# Internationally Published Papers 2017

Title:
Comments On Manuscript: Lidocaine Gel Vs Lidocaine ‎Spray In Reducing Pain During Insertion Of The ‎Intrauterine Contraceptive Device

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


Title:
Comments On: Utero-Placental Perfusion Doppler ‎Indices In Growth Restricted Fetuses: Effect Of Sildenafil ‎Citrate


Title:
Considerations On: 'Risk Of Bacterial Vaginosis, ‎Trichomonas Vaginalis And Candida Albicans Infection ‎Among New Users Of Combined Hormonal ‎Contraception Vs LNG-IUS'.‎

Author Info:
1
a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt.
2
b Department of Microbiology and Medical Immunology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Title:
Different Routes And Forms Of Uterotonics For ‎Treatment Of Retained Placenta: Methodological Issues


Authors:
Abbas AM1, Abdellah MS2, Khalaf M2, Bahloul M2, Abdellah NH3, Ali MK2, Abdelmagied AM2.

Title:
Effect Of Cervical Lidocaine-Prilocaine Cream On Pain ‎Perception During Copper T380A Intrauterine Device ‎Insertion Among Parous Women: A Randomized Double-‎Blind Controlled Trial

Abstract:
OBJECTIVE:
The objective was to investigate the analgesic effect of cervical lidocaine-prilocaine (LP) cream in alleviating pain during copper T380A intrauterine device (IUD) insertion among parous women.

STUDY DESIGN:
We conducted a randomized, double-blind, placebo-controlled trial at Assiut Women's Health Hospital, Egypt, from October 2015 to April 2016 of parous women desiring copper IUD insertion. We randomized the subjects in a 1:1 ratio to LP cream or placebo. Seven minutes prior to IUD insertion, women received 2 ml of LP cream or placebo to the anterior cervical lip, followed by 2 ml placed in the cervical canal using a Q-tip applicator. The study end point was the subjects' self-reported pain using a 10-cm visual analog scale (VAS) during cervical tenaculum placement, sound insertion, IUD insertion and 5 min postprocedure. We considered a 2-cm difference in VAS scores between study groups as clinically significant. Also, the difference in the ease of insertion score using a 10-cm VAS with 0=very easy insertion and 10=terribly difficult insertion was assessed.

RESULTS:
The study included 120 women (n=60 in each group). LP cream reduces the median VAS pain scores during tenaculum placement (2 vs. 4), sound insertion (3 vs. 6) and IUD insertion (3 vs. 6.5) with p=.0001 at all steps. A lower ease of insertion score was also determined among LP women (2.5±0.98 vs. 4.5±2.7, p=.001). Participants reported no side effects.

CONCLUSIONS:
Use of cervical LP cream prior to copper T380A IUD insertion may alleviate the IUD insertion pain among parous women.

IMPLICATIONS:
Cervical LP cream could be effective as an analgesic prior to copper T380A IUD insertion with no side effects. Further studies are needed to assess the women's satisfaction from lying with a speculum in place for 7 min while waiting for the cream to be effective.

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


Title:
Hyoscine Butylbromide And Progress Of Labor In ‎Primigravidae: Methodological Concerns


Title:
Is Ginger Really Effective For The Treatment Of The First ‎Trimester Nausea And Vomiting?‎


Title:
Uterine Artery Doppler Among Hormonal Long-Acting ‎Reversible Contraceptive Method Users: Statistical ‎Concerns


Title:
Vaginal Misoprostol Prior To Intrauterine Device ‎Insertion In Women Delivered Only By Elective Cesarean ‎Section - Reply To Letter To The Editor

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


Title:
Which Analgesic Is Efficient Prior To Intrauterine Device ‎Insertion?‎


Title:
Pre-Emptive Ketorolac For Prevention Of Intraoperative ‎Shoulder Pain In Patients Undergoing Cesarean Section: ‎A Double Blind Randomized Clinical Trial

Abstract:
BACKGROUND:
Shoulder pain is a commonly observed but mostly neglected consequence of cesarean section and little is known as well as explored about intraoperative shoulder pain. We conducted this randomized prospective double-blinded study to evaluate the efficacy of ketorolac in reducing the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section.

METHODS:
Two hundred ASA I and II patients scheduled to undergo elective cesarean section under spinal anesthesia were randomized to receive either intravenous ketorolac 30 mg (ketorolac group) or normal saline (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were severity of intraoperative shoulder pain, amount of intraoperative blood loss, incidence of hypotension, bradycardia and request for intraoperative rescue analgesia.

RESULTS:
The incidence of intraoperative shoulder pain in the control group was significantly higher than the ketorolac group (P = 0.003). Severity of shoulder pain and requests for intraoperative analgesia was significantly higher in the control group (P = 0.012, P = 0.006 respectively). Patients in the Ketorolac group experienced significantly higher incidences of bradycardia (P = 0.037).

CONCLUSION:
30 mg ketorolac administered intravenously just before the operation could decrease incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section.

CLINICAL TRIAL REGISTRATION:
ClinicalTrial.gov (Registration number: NCT02380898, first registered in 01/03/2015).

Author Info:
1
Department of Anesthesia and Intensive Care, Assiut University Hospital, Assiut University, Egypt. Electronic address: mostafasamy@aun.edu.eg.
2
Department of Anesthesia and Intensive Care, University Hospital Kerry, Tralee, Ireland. Electronic address: omnia.askar@gmail.com.
3
Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut University, Egypt. Electronic address: aboaliabdelaleem@gmail.com.


Title:
Folic Acid Protects Against Lead Acetate-Induced ‎Hepatotoxicity By Decreasing NF-Κb, IL-1β Production ‎And Lipid Peroxidation Mediataed Cell Injury

Abstract:
Folic acid plays an important role in cellular metabolic activities. The present study was designed to investigate the protective effect of folic acid against lead acetate-induced hepatotoxicity. Twenty four male Wistar albino rats were randomly divided into four groups, six animals each. Negative control group received the vehicle, positive control group received 1mg/kg folic acid for five consecutive days/week for 4 weeks orally, lead-exposed group received 10mg/kg lead acetate intraperitoneally (IP) for five consecutive days/week for 4 weeks, and lead-treated group received 10mg/kg lead acetate IP and 1mg/kg folic acid orally for five consecutive days/week for 4 weeks concurrently. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ- glutamyltransferase (GGT) were measured. Hepatic total peroxide and interleukin-1β (IL-1β) were also investigated. Histopathological studies using hematoxylin-eosin (H&E) and periodic acid shiff's (PAS) were carried out. The expression of nuclear factor kappa B (NF-κB) was evaluated using immunohistochemistry. Serum AST, ALT and GGT and hepatic total peroxide and IL-1β were significantly increased in lead-exposed group and were positively correlated with hepatic lead level. Moreover, lead-exposed rats showed hydropic degeneration, nuclear vesiculation, high lymphocytic infiltration, depletion of glycogen content and NF-κB expression. Concomitant folic acid administration resulted in a significant alleviation of biochemical and structural alteration-induced by lead. This was associated with reduction of hepatic total peroxide and IL-1β and reduction of NF-κB expression. In conclusion, folic acid protects against lead acetate-induced hepatotoxicity by decreasing NF-κB, IL-1β production and lipid peroxidation mediataed cell injury.

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.


Authors:
Abd El-Hakeem EE1, Kaki AM2, Almazlom SA2, Alsayyad AJ3.

