Abstract:
Background In the last few years, there has been a growing attention to sleep and related disorders. Numerous studies conducted within the past decade have analyzed the deleterious effects of poor sleep quality on university students and medical staff in various specialties, but only few studies have been conducted in the Middle East. Aim The aim of the study was to investigate the prevalence of poor sleep quality among (a sample of) Egyptian medical students. Participants and methods This cross-sectional, questionnaire-based, observational study was conducted during the period from April to June 2015 on 1182 undergraduate medical students from Assiut and Mansoura Universities in Egypt. The data were gathered using a sociodemographic questionnaire and Pittsburgh Sleep Quality Index (PSQI), and were analyzed using the SPSS software. Results Mean PSQI score was 6.01 (SD±2.73). According to the PSQI, 46.7% of the subjects had good sleep quality and 53.3% had poor sleep quality. Poor sleep quality was mostly prevalent among those in the early years of medical education, caffeine consumers, cigarette smokers, those with fairly bad and very bad subjective sleep quality, those with sleep latency above 30 min, sleep duration less than 7 h, fairly bad and very bad daytime functioning, those taking sleep medications, and those with sleep disturbance, and sleep efficiency below 85%. Conclusion Poor sleep quality is highly prevalent among medical students in Egypt. © 2016 Institute of Psychiatry, Ain Shams University.

Author Info:
aDepartment of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
bDepartment of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
cDepartment of Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Famuyide, A.O.aEmail Author,  Shazly, S.A.M.a,b,  Makdisi, P.B.a,  El-Nashar, S.A.a,  Breitkopf, D.M.a,  Hopkins, M.R.a,  Laughlin-Tommaso, S.K.a

Date of Publishing:
Volume 25, Issue 9, 1 September 2016, Pages 889-896

Title:
Impact of Simple Ovarian Cysts on the Interpretation of Endometrial ‎Thickness in Women with Postmenopausal Bleeding‎

Abstract:
Background: There is evidence that premenopausal hormones may persist for variable time after menopause. Histological specimens from postmenopausal women support the presence of follicular growth at that age. Residual ovarian function may explain postmenopausal bleeding (PMB), which is not associated with endometrial pathology. Our objective was to evaluate the effect of sonographic diagnosis of simple ovarian cysts on the association between thickened endometrium and endometrial pathology in women with PMB. Materials and Methods: Data were retrospectively collected from medical records of women who underwent office hysteroscopy for PMB between January 2007 and October 2011. Women with sonographic reports within 3 months of presentation were included. Endometrial thickness and the presence of a simple ovarian cyst (≤5 cm) were documented by reviewing sonographic reports. Diagnosis of endometrial pathology was abstracted according to pathology reports or hysteroscopic impression. Endometria with hyperplasia, cancer, or polyps were considered pathological. Results: Of 836 women with PMB, 356 had recent transvaginal sonography and were included in the analysis. Pathological endometrium was documented in 129 (36.2%) women, including 29 (8.2%) with endometrial cancer. In women with PMB and no evidence of a simple ovarian cyst, endometrial thickness was an independent predictor of endometrial pathology and endometrial cancer with adjusted OR = 1.13 (95% CI = 1.07-1.19) and 1.16 (95% CI = 1.07-1.25), respectively. In the presence of simple ovarian cysts, the adjusted ORs for endometrial thickness as a predictor of endometrial pathology were 1.06 (95% CI = 0.90-1.25) and 0.84 (95% CI = 0.62-1.14), respectively. Conclusion: The presence of simple ovarian cysts (≤5 cm) tempers the value of endometrial thickness in predicting endometrial pathology in women with PMB. © Copyright 2016, Mary Ann Liebert, Inc. 2016.

Author Info:
aDepartment of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, United States
bDepartment of Obstetrics and Gynecology, Assiut University, Asyut, Egypt
Abstract


Journal:
International Journal of Gynecology and Obstetrics

Date of Publishing:
Volume 132, Issue 3, 1 March 2016, Pages 356-358

Title:
Non-Hormonal Interruption of Incessant Ovulation as a Potential Approach ‎for Ovarian Cancer Prevention‎

Abstract:
Ovarian cancer is a silent killer. There is a need to intensify research efforts on prevention strategies. The causative role of incessant ovulation has been supported by the protective effect of oral hormonal contraceptives. The released follicular fluid in the process of ovulation bathes not only the surface of the ovary but also the fimbrial end of the fallopian tube. Evidence has been accumulating about a fimbrial tubal origin for ovarian high-grade serous carcinoma, and for the potential of opportunistic or elective salpingectomy as an intervention strategy. Alternatively, periodic suppression of ovulation could be beneficial among women who have no need or are not using oral hormonal contraceptives. Rupture of the ovarian follicle releasing the ovum and follicular fluid is a prostaglandin-mediated inflammatory process. It can be stopped by nonsteroidal anti-inflammatory drugs, leading to pharmacologic production of a luteinized unruptured follicle, simulating a normal non-conception cycle with unaltered steroid patterns/levels and cycle length. Non-hormonal periodic interruption of incessant ovulation could be recommended for women who are at high risk of ovarian cancer, but further research is needed to validate the potential of this approach. © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Author Info:
Department of Obstetrics and Gynecology, Assiut University, P.O.Box 30, Assiut, Egypt


Journal:
International Encyclopedia of Public Health

Title:
Sexual and Reproductive Health: Overview‎

Abstract:
The concept of sexual and reproductive health has evolved to offer a comprehensive and integrated approach to health needs related to sexuality and reproduction. Sexual and reproductive health is a public health concern, a human rights issue, and is essential for attaining Millennium Development Goals (MDGs). The global situation of sexual and reproductive health shows glaring inequities between developed and developing regions. Although a concern for both women and men, women bear the major share of the burden of sexual and reproductive ill health. Interventions beyond the health sector are needed, together with an integrated package of interdependent and interrelated health service components. © 2017 Elsevier Inc. All rights reserved.


Authors:
Galal, S.M.a,  Abdel Aal, F.H.a,  Mohammed, A.E.-D.a,  Mohamed, M.Z.b,  Abd El-Rahman, Y.G.c

Journal:
Egyptian Journal of Radiology and Nuclear Medicine

Date of Publishing:
Volume 47, Issue 3, 1 September 2016, Pages 739-748

Title:
Chronic Viral Hepatitis C in Pediatric Age Group; Assessment of Viral ‎Activity and Hepatic Fibrosis by 1h Magnetic Resonance Spectroscopy and ‎Diffusion Weighted Imaging in Asymptomatic Patient‎

Abstract:
Background Chronic hepatitis C is the most common cause of chronic liver disease and cirrhosis. Egypt is the highest affected country with a prevalence of 22%. In children, seroprevalence of HCV is 0.2% in children less than 11 years of age and 0.4% in children equal and more than 11 years of age. Aim of the work The purpose of this study was to assess the value of 1H MRS and DW-MRI as noninvasive tool in evaluation of activity and fibrosis of hepatic parenchyma in asymptomatic children with chronic hepatitis C. Subjects and methods Across-section study was conducted over a period of two years, included thirty children of asymptomatic chronic hepatitis C virus infection (mean age ± SD 14.1 ± 2.8 years) and twenty healthy children as controls were included. Abdominal ultrasonography, percutaneous liver biopsy, MRS and DW-MRI were done to all cases. Results The results showed that HCV infection was more common in our males (83.3%). The results of METAVIR grades showed 29 cases (99.9%) had activity while 17 cases (56.4%) had fibrosis. The results of MRS and DW-MRI showed significant differences between cases and controls and positive correlations between of the results of 1H MRS with the results of liver biopsy (METAVIR grades and METAVIR stages). Conclusion Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay end stage chronic parenchymal liver disease. 1H MRS may be a potential noninvasive helpful diagnostic tool in the assessment of staging and fibrosis of asymptomatic chronic hepatitis C. The increase in metabolites were correlated with histopathological changes. DW-MRI can be considered as an effective predictor in the assessment of activity in chronic hepatitis C. © 2016

Author Info:
aPediatrics Departments, Faculty of Medicine, Assiut University, Egypt
bRadiology Departments, Faculty of Medicine, Assiut University, Egypt
cPathology Departments, Faculty of Medicine, Assiut University, Egypt


Authors:
Gamal, R.M.aEmail Author,  Gaber, W.b,  Sayed, S.b,  Mohey, A.M.c,  Goma, S.H.a,  Mohamed, M.S.E.d

Date of Publishing:
Volume 41, Issue 6, 1 December 2016, Pages 492-498

Title:
Vitamin D Status in Egyptian Patients with Rheumatoid Arthritis‎

Abstract:
Background: Vitamin D is a potent regulator of calcium homeostasis and may have immunomodulatory effects. The influence of vitamin D on human autoimmune disease has not been well defined. The aim of this cross sectional study was to estimate the prevalence and determinants of vitamin D deficiency in patients with rheumatoid arthritis as compared to healthy controls and to analyze the association between 25-hydroxyvitamin D with disease activity. Methods: The study includes 55 consecutive rheumatoid arthritis patients and 25 healthy controls, not on vitamin D supplements. Together with parameters of disease activity, all patients had serum 25-hydroxyvitamin D [25(OH)D] measured by ELISA kit in a centralized laboratory. Disease activity in rheumatoid arthritis was assessed by Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ). According to activity indexes, patients were divided into subgroups with high activity of the disease (DAS28 >5.1), moderate activity of the disease (3.2 < DAS28 = 5.1), low activity of disease (2.6 = DAS28 = 3.2) and remission (DAS28 < 2.60). Associations between serum levels of 25(OH)D and age, disease duration and activity were assessed. Results: 25-hydroxyvitamin D deficiency, insufficiency and sufficiency were found in 16.00, 4.00 and 80.00 % of controls, respectively, while, 25(OH)D insufficiency and sufficiency were found in 21.80 and 78.20 % of rheumatoid arthritis patients, respectively with no significant difference between groups (P < 0.918). According to DAS28 scoring, 9.10 % of patients showed remission (DAS28 < 2.6), 7.30 % showed low disease activity (2.6 = DAS28 = 3.2), 63.60 % showed moderate activity (3.2 < DAS28 = 5.1) and 20.00 % showed high disease activity (DAS28 >5.1). Disease duration was significantly longer in patients with moderate disease activity vs. those with low and high disease activity (P < 0.026 and P < 0.001, respectively). 25(OH)D levels were lower in moderate disease activity vs. those with remission (P < 0.014). DAS28 and HAQ were significantly higher in patients with high disease activity than remission, low disease activity and moderate disease activity. DAS28 and HAQ were significantly higher in patients with moderate disease activity than remission and those with low disease activity. A significant negative correlation was found in rheumatoid arthritis patients between 25(OH)D and ESR. Conclusions: In rheumatoid arthritis patients, vitamin D deficiency is quite common, but similar to that found in control subjects; disease activity (expressed as ESR) is inversely related to 25(OH)D levels. © Georg Thieme Verlag KGStuttgart · New York

Author Info:
aRheumatology and Rehablitation, Assiut University Hospital, Assiut, Egypt
bRheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
cClinical Pathology, Cairo University Hospital, Cairo, Egypt
dMicrobiology and Immunology Department, Faculty of Medicine, Assuit University, Assiut, Egypt


Authors:
Gamal, R.M.a,  Mahran, S.A.a,bEmail Author,  Abo El Fetoh, N.c,  Janbi, F.b

Date of Publishing:
Volume 38, Issue 2, 1 April 2016, Pages 65-70

Title:
Quality of Life Assessment in Egyptian Rheumatoid Arthritis Patients: ‎Relation to Clinical Features and Disease Activity‎

Abstract:
Aim of work: To assess the impact of rheumatoid arthritis (RA) on the health related quality of life (QoL) of patients, using the 36-item short form (SF-36) and to study the influence of different disease variables. Patients and methods: Eighty-six RA patients were recruited from the Rheumatology and Rehabilitation outpatient of Assiut University Hospital. Forty-three, age and sex matched subjects were included as controls. The QoL was measured in all subjects using the SF-36 health survey. Disease activity was assessed in RA patients by the disease activity score (DAS28). Results: All domains of the SF36 were significantly lower in the patients (p < 0.0001). Patients with a lower educational level and those unemployed had significantly lower SF36 components. Those with a disease duration >5 years, positive rheumatoid factor and higher disease activity had a significantly lower SF36 physical component. Patients receiving hydroxychloroquine or prednisolone had significantly lower mental component. Significant negative correlation of the SF36 physical and mental components was found with both disease duration (p = 0.01 and p < 00001 respectively) and DAS28 (p < 0.0001 for both). Rheumatoid factor negatively correlated with the physical component (p < 0.0001). Regression analysis showed that disease duration was the most profound predictor of both SF36 components (p < 0.0001). Conclusion: The quality of life is impaired in Egyptian RA patients and disease duration was the most significant predictor. Routine assessment of the health-related QoL in those patients is recommended to detect and monitor the impact of the disease and medications used on different aspects of their quality of life. © 2015 The Authors.

Author Info:
aPhysical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
bPhysical Medicine and Rehabilitation Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
cNeurology and Psychiatry Department, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt


Authors:
Genovese, E.A.aEmail Author,  Chaer, R.A.a,  Taha, A.G.a,b,  Marone, L.K.a,  Avgerinos, E.a,  Makaroun, M.S.a,  Baril, D.T.a

Title:
Risk Factors for Long-Term Mortality and Amputation after Open and ‎Endovascular Treatment of Acute Limb Ischemia

Abstract:
Background Acute limb ischemia (ALI) is a highly morbid and fatal vascular emergency with little known about contemporary, long-term patient outcomes. The goal was to determine predictors of long-term mortality and amputation after open and endovascular treatment of ALI. Methods A retrospective review of ALI patients at a single institution from 2005 to 2011 was performed to determine the impact of revascularization technique on 5-year mortality and amputation. For each main outcome 2 multivariable models were developed; the first adjusted for preoperative clinical presentation and procedure type, the second also adjusted for postoperative adverse events (AEs). Results A total of 445 limbs in 411 patients were treated for ALI. Interventions included surgical thrombectomy (48%), emergent bypass (18%), and endovascular revascularization (34%). Mean age was 68 ± 15 years, 54% were male, and 23% had cancer. Most patients presented with Rutherford classification IIa (54%) or IIb (39%). The etiology of ALI included embolism (27%), in situ thrombosis (28%), thrombosed bypass grafts (32%), and thrombosed stents (13%). Patients treated with open procedures had significantly more advanced ischemia and higher rates of postoperative respiratory failure, whereas patients undergoing endovascular interventions had higher rates of technical failure. Rates of postprocedural bleeding and cardiac events were similar between both treatments. Excluding Rutherford class III patients (n = 12), overall 5-year mortality was 54% (stratified by treatment, 65% for thrombectomy, 63% for bypass, and 36% for endovascular, P < 0.001); 5-year amputation was 28% (stratified by treatment, 18% for thrombectomy, 27% for bypass, and 17% for endovascular, P = 0.042). Adjusting for comorbidities, patient presentation, AEs, and treatment method, the risk of mortality increased with age (hazard ratio [HR] = 1.04, P < 0.001), female gender (HR = 1.50, P = 0.031), cancer (HR = 2.19, P < 0.001), fasciotomy (HR = 1.69, P = 0.204) in situ thrombosis or embolic etiology (HR = 1.73, P = 0.007), cardiac AEs (HR = 2.25, P < 0.001), respiratory failure (HR = 2.72, P < 0.001), renal failure (HR = 4.70, P < 0.001), and hemorrhagic events (HR = 2.25, P = 0.003). Risk of amputation increased with advanced ischemia (Rutherford IIb compared with IIa, HR = 2.57, P < 0.001), thrombosed bypass etiology (HR = 3.53, P = 0.002), open revascularization (OR; HR = 1.95, P = 0.022), and technical failure of primary intervention (HR = 6.01, P < 0.001). Conclusions After the treatment of ALI, long-term mortality and amputation rates were greater in patients treated with open techniques; OR patients presented with a higher number of comorbidities and advanced ischemia, while also experiencing a higher rate of major postoperative complications. Overall, mortality rates remained high and were most strongly associated with baseline comorbidities, acuity of presentation, and perioperative AEs, particularly respiratory failure. Comparatively, amputation risk was most highly associated with advanced ischemia, thrombosed bypass, and failure of the initial revascularization procedure. © 2016 Elsevier Inc. All rights reserved.

Author Info:
aDivision of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop Street, Pittsburgh, PA 15213, United States
bDepartment of Vascular Surgery, Assiut University, Assiut, Egypt


Authors:
Hamed, E.A.aEmail Author,  Mohamed Farghaly, H.S.b,  Abdel Mola, A.F.c,  Fahmi, M.K.a,  Makhlouf, M.M.c,  Balfas, M.A.a

Journal:
Journal of Basic and Clinical Physiology and Pharmacology

Date of Publishing:
Volume 27, Issue 4, 1 June 2016, Pages 411-424

Title:
Role of Monocyte Chemoattractant Protein-1, Stromal Derived Factor-1 ‎and Retinoic Acid in Pathophysiology of Neuropathic Pain in Rats‎

Abstract:
Background: Chemokines have been recently recognized to play a role in chronic pain syndromes' pathophysiology. This study investigated the role of monocyte chemoattractant protein-1 (MCP-1), stromal cell derived factor-1 (SDF-1), and retinoic acid (RA) as targets for the therapeutic approach of neuropathic pain. Methods: A chronic constriction injury (CCI) model of neuropathic pain by unilateral ligation of left sciatic nerve was performed in adult female Wistar rats. The effects of doxycycline (Dox, 50 mg/kg/day i.p. for 7 days), single dose of bicyclam (5 mg/kg i.p.), RA (15 mg/kg/day i.p. for 7 days), and their combination(s) on behavioral tests of nociception (Von Frey filaments; paw pressure test) on days 0, 1, 3, 5, and 7 of operation were studied. Serum concentrations of MCP-1 and SDF-1 were measured by ELISA. Histological examination of the sciatic nerve was investigated. Results: CCI of sciatic nerve significantly induced mechanical allodynia and hyperalgesia and an increase of MCP-1 and SDF-1 serum levels. Dox-treated groups (Dox, Dox+bicyclam, Dox+RA, Dox+bicyclam+RA) and bicyclam-treated groups (bicyclam, Dox+bicyclam, bicyclam+RA, Dox+bicyclam+RA) attenuated CCI-induced behavioral and biochemical changes. RA inhibited CCI-induced mechanical hyperalgesia but produced a time-dependent reversal of allodynia. Histological findings showed degenerative changes of sciatic nerve after CCI that were partially recovered in Dox-treated groups. Conclusions: These findings demonstrate an association between serum MCP-1 and SDF-1 concentrations and behavioral manifestations of neuropathic pain. RA administration decreased neuropathic pain (antihyperalgesic effect) but did not cause any improvement in sciatic nerve tissues, either alone or in combination with chemokine antagonists. Thus, chemokines may serve as potential targets for drug development in neuropathic pain treatment. © 2016 by De Gruyter.

Author Info:
aFaculty of Medicine, Department of Physiology, Assiut University, Assiut, Egypt
bFaculty of Medicine, Department of Pharmacology, Assiut University, Assiut, Egypt
cFaculty of Medicine, Department of Histology, Assiut University, Assiut, Egypt


Authors:
Hamied, K.M.A.Email Author,  Mola, A.F.A.

Title:
The Protective Role of the Food Additive Butylated Hydroxytoluene in the ‎Pancreas of Aflatoxicosed Adult Albino Rats: A Histological, ‎Immunohistochemical, and Morphometric Study‎

Abstract:
Aim This work aimed to demonstrate the histopathological effects of chronic AFB1 toxicity on the exocrine and endocrine pancreas and evaluate the possible protective role of BHT in these structural changes. Materials and methods Thirty adult male albino rats were randomly divided into three groups: group I served as the control group; group II received 60 μg/kg of AFB1 orally three times weekly for 5 consecutive weeks; and group III received a concomitant dose of BHT (0.05 mg/ kg) orally along with AFB1. After the rats had been sacrificed, pancreatic specimens were taken and processed for histological, immunohistochemical, and morphometric study. Results Both exocrine and endocrine pancreas of group II showed marked degenerative changes. Acinar cells exhibited decreased or almost absent basal basophilia and reduced content of zymogen granules in periodic acid Schiff-stained sections. Periductal and perivascular fibrosis was observed with dilatation and congestion of blood vessels and inflammatory cell infiltration. β-Cells were degenerated and expressed decreased insulin immunostaining. There was significant decrease in islet surface area, islet diameter, islet volume, and numerical density of β-cells compared with the control group. The pancreas of group III showed marked improvement compared with the aflatoxicosed group. Conclusion Treatment with AFB1 for 5 weeks has a direct toxic effect on the exocrine and endocrine pancreas that can ultimately affect its performance. The use of BHT markedly attenuates these effects and can be considered an effective chemoprotective agent against AFB1 toxicity. © 2016 The Egyptian Journal of Histology 1110-0559.

Author Info:
Department of Histology, Faculty of Medicine, Assiut University, 400-Al-Ahsa (KSA) Assiut, 31982, Egypt


Authors:
Hammam, N.,  Rashed, A.,  Abdel-Wahab, N.

Date of Publishing:
Volume 55, Issue 9, 1 September 2016, Article number kew260, Pages 1709-1709

Title:
Erratum To: Hand Grip Strength in Juvenile Idiopathic Arthritis as Predictor ‎of Disease Activity and Disability in Clinical Practice [Rheumatology, 54 ‎‎(Suppl 1), I155 (2015)] ‎Doi:10.1093/Rheumatology/Kev090.037‎

Abstract:
In the above abstract, Noha Abdel-Wahab's name was incorrectly displayed as part of the affiliation. The author names should read as in this erratum. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Author Info:
Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt


Authors:
Hassan, A.K.M.a,bEmail Author,  Abdelmegid, M.A.K.F.a,b,  Hassan Ali, H.a,c,  Warda, H.M.d,e,  Mahfouz, R.A.f,  Tammam Alkhateeb, A.A.A.a

Date of Publishing:
Volume 68, Issue 1, 1 March 2016, Pages 31-36

Title:
Radial Artery Anomalies in Patients Undergoing Transradial Coronary ‎Procedures - an Egyptian Multicenter Experience‎

Abstract:
Objectives: We investigated the incidence of radial anomalies (RA) in patients undergoing transradial (TR) coronary procedure and their impact on procedural outcome in the Egyptian population. Background: Radial anomalies (RA) are considered an important factor for procedural failure. Information about anatomical variation is limited in our Egyptian population. Methods: We performed a multicentre prospective study in Egypt. A total of 650 consecutive patients undergoing their first TR coronary procedure were recruited from January 2013 till January 2015. By retrograde radial arteriography we assessed the frequency of RA and their impact on procedural outcome. Results: 650 consecutive patients were studied, 74% male, mean (SD) age 55 (10) years. The overall incidence of radial artery anomaly was 12.6% (n = 82). 40 (6.2%) patients had a high-bifurcating radial origin, 8 (1.2%) had a full radial loop, 14 (2.1%) had extreme radial artery tortuosity and 20 (3%) had other anomalies such as persistent left subclavian artery and extreme subclavian tortuosity. Overall transradial procedural success was 95%. Procedural failure was more common in patients with anomalous anatomy (39%) than in patients with normal anatomy (0.2%). Procedural failure was highest in patients with radial loop (87.5%), followed by those with subclavian tortuosity (45%), then high radial bifurcation (30%), and severe radial tortuosity (28.5%). 14 (2.1%) vascular complications occurred, all of which were treated conservatively. Conclusion: There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates. © 2015.

Author Info:
aDepartment of Cardiology, Faculty of Medicine, Assiut University, Egypt
bAssiut Cardiac Center, Assiut, Egypt
cAl Road Catherterization Center, Assiut, Egypt
dAl Hyatt Heart and Vascular, Alexandria, Egypt
eDepartment of Cardiology, Faculty of Medicine, Tanta University, Egypt
fDepartment of Cardiology, Faculty of Medicine, Zagazig University, Egypt


Title:
Intra Uterine Extra-Amniotic Versus Vaginal Misoprostol ‎For Termination Of Second Trimester Miscarriage: A ‎Randomized Controlled Trial.‎

Abstract:
BACKGROUND:
Termination of pregnancy in the second trimester using prostaglandins has been shown to be safe and effective. Misoprostol has multiple routes of administration; oral, vaginal, buccal, rectal and sublingual.

OBJECTIVE:
The study aims to compare the efficacy and safety of intrauterine extra-amniotic and vaginal misoprostol in a dose of 200 microgram every 4 hours for the termination of pregnancy in cases of second trimester miscarriage.

MATERIALS AND METHODS:
A prospective randomized open labeled clinical trial included 180 women with missed miscarriage in gestational age between 13 and 24 wks. Patients were randomized to receive subsequent doses of 200 µg misoprostol every 4 hrs either intra uterine extra-amniotic by Foley catheter or vaginally administered. Randomization was completed using a computer-generated random table. The primary outcome of this study was the mean duration from the initial misoprostol dose until complete fetal expulsion (induction-expulsion interval).

RESULTS:
The mean gestational age was 17.74 wks. The mean time to complete miscarriage in the intra uterine extra-amniotic group was 5.27 hrs, which was significantly lower than the vaginal group (9.92 hrs, p=0.001). Side effects were more common in vaginal group.

CONCLUSION:
Intra uterine extra-amniotic misoprostol with a dose of 200 µg every 4 hrs appears to be more effective and safer than vaginal misoprostol in induction of second trimester miscarriage.

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


Authors:
Abbas WA1, Kasem Ahmed SM, Abdel Aal AM, Mahmoud AA, Abdelmalek MO, Mekky MA, Abozaid MA, Ibrahim AK.

Title:
Galactin-3 And Brain Natriuretic Peptide Versus ‎Conventional Echocardiography In The Early Detection ‎Of Cirrhotic Cardiomyopathy

Abstract:
BACKGROUND/AIMS:
Cirrhotic cardiomyopathy (CCM) is defined as an abnormal heart structure and function in cirrhotic patients. CCM includes systolic and diastolic dysfunction, electrophysiological abnormalities, and structural changes, both microscopic and macroscopic. Currently, there is no one diagnostic test that can identify patients with CCM. Evaluation of the validity of galactin-3 and brain natriuretic peptide (BNP) as biomarkers in the early detection of CCM in comparison to conventional echocardiography.

MATERIALS AND METHODS:
A case control study was carried out in the Departments of internal medicine and tropical Medicine, Assuit University, Egypt. Seventy-one subjects were divided into the following three groups: 26 cirrhotic patients without ascites, 25 cirrhotic patients with ascites, and 20 healthy controls. All groups underwent clinical examination, and laboratory investigation including BNP, galactin-3, and echocardiography.

RESULTS:
There was a significant difference between the three groups (p < 0.001) with regard to corrected QT (cQT), BNP and galactin-3. Left ventricular diastolic dysfunction with different grades was the most recorded cardiac abnormality in the patient group I and II (88.5% and 96%; respectively) with significantly increased frequency and severity in ascetic patients and with the advancement of liver cirrhosis. BNP and galactin-3 were sensitive and specific biomarkers for the detection of diastolic dysfunction in cirrhotic patients (77.6%, 95.5%, 89.9% and 86.4%; respectively).

CONCLUSION:
Diastolic dysfunction is a common cardiac abnormality in cirrhotic patients that worsens with the advancement of cirrhosis. BNP and galactin-3 had higher sensitivity and specificity in the early detection of CCM compared with those of conventional echocardiography.

Author Info:
1
Department of Internal Medicine, Assiut University School of Medicine, Assiut, Egypt. drwaelabbas@yahoo.com.


Title:
Role Of Serotonin And Nuclear Factor-Kappa B In The ‎Ameliorative Effect Of Ginger On Acetic Acid-Induced ‎Colitis

Abstract:
The current study was designed to investigate the role of serotonin (5-HT) and nuclear factor-kappa beta (NF-κB) in the ameliorative effect of ginger on acetic acid (AA)-induced colitis rat model. Colitis was induced by intra-colonic instillation of 3% AA, preceded or followed by daily administration of ginger (400mg/kg) by gavage for 5 days. Colons were assessed macroscopically and microscopically and the expression of NF-κB was evaluated by immunohistochemistry. Colonic tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), total peroxide (TP), and serum 5-HT levels were assessed. Administration of ginger ameliorated the effects of AA-induced colitis by plummeting colon weight-to-length ratio, macroscopic and microscopic scores. These effects were further supported by down-regulation of NF-κB and reduction of colonic TNF-α, IL-10, TP and serum 5-HT levels. Moreover, there were significant positive correlations between serum 5-HT and macroscopic, microscopic, immunoreactivity scores and colonic TNF-α level. In conclusion, ginger ameliorated AA-induced colitis not only through its anti-inflammatory and anti-oxidant properties, but also through the reduction of 5-HT which may contribute to the down-regulation of NF-κB-dependent TNF-α expression and the reduction of lipid peroxidation and tissue damage. In addition, the therapeutic effect of ginger was more pronounced than its preventive effect.

Author Info:
1
Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: eman_sayyed2@yahoo.com.
2
Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abda E1, Selim Z1, Teleb S2, Zaghira M3, Fawzy M4, Hamed S4.

Title:
Sexual Function in Females With Rheumatoid Arthritis: Relationship With Physical and Psychosocial States

Abstract:
OBJECTIVES:
This study aims to assess the frequency rates of sexual problems and associated factors in a cohort of married females with rheumatoid arthritis (RA).

PATIENTS AND METHODS:
The study included 200 female RA patients (mean age 44.2±9.1 years; range 18 to 55 years) and 100 age matched healthy control females (mean age 42.5±6.3 years; range 18 to 55 years). Mean duration of RA was 5.8±4.1 years. All participants were assessed by Health Assessment Questionnaire Disability Index, Numerical Rating Pain Scale, Sexual Disability Scale, psychiatric interview, Beck Depression Inventory, and Spielberger's State-Trait Anxiety Inventory.

RESULTS:
Majority of the patients had grade II physical disability (62%), moderate pain (55%), depression (46%), and anxiety (77%). Sexual disability and loss of sexual desire and satisfaction were reported in 4% to 77.8% of patients which varied with age, duration of RA, degree of physical disability, and psychiatric comorbidities. Multiple regression analysis showed that scores of sexual disability and loss of sexual desire and satisfaction were significantly associated with scores of Health Assessment Questionnaire Disability Index (β=0.347; p=0.018; β=0.501; p=0.001) and depression (β=0.304; p=0.043; β=0.550; p=0.001).

CONCLUSION:
We may conclude that the frequencies of sexual problems in females with RA are high and closely related to physical disability and psychiatric comorbidities.

Author Info:
1
Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt.
2
Assiut University, Faculty of Nursing, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt.
4
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.


Authors:
Abdel-Aleem H1, El-Gibaly OM, El-Gazzar AF, Al-Attar GS.

Title:
Mobile Clinics For Women's And Children's Health

Abstract:
BACKGROUND:
The accessibility of health services is an important factor that affects the health outcomes of populations. A mobile clinic provides a wide range of services but in most countries the main focus is on health services for women and children. It is anticipated that improvement of the accessibility of health services via mobile clinics will improve women's and children's health.

OBJECTIVES:
To evaluate the impact of mobile clinic services on women's and children's health.

SEARCH METHODS:
For related systematic reviews, we searched the Database of Abstracts of Reviews of Effectiveness (DARE), CRD; Health Technology Assessment Database (HTA), CRD; NHS Economic Evaluation Database (NHS EED), CRD (searched 20 February 2014).For primary studies, we searched ISI Web of Science, for studies that have cited the included studies in this review (searched 18 January 2016); WHO ICTRP, and ClinicalTrials.gov (searched 23 May 2016); Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.cochranelibrary.com (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 7 April 2015); MEDLINE, OvidSP (searched 7 April 2015); Embase, OvidSP (searched 7 April 2015); CINAHL, EbscoHost (searched 7 April 2015); Global Health, OvidSP (searched 8 April 2015); POPLINE, K4Health (searched 8 April 2015); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (searched 8 April 2015); Global Health Library, WHO (searched 8 April 2015); PAHO, VHL (searched 8 April 2015); WHOLIS, WHO (searched 8 April 2015); LILACS, VHL (searched 9 April 2015).

SELECTION CRITERIA:
We included individual- and cluster-randomised controlled trials (RCTs) and non-RCTs. We included controlled before-and-after (CBA) studies provided they had at least two intervention sites and two control sites. Also, we included interrupted time series (ITS) studies if there was a clearly defined point in time when the intervention occurred and at least three data points before and three after the intervention. We defined the intervention of a mobile clinic as a clinic vehicle with a healthcare provider (with or without a nurse) and a driver that visited areas on a regular basis. The participants were women (18 years or older) and children (under the age of 18 years) in low-, middle-, and high-income countries.

DATA COLLECTION AND ANALYSIS:
Two review authors independently screened the titles and abstracts of studies identified by the search strategy, extracted data from the included studies using a specially-designed data extraction form based on the Cochrane EPOC Group data collection checklist, and assessed full-text articles for eligibility. All authors performed analyses, 'Risk of bias' assessments, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS:
Two cluster-RCTs met the inclusion criteria of this review. Both studies were conducted in the USA.One study tested whether offering onsite mobile mammography combined with health education was more effective at increasing breast cancer screening rates than offering health education only, including reminders to attend a static clinic for mammography. Women in the group offered mobile mammography and health education may be more likely to undergo mammography within three months of the intervention than those in the comparison group (55% versus 40%; odds ratio (OR) 1.83, 95% CI 1.22 to 2.74; low certainty evidence).A cost-effectiveness analysis of mammography at mobile versus static units found that the total cost per patient screened may be higher for mobile units than for static units. The incremental costs per patient screened for a mobile over a stationary unit were USD 61 and USD 45 for a mobile full digital unit and a mobile film unit respectively.The second study compared asthma outcomes for children aged two to six years who received asthma care from a mobile asthma clinic and children who received standard asthma care from the usual (static) primary provider. Children who receive asthma care from a mobile asthma clinic may experience little or no difference in symptom-free days, urgent care use and caregiver-reported medication use compared to children who receive care from their usual primary care provider. All of the evidence was of low certainty.

AUTHORS' CONCLUSIONS:
The paucity of evidence and the restricted range of contexts from which evidence is available make it difficult to draw conclusions on the impacts of mobile clinics on women's and children's health compared to static clinics. Further rigorous studies are needed in low-, middle-, and high-income countries to evaluate the impacts of mobile clinics on women's and children's health.

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


Authors:
Abdel-Aleem GA1,2, Khaleel EF3,4, Mostafa DG4,5, Elberier LK6,7.

Title:
Neuroprotective Effect Of Resveratrol Against Brain ‎Ischemia Reperfusion Injury In Rats Entails Reduction Of ‎DJ-1 Protein Expression And Activation Of ‎PI3K/Akt/GSK3b Survival Pathway

Abstract:
In the current study, we aimed to investigate the mechanistic role of DJ-1/PI3K/Akt survival pathway in ischemia/reperfusion (I/R) induced cerebral damage and to investigate if the resveratrol (RES) mediates its ischemic neuroptotection through this pathway. RES administration to Sham rats boosted glutathione level and superoxide dismutase activity and downregulated inducible nitric oxide synthase expression without affecting redox levels of DJ-1 forms or components of PI3K/Akt pathway including PTEN, p-Akt or p/p-GSK3b. However, RES pre-administration to I/R rats reduced infarction area, oxidative stress, inflammation and apoptosis. Concomitantly, RES ameliorated the decreased levels of oxidized forms of DJ-1 and enhancing its reduction, increased the nuclear protein expression of Nfr-2 and led to activation of PI3K/Akt survival pathway. In conclusion, overoxidation of DJ-1 is a major factor that contributes to post-I/R cerebral damage and its reduction by RES could explain the neuroprotection offered by RES.

Author Info:
1
a Department of Medical Biochemistry , Faculty of Medicine, Tanta University , Tanta , Egypt.
2
b Department of Medical Biochemistry , College of Medicine, King Khalid University , Abha , Saudi Arabia.
3
c Department of Medical Physiology , Faculty of Medicine, Cairo University , Cairo , Egypt.
4
d Department of Medical Physiology , College of Medicine, King Khalid University , Abha , Saudi Arabia.
5
e Department of Medical Physiology , Faculty of Medicine, Assiut University , Assiut , Egypt.
6
f Department of Histopathology , College of Medical Laboratory Technology, University of Science and Technology , Khartoum , Sudan , and.
7
g Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia.


Title:
The Relationship Between Female Genital Cutting And ‎Sexual Problems Experienced In The First Two Months ‎Of Marriage.‎

Abstract:
OBJECTIVE:
To examine the relationship between female genital cutting (FGC) and sexual problems experienced by couples in the first 2 months of marriage ("honeymoon distress").

METHODS:
A multicenter cross-sectional study was conducted at centers in Assiut and Sohag, Egypt, between March 1, 2011, and March 31, 2014. Eligible couples presented with sexual problems during the first 2 months of marriage. Couples were interviewed and asked to complete a pre-designed questionnaire, and a genital examination was performed. The primary outcomes of the study were the contribution of FGC to honeymoon distress and the effect of FGC on quality of life.

RESULTS:
Overall, 430 couples enrolled in the study. FGC was present in 376 (87.4%) women. The main presenting feature of honeymoon distress was superficial dyspareunia, which affected 291 (77.4%) women with FGC versus 16 (29.6%) of 54 without FGC (hazard ratio 8.13, 95% confidence interval 4.32-15.30). Women with FGC were more likely to have a poor quality of life during the first 2 months of marriage than were those without FGC (279 [74.2%] vs 13 [24.1%]; odds ratio 9.07, 95% confidence interval 4.66-17.64).

CONCLUSION:
FGC was found to be a contributing factor to honeymoon distress.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: mahmaleem2000@yahoo.co.uk.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt.


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

Title:
Warfarin-Drug Interactions: An Emphasis On Influence ‎Of Polypharmacy And High Doses Of ‎Amoxicillin/Clavulanate.

Abstract:
The objective of this study was to investigate the effect of polypharmacy and high doses of amoxicillin/clavulanate on warfarin response in hospitalized patients. This was a prospective cross-sectional observational study on 120 patients from July 2013 to January 2014. Potentially interacting drugs were classified according to their tendency of increasing international normalized ratio (INR) or bleeding risk. The 87.5% of patients prescribed high-dose amoxicillin/clavulanate (10-12 g daily) compared with 28.9% of patients prescribed a normal dose (up to 3.6 g daily) had INR values ≥ 4 during the hospital stay (P ≤ .001). Increased number of potentially interacting drugs that are known to increase INR was a significant predictor of having INR values ≥ 4 (OR, 2.5; 95%CI, 1.3-4.7), and increased number of potentially interacting drugs that are known to increase bleeding risk was a significant predictor of experiencing bleeding episodes (OR, 3.1; 95%CI, 1.3-7.3). High doses of amoxicillin/clavulanate were associated with a higher risk of over-anticoagulation when combined with warfarin than were normal doses. Increased risk of having INR ≥ 4 and bleeding events was associated with increased numbers of potentially interacting drugs prescribed, indicating that polypharmacy is a problem of concern. Frequent monitoring of warfarin therapy along with patients' medications is necessary to avoid complications.