Title:
Laparoscopic Partial Nephrectomy In A Patient On ‎Simvastatin : Delayed Recovery From Neuromuscular ‎Blockade

Abstract:
Delayed recovery from anesthesia remains a very challenging subject for anesthesiologists. This case report describes the clinical course of delayed recovery from neuromuscular blockade after laparoscopic partial nephrectomy in a patient on simvastatin. The patient was hypertensive on regular treatment with oral captopril 25 mg twice daily and amlodipine 5 mg once daily and hypercholesterolemic on regular simvastatin 40 mg once daily with a normal electrocardiogram (ECG). All preoperative laboratory findings were within normal ranges. The patient was premedicated with midazolam 1 mg and general anesthesia was induced with fentanyl 2 µg/kg body weight, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg to facilitate tracheal intubation. Anesthesia was maintained with inhalation of isoflurane 1.0-1.5 % in 40 % oxygen-enriched air and 25 µg boluses of fentanyl. The patient did not require any additional rocuronium throughout surgery which was finished after 4 h. The patient most probably had preoperative simvastatin-induced myotoxicity. This potentiated the muscle relaxant effect of rocuronium bromide and was the reason for patient unresponsiveness and delayed postoperative recovery. We can conclude that anesthesiologists should preoperatively identify statin myotoxicity and to avoid neuromuscular blocking drugs for statin-treated patients. Also, preoperative adjustment of statin dosage may be recommended.

Author Info:
1
Department of Anaesthesiology, Faculty of Medicine, Assiut University, Assiut, Egypt. esezzat@hotmail.com.
2
Department of Anaesthesiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
3
Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.


Authors:
Abd El-Rahman AM1, Othman AH1, El Sherif FA2, Mostafa MF3, Taha O4.

Title:
Comparison Of Three Different Doses Sugammadex ‎Based On Ideal Body Weight For Reversal Of Moderate ‎Rocuronium-Induced Neuromuscular Blockade In ‎Laparoscopic Bariatric Surgery

Abstract:
BACKGROUND:
The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg/kg, calculated according to ideal body weight basis, for the reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery.

METHODS:
One-hundred and eighty morbidly obese patients were randomly assigned into three groups according to sugammadex dose administrated (based on IBW after reaching T2 of TOF): Group I: patients were given 1.5 mg/kg. Group II: patients were given 2 mg/kg. Group III: patients were given 4 mg/kg. Both sugammadex and extubation times were recorded.

RESULTS:
Sugammadex time was significantly longer in groups I and II versus III (P=0.000, 0.005 respectively). Difference between groups I and II was insignificant. The extubation time was insignificantly different in the three groups (P>0.05).

CONCLUSIONS:
A dose of sugammadex of 1.5 mg/kg calculated according to IBW successfully reversed moderate rocuronium-induced NMB in laparoscopic bariatric surgeries.

Author Info:
1
Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2
Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt - fatma_anesthesia@yahoo.com.
3
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abd-Elhamid TH1,2, Conway ML1, Sinning AR1.

Title:
Expression of hLAMP-1-Positive Particles During Early Heart Development in the Chick

Abstract:
Heart development requires coordinated activity of various factors, the disturbance of which can lead to congenital heart defects. Heart lectin-associated matrix protein-1 (hLAMP-1) is a matrix protein expressed within Hensen's node at Hamburger-Hamilton (HH) stage 4, in the lateral mesoderm by HH stages 5-6 and enhanced within the left pre-cardiac field at HH stage 7. At HH stages 15-16, hLAMP-1 expression is observed in the atrioventricular canal and the outflow tract. Also, the role of hLAMP-1 in induction of mesenchyme formation in chick heart has been well documented. To further elucidate the role of this molecule in heart development, we examined its expression patterns during HH stages 8-14 in the chick. In this regard, we immunostained sections of the heart during HH stages 8-14 with antibodies specific to hLAMP-1. Our results showed prominent expression of hLAMP-1-positive particles in the extracellular matrix associated with the pre-cardiac mesoderm, the endoderm, ectoderm as well as neuroectoderm at HH stages 8-9. After formation of the linear heart tube at HH stage 10, the expression of hLAMP-1-stained particles disappears in those regions of original contact between the endoderm and heart forming fields due to rupture of the dorsal mesocardium while their expression becomes confined to the arterial and venous poles of the heart tube. This expression pattern is maintained until HH stage 14. This expression pattern suggests that hLAMP-1 may be involved in the formation of the endocardial tube.

Author Info:
1
Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA.
2
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abd-Elsalam KA1, Fares KM2, Mohamed MA2, Mohamed MF2, El-Rahman AMA3, Tohamy MM2.

Title:
Efficacy of Magnesium Sulfate Added to Local Anesthetic in a Transversus Abdominis Plane Block for Analgesia Following Total Abdominal Hysterectomy: A Randomized Trial

Abstract:
BACKGROUND:
Major abdominal surgeries are associated with severe pain, which can affect respiratory and cardiac functions if insufficiently treated; this increases postoperative morbidity.

OBJECTIVE:
We aim at evaluating the efficacy of magnesium sulfate as an adjuvant to local anesthetic in an ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in total abdominal hysterectomy.

STUDY DESIGN:
A prospective, randomized, double-blinded clinical trial.

SETTING:
An academic medical center.

METHODS:
This study is registered at https://clinicaltrials.gov (no.: NCT02930707). This randomized, double-blinded clinical trial included 60 women undergoing total abdominal hysterectomy that were divided into 2 groups (30 patients per group). Group I received a TAP block with 20 mL per side of 0.25% bupivacaine plus 2 mL magnesium sulphate 10% (200 mg). Group II received a TAP block with 20 mL per side of 0.25% bupivacaine. Visual analog scale (VAS) scores, the time of the first analgesic request, total morphine consumption, and any side effects were assessed and recorded.

RESULTS:
The mean postoperative VAS score was significantly reduced in group I compared to group II in all of the time-points except after 10 hours. The mean time of the first request for rescue analgesia was significantly prolonged in group I (15.67 hrs.) compared to group II (7.33 hrs.) (P < 0.001), and the mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in group I (7.63 ± 2.93 mg) than in group II (16.20 ± 3.24 mg) (P < 0.001). No significant difference in side effects was observed.

LIMITATIONS:
Sample size.

CONCLUSION:
The addition of 200 mg of magnesium sulfate to bupivacaine in an ultrasound-guided TAP block significantly reduced postoperative opioid requirements, prolonged the duration of analgesia, and reduced the VAS score in patients who underwent abdominal hysterectomy, without significant side effects.

Author Info:
1
Assiut University Hospital, Assiut, Egypt.
2
South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egyp.


Authors:
Abdalmageed OS1, Bedaiwy MA2, Falcone T3

Title:
Nerve Injuries in Gynecologic Laparoscopy.

Abstract:
Nerve injuries during gynecologic endoscopy are an infrequent but distressing complication. In benign gynecologic surgery, most of these injuries are associated with patient positioning, although some are related to port placement. Most are potentially preventable with attention to patient placement on the operating room bed and knowledge of the relative anatomy of the nerves. The highest risk group vulnerable to these injuries includes women who have extreme body mass index and those with longer surgical times in the Trendelenburg position. Upper and lower limb peripheral nerves are the most common nerves injured during gynecologic endoscopy. These injuries can result in transient or permanent sensory and motor disabilities that can interrupt patient recovery in an otherwise successful surgery. Numerous strategies are suggested to reduce the frequency of nerve injuries during gynecologic endoscopies. Proper patient positioning and proper padding of the pressure areas are mandatory to prevent malposition-related nerve injuries. Anatomic knowledge of the course of nerves, especially ilioinguinal and iliohypogastric, nerves can minimize injury.

Author Info:
1
Women's Health Center, Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
3
Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: falconet@ccf.org.


Authors:
Abdel Ghany SM1, Sayed AA1, El-Deek SEM2, ElBadre HM1, Dahpy MA1, Saleh MA3, Sharaf El-Deen H4, Mustafa MH4.

Title:
Obesity Risk Prediction Among Women Of Upper Egypt: ‎The Impact Of Serum Vaspin And Vaspin Rs2236242 ‎Gene Polymorphism.‎

Abstract:
BACKGROUND:
Vaspin is an adipokine that is potentially linking obesity, insulin resistance, metabolic syndrome and type-2 diabetes.