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


Authors:
Abdel-Gawad M1, Elsobky E2, Shalaby MM3, Abd-Elhameed M4, Abdel-Rahim M4, Ali-El-Dein B4.

Title:
Quantitative Evaluation of Heavy Metals and Trace Elements in the Urinary Bladder: Comparison Between Cancerous, Adjacent Non-cancerous and Normal Cadaveric Tissue

Abstract:
The role of heavy metals and trace elements (HMTE) in the development of some cancers has been previously reported. Bladder carcinoma is a frequent malignancy of the urinary tract. The most common risk factors for bladder cancer are exposure to industrial carcinogens, cigarette smoking, gender, and possibly diet. The aim of this study was to evaluate HTME concentrations in the cancerous and adjacent non-cancerous tissues and compare them with those of normal cadaveric bladder. This prospective study included 102 paired samples of full-thickness cancer and adjacent non-cancerous bladder tissues of radical cystectomy (RC) specimens that were histologically proven as invasive bladder cancer (MIBC). We used 17 matched controls of non-malignant bladder tissue samples from cadavers. All samples were processed and evaluated for the concentration of 22 HMTE by using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Outcome analysis was made by the Mann-Whitney U, chi-square, Kruskal-Wallis, and Wilcoxon signed ranks tests. When compared with cadaveric control or cancerous, the adjacent non-cancerous tissue had higher levels of six elements (arsenic, lead, selenium, strontium, zinc, and aluminum), and when compared with the control alone, it had a higher concentration of calcium, cadmium, chromium, potassium, magnesium, and nickel. The cancerous tissue had a higher concentration of cadmium, lead, chromium, calcium, potassium, phosphorous, magnesium, nickel, selenium, strontium, and zinc than cadaveric control. Boron level was higher in cadaveric control than cancerous and adjacent non-cancerous tissue. Cadmium level was higher in cancerous tissue with node-positive than node-negative cases. The high concentrations of cadmium, lead, chromium, nickel, and zinc, in the cancerous together with arsenic in the adjacent non-cancerous tissues of RC specimens suggest a pathogenic role of these elements in BC. However, further work-up is needed to support this conclusion by the application of these HMTE on BC cell lines.

Author Info:
1
Department of Urology, Emirates International Hospital (M A-G), Al Jimi, Al Ain, Abu Dhabi, United Arab Emirates. naggarm@yahoo.com.
2
Department of Urology, Al-Noor Hospital (EE), Khalifa Street, Abu Dhabi, United Arab Emirates.
3
Assiut Urology and Nephrology Hospital (MMS), Assiut University, Assiut, Egypt.
4
Urology and Nephrology Center (M A-E, M A-R, BA), Mansoura University, Mansoura, Egypt.


Authors:
Abdel-Ghaffar HS1, Mohamed SA2, Fares KM2.

Title:
Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery

Abstract:
OBJECTIVE:
To compare the analgesic effect of combined intrathecal morphine and dexmedetomidine with either drug alone for postoperative analgesia in patients undergoing major abdominal cancer surgery.

METHODS:
Ninety patients were allocated to receive intrathecal 10 mg bupivacaine 0.5% (bupivacaine group, n = 30), 10 mg bupivacaine 0.5% and 0.5 mg morphine (Morphine Group, n = 30), or 10 mg bupivacaine 0.5%, 0.5 mg morphine and 5 µg dexmedetomidine (morphine-Dex group, n = 30). The groups were compared with time to first postoperative analgesia, iv patient-controlled analgesia (PCA) morphine consumption, pain scores, hemodynamics, sedation, and adverse events in the first 48h postoperative.

RESULTS:
The time to first use of morphine PCA was longer in morphine (22.13 ± 5.21h, P = 0.000) and morphine-Dex (23.46 ± 4.69h, P = 0.000) groups compared with bupivacaine group (0.50 ± 0.09h). Dexmedetomidine addition increased the duration of intrathecal morphine (ITM) analgesia by 1.33 h (P = 0.485). Morphine consumption was less in morphine (10.83 ± 2.96 mg, P = 0.000) and morphine-Dex (11.00 ± 3.32 mg, P = 0.000) groups than in bupivacaine group (27.5 ± 4.30 mg), with a nonsignificant difference between morphine and morphine-Dex groups (P = 0.375). Morphine and morphine-Dex groups showed lower pain scores (P < 0.001). Intraoperative blood pressure and heart rate were lower in morphine and morphine-Dex groups (P < 0.05) with no significant difference between groups in postoperative hemodynamics. Patients in bupivacaine group showed a higher incidence of postoperative nausea (P < 0.03) and vomiting (P < 0.01), while patients in morphine and morphine-Dex groups had a higher incidence of pruritus (P < 0.02).

CONCLUSIONS:
Our results do not support improved analgesia with the combination of intrathecal morphine and dexmedetomidine, despite the absence of significant adverse effects.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT02435537.

Author Info:
1
*Faculty of Medicine, Anesthesia and Intensive Care, Assiut University, Egypt hallasaad@yahoo.com.
2
South Egypt Cancer Institute, Department of Anesthesia, Intensive Care and Pain Management, Assiut, Egypt.


Authors:
Abdel-Ghaffar HS, Mohamed SA, Fares KM, Osman MA1.

Title:
Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial

Abstract:
BACKGROUND:
The optimum dose of dexmedetomidine for shivering control with the least hemodynamic derangements is still under research.

OBJECTIVE:
To compare the efficacy, hemodynamic and side effects of dexmedetomidine in 3 different doses with those of meperidine for the treatment of shivering in patients undergoing spinal anesthesia for minor elective lower abdominal surgery.

STUDY DESIGN:
Prospective double-blind randomized clinically controlled study.

SETTING:
University hospital.

METHODS:
One hundred twenty patients who developed shivering under spinal anesthesia.On shivering, patients were randomly allocated to receive an intravenous 2 mL bolus dose of meperidine 0.4 mg/kg (meperidine group, n = 30), dexmedetomidine 0.5 µg/kg (DEX I group, n = 30), 0.3 µg/kg (DEX II group, n = 30), or 0.2µg/kg (DEX III group, n = 30). Control of shivering, time taken for cessation of shivering, response rate, recurrence, hemodynamic changes, sedation score, tympanic temperature, and side effects were noted and compared between groups.

RESULTS:
The groups were comparable regarding demographic profile, tympanic temperature decline, and shivering onset time (P > 0.05). Lower shivering cessation time (P < 0.001) and higher response rate (P < 0.01) were observed in DEX I and II groups compared with DEX III and meperidine groups, with a nonsignificant difference between DEX I and II groups. Recurrence of shivering activity was higher in DEX III group (36.7%, P < 0.01) compared with DEX I (10%), DEX II (6.7%) and meperidine (16.7%) groups. Lower heart rates, systolic and diastolic blood pressure mean values were recorded in DEX I group (P < 0.05). Nine patients (30%) in DEX I group were in levels 3 - 5 of sedation (P < 0.02) compared with 5 (16.66%), 2 (6.66%), and 4 (13.3) patients in DEX II, DEX III, and meperidine groups, respectively.

LIMITATIONS:
This study is limited by its small sample size.

CONCLUSIONS:
Among the 3 doses investigated, dexmedetomidine 0.3µg/kg effectively treated shivering associated with spinal anesthesia with modest hemodynamic and sedation effects.

TRIAL REGISTRATION:
ClinicalTrials.gov Identifier: NCT02382432.

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


Authors:
Abdel-Hameed EA1, Rouster SD1, Ji H2, Ulm A2, Hetta HF3, Anwar N1, Sherman KE1, Shata MT1.

Title:
Evaluating the Role of Cellular Immune Responses in the Emergence of HCV NS3 Resistance Mutations During Protease Inhibitor Therapy

Abstract:
The efficacy of protease inhibitor drugs in hepatitis C virus (HCV) treatment is limited by the selection and expansion of drug-resistant mutations. HCV replication is error-prone and genetic variability within the dominant epitopes ensures its persistence. The aims of this study are to evaluate the role of cellular immune response in the emergence of HCV protease resistance mutations and its effects on treatment outcome. Ten chronically HCV-infected subjects were treated with boceprevir (BOC)-based triple therapy. HCV-RNA was tested for BOC resistance-associated viral variants. HCV protease resistance mutations were investigated pretreatment and 24 weeks post-treatment. Synthetic peptides representing the wild-type and the potential nonstructural (NS)3 variants were used to evaluate T cell responses and human leukocyte antigen binding. Sustained viral response was achieved in 70% of patients, two patients were treatment nonresponders (NRs) and one was classified as a relapse. Pretreatment, the proportion of drug-resistant variants within individuals was higher in sustained viral responders (SVRs) than in NR patients. However, resistance-associated variants increased in NRs after BOC combined triple therapy. In contrast to NR patients, significant stronger cell-mediated immune responses were observed at the baseline among those who achieved sustained viral response for all T cell epitopes tested. Despite the increase in cell-mediated immune responses at week 24 in NRs, they failed to control the virus replication, leading to development of overt drug-resistant variants. Our data suggest that strong NS3-specific T cell immune responses at the baseline may predict a positive outcome of directly acting antiviral-based therapy, and the presence of pre-existent resistance mutations does not play a significant role in the outcome of anti-HCV combined therapy.

Author Info:
1
1 Department of Internal Medicine, University of Cincinnati , Cincinnati, Ohio.
2
2 Division of Asthma Research, Pyrosequencing Core for Genetic and Epigenetic Studies, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
3
3 Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University , Assiut, Egypt .


Authors:
Abdel-Hamid NM1, Wahid A2, Mohamed EM2, Abdel-Aziz MA3, Mohafez OM3, Bakar S4.

Title:
New Pathways Driving The Experimental ‎Hepatoprotective Action Of Tempol (4-Hydroxy-2,2,6,6-‎Tetramethylpiperidine-1-Oxyl) Against Acute ‎Hepatotoxicity

Abstract:
PURPOSE:
In absence of liver protective drugs, a large number of hepatopathies may arise during drug administration. This study was executed to investigate the possible new pathways underlying the hepatoprotective effect of Tempol (4-hydroxy-2,2,6,6- tetramethylpiperidine-1-oxyl), following oral administration of carbon tetrachloride in mice.

METHODS AND RESULTS:
Thirty albino mice were randomized into 3 equal groups. The duration of study was 28 days. The groups were classified as follows: Group I (healthy control): received saline, in the same volume of CCl4 dose, daily, orally, for 14 days, then sacrificed. Group II: received CCl4, as a single oral dose only, of 1 ml/kg body weight, dissolved in olive oil (1:1 v/v), the animals of this group were sacrificed 14 days after CCl4 single dose intoxication. Group III (protective Tempol treated): received a single dose of Tempol, 20mg/kg, orally, daily for 14 days. Two hours after the last Tempol dose, animals of group III received a single oral dose of CCl4. Fourteen days later, animals were scarified to collect blood and liver tissues for analysis. Tempol pretreatment significantly captured elevated levels of ALT and AST activities, lipid peroxidation, total bilirubin and increased total thiol and catalase contents. Notably, it significantly reduced the expression of tumor necrosis factor-alpha (TNF-α), Caspase-3 and endoplasmic reticulum (ER) inositol-requiring enzyme 1(IRE1) mRNAs, which is an ER trans membrane sensor that activates the unfolded protein response (UPR) to maintain the ER and cellular function.

CONCLUSION:
Pretreatment with Tempol has potential hepatoprotective effects against acute liver injury, induced by CCl4, through antioxidant and anti-inflammatory activities.

Author Info:
1
Department of Biochemistry, Faculty of Pharmacy, Kafer Alsheikh University, Egypt. Electronic address: nabilmohie@yahoo.com.
2
Department of Biochemistry, Faculty of Pharmacy, Minia University, Egypt.
3
Department of Biochemistry, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Egypt.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, Egypt.


Authors:
Abdel-Rahman O1, Helbling D2, Schmidt J3, Petrausch U4, Giryes A2, Mehrabi A5, Schöb O3, Mannhart M6, Zidan A7, Oweira H8.

Title:
Treatment-associated Fatigue in Cancer Patients Treated with Immune Checkpoint Inhibitors; a Systematic Review and Meta-analysis.

Abstract:
AIMS:
Fatigue is one of the most prominent side-effects of immune checkpoint inhibition. Therefore, we assessed the risk of fatigue associated with inhibitors of the immune checkpoints.

MATERIALS AND METHODS:
We examined data from the Medline and Google Scholar databases. We also examined original studies and review articles for cross-references. Eligible studies included randomised phase II and phase III trials of patients with cancer treated with ipilimumab, nivolumab, pembrolizumab and tremelimumab. The authors extracted relevant information on participants(') characteristics, all-grade and high-grade fatigue and information on the methodology of the studies.

RESULTS:
In total, 17 trials were considered eligible for the meta-analysis. The odds ratio for all-grade fatigue for CTLA-4 inhibitors was 1.23 (95% confidence interval 1.07, 1.41; P = 0.003) and for high-grade fatigue was 1.72 (95% confidence interval 1.26, 2.33; P = 0.0005). Moreover, the odds ratio for all-grade fatigue for PD-1 inhibitors was 0.72 (95% confidence interval 0.62, 0.84; P < 0.0001) and for high-grade fatigue was 0.36 (95% confidence interval 0.23, 0.56; P < 0.00001).

CONCLUSIONS:
The analysis of data showed that CTLA-4 inhibitors seem to be associated with a higher risk of all- and high-grade fatigue compared with control regimens, whereas PD-1 inhibitors seem to be associated with a lower risk of all- and high-grade fatigue compared with control regimens.

Author Info:
1
Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; OncoCentrum Zurich, Gastrointestinal Tumor Center Zurich (GITZ), Zurich, Switzerland. Electronic address: omar.abdelrhman@med.asu.edu.eg.
2
OncoCentrum Zurich, Gastrointestinal Tumor Center Zurich (GITZ), Zurich, Switzerland.
3
Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland.
4
OncoCentrum Zurich, Swiss Tumor Immunology Institute (SwissTII), Zurich, Switzerland.
5
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
6
Department of Oncology, Center of Zug, Switzerland.
7
Department of HPB and Liver Transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
8
Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.


Authors:
Abdel-Wahab N1,2, Shah M1, Suarez-Almazor ME1.

Title:
Adverse Events Associated with Immune Checkpoint Blockade in Patients with Cancer: A Systematic Review of Case Reports

Abstract:
BACKGROUND:
Three checkpoint inhibitor drugs have been approved by the US Food and Drug Administration for use in specific types of cancers. While the results are promising, severe immunotherapy-related adverse events (irAEs) have been reported.

OBJECTIVES:
To conduct a systematic review of case reports describing the occurrence of irAEs in patients with cancer following checkpoint blockade therapy, primarily to identify potentially unrecognized or unusual clinical findings and toxicity.

DATA SOURCES:
We searched Medline, EMBASE, Web of Science, PubMed ePubs, and Cochrane CENTRAL with no restriction through August 2015.

STUDY SELECTION:
Studies reporting cases of cancer develop irAEs following treatment with anti CTLA-4 (ipilimumab) or anti PD-1 (nivolumab or pembrolizumab) antibodies were included.

DATA EXTRACTION:
We extracted data on patient characteristics, irAEs characteristics, how irAEs were managed, and their outcomes.

DATA SYNTHESIS:
191 publications met inclusion criteria, reporting on 251 cases. Most patients had metastatic melanoma (95.6%), and the majority were treated with ipilimumab (93.2%). Autoimmune colitis, hepatitis, endocrinopathies, and cutaneous irAEs were the most frequently reported irAEs in ipilimumab treated patients. A broad spectrum of toxicities were reported for almost every body system. Moreover, well-defined diseases such as sarcoidosis, polyarthritis, polymyalgia rheumatica/arteritis, lupus, celiac disease, dermatomyositis, and Vogt-Koyanagi-like syndrome were reported. The most frequent irAEs reported with anti-PD1 agents were dermatitis for pembrolizumab, and thyroid disease and pneumonitis for nivolumab. Complete resolution of adverse events occurred in most cases. However, persistent irAEs and death were reported, mainly in patients treated with ipilimumab.

LIMITATIONS:
Our study is limited by information available in the original reports.

CONCLUSIONS:
Evidence from case reports shows that cancer patients develop irAEs following checkpoint blockade therapy, and can occasionally develop clearly defined autoimmune systemic diseases. While discontinuation of therapy and/or treatment can result in resolution of irAEs, long-term sequelae and death have been reported.

Author Info:
1
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
2
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.


Authors:
Abdel-Wahab N1,2, Lopez-Olivo MA1, Pinto-Patarroyo GP3, Suarez-Almazor ME4.

Title:
Systematic Review Of Case Reports Of Antiphospholipid ‎Syndrome Following Infection

Abstract:
OBJECTIVE:
The objective of this study was to conduct a systematic review of case reports documenting the development of antiphospholipid syndrome or antiphospholipid syndrome-related features after an infection.

METHODS:
We searched Medline, EMBASE, Web of Science, PubMed ePubs, and The Cochrane Library - CENTRAL through March 2015 without restrictions. Studies reporting cases of antiphospholipid syndrome or antiphospholipid syndrome-related features following an infection were included.

RESULTS:
Two hundred and fifty-nine publications met inclusion criteria, reporting on 293 cases. Three different groups of patients were identified; group 1 included patients who fulfilled the criteria for definitive antiphospholipid syndrome (24.6%), group 2 included patients who developed transient antiphospholipid antibodies with thromboembolic phenomena (43.7%), and group 3 included patients who developed transient antiphospholipid antibodies without thromboembolic events (31.7%). The most common preceding infection was viral (55.6%). In cases that developed thromboembolic events Human immunodeficiency and Hepatitis C viruses were the most frequently reported. Parvovirus B19 was the most common in cases that developed antibodies without thromboembolic events. Hematological manifestations and peripheral thrombosis were the most common clinical manifestations. Positive anticardiolipin antibodies were the most frequent antibodies reported, primarily coexisting IgG and IgM isotypes. Few patients in groups 1 and 2 had persistent antiphospholipid antibodies for more than 6 months. Outcome was variable with some cases reporting persistent antiphospholipid syndrome features and others achieving complete resolution of clinical events.

CONCLUSIONS:
Development of antiphospholipid antibodies with all traditional manifestations of antiphospholipid syndrome were observed after variety of infections, most frequently after chronic viral infections with Human immunodeficiency and Hepatitis C. The causal relationship between infection and antiphospholipid syndrome cannot be established, but the possible contribution of various infections in the pathogenesis of antiphospholipid syndrome need further longitudinal and controlled studies to establish the incidence, and better quantify the risk and the outcomes of antiphospholipid-related events after infection.

Author Info:
1
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
3
National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
4
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA msalmazor@mdanderson.org.


Authors:
Abdelbadee AY1, Paspulati RM2, McFarland HD3, Bedaiwy MA4, Ciancibello L2, Anderson G2, Zanotti KM5.

Title:
Computed Tomography Morphometrics and Pulmonary Intolerance in Endometrial Cancer Robotic Surgery

Abstract:
STUDY OBJECTIVES:
To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution.

DESIGN:
Retrospective study (Canadian Task Force classification II-2).

SETTING:
University hospital.

PATIENTS:
Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year.

INTERVENTION:
Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were quantified through waist circumference measurements along with average volume estimation of slices taken at 3 levels: mid-waist, L2-L3, and L4-L5. Mean and maximum values were obtained for intraoperative physiological data.

MEASUREMENTS AND MAIN RESULTS:
The patients' mean body mass index (BMI) was 34 (range, 20-59). Along with waist circumference, VFV and SFV quantified by CT at the mid-waist, L2-L3, and L4-L5 levels were all significant independent predictors for peak airway pressure (PAP; average and maximum) and plateau airway pressure (Pplat; average and maximum) on multivariate regression analysis after adjustment for age, ethnicity, diabetes, hypertension, pulmonary disease, smoking, obstructive sleep apnea, American Society of Anesthesiologists classification, and duration of anesthesia. Compared with the other CT parameters, L2-L3 VFV was the best predictor of average PAP (β = 0.398; p = .002), maximum PAP (β = 0.493; p < .001), average Pplat (β = 0.536; p < .001), and maximum Pplat (β = 0.573; p < .001).

CONCLUSION:
These novel CT morphometric measurements represent valid predictors of pulmonary intolerance to robotic surgery in obese patients. Of the measures analyzed, VFV at L2-L3 best predicts pulmonary tolerance in obese patients.

Author Info:
1
Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
2
Radiology Department, University Hospitals Case Medical Center, Cleveland, OH.
3
Department of Anesthesiology and Perioperative Medicine, University Hospitals Case Medical Center, Cleveland, OH.
4
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Colombia, Vancouver, BC, Canada.
5
Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: Kristine.Zanotti@UHhospitals.org.


Authors:
Abdelhafez MF1,2, Wendt-Nordahl G3, Kruck S1, Mager R4, Stenzl A1, Knoll T3, Schilling D1,5.

Title:
Minimally Invasive Versus Conventional Large-Bore ‎Percutaneous Nephrolithotomy In The Treatment Of ‎Large-Sized Renal Calculi: Surgeon's Preference?‎

Abstract:
OBJECTIVE:
The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MIP) and conventional percutaneous nephrolithotomy (PCNL) in the treatment of patients with large renal stone burden. MIP has proven its efficacy and safety in the management of small renal calculi. However, conventional PCNL is still considered the standard method for treatment of large renal stones in the upper urinary tract.

MATERIALS AND METHODS:
A search of two longitudinal databases in two tertiary referral centres for complex stone disease identified 133 consecutive patients who were treated by either MIP or PCNL for renal stones 20 mm or larger between January 2009 and August 2012. Clinical data and outcome measures of the two methods were compared by Student's t test, chi-squared test or Fisher's exact test. A p value less than 0.05 was considered statistically significant.

RESULTS:
Operative time was significantly shorter and hospital stay was significantly longer in conventional PCNL compared to MIP (p = 0.002 and < 0.001, respectively). There were no significant differences in primary stone-free rate or complication rate between the two methods. Only higher graded complications (above Clavien grade II) were significantly more common in conventional PCNL (p = 0.02).

CONCLUSION:
MIP is equally effective as conventional PCNL in the treatment of large renal calculi. Both methods have a similar complication rate. The shorter operative time in PCNL may be based on the larger diameter and quicker retrieval of large fragments; the longer mean hospital stay may be caused by the handling of the nephrostomy tube. The current data suggest that the choice of the method mainly depends on the surgeon's preference.

Author Info:
1
a Department of Urology , University Hospital Tübingen , Tübingen , Germany ;
2
b Department of Urology , Assiut University , Assiut , Egypt ;
3
c Department of Urology , Sindelfingen-Böblingen Medical Center , Sindelfingen , Germany ;
4
d Department of Urology , University Hospital Frankfurt , Frankfurt , Germany ;
5
e Department of Urology , Isar Klinikum, München , Germany.


Authors:
AbdElmagied AM1, Vaughan LE2, Weaver AL2, Laughlin-Tommaso SK3, Hesley GK4, Woodrum DA4, Jacoby VL5, Kohi MP6, Price TM7, Nieves A7, Miller MJ8, Borah BJ9, Gorny KR4, Leppert PC7, Lemens MA3, Stewart EA10.

Title:
Fibroid Interventions: Reducing Symptoms Today And ‎Tomorrow: Extending Generalizability By Using A ‎Comprehensive Cohort Design With A Randomized ‎Controlled Trial

Abstract:
BACKGROUND:
Uterine fibroids are an important source of morbidity for reproductive-aged women. Despite an increasing number of alternatives, hysterectomies account for about 75% of all fibroid interventional treatments. Evidence is lacking to help women and their health care providers decide among alternatives to hysterectomy. Fibroid Interventions: Reducing Symptoms Today and Tomorrow (NCT00995878, clinicaltrials.gov) is a randomized controlled trial to compare the safety, efficacy, and economics of 2 minimally invasive alternatives to hysterectomy: uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery. Although randomized trials provide the highest level of evidence, they have been difficult to conduct in the United States for interventional fibroid treatments. Thus, contemporaneously recruiting women declining randomization may have value as an alternative strategy for comparative effectiveness research.

OBJECTIVE:
We sought to compare baseline characteristics of randomized participants with nonrandomized participants meeting the same enrollment criteria and to determine whether combining the 2 cohorts in a comprehensive cohort design would be useful for analysis.

STUDY DESIGN:
Premenopausal women with symptomatic uterine fibroids seeking interventional therapy at 3 US academic medical centers were randomized (1:1) in 2 strata based on calculated uterine volume (<700 and ≥700 cc(3)) to undergo embolization or focused ultrasound surgery. Women who met the same inclusion criteria but declined randomization were offered enrollment in a parallel cohort. Both cohorts were followed up for a maximum of 36 months after treatment. The measures addressed in this report were baseline demographics, symptoms, fibroid and uterine characteristics, and scores on validated quality-of-life measures.

RESULTS:
Of 723 women screened, 57 were randomized and 49 underwent treatment (27 with focused ultrasound and 22 with embolization). Seven of the 8 women randomized but not treated were assigned to embolization. Of 34 women in the parallel cohort, 16 elected focused ultrasound and 18 elected embolization. Compared with nonrandomized participants, randomized participants had higher mean body mass index (28.7 vs 25.3 kg/m(2); P = .01) and were more likely to be gravid (77% vs 47%; P = .003) and smokers (42% vs 12%; P = .003). Age, race, uterine volume, number of fibroids, and baseline validated measures of general and disease-specific quality of life, pain, depression, and sexual function did not differ between the groups. When we performed a comprehensive cohort analysis and analyzed by treatment arm, the only baseline difference observed was a higher median McGill Pain Score among women undergoing focused ultrasound (10.5 vs 6; P = .03); a similar but nonsignificant trend was seen in visual analog scale scores for pain (median, 39.0 vs 24.0; P = .06).

CONCLUSION:
Using a comprehensive cohort analysis of study data could result in additional power and greater generalizability if results are adjusted for baseline differences.

Author Info:
1
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Assiut, Egypt.
2
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
3
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
4
Department of Radiology, Mayo Clinic, Rochester, MN.
5
Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
6
Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
7
Department of Obstetrics and Gynecology, Duke University, Durham, NC.
8
Department of Radiology, Duke University, Durham, NC.
9
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
10
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. Electronic address: stewart.elizabeth@mayo.edu.


Authors:
Abou Khalil NS1, Abou-Elhamd AS2, Wasfy SI1, El Mileegy IM1, Hamed MY1, Ageely HM3.

Title:
Antidiabetic and Antioxidant Impacts of Desert Date (Balanites aegyptiaca) and Parsley (Petroselinum sativum) Aqueous Extracts: Lessons from Experimental Rats

Abstract:
Medicinal plants are effective in controlling plasma glucose level with minimal side effects and are commonly used in developing countries as an alternative therapy for the treatment of type 1 diabetes mellitus. The aim of this study is to evaluate the potential antidiabetic and antioxidant impacts of Balanites aegyptiaca and Petroselinum sativum extracts on streptozotocin-induced diabetic and normal rats. The influences of these extracts on body weight, plasma glucose, insulin, total antioxidant capacity (TAC), malondialdehyde (MDA) levels, and liver-pyruvate kinase (L-PK) levels were assessed. Furthermore, the weight and histomorphological changes of the pancreas were studied in the different experimental groups. The herbal preparations significantly reduced the mean plasma glucose and MDA levels and significantly increased the mean plasma insulin, L-PK, and TAC levels in the treated diabetic groups compared to the diabetic control group. An obvious increase in the weight of the pancreas and the size of the islets of Langerhans and improvement in the histoarchitecture were evident in the treated groups compared to untreated ones. In conclusion, the present study provides a scientific evidence for the traditional use of these extracts as antidiabetic and antioxidant agents in type 1 diabetes mellitus.

Author Info:
1
Department of Physiology, Faculty of Medicine, Assiut University, Assiut 71526, Egypt.
2
Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt.
3
Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan 82621, Saudi Arabia.


Authors:
Abou-Taleb H1,2, Yamaguchi K1, Matsumura N1, Murakami R1, Nakai H3, Higasa K4, Amano Y1, Abiko K1, Yoshioka Y1, Hamanishi J1, Koshiyama M1, Baba T1, Yamada R4, Matsuda F4, Konishi I1, Mandai M3.

Title:
Comprehensive Assessment Of The Expression Of The ‎SWI/SNF Complex Defines Two Distinct Prognostic ‎Subtypes Of Ovarian Clear Cell Carcinoma.‎

Abstract:
Somatic mutations in the ARID1A tumor-suppressor gene have been frequently identified in ovarian clear cell carcinoma (CCC) cases. BAF250a encoded by ARID1A is a member of the SWI/SNF complex, but the expression and mutation status of other SWI/SNF subunits have not been explored. The current study aimed to elucidate the biological and clinical significance of the SWI/SNF complex subunits, by assessing the expression and mutation status of SWI/SNF subunits, and distinct genomic aberrations associated with their expression. Of 82 CCC specimens, 38 samples presented no BAF250a expression, and 50 samples exhibited the loss of at least one subunit of the SWI/SNF complex. Cases which lack at least one SWI/SNF complex component exhibited significantly more advanced stages, faster growth and stronger nuclear atypia compared with SWI/SNF-positive samples (p<0.05). Although BAF250a expression is not related to poor prognosis, the group presenting the loss of at least one SWI/SNF complex subunit exhibited significantly shorter overall and progression-free survivals (p<0.05). A multivariate analysis suggested that the expression status of the SWI/SNF complex serves as an independent prognostic factor (p<0.005). The cases positive for all SWI/SNF subunits demonstrated significantly greater DNA copy number alterations, such as amplification at chromosomes 8q.24.3 and 20q.13.2-20q.13.33 (including ZNF217) and deletion at chromosomes 13q12.11-13q14.3 (including RB1), 17p13.2-17p13.1 (including TP53) and 19p13.2-19p13.12. In conclusion, the CCCs exhibiting the loss of one or multiple SWI/SNF complex subunits demonstrated aggressive behaviors and poor prognosis, whereas the CCCs with positive expression for all SWI/SNF components presented more copy number alterations and a favorable prognosis.

Author Info:
Abou-Taleb H1,2, Yamaguchi K1, Matsumura N1, Murakami R1, Nakai H3, Higasa K4, Amano Y1, Abiko K1, Yoshioka Y1, Hamanishi J1, Koshiyama M1, Baba T1, Yamada R4, Matsuda F4, Konishi I1, Mandai M3.


Authors:
Abou-Taleb HA1, Koshiyama M2, Matsumura N3, Baba T3, Yamaguchi K3, Hamanishi J3, Abiko K3, Yamanoi K3, Murakami R3, Horikawa N3, Taha AA4, Kitamura S3, Konishi I3.

Title:
Clinical Efficacy Of Neoadjuvant Chemotherapy With ‎Irinotecan (CPT-11) And Nedaplatin Followed By Radical ‎Hysterectomy For Locally Advanced Cervical Cancer.‎

Abstract:
OBJECTIVE:
To investigate the clinical efficacy of neoadjuvant chemotherapy (NAC) with irinotecan (CPT-11) and nedaplatin (NED) followed by radical hysterectomy.

METHODS:
Patients with locally advanced cervical cancer (stage Ib2-IIb) were treated with NAC followed by surgery, primary surgery or primary radiotherapy. NAC was usually performed using transuterine arterial chemotherapy (TUAC) or intravenous CPT-11/NED. Survival rates were analysed in the three treatment groups; response rates and adverse events associated with NAC, TUAC and CPT-11/NED were compared, along with previously reported adverse events of chemoradiotherapy.

RESULTS:
A total of 165 patients with cervical cancer were recruited. Of these, 70 were treated with NAC followed by surgery (48 with CPT-11/NED, 18 with TUAC and four with other types of chemotherapy), 73 were treated with primary surgery and 22 with primary radiotherapy (including chemoradiotherapy). There were no significant differences in progression-free survival or overall survival rates between the three treatment groups. The response rates for the NAC regimen of CPT-11/NED and TUAC were high (75% and 78%, respectively). The frequency of severe thrombocytopenia was lower in patients receiving CPT-11/NED compared with TUAC, and the incidence of severe anaemia, vomiting and cystitis was lower in patients receiving CPT-11/NED compared with chemoradiotherapy.

CONCLUSIONS:
The use of CPT-11/NED as a NAC regimen shows favourable activity, with lower toxicity compared with NAC using TUAC or chemoradiotherapy, for the treatment of locally advanced cervical cancer.

Author Info:
1
Department of Gynaecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Gynaecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan kohiya@kuhp.kyoto-u.ac.jp.
3
Department of Gynaecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
4
Department of Gynaecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Obstetrics and Gynaecology, Faculty of Medicine, Sohag University, Sohag, Egypt.


Authors:
Abouzied MM1,2, Eltahir HM3, Taye A4, Abdelrahman MS5.

Title:
Experimental Evidence For The Therapeutic Potential Of ‎Tempol In The Treatment Of Acute Liver Injury

Abstract:
Oxidative stress is one of the mechanisms involved in the acute carbon tetrachloride (CCl4)-induced hepatotoxicity. Since 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl, known as tempol, has powerful antioxidant properties, we investigated its potential hepatoprotective effects and the underlying mechanisms that may add further benefits for its clinical usefulness using an acute model of CCl4-induced hepatotoxicity. One hour after CCl4 induction of acute hepatotoxicity, mice were treated with a daily dose of 20 mg/kg/day tempol for 3 days. It was found that treatment of animals with tempol significantly negated the pathological changes in liver function parameters as well as histology induced by CCl4. In addition, tempol significantly ameliorated CCl4-induced lipid peroxidation and GSH depletion, and improved catalase activity. Furthermore, tempol alleviated the inflammation induced by CCl4 as indicated by reducing the liver expression level of nuclear factor-kappa B (NF-κB) and tumor necrosis factor-α (TNF-α). Finally, tempol significantly reduced expression level of the B-cell lymphoma-2 protein (Bcl-2) and active caspase-3 which are known markers of apoptosis. In conclusion, the present study provides important evidences for the promising hepatoprotective effects of tempol that can be explained by amelioration of oxidative stress mainly through replenishment of GSH, restoration of antioxidant enzyme activities, and reduction of lipid peroxides alongside its anti-inflammatory properties.

Author Info:
1
Departments of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Medina, Kingdom of Saudi Arabia. m_meky2001@yahoo.com.
2
Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, Egypt. m_meky2001@yahoo.com.
3
Departments of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Medina, Kingdom of Saudi Arabia.
4
Department of Pharmacology & Toxicology, Faculty of Pharmacy, Minia University, Minia, Egypt.
5
Department of Pharmacology & Toxicology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Nosocomial Clostridium Difficile-Associated Diarrhoea In ‎Assiut University Children's Hospital, Egypt.‎

Abstract:
BACKGROUND:
There are no large epidemiological studies of Clostridium difficile-associated disease (CDAD) in hospitalised children.

AIM:
To describe the frequency, demography, clinical features and outcome of nosocomial CDAD in children admitted to Assiut University Children's Hospital, Egypt.

PATIENTS AND METHODS:
In this descriptive cross-sectional study, 72 children developed nosocomial diarrhoea between April 2010 and March 2011. A medical history, clinical assessment and culture for Clostridium difficile and direct toxin detection from stool samples by enzyme immuno-assay were undertaken in all patients.

RESULTS:
CDAD was diagnosed in 17 (23·6%) patients. Those aged ≤12 months were the most commonly affected (eight, 47%). The main cause of admission was respiratory disorders (eight, 47% of cases), followed by surgical problems (three, 17·7%). Ten patients (58·8%) had severe symptoms. There were no statistically significant differences between any of the demographic or laboratory data for children with CDAD and children with other causes of nosocomial diarrhoea. None of the patients developed complications. Seven children with CDAD (41·2%) had recurrence.

CONCLUSION:
CDAD is an important cause of nosocomial diarrhoea in children in Assiut University Children's Hospital. Established guidelines should be followed in all hospitals to minimise exposure to the pathogen. Physicians can do much to reduce the risk of a severe outcome in children by early identification and rapid management. Further research should be undertaken to identify the risk factors for recurrence.


Title:
Age-Associated Decrease In GDNF And Its Cognate ‎Receptor Gfrα-1 Protein Expression In Human Skin

Abstract:
Glial cell line-derived neurotrophic factor (GDNF) and its cognate receptor (GFRα-1) are expressed in normal human skin. They are involved in murine hair follicle morphogenesis and cycling control. We hypothesize that 'GDNF and GFRα-1 protein expression in human skin undergoes age-associated alterations. To test our hypothesis, the expression of these proteins was examined in human skin specimens obtained from 30 healthy individuals representing three age groups: children (5-18 years), adults (19-60 years) and the elderly (61-81 years). Immunofluorescent and light microscopic immunohistologic analyses were performed using tyramide signal amplification and avidin-biotin complex staining methods respectively. GDNF mRNA expression was examined by RT-PCR analysis. GDNF mRNA and protein as well as GFRα-1 protein expressions were detected in normal human skin. We found significantly reduced epidermal expression of these proteins with ageing. In the epidermis, the expression was strong in the skin of children and declined gradually with ageing, being moderate in adults and weak in the elderly. In children and adults, the expression of both GDNF and GFRα-1 proteins was strongest in the stratum basale and decreased gradually towards the surface layers where it was completely absent in the stratum corneum. In the elderly, GDNF and GFRα-1 protein expression was confined to the stratum basale. In the dermis, both GDNF and GFRα-1 proteins had strong expressions in the fibroblasts, sweat glands, sebaceous glands, hair follicles and blood vessels regardless of the age. Thus there is a decrease in epidermal GDNF and GFRα-1 protein expression in normal human skin with ageing. Our findings suggest that the consequences of this is that GFRα-1-mediated signalling is altered during the ageing process. The clinical and therapeutic ramifications of these observations mandate further investigations.

Author Info:
1
Department of Zoology, Faculty of Science, Sohag University, Sohag, Egypt.
2
Department of Dermatology and Venereology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assuit, Egypt.


Authors:
Adly MA1, Assaf HA2, Abdel-Rady SF3, Ahmed NS4, Hussein MR5.

Title:
Immunohistochemical Analysis of GDNF and Its Cognate Receptor GFRα-1 Protein Expression in Vitiliginous Skin Lesions.