AIM:
The present study aimed to investigate the impact of vaspin rs2236242 gene polymorphism on the risk of obesity, diabetes, their metabolic traits, and serum vaspin levels in a sample of Upper Egyptian women.

SUBJECTS AND METHODS:
A total of 224 subjects, 112 obese (62 non diabetics, 50 diabetics) and 112 controls were included in this case control study. Vaspin gene rs2236242 polymorphism was performed using tetra-amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) and serum vaspin levels were estimated by ELISA.

RESULTS:
The minor (A) allele of vaspin rs2236242 gene polymorphism was significantly lower in obese (30.8%) than controls (43.7%) (P=0.005). The protective effect was evident in dominant and recessive inheritance models (TT vs TA+AA, P=0.004 and TT+TA vs AA, P=0.036). After adjusting genotypes for diabetes there were no significant association between vaspin rs2236242 gene polymorphism and obesity but significant association was maintained in the obese diabetics. Vaspin serum levels were found to be lower in minor protective (AA) genotype carriers than the other two genotypes (P<0.001). In the mean-time serum vaspin levels were significantly higher in obese diabetics and non-diabetics than controls (P<0.001 each).There were significant positive correlations between vaspin levels and hs-CRP, cholesterol, LDL-C, fasting glucose, HOMA-IR, insulin, and ALT values (P<0.05 each) and a negative correlation with HDL-C (P<0.01).

CONCLUSION:
The minor A allele of vaspin rs2236242 polymorphism plays a protective role against obesity and diabetes but this relation is largely ascribed to its effect on insulin resistance. The serum vaspin concentration was lower in minor protective allele carriers. To the best of our knowledge, this is the first study of vaspin SNP in Upper Egyptian women. The entire understanding of vaspin intimate mechanistic action might enable the development of novel etiology-based treatment strategies for obesity, the complex genetic trait.

Author Info:
1
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: eldsahar123@aun.edu.eg.
3
Public Health and Community Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel-Aleem H1, Darwish A1, Abdelaleem AA1, Mansur M1.

Title:
Usefulness Of The WHO C-Model To Optimize The ‎Cesarean Delivery Rate In A Tertiary Hospital Setting.‎

Abstract:
OBJECTIVE:
To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate.

METHODS:
A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification.

RESULTS:
In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%.

CONCLUSION:
The WHO C-Model is valid and can be used in hospital settings to optimize CD rates.

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


Title:
Differentiation Of Pityriasis Rubra Pilaris From Plaque ‎Psoriasis By Dermoscopy

Abstract:
Pityriasis rubra pilaris (PRP) and plaque psoriasis (PP) are two distinctive erythemato-squamous skin diseases that often have to be differentiated from each other and from other similar dermatoses. Dermoscopy has been proven to aid the clinical diagnosis of several inflammatory disorders, minimizing the need for skin biopsy. Our aim was to determine the dermoscopic patterns of PRP compared to PP and to assess the significance of certain dermoscopic criteria in the diagnosis of PRP. This case-control study included 11 patients with biopsy proven PRP and 25 patients with biopsy proven plaque psoriasis. The most recently developed lesion of each patient was examined by non-contact dermoscopy. Whitish keratotic plugs and linear vessels in yellowish background are significant dermoscopic features of PRP compared to white diffuse scales and dotted vessels in a light red background in PP. In conclusion, PRP and PP reveal specific distinguishing dermoscopic patterns that may assist in their clinical diagnosis and may also be useful for the differential diagnosis from other resembling dermatoses.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt. saharsotohy@gmail.com.


Authors:
Abdel-Fadeil MR1, Abedelhaffez AS2, Makhlouf HA3, Al Qirshi GA4.

Title:
Obstructive Sleep Apnea: Influence Of Hypertension On ‎Adiponectin, Inflammatory Markers And Dyslipidemia.

Abstract:
Obstructive sleep apnea (OSA) is a common but often unrecognized condition with potentially serious complications. The aim of this study was to explore the possible mechanisms linking hypertension (HT), a common cardiovascular disease (CVD), with obstructive sleep apnea (OSA) by investigating the levels of morning and evening serum adiponectin, inflammatory markers (TNF-α, IL-6), and lipid profiles in OSA patients with and without HT. Four groups were enrolled in this case-control analytic study: control, OSA, OSA+HT, and HT groups, each of which included 22 subjects. The results revealed low morning and evening serum adiponectin levels in patients with OSA and OSA+HT compared with their control and HT counterparts. Serum adiponectin levels declined progressively with increasing severity of OSA. Also, morning adiponectin levels were significantly decreased at the same time that a loss of the normal diurnal rhythm was observed in the OSA and OSA+HT groups. Both TNF-α and IL-6 levels were significantly increased in the OSA and OSA+HT groups compared with levels in the control and HT groups. Altered lipid profiles was noticed in the same groups. These findings were more pronounced in the OSA+HT than in the OSA group. In conclusion, the biochemical findings of this study demonstrate predominantly low adiponectin levels, increased levels of inflammatory markers, and atherogenic lipid profiles in OSA patients with HT compared with those of the other patients studied. This highlights the possible contributing role of these factors to the pathogenesis of HT as a common cardiovascular complication in OSA patients.

Author Info:
1
Department of Medical physiology, Faculty of Medicine, Assiut University, P.O. Box No. 71526, Assiut, Egypt. Electronic address: mrafadeil@hotmail.com.
2
Department of Medical physiology, Faculty of Medicine, Assiut University, P.O. Box No. 71526, Assiut, Egypt. Electronic address: azzasalah10@hotmail.com.
3
Department of Chest Diseases and TB, Faculty of Medicine, Assiut University, P.O. Box No. 71526, Assiut, Egypt. Electronic address: hamakhlouf@yahoo.com.
4
Department of Medical, Faculty of Medicine, Aden University, Yemen. Electronic address: ghada_qirshi@yahoo.com.


Authors:
Abdel-Ghaffar HS1, Moeen SM1, Moeen AM2.

Title:
Topical Versus Caudal Ketamine/Bupivacaine ‎Combination For Postoperative Analgesia In Children ‎Undergoing Inguinal Herniotomy

Abstract:
BACKGROUND:
Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy.

PATIENTS AND METHODS:
This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative.

RESULTS:
Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia.

CONCLUSION:
Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

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


Title:
Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients.

Abstract:
BACKGROUND:
Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory.

OBJECTIVE:
To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%-25%) and Jessner's solution versus TCA (20%-25%) alone in dark patients with melasma.

MATERIALS AND METHODS:
The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV-V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course.

RESULTS:
Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma.

CONCLUSION:
Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.

Author Info:
1
*All authors are affiliated with the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdel-Motaleb AA1, Abu-Dief EE2, Hussein MR3.

Title:
Dermal Morphological Changes Following Salicylic Acid ‎Peeling And Microdermabrasion

Abstract:
BACKGROUND:
Microdermabrasion and chemical peeling are popular, inexpensive, and safe methods for treatment of some skin disorders and to rejuvenate skin.

OBJECTIVES:
To study the alterations of the dermal connective tissue following salicylic acid peeling and microdermabrasion.

METHODS:
Twenty patients were participated in our study. All participants underwent facial salicylic acid 30% peel or microdermabrasion (10 cases in each group) weekly for 6 weeks. Punch biopsies were obtained from the clinically normal skin of the right postauricular region 1 week before treatment (control group). Other punch skin biopsies were obtained 1 week after the end of the treatments from the left postauricular area. This region was treated in a similar way to the adjacent lesional skin (treated group). We used routine histological techniques (H&E stain), special stains (Masson trichrome and orcein stains), and image analyzer to study the alterations of the dermal connective tissues.