Abstract:
BACKGROUND:
Vitiligo is an idiopathic skin disease, characterized by circumscribed white macules or patches on the skin due to loss of the functional melanocytes. Glial cell line-derived neurotrophic factor (GDNF) and its cognate receptor (GFRα-1) are distal members of the transforming growth factor-β superfamily. GDNF, produced by the basal cell keratinocytes, is involved in the migration and differentiation of the melanocytes from the neural crest to the epidermis. This study examines the hypothesis that expression of GDNF protein and its cognate receptor GFRα-1 protein is altered in vitiliginous skin.

PATIENTS AND METHODS:
To test our hypothesis, we examined the expression patterns of these proteins in vitiliginous and corresponding healthy (control) skin biopsies (20 specimens each) using immunoperoxidase staining techniques.

RESULTS:
We found variations between the vitiliginous skin and healthy skin. In healthy skin, the expression of GDNF and GFRα-1 proteins was strong (basal cell keratinocytes and melanocytes), moderate (spinous layer), and weak (granular cell layer). In contrast, weak expression of GDNF protein was observed in all epidermal layers of vitiliginous skin. GFRα-1 protein expression was strong (basal cell keratinocytes and melanocytes), moderate (spinous layer), and weak (granular cell layer). In both healthy skin and vitiliginous skin, the expression of GDNF and GFRα-1 proteins was strong in the adnexal structures.

CONCLUSIONS:
We report, for the first time, decreased expression of GDNF proteins in the epidermal keratinocytes of vitiliginous skin. Our findings suggest possible pathogenetic roles for these proteins in the development of vitiligo. The clinical ramifications of these observations mandate further investigations.

Author Info:
1
Department of Zoology, Faculty of Science, Sohag University, Sohag, Egypt m.adly@yahoo.com.
2
Department of Dermatology and Venereology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Department of Dermatology and Venereology, Faculty of Medicine, Aswan University, Aswan, Egypt.
4
Department of Biochemistry, Faculty of Medicine, Sohag University, Egypt.
5
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
What Is The Best Approach To A High Systolic ‎Pulmonary Artery Pressure On Echocardiography?‎

Author Info:
1
Research Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
2
Assistant Lecturer, Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Director of Pulmonary Vascular Diseases Program, Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. E-mail: dweikr@ccf.org.
4
Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
5
Staff, Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
6
Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.


Title:
Clitoral Stones Are A Rare Complication Of Female ‎Genital Mutilation

Author Info:
1
Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: tarekalhussaini@yahoo.com.


Authors:
Al-Salahy M1, Shnawa B2, Abed G1, Mandour A3, Al-Ezzi A4.

Title:
Parasitaemia and Its Relation to Hematological Parameters and Liver Function among Patients Malaria in Abs, Hajjah, Northwest Yemen

Abstract:
Plasmodium falciparum malaria is the most common infection in Yemen. The present study aims to investigate changes in hematological and hepatic function indices of P. falciparum infected individuals. This study included 67 suspected falciparum malarial patients attended in clinics and rural Abs Hospital (Tehama, Hajjah), Yemen, from October 2013 to April 2014. The diagnosis of malaria was confirmed by thick and thin film with Giemsa staining of malaria parasite. Hematological parameters and serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and bilirubin (total and direct) as test indicators of liver function were studied. Patients with parasitaemia tended to have significantly lower hemoglobin, hematocrit, white blood cell count, lymphocytes, and platelets, compared with healthy normal subjects. Neutrophils levels were significantly higher in cases of falciparum malaria in comparison to healthy normal subjects. Serums AST, ALT, ALP, and bilirubin (total and direct) in falciparum malaria patients were significantly higher (p < 0.0001) than those of falciparum malaria of free individuals. Hematological and liver dysfunctions measured parameters were seen associated with moderate and severe parasitaemia infection. This study concludes that hematological and hepatic dysfunction parameters could be indicator of malaria in endemic regions.

Author Info:
1
Zoology Department, Faculty of Science, Assiut University, Assiut 71516, Egypt.
2
Biology Department, Faculty of Science, Soran University, Kurdistan, Iraq.
3
Parasitology Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.
4
Biology Department, Faculty of Education, Aden University, Aden, Yemen.


Title:
Treatment Adherence And Beliefs About Medicines ‎Among Egyptian Vitiligo Patients

Abstract:
Vitiligo is a chronic disorder of depigmentation that has different treatment modalities, but patients' nonadherence is common. This study aimed to assess the influence of patients' medication beliefs on patients' adherence to topical, oral medications, and phototherapy in vitiligo. Between September 2015 and February 2016, 260 patients with vitiligo were asked to fill in the Beliefs about Medicines Questionnaire (BMQ) to assess their beliefs about therapy for vitiligo. Their adherence to the therapy was examined using the 8-item Morisky Medication Adherence Scale (MMAS-8).

RESULTS:
The MMAS-8 scale and BMQ had good internal consistency (Cronbach's α = 0.78 and 0.66, respectively). Using Morisky's recommended cutoff point, 71% of patients were categorized as low or nonadherent to the scheduled therapy. Patients who perceived specific necessity of dermatological medicines significantly adhered to their therapy (OR 1.23; 95% CI 1.09, 1.38; p = 0.001) whereas patients who had specific concerns about the adverse effects exhibited significant low adherence (OR 0.65; 95% CI 0.56, 0.76; p < 0.001).

CONCLUSION:
Positive beliefs about the necessity of medications in vitiligo do not necessarily reflect high adherence. Patients' adherence behavior is a multidimensional and dynamic process. The prolonged course of treatment, its cost, and unsatisfactory outcomes influenced the patients' adherence.

Author Info:
1
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Egypt.
2
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Egypt.
3
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al Azhar University, Egypt.


Authors:
Alio JL1, Abdelghany AA2, Abdou AA3, Maldonado MJ4.

Title:
Cataract Surgery On The Previous Corneal Refractive ‎Surgery Patient

Abstract:
Cataract surgery in cases with previous corneal refractive surgery may be a major challenge for the ophthalmologist. The refractive outcome of the case deserves special attention in the preoperative planning process, which should be tailored for the type of prior refractive procedure: incisional, ablative under a flap, or on the corneal surface. Avoiding refractive surprise after cataract surgery in these cases is principally dependent on the accuracy of the intraocular lens calculation, together with the selection of the appropriate biometric formula for each case. Modern techniques for cataract surgery help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. We give practical guidelines for the cataract surgeon in the management of these challenging cases.

Author Info:
1
Vissum Corporación, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain. Electronic address: jlalio@vissum.com.
2
Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt.
3
Ophthalmology Department, AUH, Assiut University, Assiut, Egypt.
4
IOBA-Eye Institute, Valladolid, Spain; Division of Ophthalmology, University of Valladolid, Valladolid, Spain.


Authors:
Alkukhun L1, Wang XF2, Ahmed MK3, Baumgartner M4, Budev MM5, Dweik RA6, Tonelli AR7.

Title:
Non-Invasive Screening For Pulmonary Hypertension In ‎Idiopathic Pulmonary Fibrosis

Abstract:
BACKGROUND:
Pulmonary hypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) that is associated with poor prognosis. Noninvasive screening for PH in IPF patients is challenging and a combination of several noninvasive determinations can improve discrimination.

METHODS:
We included 235 IPF patients who underwent right heart catheterization (RHC) as part of the lung transplant evaluation. We measured electrocardiographic (ECG) and echocardiographic variables as well as the pulmonary artery (PA) and ascending aorta (AA) diameters on chest CT. We recorded results of arterial blood gases (ABG), pulmonary function (PFT) and 6-min walk tests (6MWT).

RESULTS:
Several variables were predictors of PH in IPF patients in univariable models including a lower arterial oxygenation and 6MWT distance; worse right ventricular (RV) function, rightward deviation of the QRS axis and a higher FVC/DLCOc ratio, PA/AA diameter ratio, and estimated RV systolic pressure. In multivariable analysis, a worse RV function and higher PA/AA ratio remained predictors of PH (c-index 0.75 (0.65-0.84)). Similarly, a worse RV function, a higher PA/AA ratio and a rightward QRS axis deviation were independent predictors of precapillary PH (c-index 0.86 (0.76-0.92)). A combination of PA/AA diameter ratio <1.1, a QRS axis <90° and normal RV function showed a negative predictive value of 85% for precapillary PH.

CONCLUSIONS:
There are significant differences in ECG, echocardiographic, chest CT, PFT and ABG parameters between IPF patients with and without PH. However, these noninvasive tests alone or combination have limited discrimination ability for PH screening in IPF.

Author Info:
1
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. Electronic address: alkukhl@ccf.org.
2
Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. Electronic address: wangx6@ccf.org.
3
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Ahmedm2@ccf.org.
4
Department of Pulmonary Medicine, Billings Clinic, Billings, MT, USA. Electronic address: mbaumgartner@billingsclinic.org.
5
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: budevm@ccf.org.
6
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: dweikr@ccf.org.
7
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: tonella@ccf.org.


Authors:
Aly MG1,2, Trojan K3, Weimer R4, Morath C5, Opelz G3, Tohamy MA6, Daniel V3.

Title:
Low-Dose Oral Cholecalciferol Is Associated With Higher ‎Numbers Of Helios(+) And Total Tregs Than Oral ‎Calcitriol In Renal Allograft Recipients: An Observational ‎Study

Abstract:
BACKGROUND:
Regulatory T cells (Tregs) are a cornerstone of graft acceptance. High numbers of Tregs are associated with better long-term graft survival. Recently, Vitamin D was suggested as an immunomodulator, in addition to its classical role in calcium metabolism. Vitamin D modulates Tregs and might, thereby, promote graft acceptance and long-term graft survival.

METHODS:
One hundred twenty-three renal allograft recipients attending either Heidelberg nephrology or Giessen internal medicine clinic were enrolled in this cross- sectional study. Sixteen healthy controls were studied in addition. Sixty-nine patients were receiving no vitamin D, 38 calcitriol, and 16 cholecalciferol supplementations. We evaluated whether there was a difference in the absolute numbers of Helios(+), Helios(-), CTLA-4(+), IFNg(+), and total Tregs among the patient groups.

RESULTS:
Cholecalciferol supplementation was associated with higher absolute numbers of Helios(+), CTLA-4(+), and total Tregs than calcitriol (p < 0.001, p = 0.004, p = 0.001 respectively). Helios(+) Tregs were also higher in cholecalciferol than no vitamin D supplementation patients (p = 0.001), whereas CTLA-4(+) and total Tregs were similar in both groups (p = NS). Helios(+), Helios(-), CTLA-4(+), IFNg(+), and total Tregs were similar in the cholecalciferol and healthy control groups (p = NS).

CONCLUSION:
Our findings indicate that cholecalciferol, even when administered at low dosages, has a stabilizing effect on Tregs (particularly the Helios + subset), in contrast to calcitriol which showed neither a stabilizing nor a proliferation-inducing effect on the same cell population.

Author Info:
1
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany. M_Gaafar1984@hotmail.com.
2
Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt. M_Gaafar1984@hotmail.com.
3
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
4
Department of Internal Medicine, University of Giessen, Klinikstrasse 33, D-35385, Giessen, Germany.
5
Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
6
Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt.


Title:
Letter to the Editor: Trocar Site Hernia Prevention in Laparoscopic Bariatric Surgery

Author Info:
1
Department of Surgery, Min-Sheng General Hospital, 168, Jingguo Rd., Taoyuan Dist., Taoyuan City, 33044, Taiwan.
2
Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Surgery, Min-Sheng General Hospital, 168, Jingguo Rd., Taoyuan Dist., Taoyuan City, 33044, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.


Authors:
Ashshi AM1, El-Shemi AG1,2, Dmitriev IP3, Kashentseva EA3, Curiel DT4.

Title:
Combinatorial Strategies Based On Crad-IL24 And Crad-‎ING4 Virotherapy With Anti-Angiogenesis Treatment For ‎Ovarian Cancer

Abstract:
BACKGROUND:
A major hurdle incurrent to the human clinical application of conditionally replicative adenovirus (CRAd)-based virotherapy agents is their limited therapeutic efficacy. In this study we evaluated whether arming our previously reported Ad5/3Δ24 CRAd vector containing a 24-base pair deletion in the E1A conserved region 2, which allows selective replication within Rb-p16-deficient tumor cells, to express therapeutic genes could improve oncolytic virus potency in ovarian cancer cells. We choose to assess the therapeutic benefits achieved by virus-mediated expression of interleukin 24 (IL-24), a cytokine-like protein of the IL-10 family, and the inhibitor of growth 4 (ING4) tumor suppressor protein.

RESULTS:
The generated CRAd-IL24 and CRAd-ING4 vectors were tested in ovarian cancer cell lines in vitro to compare their replication, yield, and cytotoxic effects with control CRAd Ad5/3∆24 lacking the therapeutic gene. These studies showed that CRAd-IL24 infection resulted in significantly increased yield of infectious particles, which translated to a marked enhancement of virus-induced cytotoxic effects as compared to CRAd-ING4 and non-armed CRAd. Testing CRAd-IL24 and CRAd-ING4 vectors combined together did not revealed synergistic effects exceeding oncolytic potency of single CRAD-IL24 vector. Both CRAds were also tested along with anti-VEGF monoclonal antibody Avastin and showed no significant augmentation of viral cytolysis by anti-angiogenesis treatment in vitro.

CONCLUSIONS:
Our studies validated that arming with these key immunomodulatory genes was not deleterious to virus-mediated oncolysis. These findings thus, warrant further preclinical studies of CRAd-IL24 tumoricidal efficacy in murine ovarian cancer models to establish its potential utility for the virotherapy of primary and advanced neoplastic diseases.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, PO Box 7607, Holy Makkah, Saudi Arabia.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
The Division of Cancer Biology and Biologic Therapeutic Center, Department of Radiation Oncology, School of Medicine, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8224, St. Louis, MO, 63110, USA.
4
The Division of Cancer Biology and Biologic Therapeutic Center, Department of Radiation Oncology, School of Medicine, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8224, St. Louis, MO, 63110, USA. dcuriel@radonc.wustl.edu.


Authors:
Badr G1, Hozzein WN2,3, Badr BM4, Al Ghamdi A5, Saad Eldien HM6, Garraud O7,8.

Title:
Bee Venom Accelerates Wound Healing in Diabetic Mice by Suppressing Activating Transcription Factor-3 (ATF-3) and Inducible Nitric Oxide Synthase (iNOS)-Mediated Oxidative Stress and Recruiting Bone Marrow-Derived Endothelial Progenitor Cells

Abstract:
Multiple mechanisms contribute to impaired diabetic wound healing including impaired neovascularization and deficient endothelial progenitor cell (EPC) recruitment. Bee venom (BV) has been used as an anti-inflammatory agent for the treatment of several diseases. Nevertheless, the effect of BV on the healing of diabetic wounds has not been studied. Therefore, in this study, we investigated the impact of BV on diabetic wound closure in a type I diabetic mouse model. Three experimental groups were used: group 1, non-diabetic control mice; group 2, diabetic mice; and group 3, diabetic mice treated with BV. We found that the diabetic mice exhibited delayed wound closure characterized by a significant decrease in collagen production and prolonged elevation of inflammatory cytokines levels in wounded tissue compared to control non-diabetic mice. Additionally, wounded tissue in diabetic mice revealed aberrantly up-regulated expression of ATF-3 and iNOS followed by a marked elevation in free radical levels. Impaired diabetic wound healing was also characterized by a significant elevation in caspase-3, -8, and -9 activity and a marked reduction in the expression of TGF-β and VEGF, which led to decreased neovascularization and angiogenesis of the injured tissue by impairing EPC mobilization. Interestingly, BV treatment significantly enhanced wound closure in diabetic mice by increasing collagen production and restoring the levels of inflammatory cytokines, free radical, TGF-β, and VEGF. Most importantly, BV-treated diabetic mice exhibited mobilized long-lived EPCs by inhibiting caspase activity in the wounded tissue. Our findings reveal the molecular mechanisms underlying improved diabetic wound healing and closure following BV treatment. J. Cell. Physiol. 231: 2159-2171, 2016.

Author Info:
1
Laboratory of Immunology and Molecular Physiology, Faculty of Science, Department of Zoology, Assiut University, Assiut, Egypt.
2
Bioproducts Research Chair, Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia.
3
Faculty of Science, Department of Botany, Beni-Suef University, Beni-Suef, Egypt.
4
Department of Radiation Biology, National Centre for Radiation Research and Technology (NCRRT), Cairo, Egypt.
5
Chair of Engineer Abdullah Baqshan for Bee Research, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia.
6
Faculty of Medicine, Department of Histology, Assiut University, Assiut, Egypt.
7
Institut National de la Transfusion Sanguine, Paris, France.
8
Université de Lyon, Saint-Etienne, France.


Title:
Analgesic Effect of Nalbuphine When Added to Intravenous Regional Anesthesia: A Randomized Control Trial.

Abstract:
BACKGROUND:
Different adjuvant drugs are currently added to lidocaine for intravenous regional anesthesia (IVRA) to decrease tourniquet and postoperative pain.

OBJECTIVE:
The aim of the study was to examine the effect of nalbuphine when added toIVRA.

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

SETTING:
Assiut University Hospitals.

METHODS:
One hundred-six adult patients scheduled for unilateral hand surgery under IVRA were randomized into 2 equal groups. The lidocaine-nalbuphine (LN) group received nalbuphine plus lidocaine and the lidocaine (L) group received lidocaine. A tourniquet and postoperative pain were assessed using a visual analogue scale (VAS). The following parameters were measured: onset and recovery time for both sensory and motor blocks, intra- and postoperative analgesic consumption, time to first analgesic request, postoperative nausea and/or vomiting (PONV), hemodynamics, and cortisol levels.

RESULTS:
Early tourniquet and postoperative pain were significantly lower in the LN group. The onset time for both sensory and motor blocks was significantly shorter in the LN group. In addition, the recovery time for both sensory and motor blocks was longer in the LN group. Intra- and postoperative fentanyl consumption was significantly lower in the LN group with no significance in postoperative diclofenac consumption. The patient first analgesic request was significantly delayed in the LN group (P < 0.0001). There were no significant differences between the 2 groups in PONV, hemodynamic parameters abnormalities, medications adverse events or cortisol levels.

LIMITATIONS:
The inclusion of a study group in which the nalbuphine administered systemically could determine whether its beneficial effects were due to its local or systemic action.

CONCLUSIONS:
Nalbuphine decreases early tourniquet and postoperative pain after IVRA and delays the need for analgesic rescue. In addition, nalbuphine accelerates the onset and prolongs the recovery time for both sensory and motor blocks with no significant adverse events. However, it has no effect on postoperative cortisol levels.Key words: Intravenous, regional anesthesia, lidocaine, nalbuphine, pain, postoperative.

Author Info:
1
Associate professor of Anesthesia, Faculty of Medicine, Assiut University, Assuit, Egypt.
2
Lecturer of Anesthesia, Faculty of Medicine, Assiut University, Assuit, Egypt.
3
Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egyp.


Title:
Management of Abnormal Uterine Bleeding with Emphasis on Alternatives to Hysterectomy.

Abstract:
Abnormal uterine bleeding (AUB) is a common problem that negatively impacts a woman's health-related quality of life and activity. Initial medical treatment includes hormonal and nonhormonal medications. If bleeding persists and no structural abnormalities are present, a repeat trial of medical therapy, a levonorgestrel intrauterine system, or an endometrial ablation can be used dependent on future fertility wishes. The levonorgestrel intrauterine system and endometrial ablation are effective, less invasive, and safe alternatives to a hysterectomy in women with AUB. A hysterectomy is the definitive treatment of AUB irrespective of the suspected cause when alternative treatments fail. Future studies should focus on detection of predictors for treatment outcomes.

Author Info:
1
Department of Obstetrics and Gynecology and Reproductive Biology, University Hospitals, Case Medical Center, Cleveland, OH, USA; Department of Reproductive Biology, University Hospitals, Case Medical Center, Cleveland, OH, USA.
2
Department of Obstetrics and Gynecology and Reproductive Biology, University Hospitals, Case Medical Center, Cleveland, OH, USA; Department of Reproductive Biology, University Hospitals, Case Medical Center, Cleveland, OH, USA; Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt. Electronic address: sherif.el-nashar@uhhospitals.org.


Authors:
Bjorklund G1, Saad K2, Chirumbolo S3, Kern JK4, Geier DA4, Geier MR4, Urbina MA5.

Title:
Immune Dysfunction And Neuroinflammation In Autism ‎Spectrum Disorder

Abstract:
Autism spectrum disorder (ASD) is a complex heterogeneous neurodevelopmental disorder with a complex pathogenesis. Many studies over the last four decades have recognized altered immune responses among individuals diagnosed with ASD. The purpose of this critical and comprehensive review is to examine the hypothesis that immune dysfunction is present more frequently, and it is related to ASD in humans. It was found that that often individuals diagnosed with ASD have alterations in immune cells such as T cells, B cells, monocytes, natural killer cells, and dendritic cells. Also, many individuals diagnosed with ASD have alterations in immunoglobulins and increased autoantibodies. Finally, an important portion of individuals diagnosed with ASD has elevated peripheral cytokines and chemokines and associated neuroinflammation. In conclusion, immune dysregulation and inflammation are important components of ASD diagnosis and are key components of the diagnosis and treatment of ASD.

Author Info:
1
Council for Nutritional and Environmental Medicine, Mo i Rana, Norway, bjorklund@conem.org.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Neurological and Movement Science, University of Verona, Verona, Italy.
4
Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA.
5
Departamento de Zoología, Facultad de Ciencias Naturales y Oceanográficas, Universidad de Concepción, Concepción, Chile.


Authors:
Bracewell-Milnes T1, Saso S2, Bora S3, Ismail AM4, Al-Memar M2, Hamed AH4, Abdalla H5, Thum MY5.

Title:
Investigating Psychosocial Attitudes, Motivations And ‎Experiences Of Oocyte Donors, Recipients And Egg ‎Sharers: A Systematic Review

Abstract:
INTRODUCTION:
The donation of oocytes has been made feasible as a result of in vitro fertilization (IVF). This treatment offers an answer for infertile women with ovarian conditions, such as primary ovarian insufficiency. Demand for oocyte donors has been on the rise globally, with infertile couples, as well as gay men, increasingly using it as a means to found their families. With an acute shortage of oocyte donors globally, the psychosocial aspects behind oocyte donation are important for fertility clinics to understand. This paper aims primarily to provide an up-to-date systematic review of the psychosocial aspects of oocyte donation from the point of view of oocyte donors and recipients and egg sharers. Its secondary aims are to explore the motives and experiences of donors as well as attitudes towards donor anonymity and disclosure. An emphasis has been placed on the analysis of donors in the UK. No review has analysed together the aforementioned donor groups along with recipient group.

METHODS:
A systematic search of English peer-reviewed journals of four computerized databases was undertaken, with no time restriction set for publications.

RESULTS:
There were 62 studies which met the inclusion criteria and were included in the systematic review. Attitudes towards donation were positive from both a donor oocyte and recipient point of view, with medical procedures being well tolerated and excellent post-donation satisfaction among all donor groups. There were distinct differences between the different donor groups and recipients in motivation for oocyte donation and decisions for disclosure. Attitudes towards anonymity issues were reassuring with a significant proportion of donors of all types willing to donate as identifiable donors. However, there were methodological limitations identified in the studies reviewed.

CONCLUSION:
This review successfully explored the important psychosocial aspects of oocyte donation. In general terms the attitudes and feeling of patients involved from all sides of the donation process were extremely positive. A number of key and consistent issues emerged which demonstrated differences and similarities between the different donor groups, as well as a greater understanding of the recipient. With regard to psychosocial well-being, the results were reassuring throughout all donor groups, especially the egg share donors. Although it seems the 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in gamete donation, oocyte donation still falls far short of demand. The UK has an increasing population of patients from different ethnic backgrounds and same sex relationships seeking oocyte donation, with very few studies including these groups of patients. An increased number of well-designed studies looking into the psychological issues surrounding gamete donation of different patient groups, could allow more directed assessment and counselling of oocyte donors and recipients, with a resulting increase in donor recruitment.

Author Info:
1
Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London, UK tjb101@doctors.org.uk.
2
Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, UK.
3
The Lister Hospital, Chelsea Bridge Road, London, UK.
4
Obstetrics & Gynecology, Faculty of Medicine, Women's Health Centre, Assiut University, Assiut, Egypt.
5
The Lister Hospital, Chelsea, London, UK.


Authors:
Cag Y1, Erdem H2, Leib S3, Defres S4, Kaya S5, Larsen L6, Poljak M7, Ozturk-Engin D8, Barsic B9, Argemi X10, Sørensen SM11, Bohr AL12, Tattevin P13, Gunst JD14, Baštáková L15, Jereb M16, Johansen IS6, Karabay O17, Pekok AU18, Sipahi OR19, Chehri M20, Beraud G21, Shehata G22, Fontana R23, Maresca M23, Karsen H24, Sengoz G25, Sunbul M26, Yilmaz G27, Yilmaz H26, Sharif-Yakan A28, Kanj S28, Parlak E29, Pehlivanoglu F25, Korkmaz F30, Komur S31, Kose S32, Ulug M33, Bolukcu S8, Coskuner SA34, Stahl JP35, Ince N36, Akkoyunlu Y37, Halac G38, Sahin-Horasan E39, Tireli H40, Kilicoglu G41, Al-Mahdawi A42, Nemli SA43, Inan A8, Senbayrak S8, Vahaboglu H44, Elaldi N45.

Title:
Managing Atypical And Typical Herpetic Central Nervous ‎System Infections: Results Of A Multinational Study

Abstract:
There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Author Info:
1
Dr Lütfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
2
Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. Electronic address: hakanerdem1969@yahoo.com.
3
Institute for Infectious Diseases, University of Bern, Switzerland.
4
Institute of Infection and Global Health, University of Liverpool, United Kingdom; Tropical Infections Diseases Unit In Royal Liverpool and Broadgreen University Hospitals NHS Trust, United Kingdom.
5
Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
6
Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark.
7
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
8
Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
9
Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia.
10
Nouvel Hôpital Civil, Department of Infectious Diseases, Strasbourg, France.
11
Aalborg University Hospital, Department of Infectious Diseases, Denmark.
12
Copenhagen University Hospital, Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Denmark.
13
University Hospital of Pontchaillou, Department of Infectious and Tropical Diseases, Rennes, France.
14
Aarhus University Hospital, Department of Infectious Diseases, Aarhus, Denmark.
15
Faculty Hospital Brno, Department of Infectious Diseases, Masaryk University, Faculty of Medicine, Brno, Czech Republic.
16
University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia.
17
Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
18
Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
19
Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
20
Hvidovre Hospital, Department of Infectious Diseases, Copenhagen, Denmark.
21
Poitiers University Hospital, Department of Infectious Diseases, France.
22
Assiut University Hospital, Department of Neurology and Psychiatry, Assiut, Egypt.
23
University of Catania, Section of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Catania, Italy.
24
Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey.
25
Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
26
Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
27
Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
28
American University of Beirut Medical Center, Beirut, Lebanon.
29
Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
30
Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey.
31
Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey.
32
Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
33
Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
34
Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
35
Joseph Fourier University and University Hospital of Grenoble, Department of Infectious Diseases, Grenoble, France.
36
Duzce University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Konuralp, Duzce, Turkey.
37
Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
38
Bezmi Alem Vakif University, School of Medicine, Department of Neurology, Istanbul, Turkey.
39
Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey.
40
Haydarpasa Numune Training and Research Hospital, Department of Neurology, Turkey.
41
Haydarpasa Numune Training and Research Hospital, Department of Radiology, Turkey.
42
Department of Neurology, Baghdad Teaching Hospital, Iraq.
43
Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
44
Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
45
Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey.


Authors:
de Bortoli N1, Guidi G1, Martinucci I1, Savarino E2, Imam H3, Bertani L1, Russo S1, Franchi R1, Macchia L1, Furnari M4, Ceccarelli L1, Savarino V4, Marchi S1.

Title:
Voluntary And Controlled Weight Loss Can Reduce ‎Symptoms And Proton Pump Inhibitor Use And Dosage ‎In Patients With Gastroesophageal Reflux Disease: A ‎Comparative Study

Abstract:
A wide variety of pieces of evidence has suggested that obesity is associated with a significant increase in the risk for gastroesophageal reflux disease (GERD) symptoms and its complications. The aim of this study was to evaluate the effect of weight loss on reflux symptoms in overweight/obese patients with proven GERD. We enrolled overweight/obese patients with typical GERD symptoms and erosive esophagitis. At baseline, patients underwent detailed reflux symptoms evaluation and anthropometric assessment, and were divided into two treatment groups: group A received proton pump inhibitor (PPI) and a personalized hypocaloric diet and aerobic exercise; and group B received PPI and a 'standard of care diet'. The dietetic treatment was considered effective if at least 10% of weight loss was achieved within 6 months. All patients were evaluated in terms of anthropometric data, GERD symptoms, and PPI use. In group A, mean body mass index (BMI) decreased from 30.3 ± 4.1 to 25.7 ± 3.1 (P < 0.05), and mean weight decreased from 82.1 ± 16.9 kg to 69.9 ± 14.4 kg (P < 0.05). In group B, there was no change in BMI and weight. Symptom perception decreased (P < 0.05) in both groups during PPI therapy, but a higher improvement was recorded in group A. In group A, PPI therapy was completely discontinued in 27/50 of the patients, and halved in 16/50. Only 7/50 continued the same PPI dosage. In group B, 22/51 halved the therapy and 29/51 maintained full dosage of therapy, but none was able to discontinue PPI due to a symptom recurrence. Overall, weight loss of at least 10% is recommended in all patients with GERD in order to boost the effect of PPI on reflux symptom relief and to reduce chronic medication use.

Author Info:
1
Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.
2
Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
3
Gastroenterology and Hepatology Unit, Internal Medicine Department, Assiut University Hospital, Assiut, Egypt.
4
Division of Gastroenterology, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy.


Authors:
Dronen NO1, Blend CK2, Khalifa RM3, Mohamadain HS4, Karar YF5.

Title:
Pelopscreadium Aegyptense N. Gen., N. Sp. And ‎Pelopscreadium Spongiosum (Bray & Cribb, 1998) N. ‎Comb., (Digenea: Lepocreadiidae), Each From Disjunct ‎Populations Of The Yellow Boxfish, Ostracion Cubicus ‎Linnaeus (Ostraciidae).‎

Abstract:
Bianium spongiosum Bray & Cribb, 1998 (Lepocreadiidae), described from the yellow boxfish, Ostracion cubicus Linnaeus (Ostraciidae), off Lizard Island, Queensland, Australia, possesses a combination of the following three morphological features which distinguishes it from all the other species currently assigned to the genus: (1) large internal patches of large cells forming sponge-like pads we have termed "pelops"("pelop" sing.) laterally in the forebody extending from near the anterior extremity to about the level of the intestinal bifurcation rather than possessing a scoop; (2) ceca that reach to near the posterior extremity where they end blindly without ani; and (3) a vitellarium which is present laterally but not dorsal to the ceca. Based on this we propose the erection of Pelopscreadium n. gen. (Lepocreadiidae) with the assignment of B. spongiosum to this new genus as the type-species, Pelopscreadium spongiosum (Bray & Cribb, 1998) n. comb. Pelopscreadium aegyptense n. sp., also from the yellow boxfish but from the Red Sea off Sharm El-Naga, Egypt, is described as the second member of the new genus because it shares these three characteristics with P. spongiosum.

Author Info:
1
Laboratory of Parasitology, Department of Wildlife & Fisheries Sciences, College of Agriculture & Life Sciences, Texas A&M University, College Station, Texas 77843-2258, USA.; Email: n-dronen@tamu.edu.
2
58 Rock Creek Drive, Corpus Christi, Texas 78412-4214, USA.; Email: ilovethesea@att.net.
3
Department of Medical Parasitology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.; Email: rkhalifa_eg@yahoo.com.
4
Department of Zoology, Faculty of Sciences, South Valley University, 83523 Qena, Egypt.; Email: dr_hodasm60@yahoo.com.
5
Department of Zoology, Faculty of Sciences, South Valley University, 83523 Qena, Egypt.; Email: yasser.karar@sci.svu.edu.eg.


Authors:
Dyab AK1, Yones DA2, Ibraheim ZZ3, Hassan TM1.

Title:
Anti-Giardial Therapeutic Potential Of Dichloromethane ‎Extracts Of Zingiber Officinale And Curcuma Longa In ‎Vitro And In Vivo

Abstract:
Giardiosis is one of the common parasitic diarrhoea in humans, especially in children, worldwide. Many drugs are used for its treatment, but there is evidence of drug resistance, insufficient efficacy and unpleasant side effects. Natural products are good candidates for discovering more effective anti-giardial compounds. This study evaluated the activity of extracts of Zingiber officinale (ginger) and Curcuma longa (curcumin) against Giardia lamblia in vitro and in vivo. Giardia cyst suspension was prepared from children faecal specimens. For the in vitro experiment, 1, 10 and 50 mg⁄mL dichloromethane extracts of ginger and curcumin separately were incubated with Giardia cysts for 5, 10, 30 and 60 min. The viability was distinguished by 0.1 % eosin and a haemocytometer. For the in vivo experiments, Balb/c mice were infected with Giardia cyst suspension containing 10,000 cysts/mL. Infected mice were administered 10 and 20 mg kg(-1) day(-1) ginger and curcumin extracts separately for 7 days post-infection. The effectiveness of the extracts was evaluated by faecal cyst and intestinal trophozoite counts and histopathological examination of the small intestine. In vitro ginger extract had a higher significant effect on cyst viability than curcumin, in a dose- and time-dependent manner. In vivo ginger (more effective) and curcumin extracts significantly treated infected mice, and this was evidenced by the faecal cyst and intestinal trophozoite counts reduction, in addition to evident improvement of intestinal mucosal damages induced by Giardia infection. Z. officinale and C. longa extracts may represent effective and natural therapeutic alternatives with low side effects and without drug resistance in the treatment of giardiosis.

Author Info:
1
Department of Medical Parasitology, Faculty of Medicine (71526), Assiut University, Assiut, Egypt.
2
Department of Medical Parasitology, Faculty of Medicine (71526), Assiut University, Assiut, Egypt. doaayones@gmail.com.
3
Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Authors:
Dyab AK1, Galal LA1, Mahmoud AE1, Mokhtar Y1.

Title:
Finding Wolbachia in Filarial larvae and Culicidae Mosquitoes in Upper Egypt Governorate.

Abstract:
Wolbachia is an obligatory intracellular endosymbiotic bacterium, present in over 20% of all insects altering insect reproductive capabilities and in a wide range of filarial worms which is essential for worm survival and reproduction. In Egypt, no available data were found about Wolbachia searching for it in either mosquitoes or filarial worms. Thus, we aimed to identify the possible concurrent presence of Wolbachia within different mosquitoes and filarial parasites, in Assiut Governorate, Egypt using multiplex PCR. Initially, 6 pools were detected positive for Wolbachia by single PCR. The simultaneous detection of Wolbachia and filarial parasites (Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens) by multiplex PCR was spotted in 5 out of 6 pools, with an overall estimated rate of infection (ERI) of 0.24%. Unexpectedly, the highest ERI (0.53%) was for Anopheles pharoensis with related Wolbachia and W. bancrofti, followed by Aedes (0.42%) and Culex (0.26%). We also observed that Wolbachia altered Culex spp. as a primary vector for W. bancrofti to be replaced by Anopheles sp. Wolbachia within filaria-infected mosquitoes in our locality gives a hope to use bacteria as a new control trend simultaneously targeting the vector and filarial parasites.

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


Authors:
El Desoky ES1, Hassan AKM2, Salem SY1, Fadil SA3, Taha AF1.

Title:
Cardioprotective Effect Of Atorvastatin Alone Or In ‎Combination With Remote Ischemic Preconditioning On ‎The Biochemical Changes Induced By ‎Ischemic/Reperfusion Injury In A Mutual Prospective ‎Study With A Clinical And Experimental Animal Arm

Abstract:
BACKGROUND:
Atorvastatin and remote ischemic preconditioning (RIPC) have beneficial cardiovascular protective effects. The aim of the study was to investigate possible effect of this drug alone and in combination with RIPC on the biochemical changes induced by ischemic/reperfusion injury (I/R) in a combined study with a clinical and experimental animal arm.

METHODS:
Thirty consecutive patients undergoing elective percutaneous coronary intervention (PCI) were divided into three groups (10 each): group I (control group without any preconditioning), group II (patients who were maintained on atorvastatin (80mg/day) for one month before PCI), and group III (similar to group II but PCI was preceded by RIPC). On the other hand, sixty adult male New Zealand white rabbits were divided into 6 groups (10 each): group I (control), group II (sham), group III (I/R as 30min ischemia followed by 120min reperfusion), group IV (regular atorvastatin 10mg/kg for 40days orally followed by I/R), group V (I/R preceded by RIPC) and group VI (similar to group IV but I/R was preceded by RIPC). Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), troponin I (cTnI), creatine kinase MB (CK-MB) and C-reactive protein (CRP) were measured in blood for all study groups.

RESULTS:
Clinical and experimental parts showed that groups with RIPC combined with atorvastatin pre-treatment showed a synergistic protective effect against I/R injury as evidenced by significant reduction (P<0.001) in the levels of TNF-α, cTnI (in patients) and IL-6, CK-MB and CRP (in rabbits) while the level of NO was significantly (P<0.001) increased compared with other groups.

CONCLUSIONS:
Pretreatment with atorvastatin combined with RIPC can exert a synergistic cardioprotective effects by reducing the possible biochemical changes related to ischemic reperfusion injury.

Author Info:
1
Pharmacology Department, Faculty of Medicine and University Hospital, Assiut University, Assiut. Egypt.
2
Cardiology Department, Faculty of Medicine and University Hospital, Assiut University, Assiut. Egypt. Electronic address: aymankhairy11@gmail.com.
3
Pathology Department, Faculty of Medicine and University Hospital, Assiut University, Assiut. Egypt.


Authors:
El Saman AM1, Khalaf M2, Salah M3, Shahin AY2, Ibrahim I2, Shazly SA4, El Saman DA5.

Title:
Complicated Balloon Vaginoplasty: Silk Suture-Guided ‎Replacement As A Novel Procedure For Management Of ‎Burst Balloons (Case Series)

Author Info:
1
Women Health Hospital, Assiut University, Assiut, Egypt. Electronic address: ali_elsaman@yahoo.com.
2
Women Health Hospital, Assiut University, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Aswan University, Aswan, Egypt.
4
Women Health Hospital, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA.
5
Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El Sherif FA1, Othman AH1, Abd El-Rahman AM1, Taha O2.

Title:
Effect Of Adding Intrathecal Morphine To A Multimodal ‎Analgesic Regimen For Postoperative Pain Management ‎After Laparoscopic Bariatric Surgery: A Prospective, ‎Double-Blind, Randomized Controlled Trial

Abstract:
BACKGROUND:
Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery.