RESULTS:
Our study demonstrates variations in the morphological changes between the control and the treated groups, and between chemical peels and microdermabrasion. Both salicylic acid 30% and microdermabrasion were associated with thickened epidermal layer, shallow dermal papillae, dense collagen, and elastic fibers. There was a significant increase among those treated sites vs control regarding epidermal thickness and collagen thickness. Also, there was a highly statistically significant increase among those treated with salicylic acid vs microdermabrasion regarding the epidermal, collagen, and elastin thickness.

CONCLUSIONS:
Both methods stimulate the repair process. The mechanisms underlying these variations are open for further investigations.

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


Authors:
Abdel-Rahman O1,2, Helbling D2, Schöb O3, Eltobgy M1, Mohamed H1, Schmidt J3, Giryes A2, Mehrabi A4, Iype S5, John H5, Tekbas A4, Zidan A6, Oweira H3,4.

Title:
Cigarette Smoking As A Risk Factor For The ‎Development Of And Mortality From Hepatocellular ‎Carcinoma: An Updated Systematic Review Of 81 ‎Epidemiological Studies

Abstract:
BACKGROUND AND AIMS:
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and its incidence has increased during the past decade. While hepatitis B and C virus infections and alcohol were established risk factors, the impact of smoking on the incidence and mortality of HCC was needed to be confirmed.

METHODS:
We reviewed cohort and case-control studies evaluating the association between cigarette smoking and incidence and mortality of HCC from MEDLINE and Google Scholar. We also checked reference lists of original studies and review articles manually for cross-references up to February 2016. We extracted the relevant information on participant characteristics and study outcomes, as well as information on the methodology of the studies. We also assessed the quality of the included trials using critical appraisal skills program checklists. Meta-analysis was performed by using RevMan 5.3 software.

RESULTS:
A total of 81 studies were included in the systematic review. Pooled OR for HCC development with current smokers was 1.55 (95% CI: 1.46 to 1.65; P < 0.00001). Pooled OR for HCC development with former smokers was 1.39 (95% CI: 1.26 to 1.52; P < 0.00001) and pooled OR for HCC development with heavy smokers was 1.90 (95% CI: 1.68 to 2.14; P < 0.00001). Pooled OR for the mortality of current smokers with HCC was 1.29 (95% CI: 1.23 to 1.34; P < 0.00001); and for former smokers with HCC, it was 1.20 (95% CI: 1.00 to 1.42; P = 0.04).

CONCLUSIONS:
Cigarette smoking increases the incidence and mortality of HCC. Further studies are needed to evaluate possible impact of quitting smoking on decreasing this risk.

Author Info:
1
Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2
Department of Medical Oncology, Gastrointestinal Tumor Center Zurich, Zurich, Switzerland.
3
Surgical Center Zurich, Hirslanden Hospital Zurich, Zurich, Switzerland.
4
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
5
Department of Surgery, Cambridge University Hospital, Cambridge, United Kingdom.
6
Department of HPB and Liver Transplantation, Rajhy Liver Hospital, Assiut University, Assiut, Egypt.


Authors:
Abdel-Wahab N1,2, Alshawa A3, Suarez-Almazor ME4.

Abstract:
Cancer immunotherapy has resulted in durable responses in patients with metastatic disease, unseen with traditional chemotherapy. Several therapies have been approved by the Food and Drug Administration for the treatment of various cancers, including: immune checkpoint inhibitors, cytokines - interleukin 2 (IL-2) and interferon alpha (IFN), and the cancer vaccine sipuleucel-T. These therapies upregulate the immune system to enhance antitumor responses. As a consequence, they can cause inflammatory and immune-related adverse events that can affect one or more organs, can be serious, and on occasion lifethreatening. The management of these adverse events is complex, and requires a multidisciplinary approach involving not only oncologists, but also other internal medicine specialists, to ensure prompt diagnosis and optimal management of these complications.

Author Info:
1
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
2
Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, 71526, Egypt.
3
Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. msalmazor@mdanderson.org.


Authors:
Abdelaal M1,2, le Roux CW1,3,4, Docherty NG1,3.

Title:
Morbidity And Mortality Associated With Obesity

Abstract:
Obesity and its repercussions constitute an important source of morbidity, impaired quality of life and its complications can have a major bearing on life expectancy. The present article summarizes the most important co-morbidities of obesity and their prevalence. Furthermore, it describes classification and grading systems that can be used to assess the individual and combined impact of co-morbid conditions on mortality risk. The literature was screened for assessment tools that can be deployed in the quantification of morbidity and mortality risk in individual patients. Thirteen specific domains have been identified that account for morbidity and mortality in obesity. Cardiovascular disease (CVD) and cancer account for the greatest mortality risk associated with obesity. The King's Criteria and Edmonton Obesity Staging System (EOSS) were identified as useful tools for the detection and monitoring of individual patient mortality risk in obesity care. The stark facts on the complications of obesity should be capitalized on to improve patient management and knowledge and referred to in the wider dissemination of public health messages aimed at improving primary prevention.

Author Info:
1
Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
2
Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt.
3
Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
4
Investigative Science, Imperial College London, London, UK.


Authors:
AbdelAziz NH1, AbdelAzeem HG2, Monazea EM3, Sherif T2.

Title:
Impact of Thrombophilia on the Risk of Hypoxic-Ischemic Encephalopathy in Term Neonates

Abstract:
BACKGROUND:
The incidence of neonatal hypoxic-ischemic encephalopathy (HIE) is reportedly high in countries with limited resources. Its pathogenesis is multifactorial. A role for thrombophilia has been described in different patterns of preterm and full-term perinatal brain injury.

AIM:
This study aims to identify risk factors associated with neonatal HIE and also to determine the contributions of genetic thrombophilia in the development of neonatal HIE.

METHODS:
Sixty-seven neonates with HIE and 67 controls were enrolled in the study. Clinical history and examination were undertaken. Patients and controls were tested for the presence of factor V G1691A and prothrombin G20210A mutations. In addition, protein S, protein C, and antithrombin III levels were assessed.

RESULTS:
Parental consanguinity and performing emergency cesarean section (CS) were significant risk factors for neonatal HIE (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.6-15.3, P < .001, OR 12.6, 95% CI 2.52-63.3, P = .002, respectively). No significant difference was found regarding maternal age and parity. About 33% of cases and 6% of controls were found to have at least 1 thrombophilic factor ( P < .001). Factor V G1691A mutation significantly increased the risk of neonatal HIE (OR 4.5, 95% CI 1.4-14.5, P = .012), while prothrombin G 20210A mutation and protein C deficiency were not.

CONCLUSION:
Parental consanguinity, emergency CS, and factor V mutation may contribute to the higher risk of developing neonatal HIE.

Author Info:
1
1 Department of Pediatrics, Assiut University Children Hospital, Assiut, Egypt.
2
2 Department of Clinical Pathology, Assiut University, Assiut, Egypt.
3
3 Department of Public Health, Assiut University, Assiut, Egypt.


Authors:
Abdelhafez Y1, Khalil M, Roshdy E, Diab WA, Eltoni L.

Title:
Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia

Abstract:
The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with Tc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.

Author Info:
1
From the *Nuclear Medicine Unit, South Egypt Cancer Institute, and †Nuclear Medicine Unit and ‡Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abdelhalim AA1, Maghraby HH2, ElZoughari IA3, AlZahrani TA4, Moustafa MS4, Alfassih KM4, Ahmad AE4.

Title:
Using Fentanyl And Propofol For Tracheal Intubation ‎During Sevoflurane Induction Without Muscle Relaxants ‎In Children: A Randomized Prospective Study

Abstract:
CONTEXT:
Tracheal intubation is frequently facilitated with sevoflurane induction without the use of muscle relaxants in children.

AIM:
The aim of this study was to compare the effects of two different doses of propofol preceded by a fixed dose of fentanyl during sevoflurane induction on quality of tracheal intubation in children.

SETTINGS AND DESIGN:
This was a prospective randomized study.