METHODS:
After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%; Group II received IT 0.3 mL saline added to 1.2 mL of bupivacaine 0.5%, immediately before induction of general anaesthesia. For both groups, 60 mg ketorolac and 1000 mg paracetamol were infused 30 minutes before the end of surgery. After wound closure, 20 mL bupivacaine 0.25% was infiltrated at wound edges.

RESULTS:
Visual Analogue Scale (VAS) score was significantly lower in group I immediately, 30 minutes and 1 hour postoperatively. Time to first ambulation, return of intestinal sounds and hospital stay were shorter in group I than group II (p < 0.05); total morphine consumption was significantly lower in group I than group II (p < 0.05). Sedation score was significantly higher in group I immediately postoperatively, while at 30 minutes, 1, 2 and 6 hours postoperatively sedation scores were significantly higher in group II. Itching was significantly higher in group I.

CONCLUSION:
The addition of IT morphine to a multimodal analgesic regimen after laparoscopic bariatric surgery was an effective and safe method that markedly reduced postoperative pain, systemic opioid consumption and length of hospital stay.

Author Info:
1
Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Fractional CO2 Laser Versus Intense Pulsed Light in Treating Striae Distensae.

Abstract:
CONTEXT:
Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried.

AIMS:
To evaluate and compare the efficacy of fractional CO2 laser with intense pulse light in treating striae distensae.

SUBJECTS AND METHODS:
Forty patients with striae distensae were recruited. Twenty of them were treated by fractional CO2 laser and 20 were treated with intense pulse light. Length and width of the largest striae were measured pre- and post-treatment. Patient satisfaction was also evaluated and graded. Patients were photographed after each treatment session and photos were examined by a blinded physician who had no knowledge about the cases.

RESULTS:
Both groups showed significant improvement after treatments (P < 0.05). Patients treated with fractional CO2 laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light (P < 0.05) in all parameters except in the length of striae (P > 0.05).

CONCLUSIONS:
The current study has provided supportive evidence to the effectiveness of both fractional CO2 laser and intense pulse light as treatments for striae distensae. Fractional CO2 laser was found to be more effective in the treatment of striae distensae compared with intense pulse light.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Qina Faculty of Medicine, South Valley University, Qena, Egypt.
2
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
El Tallawy HN1, Farghaly WM1, Rageh TA1, Saleh AO2, Mestekawy TA3, Darwish MM4, Abd El Hamed MA1, Ali AM1, Mahmoud DM1.

Title:
Construction Of Standardized Arabic Questionnaires For ‎Screening Neurological Disorders (Dementia, Stroke, ‎Epilepsy, Movement Disorders, Muscle And ‎Neuromuscular Junction Disorders)

Abstract:
A screening questionnaire is an important tool for early diagnosis of neurological disorders, and for epidemiological research. This screening instrument must be both feasible and valid. It must be accepted by the community and must be sensitive enough. So, the aim of this study was to prepare different Arabic screening questionnaires for screening different neurological disorders. This study was carried out in three stages. During the first stage, construction of separate questionnaires designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders were done. Validation of the screening questionnaires was carried out in the second stage. Finally, questionnaire preparation was done in the third stage. Questions with the accepted sensitivity and specificity in each questionnaire formed the refined separate questionnaires.

Author Info:
1
Department of Neurology and Psychiatry, Faculty of Medicine.
2
Psychology Department, Faculty of Education.
3
Psychology Department, Faculty of Arts.
4
Public Health Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Chilali K1, Farouk H2, Abdelhafez M3, Neumann T4, Alotaibi S4, Wendt D5, Thielmann M5, Jakob HG5, Ashour Z2, Sorour K2, Kahlert P4, Erbel R4.

Title:
Predictors Of Aortic Pulse Wave Velocity In The Elderly ‎With Severe Aortic Stenosis

Abstract:
Predictors of aortic pulse wave velocity (AoPWV) were not previously studied in the elderly with severe aortic stenosis (AS). We aimed to compare the AoPWV in these patients with matched controls and to study the predictors of AoPWV in this population. We measured the AoPWV during cardiac catheterisation in 40 patients with severe AS and 20 matched controls. AoPWV in both groups was similar (p = 0.198) and lied within normal reference value for age in 68 % of elderly with severe AS. Central systolic blood pressure (SBP) (adjusted β = 0.45, p = 0.001) and glomerular filtration rate (GFR) (adjusted β = -0.29, p = 0.023) were the only independent predictors of AoPWV in AS group. Central SBP >140 mmHg was the best predictor of abnormal AoPWV (≥14.6 m/s) with 100 % sensitivity and 70 % specificity, p < 0.001.

CONCLUSION:
AoPWV is not increased in the elderly with severe AS compared to controls, and lies within the reference value for age in the majority of these patients. Central SBP >140 mmHg best predicts abnormal AoPWV in the elderly with severe AS.

Author Info:
1
Department of Cardiology, West German Heart and Vascular Center, Essen University Hospital, Duisburg-Essen University, Hufelandstr. 55, 45147, Essen, Germany. karim.elchilali@uk-essen.de.
2
Department of Cardiology, Cairo University Hospitals, Cairo University, Cairo, Egypt.
3
Department of Cardiology, Assiut University Hospital, Assiut University, Asyut, Egypt.
4
Department of Cardiology, West German Heart and Vascular Center, Essen University Hospital, Duisburg-Essen University, Hufelandstr. 55, 45147, Essen, Germany.
5
Department of Cardiothoracic Surgery, West German Heart and Vascular Center, Essen University Hospital, Duisburg-Essen University, Essen, Germany.


Authors:
El-Shemi AG1,2, Ashshi AM3, Na Y4, Li Y5, Basalamah M3,6, Al-Allaf FA7, Oh E4, Jung BK4, Yun CO8.

Title:
Combined Therapy With Oncolytic Adenoviruses ‎Encoding TRAIL And IL-12 Genes Markedly Suppressed ‎Human Hepatocellular Carcinoma Both In Vitro And In An ‎Orthotopic Transplanted Mouse Model

Abstract:
BACKGROUND:
Gene-based virotherapy mediated by oncolytic viruses is currently experiencing a renaissance in cancer therapy. However, relatively little attention has been given to the potentiality of dual gene virotherapy strategy as a novel therapeutic approach to mediate triplex anticancer combination effects, particularly if the two suitable genes are well chosen. Both tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and interleukin-12 (IL-12) have been emerged as promising pharmacological candidates in cancer therapy; however, the combined efficacy of TRAIL and IL-12 genes for treatment of human hepatocellular carcinoma (HCC) remains to be determined.

METHODS:
Herein, we investigated the therapeutic efficacy of concurrent therapy with two armed oncolytic adenoviruses encoding human TRAIL gene (Ad-ΔB/TRAIL) and IL-12 gene (Ad-ΔB/IL-12), respectively, on preclinical models of human HCC, and also elucidated the possible underlying mechanisms. The effects of Ad-ΔB/TRAIL+Ad-ΔB/IL-12 combination therapy were assessed both in vitro on Hep3B and HuH7 human HCC cell lines and in vivo on HCC-orthotopic model established in the livers of athymic nude mice by intrahepatic implantation of human Hep3B cells.

RESULTS:
Compared to therapy with non-armed control Ad-ΔB, combined therapy with Ad-ΔB/TRAIL+Ad-ΔB/IL-12 elicited profound anti-HCC killing effects on Hep3B and HuH7 cells and on the transplanted Hep3B-orthotopic model. Efficient viral replication and TRAIL and IL-12 expression were also confirmed in HCC cells and the harvested tumor tissues treated with this combination therapy. Mechanistically, co-therapy with Ad-ΔB/TRAIL+Ad-ΔB/IL-12 exhibited an enhanced effect on apoptosis promotion, activation of caspase-3 and-8, generation of anti-tumor immune response evidenced by upregulation of interferon gamma (IFN-γ) production and infiltration of natural killer-and antigen presenting cells, and remarkable repression of intratumor vascular endothelial growth factor (VEGF) and cluster of differentiation 31 (CD31) expression and tumor microvessel density.

CONCLUSIONS:
Overall, our data showed a favorable therapeutic effect of Ad-ΔB/TRAIL+Ad-ΔB/IL-12 combination therapy against human HCC, and may therefore constitute a promising and effective therapeutic strategy for treating human HCC. However, further studies are warranted for its reliable clinical translation.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, PO Box 7607, Holy Makkah, Saudi Arabia. dr_adel_elshemy2006@yahoo.com.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. dr_adel_elshemy2006@yahoo.com.
3
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, PO Box 7607, Holy Makkah, Saudi Arabia.
4
Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsinmi-ro, Seongdong-gu, Seoul, Korea.
5
Graduate Program for Nanomedical Science, Yonsei University, Seoul, Korea.
6
Department of Pathology, Faculty of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
7
Science and Technology Unit & Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
8
Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsinmi-ro, Seongdong-gu, Seoul, Korea. chaeok@hanyang.ac.kr.


Title:
Erratum To: Combined Therapy With Oncolytic ‎Adenoviruses Encoding TRAIL And IL-12 Genes ‎Markedly Suppressed Human Hepatocellular Carcinoma ‎Both In Vitro And In An Orthotopic Transplanted Mouse ‎Model.‎

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, PO Box 7607, Holy Makkah, Saudi Arabia. dr_adel_elshemy2006@yahoo.com.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. dr_adel_elshemy2006@yahoo.com.
3
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, PO Box 7607, Holy Makkah, Saudi Arabia.
4
Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsinmi-ro, Seongdong-gu, Seoul, Korea.
5
Graduate Program for Nanomedical Science, Yonsei University, Seoul, Korea.
6
Department of Pathology, Faculty of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
7
Science and Technology Unit & Department of Medical Genetics,Faculty of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
8
Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsinmi-ro, Seongdong-gu, Seoul, Korea. chaeok@hanyang.ac.kr.


Authors:
El-Shemi AG1, Refaat B2, Kensara OA3, Mohamed AM4, Idris S2, Ahmad J2.

Title:
Paricalcitol Enhances the Chemopreventive Efficacy of 5-Fluorouracil on an Intermediate-Term Model of Azoxymethane-Induced Colorectal Tumors in Rats

Abstract:
Colorectal cancer is a common cancer with high mortality rate. Despite being the standard anti-colorectal cancer drug, 5-fluorouracil (5-FU) exhibits only limited therapeutic benefits. Herein, we investigated whether paricalcitol, a synthetic vitamin D analogue with potential antitumor properties, would enhance the chemopreventive efficacy of 5-FU on an intermediate-term (15 weeks) model of colorectal tumors induced by azoxymethane (AOM) in rats. After AOM injection, 5-FU was administered during the 9th and 10th weeks (12 mg/kg/day for 4 days, then 6 mg/kg every other day for another 4 doses), whereas paricalcitol (2.5 μg/kg/day; 3 days/week) was given from the 7th to the 15th week. At week 15, the animals were euthanized and their resected colons were examined macroscopically and microscopically. Quantitative RT-PCR was used to measure the transcription activities of Wnt, β-catenin, DKK-1, CDNK-1A, NF-κB, and COX-2 genes, and ELISA was used to quantify the protein levels of β-catenin, COX-2, HSP90, and VEGF. IHC was additionally used to measure β-catenin, HSP90, and inducible nitric oxide synthase (iNOS). Compared with their individual therapy, combination of 5-FU and paricalcitol showed more significant reducing effect on numbers of grown tumors and large aberrant crypts foci. Mechanistically, paricalcitol and 5-FU had cooperated together to repress the expression of procancerous Wnt, β-catenin, NF-κB, COX-2, iNOS, VEGF, and HSP-90 more, and to upregulate the expression of antitumorigenesis DKK-1 and CDNK-1A, compared with their monotherapies. Our findings suggest that combined use of paricalcitol with 5-FU exhibits an augmenting chemopreventive effect against colorectal tumors, and might potentially be useful for chemoprevention in colorectal cancer patients. Cancer Prev Res; 9(6); 491-501.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia. Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. agshemi@uqu.edu.sa.
2
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
3
Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
4
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia. Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Sherif WT1, Sayed SK1, Galal SH1, Makhlouf HA2, Hassan AT2, Yousef HA3.

Title:
Diagnostic Role of RASSF1A and p16INK4a Promoter Gene Hypermethylation in Serum DNA of Lung Cancer Patients: Clinicopathological Significance

Abstract:
The most common inactivation mechanism of tumor suppressor genes, RASSF1A and p16INK4a, in lung cancer is hypermethylation. We detected the methylation status of RASSF1A and p16INK4a in serum of lung cancer patients using methylation-specific PCR and analyzed their clinicopathological significance. Each of RASSF1A and p16INK4a hypermethylation was detected in 31.1% cancer patients but not in benign lung lesion patients. Hypermethylation was preferentially observed in small cell lung cancer (SCLC) for RASSF1A (50%), but not for p16INK4a. In non-small cell lung cancer (NSCLC), RASSF1A and p16INK4a hypermethylation were found in 27% and 37.8% respectively. Hypermethylation of RASSF1A was not correlated with clinicopathological character. While, p16INK4a hypermethylation was associated with age >60 years, smoking and squamous cell carcinoma (SCC) (P = 0.033), but not with gender and pathological stages of NSCLC. Sensitivity and specificity of each gene were 31.1% and 100% respectively and the sensitivity improved with evaluation of a combination of the two genes (55.6%). These findings suggest that serum RASSF1A and p16INK4a hypermethylation are promising diagnostic method for detection of lung cancer. As regard the clinicopathological characteristics, p16INK4a hypermethylation may provide a more specific approach than RASSF1A hypermethylation.

Author Info:
1
Department of Clinical Pathology,Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Chest,Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Radiodiagnosis,Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El-Tallawy HN1, Farghaly WM1, Badry R1, Metwally NA2, Shehata GA1, Rageh TA1, El Hamed MA1, Kandil MR1.

Title:
Prevalence Of Multiple Sclerosis In Al Quseir City, Red ‎Sea Governorate, Egypt

Abstract:
BACKGROUND:
Multiple sclerosis (MS) is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults.

OBJECTIVES:
This study aimed at detecting the prevalence of MS among the population of Al Quseir city.

METHODS:
This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of Department of Neurology, Assiut University Hospital, Egypt. Essential investigations were done.

RESULTS:
A total of three cases of MS were diagnosed with an age-specific prevalence ≥17 years of 13.7/100,000.

Author Info:
1
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
2
Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut Branch, Assiut, Egypt.


Authors:
El-Tallawy HN1, Farghaly WM1, Rageh TA1, Shehata GA1, Metwally NA2, Badry R1, Sayed MA3, Abdelwarith AM2, Kandil MR1, Hamed MA1, Mohamed KO1, Tohamy AM1.

Title:
Spectrum Of Epilepsy - Prevalence, Impact, And ‎Treatment Gap: An Epidemiological Study From Al-‎Quseir, Egypt

Abstract:
BACKGROUND:
Epidemiology continues to be an important research tool in the study of epilepsy and related disorders, providing a better understanding of the frequency, causes, and natural history of the disorder.

OBJECTIVE:
To estimate the prevalence of epilepsy in Al-Quseir, Red Sea Governorate, Egypt, and its magnitude of treatment gap.

METHODS:
The study was part of a door-to-door study, including every door, to screen all inhabitants in Al-Quseir (33,818 inhabitants) by three specialists of neurology and 15 female social workers (for demographic data collection) using a standardized screening questionnaire. All suspected cases were subjected to detailed history, clinical examination, and electroencephalogram. Neuroimaging studies and estimation of serum drug level were done in select cases if needed.

RESULTS:
The study revealed that the lifetime prevalence rate of epilepsy in Al-Quseir is 5.5/1,000, with the highest peak during early childhood, while that of active epilepsy is 3.3/1,000 population. The annual incidence rate is 48/100,000, and the age-specific incidence rate has a U-shaped pattern with two peaks of incidence in early infancy and elderly life. Localization-related epilepsy is the most frequently encountered type (58.8%). The treatment gap of epilepsy in Al-Quseir is 83.8%.

CONCLUSION:
The lifetime prevalence of epilepsy in Al-Quseir city, Red Sea Governorate, was 5.5/1000.

Author Info:
1
Department of Neurology, Assiut University, Assiut, Egypt.
2
Department of Neurology, Faculty of Medicine, Al-Azhar University - Assiut Branch, Assiut, Egypt.
3
Department of Neurology, Sohag University, Sohag, Egypt.


Authors:
Elbeh KAM1, Elserogy YMB1, Khalifa HE1, Ahmed MA1, Hafez MH1, Khedr EM2.

Title:
Repetitive Transcranial Magnetic Stimulation In The ‎Treatment Of Obsessive-Compulsive Disorders: Double ‎Blind Randomized Clinical Trial

Abstract:
Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in psychiatric research. The aim of this study was to evaluate the impact of different frequencies of rTMS over right dorsolateral prefrontal cortex (DLPFC) in OCD. Forty five patients with OCD participated in the study. Patients were evaluated using: Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression-Severity scale (CGI-S). They were randomly classified into three groups: 1st group received 1Hz rTMS; 2nd group received 10Hz rTMS; and 3rd group received sham stimulation all at 100% of the resting motor threshold for 10 sessions. They were followed up after the last treatment session and 3 months later. There was a significant "time"×"group" interaction for 1Hz versus Sham but not for 10Hz versus Sham. 1Hz versus 10Hz groups showed a significant interaction for Y-BOCS and HAM-A (P=0.001 and 0.0001 respectively). 1Hz rTMS has a greater clinical benefit than 10Hz or Sham. There was also a significantly larger percentage change in GCI-S in the 1Hz group versus either 10Hz or sham. We conclude that 1Hz-rTMS, targeting right DLPFC is a promising tool for treatment of OCD.

Author Info:
1
Neuropsychiatry Department, Assiut University Hospital, Assiut, Egypt.
2
Neuropsychiatry Department, Assiut University Hospital, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.


Authors:
Elgayar SA1, Hussein OA2, Abdel-Hafez AM2, Thabet HS2.

Title:
Nicotine Impact On The Structure Of Adult Male Guinea ‎Pig Auditory Cortex

Abstract:
BACKGROUND:
A growing body of evidence suggests that chronic cigarette smoking causes detrimental effects on brain morphology.

AIM OF WORK:
To study the structural changes in auditory cortex region (Layer V), under the influence of nicotine.

MATERIAL AND METHODS:
Three animal groups (10 each) were used; group I (control) and groups IIa and IIb received 3 and 6mg/kg nicotine respectively. The specimens from the auditory cortex were examined using light and electron microscopy and morphometry.

RESULTS:
Neurons and blood capillaries of the auditory cortex (layer V), were influenced by chronic nicotine treatment in a dose dependent manner. The neurons and their processes revealed disorganization and dissociation of microtubules. The neuronal cells nucleoli characteristically revealed large fibrillar centers detected by silver stain and ultrastructure. The blood capillaries revealed collapse, irregular lumen, thickened basal lamina, abnormal forms of nuclei and organization of microtubules. Neuroglia revealed marked reactivity. Morphometrically, there was a significant decrease in the thickness of the auditory cortex and the number of light neurons and a significant increase in the number of dark neurons in comparison to the control.

CONCLUSION:
Nicotine affects the integrity of the auditory cortex possibly by reducing metabolic and transcription activities.

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


Title:
Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires

Author Info:
1
Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University Heart Hospital, Assiut University, Assiut, Egypt.
2
Department of Chest Diseases, Assiut Police Hospital, Assiut, Egypt.


Title:
Right Pneumonectomy For Carcinoid Tumor Extending ‎Through The Intermediate Bronchus And The Interlobar ‎Artery

Abstract:
Uniportal video-assisted thoracic surgery (VATS) is the emerging technique in the modern thoracic surgery practice in Assiut University Hospitals in Egypt we try to keep up with the cutting edge of knowledge to deliver the best available service to our patient. So we invite Dr. Diego Gonzalez-Rivas the world pioneer surgeon in uniportal VATS approach to initiate a uniportal VATS program starting with a workshop with live surgery. The workshop was attended by 84 thoracic surgeons from all across Egypt with a high motivation for adopting the technique in the everyday practice. We believe that uniportal will be the first choice approach for thoracic surgeon in Egypt in the upcoming year.

Author Info:
1
Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University Heart Hospital, Assiut, Egypt.
2
Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.


Authors:
Elsayh KI1, Mohammed WS2, Zahran AM3, Saad K4.

Title:
Leukocytes Apoptosis And Adipocytokines In Children ‎With Beta Thalassemia Major

Abstract:
β-Thalassemia is a significant public health problem in Egypt. Infectious complications represent the second most common cause of mortality and the major cause of morbidity in β-thalassemia major (BTM). The increased susceptibility of these patients to infectious diseases has been attributed to the abnormalities of the immune system, which is evident by systemic inflammation and immune deficiency. In a case control study, 35 patients with BTM were compared with 30 sex- and age-matched children who served as controls. Serum ferritin, high-sensitive CRP (hsCRP), leptin and adiponectin levels were determined in all subjects. Apoptosis of neutrophils and lymphocytes was measured by the Annexin V-fluoroisothiocyanate binding assay. Serum leptin was significantly lower in patients when compared to controls. In contrast, adiponectin and hsCRP levels were significantly higher in the patients than the controls. Positive correlation was found between adiponectin and hsCRP. BTM patients had significantly higher total leukocytes, neutrophils and lymphocytes compared with controls. BTM children exhibited a significantly increased apoptosis in T-lymphocytes; however, there was no significant difference in the percentage of apoptosis of B-lymphocytes and neutrophils between the patients and the controls. There was a significant negative correlation between serum leptin and the percentage of apoptotic T-lymphocytes. Our BTM patients had a high percentage of apoptotic T-lymphocyte in comparison with controls. In addition, they had disturbed serum levels of adipocytokines and inflammatory markers. These derangements could have a role in the immunological disturbance observed in thalassemic patients.

Author Info:
1
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.
2
Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
4
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt. ksaad8@yahoo.com.


Authors:
Eltony SA1, Elmottaleb NA2, Gomaa AM2, Anwar MM2, El-Metwally TH3.

Title:
Effect of All-Trans Retinoic Acid on the Pancreas of Streptozotocin-Induced Diabetic Rat.

Abstract:
All-trans Retinoic acid (atRA) is instructive for the development of endocrine pancreas and is an integral component of β-cell induction protocols. We showed that atRA induces glucose-responsive endocrine transdifferentiation of pleomorphic pancreatic ductal adenocarcinoma cells in vitro. This study aimed to detect the role of atRA in improving the histological changes of the pancreas in diabetic rats. Forty young male Wistar rats were used and divided into three groups. Group I: normal vehicle control (N = 5). Group II: streptozotocin-induced diabetic rats (N = 20) were followed up at 0.0, 1, 2, and 4 weeks. Group III: streptozotocin-induced diabetic rats (N = 15) treated with atRA (2.5 mg/kg/day), were followed up at 1, 2, and 4 weeks. Specimens from the pancreas were processed for light, electron microscopy and pancreatic insulin mRNA expression. Blood samples were assayed for the levels of glucose, insulin, and total peroxides. In the atRA-treated group, the number of the islets and the islet area significantly increased. Strong insulin-immunoreactive endocrine-like cells were observed nearby the pancreatic acini and the interlobular ducts. Interestingly, insulin-positive cells seemed to arise from pancreatic acinar and ductal epithelium. Ultrastructurally, ß-cells, acinar, and ductal cells restored their normal appearance. Pancreatic insulin mRNA and blood indices were almost normalized. AtRA improved the histological changes of the pancreas and the blood indices in diabetic rats.

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


Title:
Histological Study On The Protective Role Of Vitamin B ‎Complex On The Cerebellum Of Diabetic Rat.‎

Abstract:
BACKGROUND:
Disorder in cerebellar structure was reported in diabetes mellitus. B vitamins are involved in many significant metabolic processes within the brain.

AIM OF THE WORK:
To detect the protective role of vitamin B complex on the histological structure of the cerebellum of experimentally induced diabetic rat.

MATERIAL & METHODS:
Eighteen adult male Wistar rats were divided into two groups. Group I: normal vehicle control (n=6). Group II: streptozotocin-induced diabetic rats (n=12), which was equally divided into two subgroups; IIA (diabetic vehicle control), IIB (diabetic vitamin B complex-treated): streptozotocin-induced diabetic rats treated with vitamin B complex (1mg/kg/day) for 6 weeks. Specimens from the cerebellum were processed for light and electron microscopy.

RESULTS:
In vitamin B complex treated group, the histological changes in Purkinje cells, astrocytes and oligodendrocytes were improved compared with the diabetic non-treated group. The white matter revealed intact myelinated axons. Inducible nitric oxide synthase (iNOS) and caspase-3 expression reduced. Glial fibrillary acidic protein (GFAP) expression revealed less activated astroglia. The number of Purkinje cells/mm(2) significantly increased. While, the number of GFAP positive astrocytes/mm(2) significantly decreased. In addition, the blood glucose level was reduced.

CONCLUSION:
Vitamin B complex protected the cerebellum from the histological changes which occurred in STZ- induced diabetic rats.

Author Info:
1
Histology Department, Faculty of Medicine, Assiut University, Egypt. Electronic address: sohair_eltony@yahoo.com.


Authors:
Farghaly HS1, Mahmoud AM2, Abdel-Sater KA3.

Title:
Effect of Dexmedetomidine And Cold Stress In A Rat ‎Model Of Neuropathic Pain: Role of Interleukin-6 And ‎Tumor Necrosis Factor-α.‎

Abstract:
Dexmedetomidine (Dex) is a novel Alpha 2-adrenoceptor agonist. It decreases sympathetic tone and attenuates the stress responses to anesthesia and surgery. People exposed to cold suffer unpleasant thermal pain, which is experienced as stress and causes the release of noradrenaline from the sympathetic terminals. The present study investigated the effects of cold stress and dexmedetomidine on chronic constriction injury (CCI) model of the sciatic nerve in rats. Sixty four male Wistar rats were divided into seven groups of eight rats each: repeated cold stress (RCS) group, sham RCS group, CCI group, sham CCI group, Dex-treated group received a single dose of Dex (5 μg/kg), CCI+Dex group, CCI+RCS group. Interleukin-6 (IL-6) and tumor necrosis factor- alpha (TNF-α) levels in the serum were measured by enzyme-linked immunosorbent assay. The mean body weight of CCI, RCS, CCI+RCS, CCI+Dex and RCS+Dex groups decreased significantly compared with pre-values. Dexmedetomidine and CCI caused significant changes of the systolic, diastolic and mean blood pressure. Both RCS and CCI groups showed significant decreased of reaction time in the hot plate test. The RCS and CCI groups demonstrated a significant mechanical hyperalgesia, while pain threshold was increased in the RCS+Dex group. A significant decrease of serum IL-6 and TNF-α was demonstrated in CCI+RCS and CCI+Dex groups. The therapeutic effectiveness of dexmedetomidine in neuropathic pain may be through inhibition of proinflammatory cytokines, primarily IL-6 and TNF-α. Moreover, cold stress may result in increased resistance to neuropathic pain.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: farghalyhanan@yahoo.com.
2
Department of Physiology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Physiology Unit, Faculty of Pharmacy, Deraya University, El-Minia, Egypt.


Authors:
Farouk A1, Hassan MH2, Nady MA1, Abdel Hafez MF1.

Title:
Role Of Oxidative Stress And Outcome Of Various ‎Surgical Approaches Among Patients With Bullous Lung ‎Disease Candidate For Surgical Interference.‎

Abstract:
BACKGROUND:
Bullous lung disease is characterized by formation of blebs, bullae and emphysema. We investigate the role of oxidative stress in the pathogenesis of bullous lung disease and compare between conventional thoracotomy versus video assisted thoracoscopic approach in surgical management of such patients.

METHODS:
This study was a prospective case control study and it was carried out on 21 patients (16 males and 5 females) with bullous lung disease selected as candidate for surgical interference. This was in addition to 21 apparently healthy age and sex matched subjects selected as control group. Plasma levels of α1-antitrypsin were estimated using commercially available ELISA assay kit, while plasma levels of malondialdehyde (MDA), β-carotene, vitamin A, vitamin C and vitamin E were estimated using spectrophotometric methods. Conventional thoracotomy approach was done in thirteen patients, while, videothoracoscopic approach was done in eight patients.

RESULTS:
There were significant higher plasma levels of MDA (P<0.001) and lower plasma levels of β-carotene (P<0.01), vitamin A, vitamin C and vitamin E (P<0.001 for each) among patients with bullous lung disease when compared with the control group. There was non-significant difference regarding the air leakage and the hospital stay among patients with bullous lung disease who managed via conventional thoracotomy approach when compared with those managed via videothoracoscopic approach.

CONCLUSIONS:
This study proves that the oxidative stress plays an important role in the pathogenesis of bullous lung disease. Also there are no significant outcome differences between conventional thoracotomy versus video assisted thoracoscopic approach in surgical treatment of such patients.

Author Info:
1
Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Medical Biochemistry and Molecular Biology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.


Authors:
Farouk O1, Mahran DG2, Said HG1, Alaa MM1, Eisa AA1, Said GZ1, Rashed H3, Ez-Eldeen A3.

Title:
Hypovitaminosis D Among Patients Admitted With Hip Fracture to a Level-1 Trauma Center in the Sunny Upper Egypt: Prevalence and Associated Correlates.

Abstract:
INTRODUCTION:
Despite abundant sunshine, hypovitaminosis D is common in the Middle East. The aim of this study was to determine the prevalence of hypovitaminosis D and related correlates among patients with hip fracture in Assiut University Hospitals in Upper Egypt.

MATERIALS AND METHODS:
A cross-sectional study was carried out in 133 patients with hip fracture, aged 50 years and older, admitted to Trauma Unit of Assiut University Hospitals, from January through December 2014. Patients were selected by systematic random sampling. Serum 25-hydroxy vitamin D level was measured by enzyme-linked immunosorbent assay; bone mineral density (BMD) by dual-energy X-ray absorptiometry. Weight and height measurements were used for body mass index (BMI) calculation.

RESULTS:
Patients' median age was 70 years (range: 50-99); 51.9% were females. Osteoporosis (femoral neck T score: <-2.5 standard deviation) prevalence was 72.2%. Of all patients, 60.9% had vitamin D deficiency (<20 ng/mL); 15.8% reported vitamin D inadequacy (from 20 to 29 ng/mL) and vitamin D levels were normal in 23.3% (>30 ng/mL). According to univariate analysis, vitamin D deficiency was significantly associated with obesity (P = .012) and low T scores of the femoral neck (P = .001), L2 (P = .021), L3 (P = .031), L4 (P = .012), and the greater trochanter (P < .001). In a multivariable logistic regression model, high BMI and low BMD of the femoral neck and greater trochanter were associated with hypovitaminosis D.

CONCLUSION:
Prevalence of hypovitaminosis D is high among patients with hip fracture and associated with low BMD and high BMI. Increasing awareness about prevention as well as detection and treatment of vitamin D deficiency is recommended.

Author Info:
1
Department of Orthopaedic Surgery, Assiut University Hospitals, Assiut, Egypt.
2
Faculty of Medicine, Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt.
3
Clinical Pathology Department, Assiut University Hospitals, Assiut University, Assiut, Egypt.


Authors:
Ferreira JF1, Ahmed Mohamed AA2, Emery P3.

Abstract:
Glucocorticoids (GCs) were discovered in the 1940s and were administered for the first time to patients with rheumatoid arthritis in 1948. However, side effects were subsequently reported. In the last 7 decades, the mechanisms of action for both therapeutic properties and side effects have been elucidated. Mechanisms for minimizing side effects were also developed. GCs are the most frequently used class of drugs in the treatment of rheumatoid arthritis because of their efficacy in relieving symptoms and their low cost. A review of clinical applications, side effects, and drug interactions is presented.

Author Info:
1
Rheumatology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
2
Rheumatology, Physical medicine and Rehabilitation Department, Assiut University Hospitals, Assiut 71515, Egypt.
3
Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. Electronic address: p.emery@leeds.ac.uk.


Title:
Omega-3 Fatty Acids Decreases Oxidative Stress, Tumor ‎Necrosis Factor-Alpha, And Interleukin-1 Beta In ‎Hyperthyroidism-Induced Hepatic Dysfunction Rat ‎Model.‎

Abstract:
Hyperthyroidism is associated with abnormalities of the liver. Omega-3 polyunsaturated fatty acids, especially their long-chain forms: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have beneficial health effects. The objectives of the present study were to assess hyperthyroidism-induced hepatic dysfunction in adult male rats and to evaluate the ameliorative effects of omega-3 on hyperthyroidism-induced hepatic dysfunction and the underlying mechanisms. Twenty four adult male rats were randomly divided into three equal groups; control group which received water for 6 weeks, hyperthyroid group which received L-thyroxine orally for 6 weeks and hyperthyroid omega-3 treated group which received L-thyroxine for 2 weeks and then co-treated with L-thyroxine and omega-3 oral compound containing 18% of EPA and 12% of DHA for 4 weeks. Hyperthyroid omega-3 treated group showed significantly increased final body weight and body weight gain, decreased liver weight to body weight ratio, decreased serum triiodo-l-thyronine level, increased serum thyroid stimulating hormone level, decreased serum levels of alanine transaminase, aspartate transaminase and tumor necrosis factor-alpha, increased hepatic levels of total antioxidant capacity and decreased hepatic levels of total peroxide and interleukin-1 beta when compared with the hyperthyroid group. Furthermore, histopathological studies revealed also marked improvement. We concluded that omega-3 had encouraging therapeutic effects against hyperthyroidism-induced hepatic dysfunction attributable to more than one mechanism: antioxidant, anti-inflammatory and anti-fibrotic effects.

Author Info:
1
Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: asmaagom3a@yahoo.com.
2
Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Goyal S1, Radi MA2, Ramadan IK2, Said HG2.

Title:
Arthroscopic Skills Assessment And Use Of Box Model ‎For Training In Arthroscopic Surgery Using Sawbones - ‎‎"FAST" Workstation‎

Abstract:
PURPOSE:
Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules.

METHODS:
Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES "FAST" arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; "Novice", "Beginner", "Intermediate" and "Advanced" based on previous arthroscopy experience, for analyses of performance.

RESULTS:
The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice - 166 s, Beginner - 135.5 s, Intermediate - 100 s, Advance - 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks.

CONCLUSION:
Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.

Author Info:
1
Orthopaedics Department, Faculty of Medicine, Assiut University Hospital, Assiut 71515, Egypt - G.G. Medical Institute and Research Centre, 106/2 Sanjay Place, Agra 282004, India.
2
Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.


Authors:
Hamed EA1, El-Saied MM2, Saad K2, Yousef HA3, Mohamed AO4, Sabry D5.

Title:
Molecular Mechanisms Underlying Fibrosis And Elastin ‎Destruction In Childhood Interstitial Lung Diseases.‎

Abstract:
OBJECTIVE:
This study aimed to evaluate fibrosis and elastin destruction in childhood interstitial lung disease (chILD) patients.

METHODS:
Sixty patients and twenty healthy children were recruited. On admission, evaluation of chILD severity was made using Fan chILD score. Participants provided urine and blood samples. Plasma levels of transforming growth factor (TGF)-β1, connective tissue growth factor (CCN2), soluble factor related apoptosis (sFas) and long non-coding RNAs and urinary levels of desmosine/urinary creatinine (UDes/UCr) were measured.

RESULTS:
In patients, clinical findings were crackles (100.00%), tachypnea (65.00%), cardiomegaly (45.00%), digital clubbing (43.30%), cough (33.00%), cyanosis (26.70%), hepatomegaly (28.30%) and wheezes (23.30%). Categorizing of the patients with Fan chILD clinical score revealed that most patients 33.30% scored (3, symptomatic with abnormal saturation/cyanosis during exercise) then 28.30% scored (5, symptomatic with clinical and echocardiographic features of pulmonary hypertension), 18.30% scored (2, symptomatic with normal room air saturations), 15.00% scored (1, asymptomatic) and 5.00% scored (4, symptomatic with abnormal room air saturation/cyanosis at rest). TGF-β1, CCN2, sFas, lncrRNA-2700086A05Rik relative gene expression and UDes/UCr levels were higher in patients than controls (P=0.002, P=0.001, P=0.001, P=0.001, P=0.001, respectively). In patients, significant positive correlations were found between TGF-β1 and CCN2, sFas, UDes/UCr; between CCN2 and both sFas and UDes/UCr; between UDes/UCr and sFas. Morbidity and mortality rates were 46.70% and 10.00%, respectively.

CONCLUSION:
Markers of fibrosis (TGF-β1, sFas, CCN2) and elastin destruction (UDes/UCr) were increased in chILD especially in patients with long disease duration. So blockage of their pathways signals may offer novel therapeutic targets.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: eah3a2010@yahoo.com.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Medical Biochemistry, Faculty of Medicine, Assiut, University, Assiut, Egypt.
5
Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt.


Authors:
Hamed SA1, Fathy RA2, Radwan ME3, Abdellah MM4.

Title:
Fatty Liver In Adults Receiving Antiepileptic Medications: ‎Relationship To The Metabolic Risks

Abstract:
This study aimed to determine the frequency of fatty liver disease (FLD) induced by antiepileptic drugs (AEDs) and its relationship to the metabolic profile. This study included 130 patients (valproate or VPA = 75; carbamazepine or CBZ = 40; lamotrigine or LTG = 15). Liver ultrasonography (US) was done. Serum lipids, uric acid, free fatty acids (FFAs), glucose, insulin and leptin were measured. Compared to controls and patients on CBZ or LTG, higher BMI; TC, TG, LDL-c, uric acid, FFAs, glucose, insulin and leptin concentrations and enlarged liver lobes volume and span and insulin resistance (45%) were reported with VPA. With FLD, significant correlations were reported between BMI with leptin (r = 0.390;p < 0.01), insulin (r = 0.655;p < 0.001) and FFAs (r = 0.570;p < 0.001) and insulin with leptin (r = 0.355;p < 0.01). In multivariate analysis, with FLD, liver span was correlated with BMI (OR:4.50;95%CI:1.54-13.3,p = 0.01) and leptin concentrations (OR:2.55;95%CI:1.04-6.27,p = 0.045). We conclude that VPA therapy is a risk for FLD and is correlated with the associated adverse metabolic profile.

Author Info:
1
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.
2
b Department of Internal Medicine , Assiut University Hospital , Assiut , Egypt.
3
c Department of Radiology , Assiut University Hospital , Assiut , Egypt.
4
d Department of Pharmacology, Faculty of Medicine , Assiut University Hospital , Assiut , Egypt.