SUBJECTS AND METHODS:
Ninety American Society of Anesthesiologists I-II children aged 2-6 years were randomly assigned to one of two equal groups to receive 2 μg/kg of fentanyl with 2 mg/kg of propofol (Group I) or 2 μg/kg of fentanyl with 3 mg/kg of propofol (Group II) during sevoflurane induction. The intubating conditions and hemodynamic responses were evaluated. The time from sevoflurane induction to loss of consciousness, to intravenous line insertion, and to intubation was measured. The occurrence of any adverse effect was recorded.

STATISTICAL ANALYSIS USED:
Results were analyzed using Student's t-test, paired t-test, and Chi-square test. P < 0.05 was considered statistically significant.

RESULTS:
The incidence of excellent intubating conditions was achieved more significantly in Group II (41/45 patients, 91%) than that in Group I (31/45 patients, 69%) (P = 0.008) (95% confidence interval [CI] =0.39-0.8). Whereas, there were no significant differences between the two groups in terms of the overall acceptable intubating conditions in Group I (40/45 patients, 89%) and Group II (43/45 patients, 96%) (P = 0.81) (95% CI = 0.71-1.31). No patient developed any adverse effect.

CONCLUSION:
The administration of 3 mg/kg propofol preceded by 2 μg/kg fentanyl provided a higher proportion of excellent intubating conditions compared with 2 mg/kg propofol preceded by 2 μg/kg fentanyl during sevoflurane induction in children without muscle relaxants.

Author Info:
1
Department of Anesthesia, Faculty of Medicine, Alexandria University, Egypt.
2
Department of Anesthesia, Faculty of Medicine, Assiut University, Egypt.
3
Department of Anesthesia, Faculty of Medicine, Al-Azhar University, Egypt, Affiliated to King Saud University, Saudi Arabia.
4
Department of Anesthesia, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.


Authors:
Abdelhamid MM1, Bayoumy MA2, Elkady HA1, Abdelkawi AF1.

Title:
Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique

Abstract:
Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation.

Author Info:
1
Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut, Egypt.
2
Department of Orthopaedic and Traumatology, Al-Azhar University Hospital, Assiut, Egypt.


Authors:
Abdelkader A1, El-Mokhtar MA2, Abdelkader O1, Hamad MA3, Elsabahy M4, El-Gazayerly ON5.

Title:
Ultrahigh Antibacterial Efficacy Of Meropenem-Loaded ‎Chitosan Nanoparticles In A Septic Animal Model

Abstract:
Antimicrobial resistance is one of the most significant health challenges worldwide. Meropenem is a broad spectrum beta-lactam antibiotic that possesses high activity against Gram-positive and Gram-negative bacteria. However, it has a short plasma half-life, and thus requiring frequent administration of high doses. For the first time, meropenem-loaded chitosan nanoparticles were prepared and evaluated as a potential tool to overcome antimicrobial resistance and to improve pharmacokinetics of the drug. Spherical nanosized particles were prepared and demonstrated ultrahigh encapsulation efficiency of meropenem (i.e. 76.3%). The nanoparticles could be stored in a freeze-dried powdered form while maintaining their physicochemical characteristics. In vitro, higher antibacterial activities of the drug-loaded nanoparticles were observed against methicillin-sensitive and methicillin-resistant Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, as compared to the free drug. The nanoparticles were then tested in a septic rat model of Klebsiella pneumoniae and showed exceptional improvement of survival and bacterial clearance, as compared to the animals treated with the free drug. Hence, meropenem-loaded chitosan nanoparticles might have great potential for overcoming antimicrobial resistance.

Author Info:
1
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut 71515, Egypt.
2
Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
3
Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
4
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut 71515, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA; Misr University for Science and Technology, 6th of October City, Egypt. Electronic address: mahmoud.elsabahy@chem.tamu.edu.
5
Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt.


Authors:
Abdellah MS1, Abbas AM2, Hegazy AM1, El-Nashar IM1.

Title:
Vaginal Misoprostol Prior To Intrauterine Device ‎Insertion In Women Delivered Only By Elective Cesarean ‎Section: A Randomized Double-Blind Clinical Trial.‎

Abstract:
OBJECTIVE:
The current study aims to evaluate if vaginal misoprostol (400 mcg) administered prior to intrauterine device (IUD) insertion increases the ease and success of insertion among women who had delivered only by elective cesarean delivery (CD).

STUDY DESIGN:
The current study was a randomized, double-blind, placebo-controlled trial conducted in Assiut Women's Health Hospital, Egypt, between the 1st of April 2015 and the 31st of March 2016 and included women who delivered only by elective CD. One hundred forty women were randomized into two groups; misoprostol group received two misoprostol 400-mcg tablets vaginally, and placebo group received two placebo tablets 3 h before a copper T380A IUD insertion. The primary outcome measure was the difference in the ease of insertion score using a 10-cm visual analog scale between both groups with 0=very easy insertion, and 10=terribly difficult insertion.

RESULTS:
The ease of insertion score was lower in the misoprostol group (2.2±0.5 vs. 4.2±0.5, p=.0001) with higher number of successful IUD insertions than the placebo group (69 [98.6%] vs. 61 [87.1%], p=.009). The mean pain score reported by the women was lower in misoprostol group (2.7±0.6 vs. 4.3±0.8) with higher level of satisfaction from the whole procedure (8.9±0.4 vs. 7.9±0.2) with p=.001 for both.

CONCLUSIONS:
Misoprostol 400 mcg vaginally prior to IUD insertion eases and increase the success of insertion with reduction of pain among women who had delivered only by elective CD.

IMPLICATIONS:
The use of vaginal misoprostol before IUD insertion in women who had never delivered vaginally before may increase the ease and success of insertion. Moreover, it may reduce the pain felt by women during the procedure.

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


Authors:
Abdelmegid MA1, Ahmed TA2, Kato M3, Ando K3, Domei T3, Iwabuchi M3, Nobuyoshi M3.

Title:
Drug-Eluting Stents Or Balloon Angioplasty For Drug-‎Eluting Stent-Associated Restenosis: An Observational ‎Follow-Up Study Of First-Time Versus Repeated ‎Restenosis

Abstract:
BACKGROUND:
The treatment of patients with repeated drug-eluting stent-in stent restenosis (DES-ISR) remains a challenge and a burdensome clinical problem.

METHODS:
Over a 3-year period, 130 lesions in 123 patients who underwent target lesion revascularization (TLR) for DES restenosis were included in the study. They were classified into two main groups: the first group having first-time DES-ISR (n = 84), and the second group having rerestenosis of DES-treated DES-ISR (n = 39). Further classification according to the treatment strategy yielded four subgroups: balloon angioplasty (BA) in first-time DES-ISR (n = 66), re-DES in the same group (n = 22), BA in rerestenosis of DES-treated DES-ISR (n = 30), and re-DES in the same group (n = 10). Angiographic follow-up was planned at 1 year, and clinical follow-up for re-TLR up to 2 years later.

RESULTS:
The mean duration of clinical follow-up was 24.8 ± 9.7 months. The angiographic follow-up data were obtained for 108 patients (87.8%) at 1 year. Among patients treated for first-time DES-ISR, late lumen loss (0.65 ± 0.83 mm and 1.02 ± 0.52 mm, p = 0.02) and binary restenosis rates (25% and 49.1%, p = 0.05) were significantly less in those undergoing re-DES compared with BA. This benefit was not evident in patients having rerestenosis of DES-treated DES-ISR. Re-TLR at 2 years was significantly less in the re-DES group compared with BA (log rank p = 0.038) in first-time DES-ISR patients, while no significant difference (log rank p = 0.58) was observed in those having rerestenosis of DES-treated DES-ISR.

CONCLUSION:
While a strategy of re-DES would be better than BA in first-time DES-ISR, this could not be extrapolated to rerestenosis cases.

Author Info:
1
Department of Cardiovascular Medicine, Asyut University Hospital, Asyut, aEgypt; Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
2
Department of Cardiovascular Medicine, Asyut University Hospital, Asyut, aEgypt.
3
Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.


Title:
Idiopathic Neonatal Pneumoperitoneum, A Case Report

Abstract:
INTRODUCTION:
There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a rare and benign condition that does not yet have a definite cause. The criteria by which a surgeon decides on which abdomen to open and which one to observe, is ill-defined. Thus, increasing the awareness of neonatologists and surgeons about this condition will help decrease complications due to unnecessary procedures.

PRESENTATION OF THE CASE:
We report a case of a neonate with a massive pneumoperitoneum who obtained a surgical intervention with negative finding. We had noted that the bag of the abdominal drain was expanded with gas every 2days, we replace the bag by new one every 2days for 10days postoperative. Nonetheless, the cause of pneumoperitoneum remains unclear.

DISCUSSION:
There are five main nonsurgical causes of free air in the peritoneal cavity. These are categorized as follow: pseudopneumoperitoneum, thoracic, abdominal, gynecological and idiopathic. This is a condition in which imaging shows free air in the peritoneal cavity that can either be managed with observation and supportive care alone or results in a negative laparotomy.

CONCLUSION:
This case demonstrated that laparotomy is not a true routine in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established. Future research is still necessary to understand the source of the free gas in the abdomen, as well as the underlying causes of delayed postoperative gas underdiaphragm and postoperative abdominal drain bag gas expansion.

Author Info:
1
Aswan University Hospital, Egypt. Electronic address: sosoramily@yahoo.com.
2
Assiut University Hospital, Egypt. Electronic address: Dr.osman@ymail.com.


Authors:
Abdelsalam YM1, Saeed WM1, Moeen AM1, Elganainy EO1, Ahmed AI1.

Title:
Retroperitoneal Varix Ligation With Sclerotherapy: A ‎Prospective Randomized Comparative Study

Abstract:
INTRODUCTION:
The aim of this article is to compare the results of high varix ligation with and without sclerotherapy.

MATERIAL AND METHODS:
Between November 2014 and December 2015, sixty patients with varicocele were included in this study. Patients were divided into two equal groups; group I (underwent high varix ligation), and group II (underwent high varix ligation with a retrograde injection of 2 mL of 5% ethanolamine oleate in the lower end of the bisected gonadal vein). The operative time, intra- and postoperative complications, postoperative pain, improvement of semen parameters, incidence of recurrence and achieving of unassisted pregnancy were recorded for both groups.

RESULTS:
The age range was 19-34 years in group I and 21-37 years in group II. The operative time was shorter in group I (34.6 ±7.81 min) than group II (43.3 ±8.5 min) (P <0.001), which was statistically significant.Improvement of semen parameters and the occurrence of spontaneous pregnancy were insignificant between both groups. No intraoperative complications occurred. The postoperative complications were statistically insignificant in both groups.

CONCLUSIONS:
Combined varix ligation with retrograde sclerotherapy does not offer significant advantages over high varix ligation alone with a longer operative time and prolonged post-operative pain.

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


Authors:
Abedelhaffez AS1, El-Aziz EAA2, Aziz MAA3, Ahmed AM4.

Title:
Lung Injury Induced By Bisphenol A: A Food ‎Contaminant, Is Ameliorated By Selenium ‎Supplementation

Abstract:
Bisphenol A (BPA), a widely used industrial chemical, is known to disrupt endocrine function. This study aimed to investigate the impact of chronic exposure to BPA on the lung tissue of adult male rats as well as any possible alleviating effects resulting from selenium (Se) treatment. Chronic exposure to BPA resulted in prominent inflammation and oxidative stress responses as evidenced by an increase in levels of malondialdehyde (MDA), reduced concentrations of superoxide dismutase (SOD), and upregulation of Interleukin-18 (IL-18) expression in lung tissue. In addition, chronic exposure led to modulation of the fibrosis-related gene expression, as we observed augmented follistatin-like1 (FSTL1) expression and diminished a disintegrin and metalloproteinase with thrombospondin motif 5 (ADAMTS5) expression. Se treatment remarkably mitigated changes in the expression of these dysregulated markers of lung injury. The biochemical changes were consistent with the histopathological findings, where cellular infiltration and inflammatory fibrotic changes were observed following BPA administration and a lessening of these effects with concomitant Se treatment. Taken together, the results from the study reveal that chronic exposure to BPA may promote the development of pulmonary inflammatory diseases with possible induction of lung fibrosis. Se treatment effectively suppressed oxidative stress, inflammation, and fibrosis, suggesting that Se has the potential to be used as a therapeutic agent in the treatment of pulmonary inflammatory diseases.

Author Info:
1
Department of Medical physiology, Faculty of Medicine, Assiut University, Assiut, P.O. Box No. 71526, Assiut, Egypt. Electronic address: azzasalah10@hotmail.com.
2
Department of Medical physiology, Faculty of Medicine, Assiut University, Assiut, P.O. Box No. 71526, Assiut, Egypt. Electronic address: ebthal2@gmail.com.
3
Department of Biochemistry, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, P.O. Box No. 71524, Assiut, Egypt. Electronic address: dr_manwar@yahoo.com.
4
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, P.O. Box No. 71526, Assiut, Egypt. Electronic address: dr.asmaamhm@yahoo.com.


Authors:
Aborehab NM1, El Bishbishy MH2, Refaiy A3, Waly NE4.

Title:
A Putative Chondroprotective Role For IL-1β And MPO In ‎Herbal Treatment Of Experimental Osteoarthritis

Abstract:
BACKGROUND:
Herbal treatment may have a chondroprotective and therapeutic effect on Osteoarthritis (OA). We investigated the mechanism of action of ginger and curcumin rhizomes cultivated in Egypt in treatment of OA in rat model.

METHODS:
Thirty-five albino rats were intra-articularly injected with Monosodium Iodoacetate in the knee joint. Ginger and curcumin was orally administered at doses of 200 and 400 mg/kg (F200 and F400). Serum levels of cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), malondialdehyde (MDA), myeloperoxidase (MPO), Interleukin-1 beta (IL-1β) and superoxide dismutase activity (SOD) were measured using ELISA. The composition of the herbal formula hydro-ethanolic extract was characterized using UPLC-ESI-MS. Histopathological changes in injected joints was examined using routine histopathology. Statistical analysis was performed using one-way ANOVA.

RESULTS:
Serum levels of COMP, HA, MPO, MDA, and IL-1β were significantly decreased in F 200, F 400 and V groups when compared to OA group (P value <0.0001). On the other hand SOD levels were significantly elevated in treated groups compared to OA groups (P value <0.0001).

CONCLUSIONS:
The ginger/curcumin at 1:1 had chondroprotective effect via anti-inflammatory and antioxidant effect in rat OA model. Further pharmacological and clinical studies are needed to evaluate this effect.

Author Info:
1
Department of Biochemistry, Faculty of Pharmacy, MSA University, Giza, 11787, Egypt.
2
Department of Pharmacognosy, Faculty of Pharmacy, MSA University, Giza, 11787, Egypt.
3
Department of Pathology Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
4
Department of Physiology, Faculty of Medicine, Helwan University, Cairo, 11795, Egypt. nwaly@icloud.com.


Authors:
Abou-Taleb DA1, Ibrahim AK, Youssef EM, Moubasher AE.

Title:
Reliability, Validity, and Sensitivity to Change Overtime of the Modified Melasma Area and Severity Index Score

Abstract:
BACKGROUND:
The new modified Melasma Area and Severity Index (mMASI) score, the recently used outcome measure for melasma, has not been tested to determine its sensitivity to change in melasma.

OBJECTIVE:
To determine the reliability, validity, and sensitivity to change overtime of the mMASI score in assessment of the severity of melasma.