Title:
Markers Of Bone Turnover In Patients With Epilepsy And ‎Their Relationship To Management Of Bone Diseases ‎Induced By Antiepileptic Drugs.‎

Abstract:
Data from cross-sectional and prospective studies revealed that patients with epilepsy and on long-term treatment with antiepileptic drugs (AEDs) are at increased risk for metabolic bone diseases. Bone diseases were reported in about 50% of patients on AEDs. Low bone mineral density, osteopenia/osteoporosis, osteomalacia, rickets, altered concentration of bone turnover markers and fractures were reported with phenobarbital, phenytoin, carbamazepine, valproate, oxcarbazepine and lamotrigine. The mechanisms for AEDs-induced bone diseases are heterogeneous and include hypovitaminosis D, hypocalcemia and direct acceleration of bone loss and/or reduction of bone formation. This article reviews the evidence, predictors and mechanisms of AEDs-induced bone abnormalities and its clinical implications. For patients on AEDs, regular monitoring of bone health is recommended. Prophylactic administration of calcium and vitamin D is recommended for all patients. Treatment doses of calcium and vitamin D and even anti-resorptive drug therapy are reserved for patients at high risk of pathological fracture.

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


Title:
The Effect Of Epilepsy And Antiepileptic Drugs On ‎Sexual, Reproductive And Gonadal Health Of Adults With ‎Epilepsy.‎

Abstract:
Epilepsy is a common chronic medical illness. Hyposexuality is the most frequent abnormality in men and women with epilepsy. In men with epilepsy, hypoandrogenimia, hypogonadism and sperm abnormalities are common. Testicular atrophy was also infrequently reported. In women with epilepsy, hyperandrogenism, polycystic ovaries (PCOs) and PCO syndrome are frequent. Decreased serum free testosterone, dehydroepiandrosterone levels, free androgen index and free testosterone/leutinizing hormone (LH) ratio and increased sex hormone binding globulin, estradiol, prolactin, LH, follicle stimulating hormone (FSH) levels and LH/FSH ratio are common with epilepsy. Disturbance of central and/or peripheral control of hypothalamic-pituitary-gonadal axis and alteration of central neurotrasmitters (GABA, glutamate and serotonin) by epileptic discharges or antiepileptic drugs (AEDs), direct gonadal toxicity by AEDs and pcyshicatric/psychosocial factors are all incriminated in sexual, reproductive and gonadal abnormalities associated with epilepsy. Patients may benefit from multidisplinary evaluation, tight seizure control, change the AED, androgen therapy, genital vasodilators, L-carnitine supplementation and psychotherapy.


Title:
Hand Grip Strength In Juvenile Idiopathic Arthritis As ‎Predictor Of Disease Activity And Disability In Clinical ‎Practice.‎

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


Authors:
Hasan G1,2, Assiri A3, Marzuuk N4, Daef E5, Abdelwahab S6, Ahmed A7, Mohamad I1, Al-Eyadhy A2, Alhaboob A2, Temsah MH2.

Title:
Incidence And Characteristics Of Hepatitis E Virus ‎Infection In Children In Assiut, Upper Egypt

Abstract:
Objective To describe the characteristics of hepatitis E virus (HEV) infection in a cohort of children from Upper Egypt using data from a large multicentre prospective study of acute viral hepatitis (AVH). Methods Data from subjects aged 2-18 years with AVH or close contacts of those with AVH found to have asymptomatic AVH were included in the analysis. Information concerning medical history, clinical examination, liver function tests and screening for hepatotropic viruses was recorded and analysed. Results A total of 123 patients (73 boys, 50 girls) were included in the analysis. Of these, 33 (26.8%) had HEV infection, 17 (13.8%) had hepatitis A virus infection, 10 (8.1%) had hepatitis B virus infection, 14 (11.4%) had cytomegalovirus hepatitis, five (4.1%) had autoimmune hepatitis, 11 (8.9%) had hepatitis due to mixed viral infections and 33 (26.8%) had non A-E hepatitis. Overall, 38 (30.9%) had infection with HEV. HEV infection was significantly higher among those using underground wells as a water source compared with tap water. Liver enzymes were significantly raised in patients with non-HEV infection compared with those with HEV infection. Conclusions HEV is a significant cause of AVH among children in Upper Egypt. Contamination of drinking water appears to be a major source of infection. Screening for HEV should be considered in all Egyptian children with AVH.

Author Info:
1
1 Department of Paediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
2 Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia.
3
3 Prince Abdullah Bin Khaled Coeliac Disease Research Chair, Department of Paediatrics, King Khaled University Hospital and College of Medicine, King Saud University, Saudi Arabia.
4
4 Department of Gastroenterology and Hepatology, Assiut Police Hospital, Assiut, Egypt.
5
5 Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
6 Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
7
7 Department of Paediatrics, Faculty of Medicine, South Valley University, Qena, Egypt.


Authors:
Hasanain A1, Mahdy R2, Mohamed A3, Ali M4.

Title:
A Randomized, Comparative Study Of Dual Therapy ‎‎(Doxycycline-Rifampin) Versus Triple Therapy ‎‎(Doxycycline-Rifampin-Levofloxacin) For Treating ‎Acute/Subacute Brucellosis.‎

Abstract:
AIM:
The aim of this study was to compare both the efficacy and safety profile of the WHO-recommended, dual therapy (doxycycline-rifampin) to a quinolone-based, triple therapy (doxycycline-rifampin-levofloxacin) for treating acute/subacute brucellosis.

PATIENTS AND METHODS:
We studied 107 consecutive, naïve patients with acute/subacute brucellosis admitted to Assiut University Hospital. Patients were randomly allocated to receive the dual therapy of doxycycline-rifampin (group-A) or to receive the triple therapy of doxycycline-rifampin-levofloxacin (group-B). Acute/subacute brucellosis was diagnosed based on the presence of: (1) contact with animals or fresh animal products, (2) suggestive clinical manifestations of less than one-year duration, and (3) positive antibody titer (1:160) by standard tube agglutination test.

RESULTS:
There was no significant difference between the two groups regarding their demographic data. Fever was the most frequent manifestation (96.3%). Epigastric pain was the most frequent adverse effect of treatment (12.1%). Group-A patients had a significantly higher relapse rate compared to group-B patients (22.6% versus 9.3%, p-value=0.01). The rate of treatment adverse effects was higher among group-B patients, although not reaching statistical significance (20.4% versus 11.3%, p-value=0.059).

CONCLUSIONS:
Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline-rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: a.fh@outlook.com.
2
Department of Internal Medicine-Gastroenterology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Title:
Anterior Versus Posterior Approach In Surgical ‎Treatment Of Tuberculous Spondylodiscitis Of Thoracic ‎And Lumbar Spine.‎

Abstract:
PURPOSE:
The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

PATIENTS AND METHODS:
A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty-two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared.

RESULTS:
The average follow-up period was 15 months (range 12-24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the two groups regarding neurological recovery, functional outcome and fusion rate.

CONCLUSION:
Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar Pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.

Author Info:
1
Assiut University Hospital, Assiut, Egypt.
2
Assiut University Hospital, Assiut, Egypt. esmorshidy@hotmail.com.


Authors:
Hassan MA1, Ahmed EH1, Abdel-Raady BA2, Amin IA2, Refaiy AE3, Soliman GM4.

Title:
Evaluation of Non Invasive versus Invasive Methods for Diagnosis of Helicobacter pylori Infection among Patients with Gastroduodenal Disorders

Abstract:
H. pylori, a spiral gram-negative bacterium, is associated with gastroduodenal diseases. All H. pylori diagnostic assays have limitations. Cytotoxin-associated gene A (cag A), a virulence marker, can be identified by PCR. We evaluated H. pylori diagnostic methods, invasive: rapid urease test (RUT), and histopathological examination (HE), and serology as non-invasive method. Positive cases were studied for presence of cag A gene. Upper endoscopies and gastric biopsies were performed on 67 dyspeptic patients for RUT, HE and PCR. Anti H. pyloriIgG were measured by ELISA. Of 67 dyspeptic patients, 23 (34%) had more than one endoscopic finding, 46 (68.7%) were H.pylori positive by HE, and 21(31.3%) were negative with variable grades of mucosal antral neutrophil infiltration. Of the 46 HE positives, PCR detected CagA in 22 (47.8%). Using HE as the gold standard test, the sensitivity of ELISA and RUT was 93.48% and 86.96%, respectively; and the specificity was 85.71% and 47.62%, respectively. In conclusion, IgG detection by ELISA is a suitable screening test for diagnosis of H. pylori associated gastroduodenal diseases. Histopathology should be performed in ELISA negative cases to exclude infection.

Author Info:
1
Department of Microbiology & Immunology,Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Microbiology & Immunology,Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.


Authors:
Hassan R1, Ibraheem T1, Taha A1, Fadel B1, Zidan A2.

Title:
Common Hepatic Artery Thrombosis After Iatrogenic ‎Injury In Pancreaticodudenectomy Operation, ‎Unexpected Course.‎

Abstract:
INTRODUCTION:
Pancreatic resection is the only effective treatment with prolonged survival in operable pancreatic cancer and peri-ampullary cancer; it is also a procedure of significant morbidity and complications. Vascular injury is one of the most serious intraoperative complications.

PRESENTATION OF CASE:
We report here a case of common hepatic artery injury during pancreaticodudenectomy followed by complete thrombosis after its repair. As common hepatic artery is the only arterial blood supply of the liver, acute liver failure and necrosis were the usual course. Surprisingly liver enzymes and bilirubin start to improve in post operatively due to small hardly detected accessory left and middle hepatic artery.

DISSCUSSION AND CONCLUSION:
Although hepatic artery is the only arterial supply of the liver, occasionally small accessory arteries may give significant arterial blood supply. In such a situation liver enzymes act as surrogate markers to assess the sufficiency of this flow to the liver.

Author Info:
1
Department of HPB and Liver Transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
2
Department of HPB and Liver Transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt. Electronic address: ahmed.zidan@med.au.edu.eg.


Authors:
Hassanin IH1, Helmy YA1, Abbas AM2, Shaaban OM3, Khalaf M3, Ahmed SR1, Abdelkarim O1.

Title:
Incarcerated Gravid Uterus Through A Rectal Prolapse: ‎First Case Report.

Author Info:
1
Obstetrics and Gynecology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
2
Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: bmr90@hotmail.com.
3
Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hetta HF1, Mekky MA2, Khalil NK3, Mohamed WA4, El-Feky MA4, Ahmed SH4, Daef EA4, Medhat A2, Nassar MI5, Sherman KE6, Shata MT6.

Title:
Extra-Hepatic Infection Of Hepatitis C Virus In The Colon ‎Tissue And Its Relationship With Hepatitis C Virus ‎Pathogenesis.‎

Abstract:
Extra-hepatic compartments might contribute to hepatitis C virus (HCV) persistence and extra-hepatic manifestations. Therefore, we investigated HCV infection in colonic tissue in patients with chronic hepatitis C (CHC) and its relationship with HCV pathogenesis. Colonic biopsies were collected from three groups with CHC infection: treatment naïve (TN; n=12), non-responders (NR; n=10) to anti-HCV therapy (pegylated interferon-α and ribavirin) and sustained virologic response (SVR; n=10) and from a fourth healthy control group (n=10). Liver biopsies were examined to assess inflammation and fibrosis. HCV infection and colonic T regulatory (Treg) frequency were detected by immunohistochemistry. HCV core and NS3 proteins were detected in B cells and macrophage/monocytes of 42 % and 25 % of TN and 50 % and 30 % of NR, respectively, but not in SVR or control group. The numbers of cells expressing HCV proteins were positively correlated with both HCV viral load and colonic Treg frequency. A significant negative correlation between HCV-expressing cells with both liver inflammation and fibrosis was identified. Our study provides evidence that HCV can infect B cells and macrophages of the colon. The correlations between HCV infection in colonic tissue and HCV viral load and liver pathology underline the significance of this extra-hepatic infection in HCV pathogenesis and response to therapy.

Author Info:
1
1​Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA 2​Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
3​Department of Gastroenterology & Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
4​Assiut Liver Institute for Treatment of Hepatitis C, Assiut, Egypt.
4
2​Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
5​Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
1​Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA.


Authors:
Hijioka S1, Hara K2, Mizuno N2, Imaoka H2, Bhatia V3, Mekky MA4, Yoshimura K5, Yoshida T2, Okuno N2, Hieda N2, Tajika M6, Tanaka T6, Ishihara M6, Yatabe Y7, Shimizu Y8, Niwa Y6, Yamao K2.

Title:
Diagnostic Performance And Factors Influencing The ‎Accuracy Of EUS-FNA Of Pancreatic Neuroendocrine ‎Neoplasms

Abstract:
BACKGROUND:
Multiple studies have investigated sampling adequacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic neuroendocrine neoplasms (pNENs). However, none have described the diagnostic performance of EUS-FNA for pNENs, or the influencing factors. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA, with post-operative pathological diagnosis as the gold standard, and factors predictive of inadequate EUS sampling.

METHODS:
From 1998 to 2014, a total of 698 patients underwent pancreatic resection and 1455 patients underwent EUS-FNA sampling for pancreatic lesions. A total of 410 cases underwent both surgical resection and preceding EUS-FNA. Of these, 60 cases (49 true pNEN, nine non-diagnostic, two misdiagnoses) were included. We studied diagnostic performance of EUS-FNA and factors that were associated with failed diagnosis.

RESULTS:
Of the 60 cases, EUS-FNA yield was 49 true-positive cases, two misdiagnoses, and nine non-diagnostic cases (including six suggestive cases). Sensitivity, specificity, and accuracy were 84.5, 99.4, and 97.3 %, respectively; including the six suggestive cases, diagnostic values were 94.8 % sensitivity (55/58), 99.4 % specificity (350/352), and 98.7 % accuracy (405/410). In multivariate analysis, sampling adequacy rates were significantly lower when lesions were located in the pancreatic head [odds ratio (OR) = 10.0] and in tumor-rich stromal fibrosis (OR = 10.45). Tumor size, needle type, tumor grading, presence of cystic component, and time period were not significant factors.

CONCLUSIONS:
EUS-FNA offers high accuracy for pNEN. However, location of the tumor in the pancreatic head and presence of rich stromal fibrosis negatively impacts sampling adequacy.

Author Info:
1
Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan. rizasusu@aichi-cc.jp.
2
Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
3
Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, New Delhi, India.
4
Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt.
5
Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
6
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
7
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
8
Department of Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.


Authors:
Hussein M1, Chai DC2, Kyama CM2, Mwenda JM2, Palmer SS3, Gotteland JP4, D'Hooghe TM5.

Title:
C-Jun NH2-Terminal Kinase Inhibitor Bentamapimod ‎Reduces Induced Endometriosis In Baboons: An ‎Assessor-Blind Placebo-Controlled Randomized Study.‎

Abstract:
OBJECTIVE:
To test the hypothesis that the c-Jun NH2-terminal kinase (JNK) inhibitor (JNKI) bentamapimod (AS602801/PGL5001) can reduce induced endometriosis in baboons.

DESIGN:
Prospective randomized placebo-controlled study.

SETTING:
Nonhuman primate research center.

ANIMAL(S):
Twenty baboons each underwent four laparoscopies. Initial screening laparoscopy (L1) was followed after one rest cycle by an endometriosis-induction laparoscopy (L2). Fifty days after L2, the baboons were randomized just before staging laparoscopy (L3). Treatment lasted for 60 days, followed by a post-treatment staging laparoscopy (L4).

INTERVENTION(S):
Randomization before a 60-day treatment in four groups: daily placebo (n = 5), daily oral administration of 20 mg/kg JNKI (n = 5), concomitant daily oral administration of 20 mg/kg JNKI and 10 mg medroxyprogesterone acetate (MPA; n = 5), or subcutaneous administration of 3 mg cetrorelix every 3 days (n = 5).

MAIN OUTCOME MEASURE(S):
Type, surface area and volume of endometriotic lesions, and revised American Society for Reproductive Medicine score and stage were recorded during L3 and L4. Menstrual cycle length and serum hormonal concentration were recorded before and after treatment.

RESULT(S):
Compared with placebo, treatment with JNKI, JNKI + PMA, or cetrorelix resulted in lower total surface area and volume of endometriotic lesions. Remodeling of red active lesions into white lesions was observed more frequently in baboons treated with JNKI + MPA than in baboons treated with JNKI only. Menstrual cycle length and serum hormonal concentration were similar between placebo and JNKI groups.

CONCLUSION(S):
JNKI alone was as effective as JNKI + MPA or cetrorelix in reducing induced endometriosis in baboons, but without severe side effects or effect on cycle length or serum reproductive hormones.

Author Info:
1
Department of Obstetrics and Gynecology, Assiut University Hospitals, Assiut, Egypt; Institute of Primate Research, Karen, Nairobi, Kenya.
2
Institute of Primate Research, Karen, Nairobi, Kenya.
3
TocopheRx, Burlington, Massachusetts.
4
Preglem, Reproductive Medicine, Geneva, Switzerland.
5
Institute of Primate Research, Karen, Nairobi, Kenya; Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. Electronic address: thomas.dhooghe@uz.kuleuven.ac.be.


Authors:
Ingale H1,2, Ughratdar I3,4, Muquit S3, Moussa AA3,5, Vloeberghs MH3.

Title:
Selective Dorsal Rhizotomy As An Alternative To ‎Intrathecal Baclofen Pump Replacement In GMFCS ‎Grades 4 And 5 Children.‎

Abstract:
BACKGROUND:
Conventionally, selective dorsal rhizotomy (SDR) has been reserved for ambulant children and implantation of intrathecal baclofen (ITB) pump for non-ambulant children with cerebral palsy. Rather than replacing the ITB pump in selected Gross Motor Function Classification System (GMFCS) grades 4 and 5 children, we elected to undertake SDR instead. We discuss the rationale and outcomes.

OBJECTIVES:
To assess if children with severe spasticity treated with long-term ITB pump would benefit from SDR as alternative procedure to replacement of ITB pump.

METHOD:
This study is a prospective review of ten children with severe spasticity. Indications for ITB pump replacement in 3/10 children were previous ITB pump infection and the remaining seven were nearing depletion of drug delivery system. Pre- and post-SDR mean modified Ashworth scores, assessment of urological function and survey of parent/carer satisfaction were undertaken.

RESULT:
Mean Ashworth score reductions post-SDR in the lower limbs and upper limbs were 2.4 and 1.70, respectively. An improvement in urological function was also noticed in 27% of patients. Overall, 90% of parents/carers felt that functional outcome with SDR was improved compared with that of ITB.

CONCLUSION:
SDR in comparison to ITB in this subgroup is cheaper, less intrusive by avoiding refills/replacement and found to be more effective than ITB in reducing spasticity and providing ease for nursing care. We therefore suggest that consideration should be given to SDR as an alternative in patients previously implanted with ITB systems complicated by infection or nearing end of battery life.

Author Info:
1
Department of Neurosurgery, Queens Medical Centre, Nottingham, UK. drharshalingale@yahoo.com.
2
Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. drharshalingale@yahoo.com.
3
Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.
4
Department of Neurosurgery, Kings College London, London, UK.
5
Department of Neurosurgery Faculty of Medicine, Assiut University, Asyut, Egypt.


Authors:
Ismail AM1, Ramadan MF1, Ali MK1, Abbas AM1, El Saman AM1, Makarem MH1.

Title:
A Randomized Controlled Study Of The Efficacy Of 4 ‎Weeks Of Supplementation With ω-3 Polyunsaturated ‎Fatty Acids In Cases Of Unexplained Oligohydramnios.‎

Abstract:
OBJECTIVE:
To investigate the effect of ω-3 fatty acids on amniotic fluid volume and uterine artery blood flow after 4 weeks of treatment.

STUDY DESIGN:
A randomized clinical trial was conducted on 140 participants with unexplained oligohydramnios at Woman's Health Hospital, Assiut University, Egypt. Participants were randomly assigned to ω-3 plus capsules or placebo. Categorical variables were analyzed by means of the χ2 test, whereas continuous variables were analyzed by means of the independent-sample T-test between the two groups.

RESULTS:
One hundred and forty women were recruited. There was significant improvement in the amniotic fluid index (AFI) in the ω-3 plus group in comparison with the placebo group (P=0.001). Moreover, there were significant decreases in the systolic/diastolic ratio (P=0.01), resistance index (P=0.041) and pulsatility index (P=0.002) of the uterine arteries in the ω-3 plus group when comparing baseline values with those after 4 weeks.

CONCLUSION:
The results suggest that ω-3 fatty acids may have a role in the increase in AFI in cases of unexplained oligohydramnios. This effect may be secondary to the increase in uterine blood flow.

Author Info:
1
Department of Obstetric and Gynecology, Woman's Health Hospital, Assiut University, Assiut, Egypt.


Authors:
Ismail AM1, Hamed AH2, Saso S3, Abu-Elhasan AM2, Abu-Elghar MM4, Abdelmeged AN5.

Title:
Randomized Controlled Study Of Pre-Conception ‎Thromboprophylaxis Among Patients With Recurrent ‎Spontaneous Abortion Related To Antiphospholipid ‎Syndrome.‎

Abstract:
OBJECTIVES:
To investigate the effects of pre-conception thromboprophylaxis among patients with recurrent spontaneous abortion and antiphospholipid syndrome.

METHODS:
A randomized placebo-controlled trial enrolled patients with a history of recurrent spontaneous abortions and antiphospholipid syndrome who attended an Egyptian center between January 2011 and June 2013. Using a computer-generated sequence, patients were randomly allocated to receive 41 mg enoxaparin subcutaneously plus 81 mg aspirin daily pre-conception, or to receive placebo pre-conception. All patients received enoxaparin and aspirin following identification of fetal heart pulsation. The primary outcomes were live-birth rate and clinical-pregnancy rate at 0-6 months, and at 6-12 months. Intention-to-treat analyses were performed. Clinicians, investigators, and data analysts were masked to the treatment assignments.

RESULTS:
The study enrolled 180 patients(90 in each group). No significant difference was observed between the intervention and control groups in the live-birth rate (67[74%] vs 59[66%]; P=0.25). At 0-6 months, the clinical-pregnancy rate was higher in the intervention group (50[56%]vs 30[33%], P=0.02). No significant difference between the intervention and control groups was observed in the clinical-pregnancy rate at 6-12 months (32[36%] vs 35[39%], P=0.52).

CONCLUSION:
Among patients with recurrent spontaneous abortion and antiphospholipid syndrome, pre-conception enoxaparin increased the clinical-pregnancy rate at 0-6 months, but did not affect the clinical-pregnancy rate at 6-12 months or the live-birth rate. ClinicalTrials.gov: NCT01661439.

Author Info:
1
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt. Electronic address: prof.alaaismail@gmail.com.
2
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Division of Surgery and Cancer, Imperial College, London, UK.
4
Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.
5
Department of Obstetrics and Gynecology, EL-Minia university, El-Minia, Egypt.


Authors:
Kaartokallio T1, Lokki AI1,2,3, Peterson H4, Kivinen K5, Hiltunen L6, Salmela E7,8, Lappalainen T9,10, Maanselkä P11, Heino S1, Knuutila S12, Sayed A13,14, Poston L15, Brennecke SP16, Johnson MP17, Morgan L18, Moses EK19,20,21, Kere J4,7,8, Laivuori H1,22.

Title:
Preeclampsia Does Not Share Common Risk Alleles In ‎‎9p21 With Coronary Artery Disease And Type 2 Diabetes.‎

Abstract:
INTRODUCTION:
Preeclampsia is a common and partially genetic pregnancy complication characterized by hypertension and proteinuria. Association with cardiovascular disease and type 2 diabetes has been reported in 9p21 by several genome-wide association studies. It has been hypothesized that cardiometabolic diseases may share common etiology with preeclampsia.

MATERIALS AND METHODS:
We tested association with the 9p21 region to preeclampsia in the Finnish population by genotyping 23 tagging single nucleotide polymorphisms (SNPs) in 15 extended preeclampsia families and in a nationwide cohort consisting of 281 cases and 349 matched controls. Replication was conducted in additional datasets.

RESULTS:
Four SNPs (rs7044859, rs496892, rs564398 and rs7865618) showed nominal association (p ≤ 0.024 uncorrected) with preeclampsia in the case-control cohort. To increase power, we genotyped two SNPs in additional 388 cases and 341 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort. Partial replication was also attempted in a UK cohort (237 cases and 199 controls) and in 74 preeclamptic families from Australia/New Zealand. We were unable to replicate the initial association in the extended Finnish dataset or in the two international cohorts.

CONCLUSIONS:
Our study did not find evidence for the involvement of the 9p21 region in the risk of preeclampsia. Key Message Chromosome 9p21 is not associated with preeclampsia.

Author Info:
1
a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
2
b Bacteriology and Immunology Department , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
3
c Immunobiology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
4
d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden ;
5
e Division of Cardiovascular Medicine, University of Cambridge , Cambridge , UK ;
6
f Finnish Red Cross Blood Service , Helsinki , Finland ;
7
g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
8
h Folkhälsan Institute of Genetics , Helsinki , Finland ;
9
i New York Genome Center , New York City , NY , USA ;
10
j Department of Systems Biology , Columbia University , New York City , NY , USA ;
11
k Institute of Biotechnology , University of Helsinki , Helsinki , Finland ;
12
l Department of Pathology , University of Helsinki , Helsinki , Finland ;
13
m Department of Medical Biochemistry, Faculty of Medicine , Assiut University , Assiut , Egypt ;
14
n School of Molecular Medical Sciences , University of Nottingham , Nottingham , UK ;
15
o Division of Women's Health , King's College London , London , UK ;
16
p Department of Maternal-Fetal Medicine , Pregnancy Research Centre and University of Melbourne's Department of Obstetrics and Gynaecology, Royal Women's Hospital , Parkville , Victoria , Australia ;
17
q South Texas Diabetes and Obesity Institute, School of Medicine , University of Texas Rio Grande Valley , Brownsville , TX , USA ;
18
r School of Life Sciences , University of Nottingham , Nottingham , UK ;
19
s Faculty of Medicine Dentistry and Health Sciences , The University of Western Australia , Perth , Australia ;
20
t School of Biomedical Sciences , Faculty of Health Science, Curtin University , Perth , Australia ;
21
u Centre for Genetic Origins of Health and Disease, Medical Research Foundation , Royal Perth Hospital , Perth , Australia ;
22
v Institute for Molecular Medicine Finland , University of Helsinki , Helsinki , Finland.


Authors:
Kadar A1, Morsy M2, Sur YJ3, Akdag O4, Moran SL5.

Title:
Capitate Fractures: A Review of 53 Patients

Abstract:
PURPOSE:
To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution.

METHODS:
We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients' demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed.

RESULTS:
Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults.

CONCLUSIONS:
This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort.

TYPE OF STUDY/LEVEL OF EVIDENCE:
Therapeutic IV.

Author Info:
1
Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
2
Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt.
3
Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
4
Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey.
5
Department of Plastic Surgery, Mayo Clinic, Rochester, MN. Electronic address: moran.steven@mayo.edu.


Authors:
Kadar A1, Kleinstern G, Morsy M, Soreide E, Moran SL.

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

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

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

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

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

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

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


Authors:
Kamel-ElSayed SA1, Tiede-Lewis LM2, Lu Y3, Veno PA2, Dallas SL2.

Title:
Corrigendum To Novel Approaches For Two And Three Dimensional Multiplexed Imaging Of Osteocytes Bone 76 (2015) [129-140].

Author Info:
1
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, 650 E. 25th Street, Kansas City, MO 64108, USA; Biomedical Sciences Department, Oakland University William Beaumont School of Medicine, 414 O'Dowd Hall, Rochester, MI 48309, USA; Medical Physiology Department, Assiut University School of Medicine, 71516 Asyut, Egypt.
2
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, 650 E. 25th Street, Kansas City, MO 64108, USA.
3
Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri, 650 E. 25th Street, Kansas City, MO 64108, USA; Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Ave., Dallas, TX 75246, USA.


Authors:
Kandil MR1, Hamed SA1, Fadel KA2, Khalifa HE1, Ghanem MK1, Mohamed KO1.

Title:
Migraine In Assiut Governorate, Egypt: Epidemiology, Risk Factors, Comorbid Conditions And Predictors Of Change From Episodic To Chronic Migraine.

Abstract:
OBJECTIVES:
Headache is one of the most common complaints in medicine. Epidemiological and population-based studies reported that migraine has a variable prevalence worldwide. This study was done to estimate the prevalence of migraine across various age groups in Assiut district, Egypt.

METHODS:
This is a door-to-door study. It included 4700 randomly selected individuals.

RESULTS:
Headache was reported in 1668 subjects (35.49%), of them, 87.65% (n = 1462) had primary headaches. Migraine prevalence was 10.51% with female-to-male ratio of 2.4:1 particularly in ages of 20-40 years. The mean age of patients was 31.46 ± 13.39 years and age at onset was 24.16 ± 12.10 years. Nearly, 63.5% had frequent attacks, 65.2% of the attacks were severe enough to stop daily activities and lasted for >1 day in 32.5% of females compared to 40.7% and 14.5% for males. Chronic or daily migraine was more in females (35.3% versus 20.7% for males). Approximately, 5.6% had chronic migraine and 1.2% had daily migraine from the start, while 24.2% had transformation from episodic to chronic migraine within 6.1 ± 4.4 years. Migraine was prevalent among those with middle educational levels and labor workers. The duration of migraine attacks was found to reduce with age but the chronic/daily migraine increased with age. Hypertension, anxiety, irritable bowel syndrome, and depression were common comorbidities with migraine.

CONCLUSIONS:
We believe that the work done in this study is informative as it determined the actual prevalence of migraine across various age groups and the important predictors of change in the severity, duration, and frequency of migraine in our locality.

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


Authors:
Kara E1, Tucci A2, Manzoni C3, Lynch DS4, Elpidorou M4, Bettencourt C4, Chelban V4, Manole A4, Hamed SA5, Haridy NA6, Federoff M7, Preza E4, Hughes D4, Pittman A4, Jaunmuktane Z8, Brandner S8, Xiromerisiou G9, Wiethoff S4, Schottlaender L4, Proukakis C10, Morris H11, Warner T12, Bhatia KP13, Korlipara LV13, Singleton AB7, Hardy J4, Wood NW14, Lewis PA3, Houlden H15.

Title:
Genetic And Phenotypic Characterization Of Complex Hereditary Spastic Paraplegia.

Abstract:
The hereditary spastic paraplegias are a heterogeneous group of degenerative disorders that are clinically classified as either pure with predominant lower limb spasticity, or complex where spastic paraplegia is complicated with additional neurological features, and are inherited in autosomal dominant, autosomal recessive or X-linked patterns. Genetic defects have been identified in over 40 different genes, with more than 70 loci in total. Complex recessive spastic paraplegias have in the past been frequently associated with mutations in SPG11 (spatacsin), ZFYVE26/SPG15, SPG7 (paraplegin) and a handful of other rare genes, but many cases remain genetically undefined. The overlap with other neurodegenerative disorders has been implied in a small number of reports, but not in larger disease series. This deficiency has been largely due to the lack of suitable high throughput techniques to investigate the genetic basis of disease, but the recent availability of next generation sequencing can facilitate the identification of disease-causing mutations even in extremely heterogeneous disorders. We investigated a series of 97 index cases with complex spastic paraplegia referred to a tertiary referral neurology centre in London for diagnosis or management. The mean age of onset was 16 years (range 3 to 39). The SPG11 gene was first analysed, revealing homozygous or compound heterozygous mutations in 30/97 (30.9%) of probands, the largest SPG11 series reported to date, and by far the most common cause of complex spastic paraplegia in the UK, with severe and progressive clinical features and other neurological manifestations, linked with magnetic resonance imaging defects. Given the high frequency of SPG11 mutations, we studied the autophagic response to starvation in eight affected SPG11 cases and control fibroblast cell lines, but in our restricted study we did not observe correlations between disease status and autophagic or lysosomal markers. In the remaining cases, next generation sequencing was carried out revealing variants in a number of other known complex spastic paraplegia genes, including five in SPG7 (5/97), four in FA2H (also known as SPG35) (4/97) and two in ZFYVE26/SPG15 Variants were identified in genes usually associated with pure spastic paraplegia and also in the Parkinson's disease-associated gene ATP13A2, neuronal ceroid lipofuscinosis gene TPP1 and the hereditary motor and sensory neuropathy DNMT1 gene, highlighting the genetic heterogeneity of spastic paraplegia. No plausible genetic cause was identified in 51% of probands, likely indicating the existence of as yet unidentified genes.

Author Info:
1
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Alzheimer's Disease Research Centre, Department of Neurology, Harvard Medical School and Massachusetts General Hospital, 114 16th Street, Charlestown, MA 02129, USA.
2
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 3 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.
3
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 4 School of Pharmacy, University of Reading, Reading RG6 6AP, UK.
4
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
5
5 Department of Neurology and Psychiatry, Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.
6
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 5 Department of Neurology and Psychiatry, Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.
7
6 Laboratory of Neurogenetics, NIH/NIA, Bethesda, MD 20892, USA.
8
7 Division of Neuropathology and Department of Neurodegenerative Disease, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
9
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 8 Department of Neurology, Papageorgiou Hospital, Thessaloniki, Greece.
10
9 Department of Clinical Neuroscience, Royal Free Campus, UCL Institute of Neurology, London, UK.
11
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 9 Department of Clinical Neuroscience, Royal Free Campus, UCL Institute of Neurology, London, UK.
12
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 10 Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
13
11 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
14
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 12 Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
15
1 Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK 2 Alzheimer's Disease Research Centre, Department of Neurology, Harvard Medical School and Massachusetts General Hospital, 114 16th Street, Charlestown, MA 02129, USA h.houlden@ucl.ac.uk.


Authors:
Kaseb AO1, Hassan M1, Lacin S1,2, Abdel-Wahab R1,3, Amin HM4, Shalaby A1, Wolff RA1, Yao J1, Rashid A4, Vennapusa B5, Feng J5, Ohtomo T6.

Title:
Evaluating Clinical And Prognostic Implications Of Glypican-3 In Hepatocellular Carcinoma.

Abstract:
Hepatocellular carcinoma (HCC) is one of the most deadly cancers worldwide. In patients with HCC, histopathogical differentiation is an important indicator of prognosis; however, because determination of HCC differentiation is difficult, the recently described immunohistochemical (IHC) marker glypican3 (GPC3) might assist in HCC prognostication.The goal of our study was to investigate GPC3's IHC staining pattern and define the relationship between its expression and patients' clinicopathologic features and overall survival. We retrieved clinical parameters from 101 pathologically diagnosed HCC patients' medical records and classified these patients into 4 clinical score categories (0-3) based on increasing GPC3 staining intensity and the percentage of stained tumor cells in their resection and biopsy specimens. Histopathological samples were well, moderately, and poorly differentiated in 33, 22, and 12 patients, respectively, and the GPC3 expression rate was 63%, 86%, and 92%,respectively. The median overall survival was 49.9 months (confidence interval (CI): 35.3-64.6 months) for clinical scores 0-1 and 30.7 months (CI: 19.4-41.9 months) for clinical scores 2-3. This difference was not statistically significant (P = .06) but showed a strong trend. In conclusion, a greater GPC3 expression is associated with a worse HCC prognosis and may be a promising prognostic marker.

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
2
Department of Medical Oncology, Hacettepe University, Medical Faculty, Ankara, Turkey.
3
Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
4
Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
5
Ventana Medical Systems, Inc., Tucson, Arizona, USA.
6
Chugai Pharmaceutical Co., LTD., Tokyo, Japan.


Authors:
Kaseb AO1, Morris JS2, Iwasaki M1, Al-Shamsi HO1, Raghav KP1, Girard L1, Cheung S1, Nguyen V3, Elsayes KM4, Xiao L2, Abdel-Wahab R5, Shalaby AS1, Hassan M1, Hassabo HM1, Wolff RA1, Yao JC1.

Title:
Phase II Trial Of Bevacizumab And Erlotinib As A Second-Line Therapy For Advanced Hepatocellular Carcinoma.

Abstract:
TRIAL REGISTRY:
Clinicaltrials.gov #NCT01180959.

BACKGROUND:
Early clinical studies of bevacizumab and erlotinib in advanced hepatocellular carcinoma (HCC) have a tolerable toxicity and a promising clinical outcome. We evaluated the efficacy and tolerability of this combination as a second-line therapy for HCC refractory to sorafenib.

METHODS:
For this single-arm, Phase II study, we recruited patients with Child-Pugh class A or B liver disease, Eastern Cooperative Oncology Group performance status 0-2, and advanced HCC that was not amenable to surgical or regional therapies and treatment with sorafenib had failed (disease progressed or patient could not tolerate sorafenib). Patients received 10 mg/kg intravenous bevacizumab every 14 days and 150 mg oral erlotinib daily for 28-day cycles until progression. Tumor response was evaluated every two cycles using Response Evaluation Criteria in Solid Tumors. The primary end point was the 16-week progression-free survival rate. Secondary end points included time to progression and overall survival.

RESULTS:
A total of 44 patients were enrolled and had a median follow-up time of 33.8 months (95% confidence interval [CI]: 23.5 months - not defined). The 16-week progression-free survival rate was 43% (95% CI: 28%-59%), median time to progression was 3.9 months (95% CI: 2.0-8.3 months), and median overall survival duration was 9.9 months (95% CI: 8.3-15.5 months). Grade 3-4 adverse events included fatigue (13%), acne (11%), diarrhea (9%), anemia (7%), and upper gastrointestinal hemorrhage (7%).

CONCLUSION:
Bevacizumab plus erlotinib was tolerable and showed a signal of survival benefit in the second-line setting for patients with advanced HCC. Because standard-of-care options are lacking in this setting, further studies to identify predictors of response to this regimen are warranted.

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
3
Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Department of Diagnostic Radiology, 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, Houston, TX, USA; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.


Authors:
Kensara OA1, El-Shemi AG2, Mohamed AM3, Refaat B4, Idris S4, Ahmad J4.

Title:
Thymoquinone Subdues Tumor Growth And Potentiates The Chemopreventive Effect Of 5-Fluorouracil On The Early Stages Of Colorectal Carcinogenesis In Rats.

Abstract:
Colorectal cancer (CRC) is one of the most prevalent cancers and has a high mortality rate. Insensitivity and the limited therapeutic efficacy of its standard chemotherapeutic drug, 5-fluorouracil (5-FU), represents an important challenge in CRC treatment. The robust antitumor properties of thymoquinone (TQ), the main bioactive constituent of Nigella sativa, have recently been demonstrated on different cancers. We investigated whether TQ could potentiate the chemopreventive effect of 5-FU to eradicate the early stages of CRC and elucidated its underlying mechanisms. An intermediate-term (15 weeks) model of colorectal tumorigenesis was induced in male Wistar rats by azoxymethane (AOM), and the animals were randomly and equally divided into five groups: control, AOM, AOM/5-FU, AOM/TQ, and AOM/5-FU/TQ. TQ (35 mg/kg/d; 3 d/wk) was given during the seventh and 15th weeks post-AOM injection, while 5-FU was given during the ninth and tenth weeks (12 mg/kg/d for 4 days; then 6 mg/kg every other day for another four doses). At week 15, the resected colons were subjected to macroscopic, histopathological, molecular, and immunohistochemical examinations. Interestingly, 5-FU/TQ combination therapy resulted in a more significant reduction on AOM-induced colorectal tumors and large aberrant crypts foci than treatment with the individual drugs. Mechanistically, 5-FU and TQ remarkably cooperated to repress the expression of procancerous Wnt, β-catenin, NF-κB, COX-2, iNOS, VEGF, and TBRAS and upregulate the expression of anti-tumorigenesis DKK-1, CDNK-1A, TGF-β1, TGF-βRII, Smad4, and GPx. Overall, our findings present the first report describing the in vivo enhancement effect of combined TQ and 5-FU against early stages of CRC; however, further studies are required to determine the value of this combination therapy in an advanced long-term model of CRC and also to realize its clinical potential.

Author Info:
1
Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
2
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia; Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
4
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.


Authors:
Khalifa RM1, Abdellatif MZ2, Ahmed AK2, Yones DA1, El-Mazary AA3, Aly LH4, El-Seify MA5, Haridi MA6.

Title:
First Case Of Intestinal Acariasis From Egypt.

Abstract:
We are hereby reporting a case where the eggs and adults of the mold mites; Tyrophagus putrescentiae (Shrank) and the trophozoites of Blastocystis sp. were found in stool of three years old child from Minia City, Egypt. Intestinal mite infection was diagnosed after repeated identification of mite' stages from six consecutive stool samples to exclude the possibilities of contamination and spurious infection. The patient was suffering from severe colicky abdominal pain and burning sensation around the anus one month ago. All other members of his family were having the same acarine in their feces, but were all symptomless. The patient was treated with ivermectin 200 µg/kg body weight once every 10 days for three doses. His cure indicated that he was having asymptomatic blastocystosis.

Author Info:
1
Medical Parasitology Departments, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Minia University, Minia, Egypt.
3
Pediatric Department, Faculty of Medicine, Minia University, Minia, Egypt.
4
Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt.
5
Parasitology Department, Faculty of Veterinary Medicine, Kafr Elsheikh University, Kafr El-Sheikh, Egypt.
6
Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khalil S1, El-Badri N1,2, El-Mokhtaar M3, Al-Mofty S1,2, Farghaly M1, Ayman R1, Habib D4, Mousa N2.

Title:
A Cost-Effective Method to Assemble Biomimetic 3D Cell Culture Platforms.

Abstract:
METHODS:
We utilized the hAM to provide the biological and the three dimensional (3D) topographic components of the prototype. The 3D nano-roughness of the hAM was characterized using surface electron microscopy and surface image analysis (ImageJ and SurfaceJ). We developed additional macro-scale and micro-scale versions of the platform which provided additional shear stress factors to simulate the fluid dynamics of the in vivo extracellular fluids.

RESULTS:
Three models of varying complexities of the prototype were assembled. A well-defined 3D surface modulation of the hAM in comparable to commercial 3D biomaterial culture substrates was achieved without complex fabrication and with significantly lower cost. Performance of the prototype was demonstrated through culture of primary human umbilical cord mononuclear blood cells (MNCs), human bone marrow mesenchymal stem cell line (hBMSC), and human breast cancer tissue.

CONCLUSION:
This study presents methods of assembling an integrated, flexible and low cost biomimetic cell culture platform for diverse cell culture applications.

Author Info:
1
Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt.
2
University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt.
3
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khedr EM1, Gabra RH2, Noaman M2, Abo Elfetoh N2, Farghaly HSM3.

Title:
Cortical Excitability In Tramadol Dependent Patients: A Transcranial Magnetic Stimulation Study.

Abstract:
BACKGROUND:
Addiction to tramadol, a widely used analgesic, is becoming increasingly common. Tramadol can also induce seizures even after a single clinical dose. We tested whether the epileptogenicity of tramadol was associated with any changes in cortical excitability and inhibitory transmission using transcranial magnetic stimulation (TMS).

METHODS:
The study included 16 tramadol dependent patients and 15 age and sex matched healthy volunteers. Clinical evaluation was conducted using an addiction severity index. TMS assessment of excitability was conducted on the motor cortex since the response to each TMS pulse at that site is easily measured in terms of the amplitude of the twitches it evokes in contralateral muscles. Measures included resting and active motor threshold (RMT and AMT respectively), motor evoked potential (MEP) amplitude, cortical silent period (CSP) duration, transcallosal inhibition (TCI), and short interval intracortical inhibition and facilitation (SICI and ICF respectively). Urinary level of tramadol was measured immediately before assessing cortical excitability in each patient.

RESULTS:
RMT and AMT were significantly lower, the duration of the CSP was shorter and SICI was reduced in patients compared with the control group. These findings are suggestive of increased neural excitability and reduced GABAergic inhibition following exposure to tramadol. Also there were negative correlations between the severity of tramadol dependence and a number of cortical excitability parameters (AMT, RMT, and CSP with P=0.002, 0.005, and 0.04 respectively).

CONCLUSIONS:
The results provide evidence for hyperexcitability of the motor cortex coupled with inhibitory deficits in tramadol dependent patients.

Author Info:
1
Neuropsychiatry Department, Assiut University Hospital, Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Neuropsychiatry Department, Assiut University Hospital, Assiut, Egypt.
3
Pharmacology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Khedr EM1, Elbeh KA2, Elserogy Y2, Khalifa HE2, Ahmed MA2, Hafez MH2, Ali AM2, Elfetoh NA2.

Title:
Motor Cortical Excitability In Obsessive-Compulsive Disorder: Transcranial Magnetic Stimulation Study.

Abstract:
OBJECTIVES:
Transcranial magnetic stimulation is a non-invasive method of stimulating the brain that is increasingly being used in neuropsychiatric research. Previous work has suggested that the pathophysiology of obsessive-compulsive disorder (OCD) may involve dysfunction of excitatory and/or inhibitory brain function. This study aimed to extend those findings.

METHODS:
The study included 45 OCD patients and 15 age- and sex-matched healthy volunteers. Clinical evaluation was conducted using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression rating scale (CGI). Physiological measures were resting and active motor thresholds (RMT and AMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP) and transcallosal inhibition (TCI) durations, short-interval intracortical inhibition (SICI), and intracortical facilitation.

RESULTS:
RMT and AMT were significantly lower in patients than in the control group. The mean duration of the CSP and TCI were also significantly shorter. Obsessive trait was associated with significant reduction of TCI duration compared to compulsive trait. There was significant reduction in SICI in OCD patients compared to controls. There were no significant correlations between the Y-BOCS, HAM-A and CGI scores and the cortical excitability parameters.

CONCLUSION:
These results provide further evidence for inhibitory deficits or increased facilitation in cortical circuits of patients with OCD.

Author Info:
1
Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Department of neuropsychiatry, faculty of medicine, Assiut university hospital, 71511 Assiut, Egypt.


Authors:
Khedr EM1, Fawi G2, Abbas MA3, El-Fetoh NA1, Zaki AF3, Gamea A3.

Title:
Prevalence of Bell's palsy in Qena Governorate, Egypt.

Abstract:
BACKGROUND AND PURPOSE:
There have been few studies to estimate the prevalence of Bell's palsy (BP) in Arab countries. A community-based study was conducted to estimate the prevalence, incidence rates, precipitating factors, and outcome of BP in Qena Governorate, Egypt.

SUBJECTS AND METHODS:
A door-to-door survey was carried out, with random sampling of 10 districts, involving 9303 inhabitants, 51.1% males and 48.9% females. Seventeen subjects were positive in screening questionnaire and referred to Qena University hospital and were subjected to a full clinical examination, House Brackmann's Facial grading system.

RESULTS:
In a total population of 9303 individuals, 15 cases were confirmed as having BP giving a prevalence rate (PR) 161/10(5) for all ages 95%CI (80-243). It was slightly but not significantly higher among women and the rural community. The incidence rate of BP was 107/10(5). The highest age-specific rate was 40-49 years age. The most frequent precipitating factors for an episode of BP were exposure to air draft in 40%, physical stress (13.3%), and upper respiratory tract infection (13.3%). Moreover, 46.7% had predisposing risk factors, DM and hypertension in 33.3%. Sixty percent of cases had complication and poor outcome.

CONCLUSION:
The overall prevalence and incidence rates of BP in Qena governorate were high. This could be related to the variation in day and night temperature in our community and the susceptibility to air draft exposure during the night. The high frequency of poor outcome among studied cases suggests that better local guidelines should be implemented to recognize and treat BP.

Author Info:
1
a Faculty of Medicine, Department of Neuropsychiatry , Assiut University , Assiut , Egypt.
2
b Faculty of Medicine, Department of Neuropsychiatry , Sohag University , Sohag , Egypt.
3
c Faculty of Medicine, Department of Neuropsychiatry , South Valley University , Qena , Egypt.


Authors:
Abbas, A.M.,  Amin, M.T.b,  Tolba, S.M.c,  Ali, M.K.a

Date of Publishing:
Volume 21, Issue 1, 1 March 2016, Pages 41-45

Title:
Hemorrhagic Ovarian Cysts: Clinical and Sonographic Correlation with the ‎Management Options‎

Abstract:
Background: Hemorrhagic ovarian cysts (HOCs) are commonly seen in clinical practice. Most of them disappear spontaneously with follow-up except in minority of cases in which surgical intervention is stated. Our aim in this study was to review the cases diagnosed as having HOCs in our hospital and clarify the clinical and sonographic features of both surgically and conservatively managed patients. Materials and methods: Forty-eight patients who had been diagnosed as having HOCs were enrolled in this retrospective study divided into 2 groups: the first was surgically managed after hospitalization and the other managed conservatively with follow-up. Clinical and sonographic features with management options of both groups were reviewed. Results: Out of 48 patients, 16 patients (33.3%) underwent a surgical procedure, and 32 (66.7%) managed conservatively. The two groups were comparable regarding clinical features. The sonographic features revealed that the mean volume of HOCs was 65.7 ml and the mean length of their greatest diameters was 4.8 cm. There was significant difference between both groups, as the values in surgical group were significantly greater than those in the conservative group (P <0.05). According to the sonographic morphological pattern of HOCs, 8 cases (16.7%) showed a diffuse dense echo pattern mimicking a solid mass, 25 cases (52.1%) showed a sponge like pattern and 15 cases (31.2%) displayed a mixed cystic-solid pattern. Conclusion: Clinical, laboratory and ultrasound features of patients with HOCs can guide the gynecologists to the optimum management of such cases avoiding unnecessary surgery. © 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.

Author Info:
Women Health Hospital, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt
bPublic Health Department, Faculty of Medicine, Assiut University, Egypt
cAssiut University Hospital, Faculty of Medicine, Assiut University, Egypt


Authors:
Abbas, A.M.a,  Fawzy, F.M.b,  Ali, M.N.a,  Ali, M.K.a

Date of Publishing:
Volume 21, Issue 3, 1 September 2016, Pages 196-198

Title:
An Unusual Case of Uterine Rupture at 39 Weeks of Gestation after ‎Laparoscopic Cornual Resection: A Case Report‎

Abstract:
Spontaneous rupture of the uterus in primigravida at third trimester after laparoscopic cornual resection is very rare and may lead to serious obstetric complications. A 24-year-old primigravida woman with 39 weeks of pregnancy with history of laparoscopic left cornual resection presented with abruptio placenta. However, rupture left cornu of uterus was diagnosed shortly after successful vaginal delivery. Although rupture uterus after laparoscopic cornual resection is a rare entity, however a great care should be taken during the procedure to leave a strong cornual scar and prevent maternal morbidity and mortality. © 2015 The Authors

Author Info:
aDepartment of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
bFaculty of Medicine, Assiut University, Assiut, Egypt


Authors:
Khedr EM1, Fawi G, Allah Abbas MA, El-Fetoh NA, Zaki AF, Gamea A.

Title:
Prevalence of Common Types of Compression Neuropathies in Qena Governorate/Egypt: A Population-Based Survey.

Abstract:
BACKGROUND:
No epidemiological studies on the prevalence of compressive neuropathy have been undertaken in Arab countries. The aim of the study was to estimate the prevalence of the most common types of compressive neuropathies in Qena governorate/Egypt.

METHODS:
The study was part of a community-based survey carried out to assess the prevalence of neuromuscular disorders among the Qena population. A random sampling of 10 districts, 5,039 inhabitants aged ≥20. There were 3,050 urban residents (60.5%) and 1,989 (39.5%) from the rural community. Patients were diagnosed using a screening questionnaire for diagnosis of entrapment neuropathies. Positive cases were referred to the Qena University Hospital. They were given full clinical, electrophysiological and laboratory investigations.

RESULTS:
Compressive neuropathy was recorded in 165 cases giving a CPR = 3.3% of population at risk (≥20 years). Carpal tunnel syndrome (CTS) was diagnosed in 155 cases giving a CPR = 3.1% with a significantly higher prevalence among females than males (5.3 vs. 0.9%) and in rural compared with urban populations (4.6 vs. 2.1%). Ulnar neuropathy at the elbow was the second common type of entrapment with a CPR = 0.1% followed by radial nerve palsy, tarsal tunnel syndrome and common peroneal nerve palsy.

CONCLUSION:
The overall crude prevalence rate of CTS is comparable with that in other countries.

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


Authors:
Khedr EM1, Fawi G, Allah Abbas MA, El-Fetoh NA, Al Attar G, Zaki AF, Gamea A.

Title:
Prevalence of Diabetes and Diabetic Neuropathy in Qena Governorate: Population-Based Survey.

Abstract:
BACKGROUND:
No previous study was done to estimate the prevalence of diabetic neuropathy (DN) in Arabic countries. The aim of this study was to estimate the prevalence of DN and its characteristics in Qena governorate.

MATERIAL AND METHODS:
This is a random sampling of 10 study areas, involving 9,303 inhabitants; 51.1% men and 48.9% women were recruited. There were 57.3% urban residents and 42.7% rural residents. Patients were diagnosed using a screening questionnaire for diabetes mellitus (DM) as well as for DN in addition to measuring blood sugar in suspected cases. All positive cases were referred to Qena University Hospital and were subjected to full clinical, electrophysiological and laboratory investigations.

RESULTS:
Out of 9,303 people screened, 837 were diabetic giving prevalence 8.99% of the population. Eight hundred eleven had type II DM and 26 cases had type I giving prevalence of 8.7 and 0.3%, respectively. One hundred fifty-five out of 837 (18.5%) diabetic patients had evidence of DN with prevalence rate being 1.7% of the total population. Diabetic polyneuropathy was the commonest type with prevalence 1.5%. The prevalence of DN was higher in women than in men. Rural residents had significantly higher prevalence of DN compared to urban residents (1.9 vs. 1.4) and illiterate population more than educated (5.8 vs. 1.2).

CONCLUSION:
The overall crude prevalence rate of DM and DN is nearly the same as in European countries and lower than that in other Arabic countries.


Authors:
Khedr EM1, Fawi G2, Abbas MA3, Abo El-Fetoh N1, Zaki AF3, Gamea A3, Al Attar G4.

Title:
Prevalence Of Neuromuscular Disorders In Qena Governorate/Egypt: Population-Based Survey.

Abstract:
BACKGROUND:
Few epidemiological studies of the prevalence of neuromuscular disorders have been undertaken. The aim of the study was to estimate the prevalence of the most common types of neuromuscular disorders in Qena governorate/Egypt.

METHODS:
A random sample was taken from 11 districts, involving 9303 inhabitants with 57.3% urban residents and 42.7% rural residence. Patients were diagnosed using a screening questionnaire for the diagnosis of neuromuscular disorders. All positive cases were referred to Qena University hospital where they underwent full clinical, electrophysiological, and laboratory investigations.

RESULTS:
Out of 9303 participants 448 cases were identified positive during survey. Four hundred and twenty-six cases proved to have neuromuscular disorders giving a crude prevalence rate (CPR) of 4.57%; 408 cases had definite neuropathy and 18 cases had muscular disorders equivalent to CPR of 4.39% and 193/105 respectively. There was a higher prevalence in the rural than urban population. The CPR of focal compression neuropathies was 1.8%, with the majority of cases having carpal tunnel syndrome (CPR = 1.67%). CPR of diabetic neuropathy was 1.67%. The CPR of compressive radiculopathy was 0.34%. Traumatic nerve injury had a CPR 0.06%. The lifetime prevalence of Bell's palsy was 0.16%. Hereditary motor and sensory neuropathy had a CPR 0.08%. The CPR of idiopathic neuropathy was 0.09% and Infective Leprotic neuropathy was 0.04%. Five patients were diagnosed as having muscular dystrophy and another 5 patients had myotonia with CPR of 54/105 for each. Two cases of myasthenia gravis and another two cases with systemic myopathy were recorded giving a CPR of 21/105.

CONCLUSION:
The overall CPR of neuromuscular disorders in the general population in Qena governorate/Egypt was higher than reported in other countries.

Author Info:
1
a Faculty of Medicine, Department of Neuropsychiatry , Assiut University , Assiut , Egypt.
2
b Faculty of Medicine, Department of Neuropsychiatry , Sohag University , Sohag , Egypt.
3
c Faculty of Medicine, Department of Neuropsychiatry , South Valley University , Qena , Egypt.
4
d Faculty of Medicine, Department of Public Health and Community Medicine , Assiut University , Assiut , Egypt.


Authors:
Khedr EM1, Badry R1, Ali AM1, Abo El-Fetoh N1, El-Hammady DH2, Ghandour AM2, Abdel-Haleem A1.

Title:
Steroid/Antiviral For The Treatment Of Bell's Palsy: Double Blind Randomized Clinical Trial.

Abstract:
BACKGROUND:
A large number of patients with Bell's palsy fail to recover facial function completely after steroid therapy. Only a few small trials have been conducted to test whether outcomes can be improved by the addition of antiviral therapy.

OBJECTIVE:
To evaluate the efficacy of treatment with steroid alone versus steroid + antiviral in a group of patients with moderately severe to severe acute Bell's palsy.

METHODS:
Fifty eligible patients out of a total of 65 with acute onset Bell's palsy were randomized to receive the two treatments. Evaluation was performed before starting treatment, after 2 weeks of treatment and 3 months after onset, using the House and Brackmann facial nerve grading system (HB) and the Sunnybrook grading system.This study was registered with ClinicalTrials.gov, number NCT02328079.

RESULTS:
Both treatments had comparable demographics and clinical scores at baseline. There was greater improvement in the mean HB and Sunnybrook scores of the steroid + antiviral group in comparison to steroid group at 3 months. At the end of the 3rd month, 17 patients (68%) had good recovery and 8 patients (32%) had poor recovery in the steroid group compared with 23 patients (92%) and 2 (8%) respectively in the steroid and antiviral group (p = 0.034).

CONCLUSION:
The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy.

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


Authors:
Khojah HM1, Ahmed S2, Abdel-Rahman MS3, Hamza AB4.

Title:
Reactive Oxygen And Nitrogen Species In Patients With Rheumatoid Arthritis As Potential Biomarkers For Disease Activity And The Role Of Antioxidants.

Abstract:
Reactive oxygen species (ROS) and reactive nitrogen species (RNS) have distinct contribution to the destructive, proliferative synovitis of rheumatoid arthritis (RA) and play a prominent role in cell-signaling events. However, few studies had clarified the role of individual ROS and RNS in the etiopathogenesis of RA. To date, most of the studies were concerned with the measurement of the total oxidative and nitrative stress levels in RA. The aim of this study was to monitor the levels of individual ROS and RNS to emphasize the role that each plays in the pathogenesis of RA and their usefulness as possible biomarkers for the disease activity. In addition, the effect of an antioxidant (ascorbic acid), added to the treatment regimen, on the levels of ROS, RNS and disease activity has been evaluated. Forty-two Saudi RA patients and 40 healthy controls of both genders were included in this study. Serum levels of six different ROS and three different RNS were measured using specific fluorescent probes. The ROS included the hydroxyl radical ((•)OH), the superoxide anion (O2(•-)), hydrogen peroxide (H2O2), the singlet oxygen ((1)O2), the hypochlorite radical (OHCl(•)), and the peroxyl radical (ROO(•)). The RNS included nitric oxide (NO(•)), nitrogen dioxide (ONO-) and peroxynitrite (ONOO-). The main clinical and biochemical markers for disease activity were assessed and correlated with ROS and RNS levels. The clinical markers included the 28 swollen joint count (SJC-28), the 28-tender joint count (TJC-28), morning stiffness and symmetric arthritis, in addition to the disease activity score assessing 28 joints with erythrocyte sedimentation rate (DAS28-ESR). The biochemical markers included undercarboxylated osteocalcin (ucOC), matrix metalloproteinase (MMP-3), ESR, C-reactive protein (CRP), rheumatoid factor (RF) and anticyclic citrullinated polypeptide (Anti-CCP). Ascorbic acid (1mg/day) was added as an antioxidant to the regular treatment regimen of RA patients for two months, and the levels of ROS and RNS, as well as disease activity were re-evaluated. The results have shown significant higher serum levels of individual ROS and RNS in RA patients compared with healthy subjects. Moreover, this study might be the first to report strong positive correlations between most of the reactive species and the clinical and biochemical markers of RA. Interestingly, the addition of ascorbic acid had significantly reduced the levels of all ROS and RNS in RA patients. In conclusion, the role of oxidative and nitrative stress in the pathogenesis of RA has been confirmed by this study. Serum levels of ROS and RNS may effectively serve as biomarkers for monitoring disease progression. Finally, the addition of an antioxidant, such as ascorbic acid, in the management of RA may be of a great value.

Author Info:
1
Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia. Electronic address: hkhojah@taibahu.edu.sa.
2
Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia.
3
Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
King Fahd Hospital, Al Madinah AlMunawarah, Saudi Arabia.


Authors:
Khojah HM1, Ahmed S2, Abdel-Rahman MS3,4, Alkhalil KM5, Hamza AB5.

Title:
Vitamin K Homologs As Potential Biomarkers For Disease Activity In Patients With Rheumatoid Arthritis.

Abstract:
The aim of this study was to evaluate the possible role of vitamin K homologs as potential biomarkers for disease activity in patients with rheumatoid arthritis (RA). In this study, 42 patients with RA and 40 healthy controls were enrolled. Serum levels of vitamin K homologs were measured using a high-performance liquid chromatography-fluorescence method. Different biochemical and clinical markers for disease activity were measured and correlated with serum levels of vitamin K homologs. There were no significant differences between RA patients and healthy subjects in demographic data. Patients with RA showed significantly higher levels of biochemical markers compared with healthy subjects (p < 0.001). These markers included rheumatoid factor (RF), anticyclic citrullinated polypeptide (anti-CCP), undercarboxylated osteocalcin (ucOC), matrix metalloproteinase (MMP-3), C-reactive protein (CRP), and disease activity score assessing 28 joints with erythrocyte sedimentation rate (DAS28-ESR). In addition, serum levels of vitamin K homologs were reduced in RA patients, and the levels of menaquinone-4 (MK-4) and menaquinone-7 (MK-7) were moderately to strongly inversely correlated with the clinical articular features in RA patients, whereas phylloquinone (PK) levels were weakly correlated. Serum levels of MK-4, MK-7 and PK were strongly inversely correlated with ucOC, MMP-3 and DAS28-ESR in RA patients. In contrast, serum levels of MK-4, MK-7 and PK were weakly correlated with CRP, RF and anti-CCP. These results suggest that serum levels of vitamin K homologs may be considered as potential biomarkers for disease activity. In addition, the results confirm the role of vitamin K deficiency in the etiology of RA.

Author Info:
1
Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia. hkhojah@taibahu.edu.sa.
2
Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia.
3
Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al Madinah AlMunawarah, Saudi Arabia.
4
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Rheumatology, King Fahd Hospital, Al Madinah AlMunawarah, Saudi Arabia.


Authors:
Lammer J1, Prager SG1, Cheney MC2, Ahmed A3, Radwan SH4, Burns SA5, Silva PS6, Sun JK6.

Title:
Cone Photoreceptor Irregularity on Adaptive Optics Scanning Laser Ophthalmoscopy Correlates With Severity of Diabetic Retinopathy and Macular Edema.

Abstract:
PURPOSE:
To determine whether cone density, spacing, or regularity in eyes with and without diabetes (DM) as assessed by high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) correlates with presence of diabetes, diabetic retinopathy (DR) severity, or presence of diabetic macular edema (DME).

METHODS:
Participants with type 1 or 2 DM and healthy controls underwent AOSLO imaging of four macular regions. Cone assessment was performed by independent graders for cone density, packing factor (PF), nearest neighbor distance (NND), and Voronoi tile area (VTA). Regularity indices (mean/SD) of NND (RI-NND) and VTA (RI-VTA) were calculated.

RESULTS:
Fifty-three eyes (53 subjects) were assessed. Mean ± SD age was 44 ± 12 years; 81% had DM (duration: 22 ± 13 years; glycated hemoglobin [HbA1c]: 8.0 ± 1.7%; DM type 1: 72%). No significant relationship was found between DM, HbA1c, or DR severity and cone density or spacing parameters. However, decreased regularity of cone arrangement in the macular quadrants was correlated with presence of DM (RI-NND: P = 0.04; RI-VTA: P = 0.04), increasing DR severity (RI-NND: P = 0.04), and presence of DME (RI-VTA: P = 0.04). Eyes with DME were associated with decreased density (P = 0.04), PF (P = 0.03), and RI-VTA (0.04).

CONCLUSIONS:
Although absolute cone density and spacing don't appear to change substantially in DM, decreased regularity of the cone arrangement is consistently associated with the presence of DM, increasing DR severity, and DME. Future AOSLO evaluation of cone regularity is warranted to determine whether these changes are correlated with, or predict, anatomic or functional deficits in patients with DM.

Author Info:
1
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States 2Department of Ophthalmology, Medical University Vienna, Vienna, Austria.
2
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States.
3
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States 3Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States 4Department of Ophthalmology, Cairo University, Cairo, Egypt.
5
School of Optometry, Indiana University, Bloomington, Indiana, United States.
6
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States 6Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States.


Authors:
Mahmoud AE1, Attia RA1, Eldeek HE1, Farrag HM1, Makboul R2.

Title:
Polymerase Chain Reaction Detection And Inducible Nitric-Oxide Synthase Expression Of Leishmania Major In Mice Inoculated By Two Different Routes.

Abstract:
INTRODUCTION:
Leishmania major needs a sensitive and specific method for proper diagnosis. This study aims to study the course and histopathology of L. major in certain tissues of experimentally infected BALB/c mice after subcutaneous (sc) and intraperitoneal (ip) inoculation.

MATERIALS AND METHODS:
After infecting BALB/c mice using sc and ip inoculation, the histopathology was studied. The kinetoplastic DNA polymerase chain reaction (PCR) for its molecular detection and detect the inducible nitric-oxide synthase (iNOS) pattern during the first 3 months of infection.

RESULT:
PCR could detect the presence of L. major in all spleens, lymph nodes, and skin ulcers by both inoculation routes while (33%) and (42%) of livers were positive after sc and ip routes, respectively. Chronic inflammatory cell infiltrates with capsulitis was found in the spleen, lymph nodes, and liver. Granulomas were found in the spleen and liver. There was a statistically significant difference in iNOS expression along the experiment in the spleen and lymph nodes by both routes and in the liver by ip only. Apart from the liver, iNOS could not be detected on the 2(nd) week postinfection and was high after 1 month for both routes in all samples; a moderate decrease at 2 months and the highest decrease were detected after 3 months.

CONCLUSIONS:
L. major inoculation by both routes produce visceral disease in mice, and kinetoplastic DNA PCR can detect its presence from the 2(nd) week up to the 3(rd) month postinfection. The iNOS expression was high at 1 and 2 months and remained throughout the 3 months of the experiment; which plays an important role in the disease course and control.

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


Authors:
Mahmoud O1, Vikatmaa P2, Aho P2, Halmesmäki K2, Albäck A2, Rahkola-Soisalo P3, Lappalainen K4, Venermo M2.

Title:
Efficacy Of Endovascular Treatment For Pelvic Congestion Syndrome.

Abstract:
BACKGROUND:
Chronic pelvic pain is not a rare health problem among women. One of the most common causes of chronic pelvic pain is pelvic congestion syndrome (PCS). We have reviewed all medical literature on the endovascular treatment of PCS and hereby provide a brief overview of the anatomy, pathophysiology, and clinical aspects of ovarian and pelvic varices. We describe the technique of transcatheter embolization, the complications thereof and the clinical results of the treatment.

METHODS:
A literature search was performed using PubMed, Science Direct, Google Scholar, and Scopus to identify case series on the endovascular treatment of PCS up until the end of November 2014.

RESULTS:
Twenty studies with a total of 1081 patients were included in the review. There were no randomized trials, and only one study included a control group. The immediate technical success rate in the occlusion of the affected veins was 99%. Seventeen studies reported the 1- to 3-month clinical success of 641 patients. Of these, 88.1% reported moderate to significant relief in the symptoms and 11.9% reported little or no relief. In 17 studies, long-term results were reported, and the follow-up varied between 7.3 months and 5 years. In late follow-up, 86.6% reported relief of the symptoms and 13.6% experienced little or no relief.

CONCLUSIONS:
The immediate success rate for the endovascular treatment of PCS is good and the complication rate low. Most patients report relief in the symptoms for up to 5 years after the procedure. However, there are no randomized or high-quality controlled trials, and the level of evidence therefore remains at C.

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 Hospitals, Assiut, Egypt. Electronic address: osmanmahmoud15@yahoo.com.
2
Department of Vascular Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
3
Department of Obstetrics and Gynaecology, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
4
Department of Radiology, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.


Authors:
Mahran DG1, Farouk O2, Qayed MH1, Berraud A3.

Title:
Pattern and Trend of Injuries Among Trauma Unit Attendants in Upper Egypt.

Abstract:
BACKGROUND:
Injury is a growing public health problem worldwide. Deaths due to injuries account for 10% of the world's mortality. More than 90% of the world's injury deaths occur in low and middle income countries. In Egypt, injury is a hidden epidemic and its related deaths are misclassified due to lack of accurate national data. Furthermore, as a research problem it has also been largely ignored in developing countries.

OBJECTIVES:
To determine the pattern and trend of injury from January 2002 to December 2009 among attendants at trauma unit in Assiut university hospital in Upper Egypt.

PATIENTS AND METHODS:
A descriptive retrospective study was conducted at the trauma unit in Assiut university hospital in Upper Egypt. All registered injuries during January 2002 to December 2009 were included in the study.

RESULTS:
During January 2002 to December 2009, 213835 injured cases were admitted to the trauma unit. The number of attendants increased every year from 9.3% from the total cases in all study period in 2002 up to 15.3% in 2009 with a statistically significant difference (P = 0.000). Young adults aged 20 - 29 years were the most common group affected by injuries (22.2%). Male to female ratio was 3:1. Falls represent one half of injuries (49.6%) from all attended cases, followed by exposure to inanimate mechanical forces (19.5%) and transport accidents (18.3%). Falls were ranked as the leading cause of injuries, while transport accidents were the second cause in 2007 - 2009.

CONCLUSIONS:
Trauma in Upper Egypt is an under-recognized problem, which requires prioritized attention. Increasing the awareness of community, making policies and establishment of a trauma system are important to decrease the burden of injuries.

Author Info:
1
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Orthopedic Surgery, Assiut University Hospitals, Assiut, Egypt.
3
Ministry of Health, Hadhramout, Yemen.


Authors:
Mahvash A1, Murthy R1, Odisio BC1, Raghav KP2, Girard L2, Cheung S1, Nguyen V3, Ensor J4, Gadani S5, Elsayes KM6, Abdel-Wahab R7, Hassan M1, Shalaby AS1, Yao JC1, Wallace MJ1, Kaseb AO2.

Title:
Yttrium-90 Resin Microspheres As An Adjunct To Sorafenib In Patients With Unresectable Hepatocellular Carcinoma.

Abstract:
PURPOSE:
The safety and efficacy of the combined use of sorafenib and yttrium-90 resin microspheres (Y90 RMS) to treat advanced hepatocellular carcinoma (HCC) is not well established. We determined the incidence of adverse events with this combination therapy in patients with advanced HCC at our institution and analyzed the treatment and survival outcomes.

MATERIALS AND METHODS:
We reviewed the records of 19 patients with Barcelona Clinic Liver Cancer class B or C HCC who underwent treatment with Y90 RMS (for 21 sessions) while receiving full or reduced doses of sorafenib between January 2008 and May 2010. Therapy response was evaluated using Response Evaluation Criteria in Solid Tumors. We evaluated median overall survival (OS) and progression-free survival (PFS) as well as hepatic and extrahepatic disease PFS and incidence of adverse events.

RESULTS:
The median patient age was 67 years, and portal or hepatic venous invasion was present in eight patients (42%). Ten patients received reduced doses of sorafenib. The median Y90 radiation activity delivered was 41.2 mCi. The partial response of Response Evaluation Criteria in Solid Tumors was observed in four patients (19%). The median hepatic disease PFS was 7.82 months, extrahepatic disease PFS was 8.94 months, OS was 19.52 months, and PFS was 6.63 months. Ninety days after treatment with Y90 RMS, five patients (26%) had grade II adverse events and four patients (21%) had grade III adverse events.

CONCLUSION:
OS and PFS outcomes were superior to those observed in prior studies evaluating sorafenib alone in patients with a similar disease status, warranting further study of this treatment combination.

Author Info:
1
Department of Interventional Radiology.
2
Department of Gastrointestinal Medical Oncology.
3
Department of Pharmacy.
4
Department of Statistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
5
Department of Radiology, Saint Louis University Hospital, St Louis, MO.
6
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
7
Department of Interventional Radiology; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.


Authors:
Makboul M1, Abdelhamid MS2, Al-Attar GS3.

Title:
Long-Term Follow-Up And Patient Satisfaction After Reduction Mammoplasty: Superomedial Versus Inferior Pedicle.

Abstract:
BACKGROUND:
Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result.

PATIENTS AND METHODS:
This study was carried out on sixty cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and were asked for late post-operative results and overall patients' satisfaction.

RESULTS:
Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method.

CONCLUSION:
The superomedial pedicle shows better long-term cosmetic results.

Author Info:
1
Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Plastic Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt.
3
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Makboul R1, Refaiy A1, Abdelkawi IF2, Hameed DA3, Elderwy AA3, Shalaby MM3, Merseburger AS4, Hussein MR1.

Title:
Alterations of mTOR and PTEN Protein Expression In Schistosomal Squamous Cell Carcinoma And Urothelial Carcinoma.

Abstract:
BACKGROUND:
mTOR signaling pathway is commonly activated in cancer. PTEN, a tumor suppressor gene, is a potent inhibitor of this pathway. To date the expression pattern of mTOR and PTEN in schistosomal bladder squamous cell carcinoma and urothelial carcinoma was not investigated. Also, whether alterations of these proteins are associated with pathological parameters was not established.

HYPOTHESIS:
We hypothesize that "expression of mTOR and/or PTEN will be altered in schistosomal-related urothelial and squamous cell carcinomas".

PATIENTS AND METHODS:
To test our hypothesis we examined the expression pattern of mTOR and PTEN in normal and hyperplastic urothelium, squamous metaplasia, schistosomal urothelial carcinomas (70 cases) and squamous cell carcinomas (47 cases) using immunohistochemical methods.

RESULTS:
mTOR protein expression was absent in the normal, hyperplastic urothelium and metaplastic squamous epithelium. mTOR was over-expressed in muscle invasive urothelial and high grade squamous cell carcinomas. In contrast, PTEN protein expression was seen in the normal and hyperplastic urothelium. The expression was reduced (metaplastic squamous epithelium) or lost in muscle invasive urothelial and high grade squamous carcinomas. Alterations of these proteins were associated with some clinicopathological features. mTOR expression was negatively correlated with PTEN expression in urothelial carcinoma only.

CONCLUSIONS:
We report, for the first time, altered expression of mTOR and PTEN proteins in schistosomal urothelial and squamous cell carcinomas. Alterations of these proteins may contribute to the progression and aggressive behavior of schistosomal bladder carcinoma. Targeting mTOR, may be a promising therapeutic strategy in these tumors.

Author Info:
1
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Islamfaa@yahoo.com.
3
Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Urology, Campus Lübeck University Hospital Schleswig-Holstein, Germany.


Authors:
Makhlouf NA1, Farghaly AM1, Zaky S1, Rashed HA2, Abu Faddan NH3, Sayed D4, El-Badawy O5, Afifi N5, Hamza WS6, El-Sayed Y7.

Title:
The Efficacy Of Hepatitis B Vaccination Program In Upper Egypt: Flow Cytometry And The Evaluation Of Long Term Immunogenicity.

Abstract:
Anti-HBs levels wanes with time. Many studies discussed the B cell response to HBV vaccine. However, the data about memory T cell response are limited. To evaluate the efficacy of hepatitis B vaccine via evaluating anti-HBs levels and HBsAg specific memory T-lymphocytes through descriptive study. The study was conducted in a tertiary care setting. This study included 440 vaccinated persons during infancy. Group I: 6 to less than 10 years old; Group II: 10 to less than 14 years old; Group III: 14 to less than 17 years old; Group IV: 17 years old. The serum samples were screened for HBV markers. Cytokines secretion by HBsAg-specific memory CD45RO(+) CD4(+) T cells was measured after in vitro culture using flow cytometry. The mean titer of anti-HBs was higher in group I in comparison to others (P-value = 0.000 for each). IFN-γ and IL-4 secreted by memory CD4(+) T cells were positive in all with anti-HBs >100 mIU/ml, while positive in 87% and 75% of participants with anti-HBs <10 mIU/ml and positive in 73% and 32% of participants with absent anti-HBs. The percentage of cells secreting IFN-γ and those secreting IL-4 were higher among participants with serum anti-HBs >100 mIU/ml than those having <10 mIU/ml or absent (P < 0.001 for each). Anti-HBs positivity decreased with time since childhood vaccination. Breakthrough infections are rare in vaccinated persons. Hepatitis-B vaccine is efficient in controlling HBV infection. Flow cytometry is a useful tool to assess the long term persistence of T cell memory after childhood vaccination. J. Med. Virol. 88:1567-1575, 2016.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Flow Cytometry Laboratory, Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
5
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
7
Department of Pediatric Nursing, Faculty of Nursing, Sohag University, Egypt.


Authors:
Makhlouf NA1, Morsy KH2, Ammar S3, Mohammed RA3, Yousef HA4, Mostafa MG5.

Title:
Wandering Spleen In The Pelvic Region In An Adult Man With Symptoms Of Acute Abdomen.