METHODS:
Pearson correlation, Cronbach alpha, and intraclass correlation coefficient were calculated to assess the reliability of the mMASI score. Validity of the mMASI scale was carried out using Spearman correlation between mMASI total score (before and after treatment), clinical data, and patient's responses.

RESULTS:
The mMASI score showed excellent reliability and good validity for assessment of the severity of melasma. The authors also determined that the mMASI score demonstrated sensitivity to change over time.

CONCLUSION:
An excellent degree of agreement between the mMSAI and MASI scores was revealed. The mMASI score is reliable, valid, and responsive to change in the assessment of severity of melasma. Moreover, the mMASI score was found to be easier to learn and perform and simpler in calculation compared with the MASI score. Overall, the mMASI score can effectively replace the MASI score

Author Info:
1
Departments of *Dermatology, Venereology, and Andrology, and †Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abouarab AA1, Elsayed HH2, Elkhayat H3, Mostafa A2, Cleveland DC1, Nori AE2.

Title:
Current Solutions for Long-Segment Tracheal Reconstruction

Abstract:
This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent, successful and promising results of the different solutions for reconstruction that are rather innovative and suitable for imminent clinical application. Latest efforts to minimize the limitations associated with each method have been covered as well. In summary, autologous and allogenic tissue reconstruction of the trachea have been successful methods for reconstruction experimentally and clinically. Autologous tissues were best utilized clinically to enhance revascularization, whether as a definitive airway or as an adjunct to allografts or tissue-engineered trachea (TET). Allogenic tissue transplantation is, currently, the most suitable for clinical application, especially after elimination of the need for immunosuppressive therapy with unlimited supply of tissues. Similar results have been reported in many studies that used TET. However, clinical application of this method was limited to use as a salvage treatment in a few studies with promising results. These results still need to be solidified by further clinical and long-term follow-up reports. Combining different methods of reconstruction was often required to establish a physiological rather than an anatomical trachea and have shown superior outcomes.

Author Info:
1
Cardiothoracic Surgery Division, University of Alabama at Birmingham, Birmingham, Alabama, USA.
2
Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3
Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Abozaid HSM1, Imam HMK2, Abdelaziz MM3, El-Hammady DH4, Fathi NA3, Furst DE5.

Title:
High-resolution manometry compared with the University of California, Los Angeles Scleroderma Clinical Trials Consortium GIT 2.0 in Systemic Sclerosis

Abstract:
OBJECTIVES:
To study esophageal high resolution manometry (HRM) in systemic sclerosis (SSc) patients and the correlation of findings to The University of California, Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA SCTC_GIT 2.0).

METHODS:
Forty SSc patients were administered to the UCLA SCTC GIT 2.0. Patients underwent HRM study (Solar GI MMS). HRM data were compared with 15 healthy volunteers.

RESULTS:
Forty patients with mean age 46 ± 7 years and disease duration 9.3 ± 7 years reported upper (85.7%), lower GI symptoms (75%), while 5% reported no symptoms. Mean ± SD scores of UCLA SCTC_GIT 2.0 items were as follows: reflux 1.2 ± 0.8, distention 1.6 ± 1.2, fecal soiling 0.3 ± 0.9, diarrhea 0.8 ± 1, social 1 ± 1, emotional 1 ± 1.1, constipation 0.5 ± 0.9, and total GIT score 0.9 ± 0.6. Lower esophageal sphincter (LES) pressure and distal esophageal amplitude were significantly lower in SSc patients than controls. Main manometric findings were decreased LES resting pressure (40%) and aperistalsis (40%). Regression analyses showed distal esophageal amplitude and LES resting pressure negatively correlated with reflux score (r = -0.64; p = 0.001 and r = -0.46; p = 0.019, respectively), and total GIT score (r = -0.54; p = 0.007 and r = -0.42; p = 0.03, respectively). LES resting pressure had negative correlations with diarrhea score (r = -0.062; p = 0.002).

CONCLUSIONS:
Decreased distal esophageal amplitude encountered as hypoperistalsis or even aperistalsis was associated with increased reflux and GIT scores (negatively correlated) UCLA SCTC_GIT 2.0 questionnaires. The GIT2.0 is easy to use and can serve as an indicator that further testing of the GI tract, including the esophagus, is indicated.

Author Info:
1
Rheumatology and Rehabilitation Department, Sohag University Hospital, Sohag, Egypt. Electronic address: hanan72eg@yahoo.com.
2
Gastrointerology and Hepatology Unit, Internal Medicine Department, Assiut University Hospital, Assiut, Egypt.
3
Rheumatology and Rehabilitaion Department, Assiut University Hospital, Assiut, Egypt.
4
Rheumatology and Rehabilitaion Department, Assiut University Hospital, Assiut, Egypt; Rheumatology and Rehabilitation Department, Helwan University, Cairo, Egypt.
5
Department of Medicine, Division of Rheumatology, University of California in Los Angeles(emeritus), Los Angeles, California; Department of Rheumatology, Division of Rheumatology, University of Washington, Seattle Washington; Division of Rheumatology and Experimental Medicine, University of Florence, Florence, Italy.


Authors:
Abu Faddan NH1, Sherif TM2, Mohammed OA2, Nasif KA3, El Gezawy EM2.

Title:
Intestinal Barrier Integrity And Function In Infants With ‎Cholestasis

Abstract:
BACKGROUND/AIMS:
The safety of the human body is maintained by effective monitoring of the mucosal surface integrity and protection against potentially harmful compounds. This function of the gut called intestinal barrier function can be affected by cholestasis and the absence of bile in the intestinal lumen. We aimed to determine whether the gut barrier integrity is impaired in infants with cholestasis by evaluation of the intestinal fatty acid binding proteins (I-FABP) and ileal bile acid binding protein (I-BABP) as markers of intestinal epithelial cell damage and plasma D-lactate level as a marker of gut wall permeability.

METHODS:
This case-control study included 53 infants with cholestasis and 29 controls. Serum levels of I-FABP, I-BABP, and D-lactate were measured in all subjects.

RESULTS:
Both groups of patients with neonatal hepatitis and biliary atresia showed significantly higher levels of I-FABP and I-BABP than the controls. There were no differences in the serum D-lactate level between the cases and controls. There was no difference between the two groups of patients (I and II) regarding any of the parameters studied. No significant correlations between serum levels of I-FABP, I-BABP, or D-lactate and total or direct bilirubin levels were found in the cholestatic infants.

CONCLUSIONS:
The intestinal epithelial barrier integrity is breached nearly in all parts of the intestine in infants with cholestasis. Further research is recommended to determine the impact of this finding on the management of these infants. The relationship between physical intestinal barrier damage and its functional failure remains subject for further research.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Biochemistry, Faculty of Medicine, Minya University, Minya, Egypt.


Authors:
Ahmed Hassan E1, Sharaf El-Din Abd El-Rehim A1, Ahmed Sayed ZE2, Farah Mohamed Kholef E3, Sabry A4, Abd El-Rehim Abo Elhagag N5.

Title:
VAP Score As A Novel Non-Invasive Liver Fibrosis Model ‎In Patients With Chronic Hepatitis C

Abstract:
AIM:
Assessment of liver fibrosis in chronic hepatitis C (CHC) patients is necessary before antiviral treatment. This study aimed to evaluate the effectiveness of eight non-invasive models (aspartate aminotransferase [AST]/alanine transaminase ratio [AAR], AST/platelet ratio index [APRI], fibrosis-cirrhosis index [FCI], fibrosis index [FI], fibrosis-4 [FIB-4] score, fibrosis quotient [FibroQ], King, and von Willebrand factor antigen (vWF-Ag)/thrombocyte ratio [VITRO] scores) for predicting fibrosis compared with liver biopsy and to create a new score for predicting different fibrosis stages with increased accuracy.