Abstract:
Wandering or ectopic spleen is a condition characterised by migration of spleen in the abdomen or pelvis. This anomaly is rare, with a reported incidence of <0.2%. It occurs mostly in women between 20 and 40years of age. Clinical diagnosis is difficult because of lack of precise signs, symptoms, and nonspecific laboratory data. Diagnosis of a wandering spleen highly depends on the results of imaging studies such as abdominal ultrasound and abdominopelvic computed tomography (CT) scanning. Treatment includes surgery with the choice between splenopexy in a noninfarcted spleen and splenectomy when infarction has occurred. We report a rare case of wandering spleen in a 27-year-old man with infarction due to torsion of its pedicle, which was diagnosed by CT and treated by splenectomy.

CONCLUSION:
Despite the rarity of wandering spleen, the possibility of torsion of its long pedicle with acute splenic infarction should be considered in the differential diagnosis of acute abdomen.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.
2
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Egypt.
3
Department of General Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.
4
Department of Radiodiagnosis, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.
5
Department of Pathology, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.


Authors:
Manole A1,2, Chelban V1,3, Haridy NA1, Hamed SA4, Berardo A5, Reilly MM1,2, Houlden H6,7.

Title:
Severe Axonal Neuropathy Is A Late Manifestation Of SPG11.

Abstract:
Complex hereditary spastic paraplegia (HSP) is a clinically heterogeneous group of disorders usually inherited in an autosomal recessive manner. In the past, complex recessive spastic paraplegias have been frequently associated with SPG11 mutations but also with defects in SPG15, SPG7 and a handful of other rare genes. Pleiotropy exists in HSP genes, exemplified in the recent association of SPG11 mutations with CMT2. In this study, we performed whole exome sequence analysis and identified two siblings with novel compound heterozygous frameshift SPG11 mutations. The mutations segregated with disease were not present in control databases and analysis of skin fibroblast derived mRNA indicated that the SPG11 truncated mRNA species were not degraded significantly by non-sense mediated mRNA decay. These siblings had severe early-onset spastic paraplegia but later in their disease developed severe axonal neuropathy, neuropathic pain and blue/black foot discolouration likely caused by a combination of the severe neuropathy with autonomic dysfunction and peripheral oedema. We also identified a similar late-onset axonal neuropathy in a Cypriot SPG11 family. Although neuropathy is occasionally present in SPG11, in our SPG11 patients reported here it was particularly severe, highlighting the association of axonal neuropathy with SPG11 and the late manifestation of axonal peripheral nerve damage.

Author Info:
1
Department of Molecular Neuroscience and Neurogenetics Laboratory, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
2
MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
3
Department of Neurology, Medical University N. Testemitanu, Chisinau, Republic of Moldova.
4
Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
5
Instituto de Neurociencias Conci Carpinella, Laboratorio de Neurobiologìa, Instituto de Investigaciónes Medicas "Mercedes y Martín Ferreyra", INIMEC-CONICET-UNC, Córdoba, Argentina.
6
Department of Molecular Neuroscience and Neurogenetics Laboratory, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK. h.houlden@ucl.ac.uk.
7
MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK. h.houlden@ucl.ac.uk.


Authors:
Markeb AA1, El-Maali NA1, Sayed DM2, Osama A3, Abdel-Malek MA4, Zaki AH5, Elwanis ME6, Driscoll JJ7.

Title:
Synthesis, Structural Characterization, and Preclinical Efficacy of a Novel Paclitaxel-Loaded Alginate Nanoparticle for Breast Cancer Treatment.

Abstract:
PURPOSE:
The antitumor activity of a novel alginate (ALG) polymer-based particle that contained paclitaxel (PTX) was evaluated using human primary breast cancer cells.

MATERIALS AND METHODS:
PTX was combined with ALG in a nanoparticle as a drug delivery system designed to improve breast cancer tumor cell killing. PTX-ALG nanoparticles were first synthesized by nanoemulsification polymer cross-linking methods that improved the aqueous solubility. Structural and biophysical properties of the PTX-ALG nanoparticles were then determined by transmission electron microscopy (TEM) and high performance liquid chromatography (HPLC) fluorescence. The effect on cell cycle progression and apoptosis was determined using flow cytometry.

RESULTS:
PTX-ALG nanoparticles were prepared and characterized by ultraviolet (UV)/visible (VIS), HPLC fluorescence, and TEM. PTX-ALG nanoparticles demonstrated increased hydrophobicity and solubility over PTX alone. Synthetically engineered PTX-ALG nanoparticles promoted cell-cycle arrest, reduced viability, and induced apoptosis in human primary patient breast cancer cells superior to those of PTX alone.

CONCLUSION:
Taken together, our results demonstrate that PTX-ALG nanoparticles represent an innovative, nanoscale delivery system for the administration of anticancer agents that may avoid the adverse toxicities with enhanced antitumor effects to improve the treatment of breast cancer patients.

Author Info:
1
Department of Chemistry, Faculty of Science, Assiut University, Assiut 71516, Egypt.
2
Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut 71516, Egypt.
3
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
4
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt; The Vontz Center for Molecular Studies, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
5
Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
6
Department of Radiotherapy, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
7
The Vontz Center for Molecular Studies, University of Cincinnati College of Medicine, Cincinnati, OH, USA; University of Cincinnati Cancer Institute, Cincinnati, OH, USA.


Authors:
Mehta M1, Hetta HF1,2, Abdel-Hameed EA1, Rouster SD1, Hossain M3, Mekky MA4, Khalil NK5, Mohamed WA2, El-Feky MA2, Ahmed SH2, Daef EA2, El-Mokhtar MA2, Abdelwahab SF6, Medhat A4, Sherman KE1, Shata MT7,8.

Title:
Association between IL28B rs12979860 Single Nucleotide Polymorphism And The Frequency Of Colonic Treg In Chronically HCV-Infected Patients.

Abstract:
The IL28B gene is associated with spontaneous or treatment-induced HCV viral clearance. However, the mechanism by which the IL28B single nucleotide polymorphism (SNP) affects the extra-hepatic HCV immune responses and its relationship to HCV pathogenesis have not been thoroughly investigated. To examine the mechanism by which IL28B affects HCV clearance. Forty Egyptian patients with chronic HCV infection receiving an Interferon/ribavirin treatment regimen were enrolled into this study. There were two groups: non-responders (NR; n = 20) and sustained virologic responders (SVR; n = 20). The initial plasma HCV viral loads prior to treatment and IL28B genotypes were determined by quantitative RT-PCR and sequencing, respectively. Liver biopsies were examined to determine the inflammatory score and the stage of fibrosis. Colonic regulatory T cell (Treg) frequency was estimated by immunohistochemistry. No significant association between IL28B genotypes and response to therapy was identified, despite an odds ratio of 3.4 to have the TT genotype in NR compared to SVR (95 % confidence interval 0.3-35.3, p = 0.3). Patients with the TT-IL28Brs12979860 genotype (unfavorable genotype) have significantly higher frequencies of colonic Treg compared to the CT (p = 0.04) and CC (p = 0.03) genotypes. The frequency of colonic Treg cells in HCV-infected patients had a strong association with the IL-28B genotype and may have a significant impact on HCV clearance.

Author Info:
1
Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, Cincinnati, OH, 45267-0595, USA.
2
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4
Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Assiut Liver Institute for Treatment of Hepatitis C, Assiut, Egypt.
6
Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minya, Egypt.
7
Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, Cincinnati, OH, 45267-0595, USA. mohamed.shata@uc.edu.
8
Department of Microbiology, Saint James School of Medicine, Saint Vincent, Arnos Vale, Saint Vincent and the Grenadines. mohamed.shata@uc.edu.


Authors:
Metwalley KA1,2, Farghaly HS3, Sherief T4.

Title:
Left Ventricular Dysfunction And Subclinical Atherosclerosis In Children With Classic Congenital Adrenal Hyperplasia: A Single-Center Study From Upper Egypt.

Abstract:
Few studies assessed carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function in children with congenital adrenal hyperplasia (CAH) as compared to adults. This study aimed to assess carotid artery structural changes and myocardial function with CAH. The study included 32 children with classic CAH and 32 healthy children matched for age, gender, pubertal status, and socioeconomic status. Blood levels of high-sensitivity C-reactive protein (hs-CRP) and circulating endothelial cells (CECs) were measured. LV mass (LVM) and function were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT. Compared to controls, patients had higher hs-CRP and CEC concentrations (p < 0.001) and increased CA-IMT (p < 0.001), indicating vascular endothelial injury and subclinical atherosclerosis; higher LVM index (LVMI) (p < 0.001), indicating LV hypertrophy; and lower ratio of E/A wave and prolonged mitral deceleration time (DcT) and isovolumic relaxation times (IVRTs) (p < 0.001), indicating LV dysfunction. Abnormalities were marked in uncontrolled children on medical treatment. Testosterone levels were positively correlated with CA-IMT, LVMI, and DcT values.

CONCLUSION:
This study indicates that children with CAH and enhanced androgen levels are at increased risk of vascular endothelial injury, subclinical atherosclerosis, and LV dysfunction. These findings highlight early monitoring of children with CAH for cardiovascular abnormalities.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. kotb72@yahoo.com.
2
Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O. 71111, Assiut, Egypt. kotb72@yahoo.com.
3
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. hekma73@hotmail.com.
4
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Metwalley KA1, Farghaly HS1, Saad K2,3, Othman HA4.

Title:
Oxidative Status In Children And Adolescents With Autoimmune Thyroiditis.

Abstract:
Oxidative status in autoimmune thyroiditis (AIT) has not been investigated previously in children and adolescents. We investigated oxidant and antioxidant systems in a cohort of Egyptian children and adolescents with AIT to explore these as biomarkers of autoimmunity and thyroid function. Our case control study included 32 children with AIT and 32 healthy subjects with matching age and sex as a control group. After a thorough history and physical examination, a thyroid ultrasound, measurements of thyroid-stimulating hormone (TSH), free thyroxin (FT4), antithyroid peroxidase antibodies (TPOAb), and antithyroglobulin antibody were done with assessment of malondialdehyde (MDA) and total antioxidant capacity (TAC) levels as oxidative stress markers. Overt hypothyroidism was detected in 23/32, while subclinical hypothyroidism was detected in nine of the 32 studied patients. MDA levels were significantly elevated, while TAC levels were significantly decreased in AIT patients compared with healthy controls. The difference was more evident in patients with overt hypothyroidism than those with subclinical hypothyroidism. We also observed significant positive correlations of TPOAb levels with age, TSH, MDA, and thyroid volume, finding a negative correlation with TAC and FT4. In conclusion, the high serum MDA and lower TAC levels in patients with AIT and the correlation of thyroid antibodies with biomarkers of oxidative stress may reflect the role of autoimmunity in the development of oxidative stress. Future studies are needed for evaluation of antioxidant therapy for AIT patients. ClinicalTrials.gov Identifier NCT02318160. https://clinicaltrials.gov/ct2/show/NCT02318160 .

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Asyût, Egypt.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Asyût, Egypt. ksaad8@yahoo.com.
3
Associate professor of pediatrics, Faculty of Medicine, University of Assiut, Asyût, 71516, Egypt. ksaad8@yahoo.com.
4
Department of Clinical Pathology, Faculty of Medicine, Aswan University, Aswân, Egypt.


Authors:
Metwalley KA1, Farghaly HS2, Sherief T3, Hussein A2.

Title:
Vitamin D Status In Children And Adolescents With Autoimmune Thyroiditis.

Abstract:
BACKGROUND:
Vitamin D deficiency is a global health problem. Its role as an immune modulator has been recently emphasized. There is increasing evidence for the significant role of vitamin D in reducing the incidence of autoimmune diseases. However, little is known about the status of vitamin D in children and adolescents with autoimmune thyroiditis (AIT).

OBJECTIVE:
The goal of the present study was to assess vitamin D status in Egyptian children and adolescents with AIT and to explore its relation to biomarkers of autoimmunity and thyroid function.

DESIGN:
A prevalence case-control study that included 56 children with AIT and 56 healthy, age- and sex-matched subjects that served as the control group. The following was done for all participants: thorough history, physical examination, thyroid ultrasound, measurement of thyroid-stimulating hormone (TSH), free thyroxin (FT4), anti-thyroid peroxidase antibodies (TPOAb), anti-thyroglobulin antibody (TgAb) and assessment of serum 25-hydroxy vitamin D (25OHD) level.

RESULTS:
Overt hypothyroidism was detected in 42/56 while subclinical hypothyroidism was detected in 14/56 of the studied patients. Vitamin D deficiency rate was significantly higher in the AIT group compared to the control subjects (71.4 vs 21.4 %, P < 0.001). In AIT group, the mean level of 25OHD was significantly lower compared to the control group (16.2 ± 8.2 vs 33.9 ± 12.7 nmol/L, P < 0.001). The difference was more evident in patients with overt hypothyroidism than those with subclinical hypothyroidism (P < 0.01). There were significant negative correlations between serum 25OHD and age, duration of the disease, BMI, anti-TPOAb, anti-TGAb and TSH (P < 0.001 each). On the other hand, serum 25OHD correlated positively with FT4 levels. While 25OHD level was an independent risk factor for AIT, it failed to qualify as an independent risk for the progression of AIT to overt hypothyroidism after adjustment for other potential confounding factors; age, sex and BMI.

CONCLUSIONS:
Low serum vitamin D is significantly associated with AIT in Egyptian children. However, vitamin D level is not an independent risk for the progression of AIT to overt hypothyroidism. BMI may have an influence on serum 25OHD levels.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, B.O 71111, Assiut, Egypt. kotb72@gmail.com.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, B.O 71111, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Moaddab A1, Nassr AA2, Espinoza J1, Ruano R1, Bateni ZH1, Shamshirsaz AA1, Mandy GT3, Welty SE3, Erfani H1, Popek EJ4, Belfort MA1, Shamshirsaz AA5.

Title:
Twin Anemia Polycythemia Sequence: A Single Center Experience And Literature Review.

Abstract:
Twin anemia polycythemia sequence (TAPS) is defined by significant intertwin hemoglobin discordance without the amniotic fluid discordance that characterizes twin-twin-transfusion syndrome (TTTS) in monochorionic twin pregnancies. TAPS is an uncommon condition which can either occur spontaneously, or following fetoscopic laser ablation for TTTS. This complication is thought to result from chronic transfusion through very small placental anastomoses; however, the pathogenesis of TAPS remains unknown. Consequently, there is no consensus in the management of TAPS. In this article, three cases of TAPS are described and we review the literature on this uncommon pregnancy complication.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
2
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Egypt.
3
Department of Pediatric Medicine, Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
4
Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
5
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA. Electronic address: alirezashamshirsaz@yahoo.com.


Title:
Could Acupuncture Be An Adequate Alternative To Dexamethasone In Pediatric Tonsillectomy?

Abstract:
BACKGROUND:
Usage of nonpharmacological treatment contributes to an overall patient well-being, assisting in physical and emotional healing. Acupuncture has been reported to be useful in reducing early postoperative vomiting (POV) and attenuating postoperative pain.

AIM:
The aim of this study was to compare the effect of dexamethasone vs acupuncture at P6 bilaterally and CV13 on the incidence and severity of POV in children undergoing tonsillectomy with or without adenoidectomy.

METHOD:
One hundred and twenty children, ASA I-III aged 2-8 years undergoing elective tonsillectomy were included in this prospective randomized double-blind study. Children were randomly divided into two equal groups (60 each). At induction of anesthesia, the dexamethasone group received 0.15 mg·kg(-1) dexamethasone IV plus sham acupuncture, and the acupuncture group received acupuncture at P6 bilaterally and CV13 plus 2 ml of normal saline IV. Vomiting was recorded at 0-6, 6-24, and 0-24 h postoperatively.

RESULTS:
There was no difference in the incidence of vomiting between the acupuncture and dexamethasone groups. The mean difference in time to first oral intake (95% CI) was 4.3 (0.5-8.6) min between dexamethasone group and acupuncture group; P = 0.426. The mean difference in time until first vomit (95% CI) was 12 (9.5-13.8) min between both groups. No significant differences between Kaplan-Meier curves for time until first vomit (log-rank test) were obtained (P = 0.697).

CONCLUSION:
Acupuncture at P6 bilaterally and CV13 provided similar antiemetic effect to dexamethasone in children undergoing tonsillectomy.

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


Title:
Response To Comment "Cox: Alternative Therapies And Postoperative Vomiting".


Authors:
Abd-Elshafy, S.K.aEmail Author,  Yacoup, A.M.a,  Abdalla, E.E.M.a,  El-Melegy, T.T.H.b,  Abd-Elsalam, K.A.a

Date of Publishing:
Volume 19, Issue 6, August 2016, Pages E841-E852

Title:
A New Look on Adding Dexamethasone as an Adjuvant to Caudal ‎Bupivacaine; Efficacy on Postoperative Pain and Vomiting in Pediatric ‎Patients‎

Abstract:
Background: Controlling postoperative pain and vomiting in children remains a great challenge. Objective: Study the efficacy of adding dexamethasone to caudal bupivacaine on postoperative analgesia and vomiting. Study Design: Prospective, randomized double blind controlled clinical trial. Setting: Assiut University Hospital. Patients: Ninety children ASA I-II, undergoing lower orthopedic surgeries. Methods: Patients were randomly allocated into 3 equal groups. All received caudal block after induction of anesthesia with 0.5 mL/kg of 0.25% bupivacaine in addition to 5 mL intravenous (IV) normal saline in the control group, IV 0.5 mg/kg dexamethasone in IV dexamethasone group and lastly 0.1 mg/kg dexamethasone in the caudal dexamethasone group. Postoperative pain scores and rescue analgesic consumption were recorded. Blood glucose, postoperative vomiting, and other side effects were evaluated up to 24 hours after extubation. Results: The time of first analgesia and the number of patients requiring rescue analgesics were significantly decreased with intravenous or caudal dexamethasone. No significant increase in postoperative blood glucose levels were observed. A significant increase in β- Endorphin level at 3 and 24 hours postoperative was found in both dexamethasone groups when compared with the preoperative baseline value. The incidence of postoperative vomiting was significantly decreased in both dexamethasone groups in comparison with the control group. No other side effects were detected. Limitations: Measurement of serum cortisol. Conclusion: Analgesic and antiemetic effects of dexamethasone as an adjunct to caudal block with bupivacaine (0.25%) 0.5 mL/kg is similar whether administered intravenously 0.5 mg/kg or caudally 0.1 mg/kg. © 2016, American Society of Interventional Pain Physicians. All rights reserved.

Author Info:
aDepartment of Anesthesia, College of medicine, Assiut University, Assiut, Egypt
bDepartment of Clinical Pathology, College of medicine, Assiut University, Assiut, Egypt


Authors:
Mohamed AA1, Al-Hussaini TK2, Fathalla MM2, El Shamy TT1, Abdelaal II2, Amer SA3.

Title:
The Impact Of Excision Of Benign Nonendometriotic Ovarian Cysts On Ovarian Reserve: A Systematic Review.

Abstract:
BACKGROUND:
Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve.

OBJECTIVE:
The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti-Müllerian hormone level.

DATA SOURCES:
MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically.

STUDY DESIGN:
All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Müllerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis.

DATA EXTRACTION:
Two reviewers performed the data extraction independently.

RESULTS:
A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Müllerian hormone concentration after ovarian cystectomy (weighted mean difference, -1.14 ng/mL; 95% confidence interval, -1.36 to -0.92; I(2) = 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti-Müllerian hormone assay and studies using IOT anti-Müllerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti-Müllerian hormone (weighted mean difference, -1.44 [95% confidence interval, -1.71 to -1.1; I(2) = 0%], -0.88 [95% confidence interval, -1.71 to -0.04; I(2) = 0%], and -1.56 [95% confidence interval, -2.44 to -0.69; I(2) = 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Müllerian hormone.

CONCLUSION:
Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Müllerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

Author Info:
1
Royal Derby Hospital, University of Nottingham, Derby, United Kingdom.
2
Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt.
3
Royal Derby Hospital, University of Nottingham, Derby, United Kingdom. Electronic address: saad.amer@nottingham.ac.uk.


Authors:
Mohamed SA1, Abdel-Ghaffar HS, Kamal SM, Fares KM, Hamza HM.

Title:
Effect of Topical Morphine on Acute and Chronic Postmastectomy Pain: What Is the Optimum Dose?

Abstract:
BACKGROUND AND OBJECTIVES:
Poorly controlled postoperative pain is strongly associated with the development of chronic pain. We aimed to investigate the effect of topical morphine (in 1 of 3 doses: 5, 10, or 15 mg) on acute and chronic neuropathic pain after modified radical mastectomy for cancer breast.

METHODS:
In this registered clinical trial (ClinicalTrials.gov identifier: NCT02462577), 90 patients were allocated to receive 10 mL plain bupivacaine 0.5% plus either 5, 10, or 15 mg morphine (designated by the group names Morphine5, Morphine10, and Morphine15, respectively). The combination was diluted by saline 0.9% to 20 mL and irrigated in the wound before skin closure. Groups were compared for the following: time to first postoperative analgesia; intravenous patient-controlled analgesia (PCA) morphine consumption; pain scores; hemodynamics; sedation; adverse events in first postoperative 48 hours; and Leeds Assessment of Neuropathic Symptoms and Signs scores in first and third postoperative months.

RESULTS:
No patient in the Morphine15 group requested postoperative PCA morphine versus 19 and 8 in the Morphine5 and Morphine10 groups, respectively (P < 0.002). Time to first analgesic request and total consumption of PCA morphine analgesia were 7.31 ± 3.12 hours versus 14.00 ± 3.54 hours (P < 0.000) and 1.42 ± 0.50 mg versus 1.00 ± 0.00 mg (P = 0.371) in the Morphine5 and Morphine10 groups, respectively. Lowest scores on visual analog pain scale at rest (P < 0.001) and visual analog pain scale during movement (P < 0.01) were recorded in the Morphine15 group, followed by Morphine10 then Morphine5 group. Lowest Leeds Assessment of Neuropathic Symptoms and Signs scores were recorded in the Morphine15 group in the first month (1.10 ± 0.37 vs 5.76 ± 3.26 and 4.73 ± 2.87, P < 0.0001) and third postoperative month (4.40 ± 1.77 vs 6.33 ± 3.21 and 5.43 ± 2.67, P < 0.006) compared with Morphine5 and Morphine10 groups, respectively. No patient in the Morphine15 group developed chronic pain versus 4 and 2 in Morphine5 and Morphine10 groups, respectively.

CONCLUSIONS:
Topical morphine controlled acute postmastectomy pain in a dose-dependent manner and reduced the incidence and severity of chronic postmastectomy pain syndrome.

Author Info:
1
From the *Department of Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, †Department of Anesthesia and Intensive Care, Faculty of Medicine, and ‡Department of Surgery, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Title:
Effect Of Intracameral Triamcinolone Acetonide On Postoperative Intraocular Inflammation In Pediatric Traumatic Cataract.

Abstract:
PURPOSE:
To study the effect of a single intracameral injection of triamcinolone acetonide at the end of pediatric traumatic cataract surgery on postoperative inflammation.

METHODS:
This prospective interventional study comprised 40 eyes of children with unilateral traumatic cataract. Patients were classified into 2 groups: the study group, in which intraoperative intracameral triamcinolone acetonide (2 mg) was used at the end of surgery; and a control group, which did not receive intracameral triamcinolone acetonide.

RESULTS:
The study group included 20 eyes of patients with an average age of 6 ± 2.8 years. The control group included 20 eyes of patients with an average age of 6 ± 2.1 years. No serious intraoperative complications occurred. In the immediate postoperative period, 3 eyes of the control group (15.0%) developed a fibrinous anterior chamber reaction. None of the study group eyes developed a similar reaction. There were no cases of endophthalmitis. In addition, 3 eyes (15%) in the control group had obscuration of the visual axis at the last follow-up. This complication was not encountered in the study group. Posterior synechiae and cellular deposits were observed in 4 eyes (20%) in the study group and 8 eyes (40%) in the control group at 1 month and at the last follow-up.

CONCLUSIONS:
The use of intracameral triamcinolone decreased anterior segment inflammation postoperatively in children who had surgery for traumatic cataract.

Author Info:
1
Ophthalmology Department, Assiut University Hospital, Assiut - Egypt.


Authors:
Mohan AT1, Sur YJ, Zhu L, Morsy M, Wu PS, Moran SL, Mardini S, Saint-Cyr M.

Title:
The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction.

Abstract:
LEARNING OBJECTIVES:
After studying this article, the participant should be able to: 1. Understand the history and physiology of perforator flaps. 2. Understand the concept of "free-style" perforator flaps and principles in design and harvest. 3. Understand the uses of perforator flaps in reconstruction and applications in new settings. 4. Understand new principles in single and multiple perforator flap harvest and adjunct techniques that can be used in perforator flaps. 5. Highlight pertinent anatomy and techniques for selected perforator flaps described.

SUMMARY:
Extended knowledge of vascular anatomy has propagated the development of perforator flaps, which preserve muscle function and reduce morbidity. This has been achieved through the exemplary works of Manchot, Salmon, Milton, Taylor, and many others. With over 350 clinically relevant perforators in the body, this has created new flap options and a sense of creative freedom for reconstruction tailored toward a specific defect, without constraints of specific landmarks and using a "free-style" approach. Dominant perforators may be found in zones of high perforator density or "hot spots," which can help to conceptualize local flap options and aid flap design. This article aims to outline the history, physiology, and principles of flap design and harvest, and highlight traditional and evolving concepts and modifications of contemporary and traditional flaps that are changing reconstructive practice. This is a broad overview focusing on clinical applications, highlighting key concepts in a selection of new or evolving flaps being used in clinical practice and providing source references to acquire detailed flap descriptions.

Author Info:
1
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.


Authors:
Morsy KM1, Osman AM1, Shaaban OM1, El-Hammady DH1.

Title:
Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study.

Abstract:
BACKGROUND:
Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition.

OBJECTIVE:
The current study aims to verify the incidence and chronicity of PDPH in FMS patients.

STUDY DESIGN:
Case control study.

METHODS:
In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women scheduled for elective cesarean delivery who had no history of chronic pain and is used as a control group. Both groups were compared regarding the incidence of development of PDPH in the first postoperative 48 hours and the persistence of PDPH for 7 days or more.

SETTINGS:
Women's Health Hospital, Assiut University, antenatal Clinic.

RESULTS:
The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to the control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH continued for more than 3 months in 2 patients in the fibromyalgia group (2.86%).

LIMITATIONS:
Difficulty in calculating the dose of analgesics as patients with fibromyalgia may use other analgesics due to musculoskeletal pain.

CONCLUSION:
Dural puncture increases the incidence of PDPH in fibromyalgia patients in comparison with normal controls without increasing other postoperative side effects.

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


Authors:
Mostafa A1, Shimakawa Y2, Medhat A3, Mikhail NN4, Chesnais CB5, Arafa N1, Bakr I1, El Hoseiny M1, El-Daly M6, Esmat G7, Abdel-Hamid M8, Mohamed MK1, Fontanet A9.

Title:
Excess Mortality Rate Associated With Hepatitis C Virus Infection: A Community-Based Cohort Study In Rural Egypt.

Abstract:
BACKGROUND & AIMS:
>80% of people chronically infected with hepatitis C virus (HCV) live in resource-limited countries, yet the excess mortality associated with HCV infection in these settings is poorly documented.

METHODS:
Individuals were recruited from three villages in rural Egypt in 1997-2003 and their vital status was determined in 2008-2009. Mortality rates across the cohorts were compared according to HCV status: chronic HCV infection (anti-HCV antibody positive and HCV RNA positive), cleared HCV infection (anti-HCV antibody positive and HCV RNA negative) and never infected (anti-HCV antibody negative). Data related to cause of death was collected from a death registry in one village.

RESULTS:
Among 18,111 survey participants enrolled in 1997-2003, 9.1% had chronic HCV infection, 5.5% had cleared HCV infection, and 85.4% had never been infected. After a mean time to follow-up of 8.6years, vital status was obtained for 16,282 (89.9%) participants. When compared to those who had never been infected with HCV in the same age groups, mortality rate ratios (MRR) of males with chronic HCV infection aged <35, 35-44, and 45-54years were 2.35 (95% CI 1.00-5.49), 2.87 (1.46-5.63), and 2.22 (1.29-3.81), respectively. No difference in mortality rate was seen in older males or in females. The all-cause mortality rate attributable to chronic HCV infection was 5.7% (95% CI: 1.0-10.1%), while liver-related mortality was 45.5% (11.3-66.4%).

CONCLUSIONS:
Use of a highly potent new antiviral agent to treat all villagers with positive HCV RNA may reduce all-cause mortality rate by up to 5% and hepatic mortality by up to 40% in rural Egypt.

Author Info:
1
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
3
Department of Gastroenterology & Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
5
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.
6
Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; National Liver Institute, Menoufia University, Menoufia, Egypt.
7
Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
8
Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
9
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; Département d'Infection et Épidémiologie, Conservatoire National des Arts et Métiers, Paris, France. Electronic address: fontanet@pasteur.fr.


Title:
Macular Choroidal Thickness In Normal Egyptians Measured By Swept Source Optical Coherence Tomography.

Abstract:
BACKGROUND:
To provide a normal database of choroidal thickness (CT) in nine Early Treatment Diabetes Retinopathy Study (ETDRS) subfields in Egypt using deep-range imaging swept source optical coherence tomography (DRI SS OCT).

METHODS:
This study included a total of 129 eyes of 71 normal Egyptian subjects, comprising 63 males and 66 females. The mean age was 36.85 ± 14.22 years (range, 16-67 years). The mean axial length was 23.84 ± 0.78 mm. CT was measured in nine subfields as defined by the ETDRS-style grid using a DRI SS OCT, and line measurements of subfoveal choroidal thicknesses (SFCT) were also performed.

RESULTS:
Mean SFCT was 300.87 ± 72.256 μm for ring measurements and 319.72 ± 76.45 μm for line measurements (P = 0.04). CT was higher in the superior and temporal quadrants than the inferior and nasal quadrants. A negative correlation between subfoveal choroidal thickness and age was detected in all regions (P < 0.001) except the nasal quadrant. A negative correlation between the SFCT and axial length was also detected (P < 0.001). Males tended to have a thicker choroid than females; however, the difference was not significant.

CONCLUSIONS:
DRI SS OCT provides a topographic map of choroidal thickness with an ETDRS layout. This study establishes, for the first time, a normal database for CT in the Egyptian population. Age and axial length were associated with choroidal parameters in healthy subjects. Line measurements of the SFCT differed significantly from SFCT ring measurements, so it is recommended that each method be compared independently.

Author Info:
1
Ophthalmology Department, Tanta University, Tanta, Egypt.
2
Mansoura Ophthalmic Center, Mansoura, Egypt.
3
Ophthalmology Department, Assiut University Hospitals, Assiut, Egypt. waelsoliman73@yahoo.com.


Title:
'Pseudofailure' Of Spinal Cord Stimulation For Neuropathic Pain Following A New Severe Noxious Stimulus: Learning Points From A Case Series Of Failed Spinal Cord Stimulation For Complex Regional Pain Syndrome And Failed Back Surgery Syndrome.

Abstract:
Failure of spinal cord stimulation (SCS) may be due to hardware problems, migration of electrodes and, in the long-term, plasticity in the spinal cord with habituation to the stimulation current. We describe a series of seven patients who experienced acute therapeutic loss of SCS effects following an acute nociceptive event unrelated to primary pathology. There were no hardware problems. We called this 'Pseudofailure', as the effective stimulation returned in all patients following a period off stimulation or reprogramming. This phenomenon has not been reported previously in the literature. Over a 4-year period, we managed seven patients with this feature: four had received SCS for complex regional pain syndrome and three for failed back surgery syndrome. In all seven cases, there was cessation of the pain relief afforded by SCS following an acute painful event: four patients had trauma, two patients had domestic electric shock and one patient suffered shingles (varicella zoster infection). We excluded hardware-related problems in all cases. In two patients, SCS effects could be regained by an initial attempt at reprogramming. In the remaining five cases reprogramming was unsuccessful, and stimulation was switched off for several months before recommencing, when we discovered a return of good therapeutic effect. We conclude that SCS may seem to fail following a separate strong nociceptive stimulus. Stimulation may be regained with reprogramming or following a period with stimulation switched off. We would, therefore, advise against removal of SCS hardware in the first instance.

Author Info:
1
Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
2
Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK; Department of Neuro Surgery, Faculty of Medicine, Assiut University, Asiut, Egypt.


Authors:
Nafady-Hego H1, Elgendy H, Nafady A, Uemoto S.

Title:
Outcome of Hepatitis B Virus Infection After Living-Donor Liver Transplant: A Single-center Experience Over 20 Years.

Abstract:
OBJECTIVES:
Despite living-donor liver transplant being a life-saving therapy for patients with hepatitis B virus with or without hepatocellular carcinoma, outcomes for patients with these diseases are worse. Hepatitis B virus recurrence or relapse of hepatocellular carcinoma can result in subsequent graft loss or patient death. In this study, we discuss the postoperative outcomes of patients with hepatitis B virus infection after living-donor liver transplant.

MATERIALS AND METHODS:
We retrospectively analyzed 125 patients with hepatitis B virus-related end-stage liver disease, comparing results with 1228 control patients who had other pathologies, including hepatitis C virus, combined hepatitis B virus and hepatitis C virus, and neither virus.

RESULTS:
Survival rates of patients with hepatitis B virus did not differ from the control groups (P > .05). Patients with concurrent hepatitis B virus and hepatocellular carcinoma were significantly older (P < .0001), had critical status (P < .0001), had chronic underlying pathology (P = .001), lower graft-to-recipient body weight ratio (P = .047), needed more intraoperative plasma transfusion, and experienced more rejection episodes than those without hepatocellular carcinoma. Of interest, in 5 patients who had hepatitis B virus recurrence after living-donor liver transplant, Model for End-Stage Liver Disease score was significantly higher than those who did not have recurrence (P = .015). In addition, 2 patients had hepatocellular carcinoma recurrence in the form of peritoneal metastasis, with both patients having high preoperative alpha-fetoprotein levels.

CONCLUSIONS:
Our study provides details on long-term outcomes of patients with hepatitis B virus infection who had undergone living-donor liver transplant. Based on our results, we suggest that prolonged antiviral prophylactic therapy in the form of hepatitis B immunoglobulin with either lamivudine or entecavir be considered for patients who associated with risk factors to prevent postoperative recurrence.

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


Authors:
Nafady-Hego H1, Li Y2, Ohe H2, Elgendy H3, Zhao X2, Sakaguchi S4, Bishop GA5, Koshiba T6.

Title:
Utility Of CD127 Combined With FOXP3 For Identification Of Operational Tolerance After Liver Transplantation.

Abstract:
Loss of cell surface expression of CD127 on CD4(+)CD25(++) regulatory T-cells (Tregs) may be a useful marker to efficiently isolate Tregs. As FOXP3 was specifically used to identify Tregs, combining these two markers could give better identification for patient with operational tolerance (OT) after liver transplantation. To testify this mixed lymphocyte reaction (MLR), the function of circulating CD4(+)CD25(++)CD127(dim) cells (CD127(dim) cells) was examined in immunosuppression (IS)-free pediatric recipients after liver transplantation (LTx) (group operational tolerance: OT) (Gr-tol n=25) compared to recipients who could not stop IS due to clinically overt rejection (group intolerance) (Gr-intol n=18), recipients who were weaning IS (Gr-weaning n=11) and age-matched healthy volunteers (Gr-vol n=11). In addition, the frequencies of CD127(dim) cells vs CD4(+)CD25(++)CD127(dim)FOXP3(+) (CD127(dim)FOXP3(+)) cells were compared in these four groups by FACS analyses. Our results showed that The proliferation of CD4 cells to donor antigens was reduced compared to third-party antigens only in Gr-tol (P=0.022) but not in other groups (P=NS). Depletion of CD127(dim) cells resulted in a donor antigen-specific abrogation of this MLR hyporesponsiveness in Gr-tol (P<0.001) but not other groups (P=NS). This implied that CD127 efficiently isolated donor antigen-specific Tregs. The frequencies of CD127(dim) cells were significantly lower in Gr-intol (5.2%±1.9%) compared to those in Gr-tol (7.8%±1.8%) (P<0.001) as were the frequencies of CD127(dim) FOXP3(+) cells (Gr-tol: 5.4%±1.7% vs Gr-intol: 2.9%±1.0%, P<0.001). Of interest, there were fewer CD127(dim)FOXP3(+) cells in Gr-intol (2.9%±1%) than in Gr-weaning (5.1%±1.8%) (P=0.002), but no difference in CD127(dim) cells (Gr-intol: 5.2%±1.9% vs Gr-weaning: 6.7%±2.0%) (NS). Thus, combining FOXP3 with CD127 for phenotype analysis demonstrated an unequivocal difference between Gr-intol and Gr-weaning that was not detected by CD127 alone. In conclusion CD127 was a useful surface marker to isolate donor-antigen-specific-Tregs in OT after LTx. The additive effect of its combination with FOXP3 is important in phenotypical Treg analyses of OT patients.

Author Info:
1
Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt; Department of Hematology and Immunology, College of Medicine, Umm Al-Qura University, Mecca 50431, Saudi Arabia.
2
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
3
Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut 71515, Egypt; Department of Anesthesiology, King Abdullah Medical City, Mecca 21955, Saudi Arabia.
4
World Premier International Research Center, Immunology Frontier Research Center, Osaka University, Osaka 565-0871, Japan.
5
Transplantation Laboratory, The University of Sydney, Sydney, NSW 2006, Australia.
6
Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima 960-1295, Japan. Electronic address: tkoshiba@fmu.ac.jp.


Authors:
Nassr AA1,2, Koh CK3, Shamshirsaz AA1, Espinoza J1, Sangi-Haghpeykar H1, Sharhan D1, Welty S4, Angelo J5, Roth D3, Belfort MA1, Braun M5, Ruano R6.

Title:
Are Ultrasound Renal Aspects Associated With Urinary Biochemistry In Fetuses With Lower Urinary Tract Obstruction?

Abstract:
OBJECTIVE:
To evaluate the association between ultrasonographic renal parameters and urine biochemistry in fetuses with lower urinary tract obstruction (LUTO).

METHODS:
Data were collected prospectively from 31 consecutive fetuses with LUTO that underwent vesicocentesis for fetal urinary biochemistry between April 2013 and September 2015. The following renal ultrasound markers were assessed immediately before the vesicocentesis: renal echogenicity, presence of cortical cysts, presence of findings suggestive of 'renal dysplasia' (hyperechogenic cystic kidneys with no cortical-medullary differentiation) and severe oligohydramnios (amniotic fluid < 5th percentile). The association of these parameters to the fetal urinary concentration of sodium, chloride, calcium, osmolality and beta2-microglobulin was investigated by logistic regression analysis.

RESULTS:
There was no relationship between any of the ultrasonographic fetal renal characteristics and fetal urinary biochemistry.

CONCLUSIONS:
In LUTO, the ultrasound appearance of the fetal kidneys and urinary biochemistry are not correlated. It may be better to take both ultrasound and biochemistry into account when evaluating fetuses with fetal LUTO.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
2
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Asiut, Egypt.
3
Division of Pediatric Urology, Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
4
Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
5
Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
6
Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, Rochester, MN, USA.


Authors:
Nassr AA1, El-Nashar SA2, Shazly SA2, White WM3, Brost BC3.

Title:
Expected Probability Of Congenital Heart Disease And Clinical Utility Of Fetal Echocardiography In Pregnancies With Pre-Gestational Diabetes.

Abstract:
OBJECTIVES:
To establish a prediction model for fetal congenital heart disease (CHD) that could facilitate selective fetal echocardiography screening for diabetic women, and to provide cost analysis of selective versus global screening of these women.

STUDY DESIGN:
A historical cohort study included women with pre-gestational diabetes who received perinatal care at Mayo Clinic, Minnesota from 2007 through 2013. Anatomical scans and fetal echocardiograms were reviewed and charts for postnatal outcomes were abstracted. Logistic regression models were utilized to identify predictors of CHD. Cost of global versus selective screening was estimated using cost per case detected.

RESULTS:
A cohort of 152 women was included. Abnormal anatomy scan was reported in five (3.3%). Among 51 (33.6%) who had fetal echocardiography, eight (15.7%) had abnormal findings. Postnatal echocardiography was conducted in 36 neonates, 12 had abnormalities. Only first trimester HbA1c was independent predictor with observed incidence of CHD of 1.8, 14.3, and 40% and HbA1c of <8, 8-10, and >10% respectively. Global screening strategy missed 22% of fetal cardiac abnormalities, while selective screening missed 33%.

CONCLUSIONS:
According to our probability model, selective screening based on HbA1c and/or anatomic surveys seems to be an accurate and cost effective strategy for prenatal diagnosis of CHD among diabetic pregnancies.

Author Info:
1
Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt; Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. Electronic address: Nassr.ahmed@mayo.edu.
2
Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt; Division of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
3
Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.


Authors:
Nguyen NC1, Abhishek K2, Nyon S3, Farghaly HR4, Osman MM1, Reimers HJ2.

Title:
Are There Radiographic, Metabolic, And Prognostic Differences Between Cavitary And Noncavitary Nonsmall Cell Lung Carcinoma? A Retrospective Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Study.

Abstract:
AIMS:
The prognosis of nonsmall cell lung cancer with cavitation (NSCLC-c) is not well-known. We compared the positron emission tomography/computed tomography (PET/CT) findings and survival data of patients with NSCLC-c patients with those without cavitation (NSCLC-nc).

METHODS:
Between 7/2004 and 6/2007, cavitary lung lesions were identified in 46/248 patients undergoing fluorodeoxyglucose (FDG) PET/CT for lung nodule characterization or lung cancer staging. Within the same period, 40 of 202 patients with NSCLC-nc were randomly selected for comparison. The primary was assessed by location, size, cell type, and standardized uptake value (SUV). Disease stage was determined according to American Joint Committee on Cancer guidelines for lung cancer. Kaplan-Meier method was used for survival analysis and Cox regression to assess the effect of clinical and imaging variables on survival.

RESULTS:
NSCLC-c was found in 87% of patients that had a cavitary lung lesion at PET/CT. Squamous cell carcinoma, primary size and primary-to-liver SUV ratio differed significantly between NSCLC-c and NSCLC-nc, whereas age, gender, primary location, primary SUV, type of treatment, and disease stage did not. Median survival and overall 5-year survival were 19 months and 24% for NSCLC-c, and 31 months and 31% for NSCLC-nc, P = 0.23. Disease stage was the only predictor of survival.

CONCLUSION:
Cavitary lung lesions in patients undergoing FDG PET/CT harbor a significant risk for cancer. NSCLC-c is associated with squamous cell carcinoma, larger size, and greater FDG metabolism compared with NSCLC-nc, although these variables may not be predictive of survival. Nonetheless, PET/CT contributes to accurate staging and has an indirect impact on prognosis.

Author Info:
1
Department of Radiology, Saint Louis University, Saint Louis, MO, USA.
2
Department of Internal Medicine, Division of Hematology and Oncology, Saint Louis University, Saint Louis, MO, USA.
3
School of Medicine, Saint Louis University, Saint Louis, MO, USA.
4
Department of Clinical Oncology and Nuclear Medicine, Nuclear Medicine Unit, Assiut University Hospital, Egypt.


Authors:
Okasha HH1, Amin M2, Ezzat R3, El-Nady M1, Nagy A4.

Title:
Small Bowel Intussusception Induced By A Jejunal Gastrointestinal Stromal Cell Tumor Diagnosed By Endoscopic Ultrasound.

Author Info:
1
Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
2
Department of Surgery, Maadi Military Hospital, Cairo, Egypt.
3
Department of Internal Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
4
Department of Tropical Medicine, Cairo University, Cairo, Egypt.


Title:
Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study.

Abstract:
BACKGROUND:
Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations.

OBJECTIVES:
To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain.

STUDY DESIGN:
Prospective comparative study.

SETTING:
Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital.

METHODS:
Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention.

RESULTS:
All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P < 0.001).

LIMITATIONS:
No randomization.

CONCLUSIONS:
PRF to the medial calcaneal nerve is a safe and effective method for treatment of chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantar fasciitis, plantar aponeurosis, visual analogue scale.

Author Info:
1
Assiut University, Faculty of Medicine, Egypt.
2
Assistant professor of Upper limb, Hand and Reconstructive Microsurgery Unit, Orthopedic Department, Faculty of Medicine, Assiut University.


Title:
Effects Of Ginko Biloba Leaf Extract On The Neurogenesis Of The Hippocampal Dentate Gyrus In The Elderly Mice.

Abstract:
Aging is associated with reduced hippocampal neurogenesis, which may in turn contribute to cognitive impairment. We assessed the effect of Ginkgo biloba (Gb) on hippocampal neurogenesis in elderly male mice using immunohistochemistry. We used anti-caspase-3 as a marker of apoptosis, anti-GFAP as a marker of neural stem cells, anti-Ki-67 as a specific marker for cellular proliferation and anti-doublecortin (DCX) to detect newly born neurons in the hippocampal dentate gyrus (DG) of aged male mice. The 24-month-old male mice were divided into two groups: a control group treated with distilled water and a group fed with Gb at a dose of 100 mg/kg once daily for 28 days. A sharp decrease in apoptotic cells in Gb-treated compared to nontreated mice was observed by anti-csapase-3 immunostaining. A large number of GFAP+ve cells was found in the subgranular zone of the DG of Gb-treated mice, suggesting an increase in the pool of neural stem cells by Gb treatment. There was also an increase in Ki-67 immunoreactive cells, indicating increased cell proliferation in the DG in the Gb-treated compared to nontreated group. A significant increase in newborn DCX+ve neurons with well-developed tertiary dendrites was also found in the Gb-treated compared to nontreated group. Using Western blot analysis, the expression of DCX protein in the Gb group was also significantly increased compared to the control. The results support a beneficial role of Gb on hippocampal neurogenesis in the context of brain aging.

Author Info:
1
Department of Human Anatomy and Embryology, Faculty of Medicine, Minia University, El Minia, 61511, Egypt. noura.mohamed@mu.edu.eg.
2
Department of Human Anatomy and Embryology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Histology, Faculty of Medicine, Minia University, El Minia, 61511, Egypt.


Authors:
Othman ER1, Curiel DT2, Hussein M3, Abdelaal II3, Fetih AN3, Al-Hendy A4.

Title:
Enhancing Adenoviral-Mediated Gene Transfer and Expression to Endometrial Cells.

Abstract:
OBJECTIVE:
Our aim was to screen a panel of modified adenoviral gene transfer vectors to identify those which can sustain high gene expression in human endometrial cells.

METHODS:
Normal endometrial stromal cell cultures were established from endometrial lining of hysterectomy specimens performed for benign gynecologic indications. Human endometrial stromal cells were transfected by modified adenoviruses expressing luciferase reporter gene. Luciferase activity mediated by each virus was expressed as a percentage of adenovirus serotype 5 (Ad5-CMV-luc) activity. The 2-tailed Student t test was used to compare data.

RESULTS:
At a multiplicity of infection (MOI) of 10 pfu/cell, of the transductionally modified adenoviruses, adenovirus-RGD (Ad-RGD-luc) mediated highest level of endometrial cell transduction with transgene expression around 4 times higher when compared to Ad5 (P < .001). Of the transcriptionally targeted adenoviruses, adenovirus under secretory leukocyte protease inhibitor promoter (Ad-SLPI-luc) and adenovirus under heparanase promoter (Ad-heparanase-luc)-mediated luciferase activation were 5.8- and 4.3-folds higher than Ad5-CMV-luc, respectively (P = .02 and .03, respectively). At MOI of 50 pfu/cell, Ad-RGD-luc and AD-SLPI-luc mediated significantly higher gene transfer efficiency compared to Ad5-CMV-luc (P values < .001, for each virus). Ad-heparanase-luc achieved higher gene activity, but difference was not significant (P = .1). Ad-SLPI-luc, at low viral dose (10 pfu/ cell), mediated gene expression effect comparable to Ad5-CMV-luc at a high dose (50 pfu/cell), with no significant difference.

CONCLUSIONS:
We conclude that when compared to the wild-type adenovirus, Ad-RGD-luc, Ad-SLPI-luc, and Ad-heparanase-luc mediate higher reporter gene activity in endometrial cells and can work as effective gene transfer vectors in gene therapy applications to the endometrium.

Author Info:
1
OB-GYN Department, Assiut University, Assiut, Egypt Center of Excellence of Stem Cells and Regenerative Medicine CESCRM, Assiut University, Assiut, Egypt essamrash@yahoo.com.
2
Division of Cancer Biology, Department of Radiation Oncology, Washington University Medical School, Washington, DC, USA.
3
OB-GYN Department, Assiut University, Assiut, Egypt.


Authors:
Othman ER1, Fayez MF1, El Aal DE1, El-Dine Mohamed HS1, Abbas AM1, Ali MK2.

Title:
Sublingual Misoprostol Versus Intravenous Oxytocin In Reducing Bleeding During And After Cesarean Delivery: A Randomized Clinical Trial.

Abstract:
OBJECTIVE:
This study compares the efficacy of sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery.

MATERIALS AND METHODS:
A randomized clinical trial conducted on 120 pregnant women at term (37-40 weeks) gestation scheduled for elective cesarean delivery, who were assigned to either sublingual misoprostol 400 μg or intravenous infusion of 20 units of oxytocin after delivery of the neonate. The main outcome measures were blood loss at and 2 hours after cesarean delivery, change in hematocrit value, need for any additional oxytocic drugs, and drug-related side effects.

RESULTS:
The overall mean blood loss was significantly lower in the misoprostol group compared to the oxytocin group (490.75 ± 159.90 mL vs. 601.08 ± 299.49 mL; p = 0.025). However, changes in hematocrit level (pre- and postpartum) was comparable between both groups. There was a need for additional oxytocic therapy in 16.7% and 23.3% after use of misoprostol and oxytocin, respectively (p = 0.361). Incidence of side effects such as shivering and metallic taste were significantly higher in the misoprostol group compared to the oxytocin group (p < 0.001).

CONCLUSIONS:
Sublingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss during and after cesarean delivery. However, occurrence of temporary side effects such as shivering and metallic taste was more frequent with the use of misoprostol.

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


Authors:
Oweira H1, Lahdou I2, Daniel V3, Opelz G4, Schmidt J5, Zidan A6, Mehrabi A7, Sadeghi M8.

Title:
Early Post-Operative Acute Phase Response In Patients With Early Graft Dysfunction Is Predictive Of 6-Month And 12-Month Mortality In Liver Transplant Recipients.

Abstract:
Early allograft dysfunction (EAD) after liver transplantation is mostly a reversible event caused by factors related to ischemia/reperfusion (I/R) injury. EAD represents a hepatic injury associated with pre- and early post-transplant inflammatory cytokine responses. Aim of the present study was to evaluate the prognostic and diagnostic value of CRP in liver transplant recipients with EAD.

MATERIALS AND METHODS:
Forty-seven patients with EAD were compared with 115 non-EAD patients. Pre- and post-transplant parameters were analyzed. EAD was defined based on postoperative liver function tests such as INR, bilirubin and liver enzymes. Statistical analysis was performed using SPSS version 18.0.

RESULTS:
Pre-transplant liver enzyme were not significantly different in the two groups. At day 3, 5 and 10 post-transplant CRP was significantly higher in patients with EAD than in non-EAD patients (p⩽0.001 for all investigations) and remained consistently high in patients with EAD and low in non-EAD patients. EAD patients with high CRP at post-transplant days 3 and 5 showed lower survival at 6-month and 12-month post-transplant than patients with low CRP.

CONCLUSION:
Our results indicate a prognostic and diagnostic value of CRP in patients with early graft dysfunction and predict 6-month and 12-month mortality in liver transplant recipients.

Author Info:
1
Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland. Electronic address: Hani.oweira@hirslanden.ch.
2
Transplantation Immunology, University of Heidelberg, Germany. Electronic address: imadlahdo@hotmail.com.
3
Transplantation Immunology, University of Heidelberg, Germany. Electronic address: volker.daniel@med.uni-heidelberg.de.
4
Transplantation Immunology, University of Heidelberg, Germany. Electronic address: gerhard.opelz@med.uni-heidelberg.de.
5
Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland. Electronic address: Jan.Schmidt@hirslanden.ch.
6
Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Department of HPB and Liver Transplantation Surgery, Rajhy Liver Hospital, Assiut University Hospital, Assuit, Egypt. Electronic address: ahmed.zidan@med.au.edu.eg.
7
Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: arianeb.mehrabil@med.uni-heidelberg.de.
8
Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: mahmoud.sadeghi@med.uni-heidelberg.de.


Authors:
Penrose H1, Heller S1, Cable C1, Makboul R2, Chadalawada G1, Chen Y1, Crawford SE3, Savkovic SD4.

Title:
Epidermal Growth Factor Receptor Mediated Proliferation Depends On Increased Lipid Droplet Density Regulated Via A Negative Regulatory Loop With FOXO3/Sirtuin6.

Abstract:
Epidermal Growth Factor Receptor Mediated Proliferation Depends On Increased Lipid Droplet Density Regulated Via A Negative Regulatory Loop With FOXO3/Sirtuin6.

Author Info:
1
Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, 1430 Tulane Ave SL-79, New Orleans, LA 70112, USA.
2
Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, 1430 Tulane Ave SL-79, New Orleans, LA 70112, USA; Pathology Department, Assiut University, Assiut, Egypt.
3
Department of Pathology, Saint Louis University School of Medicine, 1402 South Grand Blvd, Saint Louis, MO 63104, USA.
4
Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, 1430 Tulane Ave SL-79, New Orleans, LA 70112, USA. Electronic address: ssavkovi@tulane.edu.


Authors:
Reddy HM1, Hamed SA2, Lek M3,4, Mitsuhashi S5, Estrella E5, Jones MD1, Mahoney LJ5, Duncan AR5, Cho KA1, Macarthur DG3,4, Kunkel LM5, Kang PB6,7.

Title:
Homozygous Nonsense Mutation In SGCA Is A Common Cause Of Limb-Girdle Muscular Dystrophy In Assiut, Egypt.

Abstract:
INTRODUCTION:
The genetic causes of limb-girdle muscular dystrophy (LGMD) have been studied in numerous countries, but such investigations have been limited in Egypt.

METHODS:
A cohort of 30 families with suspected LGMD from Assiut, Egypt, was studied using immunohistochemistry, homozygosity mapping, Sanger sequencing, and whole exome sequencing.

RESULTS:
Six families were confirmed to have pathogenic mutations, 4 in SGCA and 2 in DMD. Of these, 3 families harbored a single nonsense mutation in SGCA, suggesting that this may be a common mutation in Assiut, Egypt, originating from a founder effect.

CONCLUSIONS:
The Assiut region in Egypt appears to share at least several of the common LGMD genes found in other parts of the world. It is notable that 4 of the 6 mutations were ascertained by means of whole exome sequencing, even though it was the last approach adopted. This illustrates the power of this technique for identifying causative mutations for muscular dystrophies. Muscle Nerve 54: 690-695, 2016.

Author Info:
1
Division of Pediatric Neurology, University of Florida College of Medicine, PO Box 100296, Gainesville, Florida, USA, 32610.
2
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
3
Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
4
Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA.
5
Division of Genetics & Genomics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
6
Division of Pediatric Neurology, University of Florida College of Medicine, PO Box 100296, Gainesville, Florida, USA, 32610. pbkang@ufl.edu.
7
Department of Neurology and Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida, USA. pbkang@ufl.edu.


Authors:
Refaat B1, El-Shemi AG2,3, Mohamed AM2,4, Kensara OA5, Ahmad J2, Idris S2.

Title:
Activins And Their Related Proteins In Colon Carcinogenesis: Insights From Early And Advanced Azoxymethane Rat Models Of Colon Cancer.

Abstract:
BACKGROUND:
Activin-A may exert pro- or anti-tumorigenic activities depending on cellular context. However, little is known about its role, or the other mature activin proteins, in colorectal carcinoma (CRC). This study measured the expression of activin βA- & βB-subunits, activin type IIA & IIB receptors, smads 2/3/4/6/7 and follistatin in CRC induced by azoxymethane (AOM) in rats. The results were compared with controls and disseminated according to the characteristics of histopathological lesions.

METHODS:
Eighty male Wistar rats were allocated into 20 controls and the remaining were equally divided between short 'S-AOM' (15 weeks) and long 'L-AOM' (35 weeks) groups following injecting AOM for 2 weeks. Subsequent to gross and histopathological examinations and digital image analysis, the expression of all molecules was measured by immunohistochemistry and quantitative RT-PCR. Activin-A, activin-B, activin-AB and follistatin were measured by ELISA in serum and colon tissue homogenates.

RESULTS:
Colonic pre-neoplastic and cancerous lesions were identified in both AOM groups and their numbers and sizes were significantly (P < 0.05) greater in the L-AOM group. All the molecules were expressed in normal colonic epithelial cells. There was a significantly (P < 0.05) greater expression of βA-subunit, IIB receptor and follistatin in both pre-neoplastic and cancerous tissues. Oppositely, a significant (P < 0.05) decrease in the remaining molecules was detected in both AOM groups. Metastatic lesions were only observed within the L-AOM group and were associated with the most significant alterations of all molecules. Significantly higher concentrations of activin-A and follistatin and lower activin-AB were also detected in both groups of AOM. Tissue and serum concentrations of activin-A and follistatin correlated positively, while tissue activin-AB inversely, and significantly with the numbers and sizes of colonic lesions.

CONCLUSIONS:
Normal rat colon epithelial cells are capable of synthesising, controlling as well as responding to activins in a paracrine/autocrine manner. Colonic activin systems are pathologically altered during tumorigenesis and appear to be time and lesion-dependent. Activins could also be potential sensitive markers and/or molecular targets for the diagnosis and/or treatment of CRC. Further studies are required to illustrate the clinical value of activins and their related proteins in colon cancer.

Author Info:
1
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia. bassem.refaat@yahoo.co.uk.
2
Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia.
3
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, 71526, Assiut, Egypt.
5
Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdeyah, PO Box 7607, Makkah, Kingdom of Saudi Arabia.


Authors:
Saad K1, Mohamad IL2, Abd El-Hamed MA3, Tawfeek MS2, Ahmed AE4, Abdel Baseer KA4, El-Shemy AS5, El-Houfey AA6, Tamer DM2.

Title:
A Comparison Between Plasmapheresis And Intravenous Immunoglobulin In Children With Guillain-Barré Syndrome In Upper Egypt.

Abstract:
OBJECTIVE:
The aim of our study is to assess the clinico-electrophysiological proﬁle of children with Guillain-Barré syndrome (GBS) in Upper Egypt and to compare the efficacy of plasmapheresis versus other treatment modalities.

PATIENTS AND METHODS:
This was a retrospective study of children from January 2010 to October 2014 diagnosed as GBS. It included 62 cases.

RESULTS:
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most prevalent type of GBS in our locality. As regards the treatment, 32 cases received plasmapheresis while 30 patients received intravenous immunoglobulin. We found a significant decrease in the duration of hospitalization and a significant increase in the number of children with complete recovery in cases treated with plasmapheresis.

CONCLUSION:
GBS is not uncommon in children of Upper Egypt, with AIDP the most prevalent type. Plasmapheresis is the best treatment modalities for GBS as it reduces the duration of hospital stay and hastens the recovery of those children.

Author Info:
1
Associate Professor of Pediatrics, Faculty of Medicine, University of Assiut, Assiut 71516, Egypt.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt.
5
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
6
Department of Community Health Nursing, Assiut University, Assiut, Egypt.


Authors:
Saad K1, Abo-Elela MG, El-Baseer KA, Ahmed AE, Ahmad FA, Tawfeek MS, El-Houfey AA, AboulKhair MD, Abdel-Salam AM, Abo-Elgheit A, Qubaisy H, Ali AM, Abdel-Mawgoud E.

Title:
Effects Of Bovine Colostrum On Recurrent Respiratory Tract Infections And Diarrhea In Children.

Abstract:
BACKGROUND:
Bovine colostrum (BC) has direct antimicrobial and endotoxin-neutralizing effects throughout the alimentary tract, as well as other bioactivities that suppress gut inflammation and promote mucosal integrity and tissue repair under various conditions related to tissue injury. The precise role of BC in respiratory and gastrointestinal (GI) infections in children is not well defined. The aim of this study was to evaluate the efficacy and tolerability of BC administration in preventing recurrent upper respiratory tract infections (URTI) and diarrhea in children.

METHODS:
One hundred sixty children (aged 1-6 years) having recurrent episodes of URTI or diarrhea received BC for 4 weeks. The number of episodes of URTI, diarrhea, and frequency of hospitalization required for URTI and diarrhea occurring during the study period were assessed at weeks 8 and 24.

RESULTS:
From a total number of 160 children, 81 patients (50.63%) were males. The mean age (± SD) was 3.65 (± 2.01) years. The mean (± SD) total number of infections was significantly decreased after BC therapy from 8.6 ± 5.1 at baseline to 5.5 ± 1.2 after 2 months (P < 0.001) and to 5.7 ± 1.6 after 6 months (P < 0.001). The mean (± SD) total number of URTI (P < 0.0001), number of episodes of diarrhea (P < 0.001), and number of hospital admissions (P < 0.001) were significantly decreased after BC therapy.

CONCLUSION:
BC is effective in the prophylaxis of recurrent URTI and diarrhea as it reduces the number of episodes and the hospitalization due to these infections. Results of this study suggest that BC could be provided as a therapeutic option for children with recurrent URTI and diarrhea.

Author Info:
1
aDepartment of Pediatrics, Faculty of Medicine, Assiut University bDepartment of Pediatrics, Qena Faculty of Medicine, South Valley University cDepartment of Community Health Nursing, Faculty of Nursing, Assiut University dDepartment of pediatrics, faculty of medicine, Al-Azhar university eDepartment of Pharmaceutics and Industrial Pharmacy, Al-Azhar University, Egypt.


Authors:
Saad K1, Abdel-Rahman AA2, Elserogy YM2, Al-Atram AA3, Cannell JJ4, Bjørklund G5, Abdel-Reheim MK6, Othman HA7, El-Houfey AA8, Abd El-Aziz NH1, Abd El-Baseer KA9, Ahmed AE9, Ali AM1.

Title:
Vitamin D Status In Autism Spectrum Disorders And The Efficacy Of Vitamin D Supplementation In Autistic Children.

Abstract:
OBJECTIVES:
Autism spectrum disorder (ASD) is a developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. Vitamin-D deficiency was previously reported in autistic children. However, the data on the relationship between vitamin D deficiency and the severity of autism are limited.

METHODS:
We performed a case-controlled cross-sectional analysis conducted on 122 ASD children, to assess their vitamin D status compared to controls and the relationship between vitamin D deficiency and the severity of autism. We also conducted an open trial of vitamin D supplementation in ASD children.

RESULTS:
Fifty-seven percent of the patients in the present study had vitamin D deficiency, and 30% had vitamin D insufficiency. The mean 25-OHD levels in patients with severe autism were significantly lower than those in patients with mild/moderate autism. Serum 25-OHD levels had significant negative correlations with Childhood Autism Rating Scale (CARS) scores. Of the ASD group, 106 patients with low-serum 25-OHD levels (<30 ng/ml) participated in the open label trial. They received vitamin D3 (300 IU/kg/day not to exceed 5000 IU/day) for 3 months. Eighty-three subjects completed 3 months of daily vitamin D treatment. Collectively, 80.72% (67/83) of subjects who received vitamin D3 treatment had significantly improved outcome, which was mainly in the sections of the CARS and aberrant behavior checklist subscales that measure behavior, stereotypy, eye contact, and attention span.

CONCLUSION:
Vitamin D is inexpensive, readily available and safe. It may have beneficial effects in ASD subjects, especially when the final serum level is more than 40 ng/ml.

TRIAL REGISTRATION NUMBER:
UMIN-CTR Study Design: trial Number: R000016846.

Author Info:
1
a Department of Pediatrics, Faculty of Medicine , Assiut University , Egypt.
2
b Department of Neuropsychiatry, Faculty of Medicine , Assiut University , Egypt.
3
c Department of Psychiatry, College of Medicine , Almajmaah University , KSA.
4
d Vitamin D Council , 1411 Marsh Street, Suite 203, San Luis Obispo , CA 93401 , USA.
5
e Council for Nutritional and Environmental Medicine , Mo i Rana, Norway.
6
f Dorset County Hospital , Dorchester, UK.
7
g Department of Clinical Pathology , Aswan University , Egypt.
8
h Department of Community Health Nursing, Faculty of Nursing , Assiut University , Egypt.
9
i Department of Pediatrics, Qena Faculty of Medicine , South Valley University , Egypt.


Title:
Meniscus Delivery: A Maneuver For Easy Arthroscopic Access To The Posterior Horn Of The Medial Meniscus.

Abstract:
Pathology of posterior horn of medial meniscus is common and often presents a difficult approach during arthroscopy for various reasons. We describe an easy maneuver to facilitate "delivery of the medial meniscus" during arthroscopy.

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


Authors:
Sayed FG1, Hamza AI1, Galal LA1, Sayed DM2, Gaber M1.

Title:
Virulence Of Geographically Different Cryptosporidium Parvum Isolates In Experimental Animal Model

Abstract:
Cryptosporidium parvum is a coccidian parasite which causes gastrointestinal disease in humans and a variety of other mammalian species. Several studies have reported different degrees of pathogenicity and virulence among Cryptosporidium species and isolates of the same species as well as evidence of variation in host susceptibility to infection. The study aimed to investigate infectivity and virulence of two Cryptosporidium parvum “Iowa isolate” (CpI) and a “local water isolate” (CpW). Thirty-three Swiss albino mice have been divided into three groups: Negative control Group (C), the CpI group infected with “Iowa isolate “and the CpW group infected with C. parvum oocysts isolated from a local water supply. Infectivity and virulence have been measured by evaluating clinical, parasitological and histological aspects of infection. Significant differences were detected regarding oocysts shedding rate, clinical outcomes, and the histopathological picture of the intestine, lung, and brain. It was concluded that the local water isolate is significantly more virulent than the exported one.

Author Info:
1
Department of Parasitology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
2
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut 71515, Egypt


Authors:
Sayed IM1,2, Vercouter AS1, Meuleman P1.

Title:
Hepatitis E Virus In Acute Liver Failure: An Unusual Suspect?

Author Info:
1
Laboratory of Liver Infectious Diseases, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
2
Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Sayyed HG1, Osama A2, Idriss NK2, Sabry D3, Abdelrhim AS4, Bakry R5.

Title:
Comparison Of The Therapeutic Effectiveness Of Human CD34+ And Rat Bone Marrow Mesenchymal Stem Cells On Improvement Of Experimental Liver Fibrosis In Wistar Rats.

Abstract:
BACKGROUND AND OBJECTIVE:
Human umbilical cord blood (UCB) cells and bone marrow mesenchymal stem cells (BM-MSCs) have numerous advantages as grafts for cell transplantation. We hypothesized differing impacts of human UCB cells and rat BM-MSCs on reversal of hepatic injury and revival of liver function in carbon tetrachloride (CCl4)-induced liver fibrosis.

METHODS:
Forty rats were divided into 4 groups; control group, CCl4 group, CCl4/CD34+ group and CCl4/BM-MSCs group. Blood samples were driven from rats at 4, 8 and 12 weeks to measure serum concentration of albumin and alanine aminotransferase (ALT). Quantitative expression of collagen Iα, TGF-β, α-SMA, albumin, MMP-2, MMP-9 and TNF-α were assessed by polymerase chain reaction. Histopathological examination of the liver tissue was performed. GFP labeled cells were detected in groups injected with stem cells.

RESULTS:
Regarding liver function, CD34+ were more efficient than BM-MSCs in elevating albumin (P<0.05) and reducing ALT (P<0.05) concentrations. Concerning gene expression, CD34+ were more effective than BM-MSCs in reducing gene expressions of collagen Iα (P<0.01), TGF-β1 (P<0.01) and α-SMA (P<0.01). Both CD34+ and BM-MSCs have the same efficacy in reducing TNF-α (P<0.001 and P<0.01, respectively). Furthermore, CD34+ were more valuable than BM-MSCs in increasing gene expression of albumin (P<0.05) and MMP-9 (P<0.01).

CONCLUSION:
Taken together; human UCB CD34+ stem cells were more efficient in improvement of experimental liver injury than BM-MSCs. This study highlighted an important role of human UCB CD34+ stem cells in liver fibrosis therapy.

Author Info:
1
Department of Medical Physiology, Faculty of Medicine, Assiut University Assuit, Egypt.
2
Department of Medical Biochemistry, Faculty of Medicine, Assiut University Assuit, Egypt.
3
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University Cario, Egypt.
4
Department of Anatomy, Faculty of Medicine, Sohag University Sohag, Egypt.
5
Department of Oncological Clinical Pathology, South Egypt Cancer Institute, Assiut University Assuit, Egypt.


Author Info:
1
Department of Obstetrics and Gynecology, Assiut University College of Medicine, Assiut University Maternity Hospital, Assiut, Egypt.
2
Department of Dermatology and Venereology, Assiut University College of Medicine, Assiut University Hospital, Assiut, Egypt.


Authors:
Shahat A1, Elderwy A1, Safwat AS2, Abdelkawi IF1, Reda A1, Abdelsalam Y1, Sayed M1, Hammouda H1.

Title:
Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

Abstract:
PURPOSE:
We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones.

MATERIALS AND METHODS:
A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation.

RESULTS:
Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649).

CONCLUSIONS:
Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones.

Author Info:
1
Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
2
Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt. Electronic address: assafwat@gmail.com.


Authors:
Shaltout AS1, Sayed D2, Badary MS1, Nafee AM1, El Zohri MH3, Bakry R4, Ahmed SH1.

Title:
Effect Of IL6 And IL23 On Double Negative T Cells And Anti Ds-DNA In Systemic Lupus Erythematosus Patients.

Abstract:
Several evidences suggest that DN T cells, IL23 and IL6 play a role in the pathogenesis of SLE. This study aimed to evaluate the frequency of DN T cells in SLE patients and the relation to their activity also to assess the possible role of IL6 and IL23 on DN T cells. Thirty patients with SLE and sixteen healthy blood donor females were enrolled. There was a significant increase in DN T cells in patients than controls (P=0.001). These cells had a significant positive correlation with SLEDAI (r=0.486, P=0.006). DN T cells from SLE patient samples were expanded when stimulated in vitro with RhIL6 or RhIL23 in patients than controls. Furthermore, anti ds-DNA level was found to be increased in supernatant of PBMCs when stimulated by these cytokines in different concentrations. Our findings suggest that IL6 and IL23 may play role in SLE pathogenesis through their effect on DN T cells and anti ds-DNA.

Author Info:
1
Medical Microbiology & Immunology, Faculty of Medicine Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Egypt. Electronic address: douaa_sayed@hotmail.com.
3
Internal Medicine, Rheumatology Unit, Assiut University, Assiut, Egypt.
4
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Egypt.


Authors:
Shazly SA1,2, Abbas AM1, Ali SS1, Salem NZ1.

Title:
Integrative Mid-Trimester Anomaly (IMTA) Chart: A Novel Sonographic Approach For Syndromatic Challenges (Pilot Study).

Abstract:
OBJECTIVE:
To validate the use of the integrative mid-trimester anomaly (IMTA) chart, a novel chart that aims to increase sonographers' ability to diagnose fetal syndromes and complex anomalies.

METHODS:
This study was conducted between September 2014 and January 2015. Pregnant women who attended our hospital for fetal medicine consultation during the second trimester were recruited. The diagnosis was assigned by a qualified consultant. The research coordinator randomized women between two groups (each consisted of two sonographers with comparable experience) and each was then examined twice (once with and once without the chart). Supposed diagnosis, patient and sonographer satisfactions were reported.

RESULTS:
Twenty five women were recruited. Their average age was 26.48 ± 4.49 years and gestational age at examination was 24.39 ± 6.39. There were 17 (68%) fetuses that had multiple anomalies. The duration of examination was comparable. However, patient and sonographer satisfactions were higher when the same women were examined with the chart (p < 0.0001). The accuracy of diagnosis was also significantly higher (p = 0.03).

CONCLUSION:
The IMTA chart seems to be a useful tool for novice sonographers that could increase their diagnostic accuracy and improve their patient and their own satisfaction.

Author Info:
1
a Women's Health Hospital, Assiut University , Assiut , Egypt and.
2
b Division of Gynecology , Mayo Clinic , Rochester , MN , USA.


Authors:
Shazly SA1, Laughlin-Tommaso SK2, Dowdy SC3, Famuyide AO4.

Title:
Staging For Low Malignant Potential Ovarian Tumors: A Global Perspective.

Abstract:
OBJECTIVE:
We describe current evidence for staging low malignant potential ovarian tumors and their conformity to current consensus guidelines and practice from an international perspective.

DATA SOURCES:
A search of MEDLINE, EMBASE, and SCOPUS databases was conducted for articles published between January 1990 and April 2015.

STUDY ELIGIBILITY CRITERIA:
Studies on low malignant potential ovarian tumors that evaluated the prognostic value of disease stage, staging vs no staging, complete vs incomplete staging, or discrete components of staging were eligible. Studies that described only crude survival rates were excluded.

STUDY APPRAISAL AND SYNTHESIS METHODS:
Eligible studies were categorized according to their outcome (disease stage, staging procedure, or discrete staging elements). Data were abstracted using a standard form. Inconsistencies on data abstraction were resolved by consensus among the authors. Risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS:
Of 1116 studies, 702 were excluded for irrelevance and 364 for not meeting inclusion criteria. Nine studies were excluded for describing crude survival rates without a comparative conclusion. We found that studies supporting the value of defining disease stage or staging procedures (mostly conducted in northern Europe) included more patients than studies that did not find disease stage or staging useful (predominantly from North America, 4072 vs 3951). Disease stage correlated with survival in 13 of 25 studies, whereas none of the studies that evaluated the value of staging found it beneficial (9 studies, 1979 patients). Studies that evaluated isolated components of staging found no benefit to these procedures. Regional guidelines and consensus reviews drew conclusions based on a limited number of studies that generally originated from the same region.

CONCLUSIONS:
Although the correlation of stage with survival was mixed, performing staging procedures for low malignant potential ovarian tumors is not supported by the best available evidence. Guidelines in support of staging based their recommendations on a few regional studies and conflict with better-quality data that do not support staging procedures. An international consensus statement is needed to standardize the surgical management of low malignant potential ovarian tumors.

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


Authors:
Sheiban I1, Moretti C2, D'Ascenzo F3, Chieffo A4, Taha S5, Connor SO6, Chandran S7, de la Torre Hernández JM8, Chen S9, Varbella F10, Omedè P2, Iannaccone M2, Meliga E11, Kawamoto H4, Montefusco A2, Mervyn C7, Garot P6, Sin L9, Gasparetto V12, Abdirashid M2, Cerrato E13, Biondi Zoccai G14, Gaita F2, Escaned J15, Hiddick Smith D7, Lefèvre T6, Colombo A4.

Title:
Long-Term (≥10 Years) Safety of Percutaneous Treatment of Unprotected Left Main Stenosis With Drug-Eluting Stents.

Abstract:
Percutaneous coronary intervention (PCI) of unprotected left main disease (ULM) with drug-eluting stents (DES) is hampered by lack of information on long-term (≥10 years) safety data. All patients treated with PCI on ULM in 9 international centers with at least 10 years follow-up were enrolled. Baseline and procedural features were recorded. Repeat PCI (re-PCI) on ULM at 10 years was the primary end point. Secondary end points included major adverse cardiac events and its components (cardiac and noncardiac death, myocardial infarction, re-PCI not on ULM, and stent thrombosis). Sensitivity analysis was performed according to the presence of isolated ULM disease: 284 patients were enrolled. A total of 70 patients (21%) performed a re-PCI on ULM, 39 in the first year, and 31 between 1 and 10 years (only 5 overall performed for acute coronary syndrome). Patients with re-PCI on ULM did not show differences in baseline and procedural features, or experience higher rates of cardiovascular death (12% vs 11%, p 0.65), myocardial infarction (11% vs 6%, p 0.56), or of re-PCI on non-ULM disease (31% vs 27%, p 0.76) compared with those without re-PCI on ULM. At Kaplan-Meier analysis, patients with PCI in other coronary vessels were at higher risk of major adverse cardiac events, driven by target vessel revascularization (20.4% vs 32.9%, p 0.009), as confirmed at multivariate analysis (stenosis other than LM; hazard ratio 2, 1.4 to 2.7, all CI 95%). In conclusion, despite of using first-generation stents, PCI on ULM is safe, with low rates of recurrent events due to index revascularization. Progression of atherosclerotic lesions on other coronary vessels represents the only independent predictive factor for prognosis.

Author Info:
1
Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy; Division di Cardiologia, Ospedale Pederzoli, Verona, Italy.
2
Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy.
3
Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
4
Cardiology Department, Scientific Institute S. Raffaele, Milan, Italy.
5
Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy; Cardiology Department, Assiut University, Assiut, Egypt.
6
Department of Cardiology, Institute Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
7
Department of Cardiology, Sussex Cardiac Centre, Brighton, United Kingdom.
8
Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain.
9
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
10
Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy.
11
Division of Cardiology, Ospedale Mauriziano, Turin, Italy.
12
Division di Cardiologia, Ospedale Pederzoli, Verona, Italy.
13
Cardiology Department, Ospedale degli Infermi, Rivoli TO, Italy; Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain.
14
Division of Cardiology, La Sapienza, Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
15
Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain.