METHODS:
We prospectively studied 127 treatment-naive CHC patients who underwent liver biopsy. The AAR, APRI, FCI, FI, FIB-4, FibroQ, King and VITRO scores were calculated and correlated with fibrosis stages. A new score (VAP) was derived from vWF-Ag, AST, and platelets: [VAP = (AST (U/L) × vWF-Ag)/platelets (109 /L)].

RESULTS:
Apart from AAR, readily available scores were correlated with liver fibrosis stages. VITRO (r = 0.62) and APRI (r = 0.46) showed the closest correlation. Our new (VAP) score significantly correlated with fibrosis stages (r = 0.702, P < 0.001). Compared to other scores, VAP had the highest area under the receiver operating characteristic curve, with 0.854, 0.921, 0.849, and 0.861 for mild (F1), significant (≥F2), advanced (≥F3) fibrosis, and cirrhosis (F4) respectively. At a cut-off value >1, VAP had 75.2% sensitivity and 100% positive predictive value for predicting mild fibrosis. At a cut-off value >2.3 for predicting cirrhosis, VAP had 73% sensitivity and 81.7% positive predictive value.

CONCLUSIONS:
The VAP score is a novel model that had higher diagnostic performance to predict different fibrosis stages and subclinical cirrhosis among CHC patients compared to the other studied scores and hence may offer a useful strategy to stratify patients who would benefit from direct-acting antivirals.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Aswan University, Aswan, Egypt.
4
Department of Internal Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.
5
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Ahmed A1,2, Wang LL1,3, Abdelmaksoud S2, Aboelgheit A2, Saeed S2, Zhang CL4,5.

Title:
Minocycline Modulates Microglia Polarization In Ischemia-Reperfusion Model Of Retinal Degeneration And Induces Neuroprotection

Abstract:
Retinal ischemia-reperfusion (IR) injury causes irreversible loss of neurons and ultimately leads to permanent visual impairment and blindness. The cellular response under this pathological retinal condition is less clear. Using genetically modified mice, we systematically examined the behavior of microglia/macrophages after injury. We show that IR leads to activation of microglia/macrophages indicated by migration and proliferation of resident microglia and recruitment of circulating monocytes. IR-induced microglia/macrophages associate with apoptotic retinal neurons. Very interestingly, neuron loss can be mitigated by minocycline treatment. Minocycline induces Il4 expression and M2 polarization of microglia/macrophages. IL4 neutralization dampens minocycline-induced M2 polarization and neuroprotection. Given a well-established safety profile as an antibiotic, our results provide a rationale for using minocycline as a therapeutic agent for treating ischemic retinal degeneration.

Author Info:
1
Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA.
2
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA.
4
Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA. Chun-Li.Zhang@UTSouthwestern.edu.
5
Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA. Chun-Li.Zhang@UTSouthwestern.edu.


Title:
Radiation Exposure, The Forgotten Enemy: Toward Implementation Of National Safety Program.

Abstract:
Radiation safety is an important counterpart in all facilities utilizing ionizing radiations. The concept of radiation safety has always been a hot topic, especially with the late reports pointing to increased hazards with chronic radiation exposure. Adopting a nationwide radiation safety program is considered one of the most urging topics, and is a conjoint responsibility of multiple disciplines within the health facility.

Author Info:
1
Interventional Cardiology, Department of Cardiovascular Medicine, Asyut University Hospital, Egypt


Authors:
Al-Attar G1, De Meyer S2, El-Gibaly O3, Michielsen K2, Animosa LH4, Mmari K4.

Title:
"A Boy Would Be Friends With Boys … and a Girl … With Girls": Gender Norms in Early Adolescent Friendships in Egypt and Belgium

Abstract:
PURPOSE:
A gender analysis was conducted to illuminate the key elements of friendships highlighted by early adolescent girls and boys in two sites for the purpose of better understanding the impact of gender norms on adolescent friendships in different contexts.

METHODS:
Narrative interviews with early adolescents were conducted in two sites: Assiut, Egypt (n = 37) and Ghent, Belgium (n = 30). The interviews were recorded, transcribed, translated into English, and coded using Atlas.ti for analysis.

RESULTS:
In both Assiut and Ghent, early adolescents reported some similarities in defining key characteristics of their same-sex friends as well as in the activities they share. However, differences were noticed among boys and girls within each site. In addition, the scope of shared activity was broader in Ghent than in Assiut. In both sites, few opposite-sex friendships were reported. Gender norms influenced choice of friends as well as the type and place of shared activities.

CONCLUSIONS:
Building on knowledge that adolescent friendships guide and reinforce attitudes, beliefs, and behaviors that impact immediate and long-term health, our findings indicate that gender norms inform early adolescent friendships, which may impact healthy development.

Author Info:
Al-Attar G1, De Meyer S2, El-Gibaly O3, Michielsen K2, Animosa LH4, Mmari K4.


Title:
Cost-Effectiveness Analysis of Family Planning Services Offered by Mobile Clinics versus Static Clinics in Assiut, Egypt

Abstract:
Cost effectiveness studies of family planning (FP) services are very valuable in providing evidence-based data for decision makers in Egypt. Cost data came from record reviews for all 15 mobile clinics and a matched set of 15 static clinics and interviews with staff members of the selected clinics at Assiut Governorate. Effectiveness measures included couple years of protection (CYPs) and FP visits. Incremental cost-effectiveness ratios (ICER) and sensitivity analyses were calculated. Mobile clinics cost more per facility, produced more CYPs but had fewer FP visits. Sensitivity analysis was done using: total costs, CYP and FP visits of mobile and static clinics and showed that variations in CYP of mobile and static clinics altered the ICER for CYP from $2 -$6. Mobile clinics with their high emphasis on IUDs offer a reasonable cost effectiveness of $4.46 per additional CYP compared to static clinics. The ability of mobile clinics to reach more vulnerable women and to offer more long acting methods might affect a policy decision between these options. Static clinics should consider whether emphasizing IUDs may make their services more cost-effective.

Author Info:
1
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Population, Family & Reproductive Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.


Authors:
Al-Eyadhy AA1, Hasan G2, Bassrawi R3, Al-Jelaify M4, Temsah MH5, Alhaboob A1, Al-Sohime F1, Alabdulhafid M1.

Title:
Cytomegalovirus Associated Severe Pneumonia, Multi-Organ Failure And Ganciclovir Associated Arrhythmia In Immunocompetent Child

Abstract:
Cytomegalovirus (CMV) can rarely cause severe manifestations in immunocompetent individuals. Hereby, we report a twelve-year-old boy who presented with tachycardia, tachypnea, fever and leukocytosis, which progressed to hypoxemic respiratory failure and severe acute respiratory distress syndrome (ARDS). Subsequently, he developed multi-organ failure despite the ongoing full supportive care and empiric broad spectrum antibiotics. Cytomegalovirus infection was diagnosed by Polymerase Chain Reaction (PCR) in blood and histopathological examination of lung biopsy. Immunological work up for the child was unremarkable. Ganciclovir therapy was introduced and showed significant improvement until full recovery. However, our patient developed transient heart block as a rare complication for Ganciclovir therapy throughout his course. We present this case with literature review for the CMV infection associated morbidity and mortality among immunocompetent children.

Author Info:
1
Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
2
Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Assiut University Children Hospital, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: gahmed@ksu.edu.sa.
3
Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia.
4
Pharmacy Services, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia.
5
Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Prince Abdullah Bin Khaled Coeliac Disease Research Chair (PAK CDRC), Saudi Arabia.


Authors:
Alanwar A1, Al-Sayed HM1, Ibrahim AM1, Elkotb AM1, Abdelshafy A1, Abdelhadi R1, Abbas AM2, Abdelmenam HS3, Fares T3, Nossair W4, Abdallah AA5, Sabaa H1, Nawara M1.

Title:
Urinary Tract Injuries During Cesarean Section In Patients With Morbid Placental Adherence: Retrospective Cohort Study

Abstract:
BACKGROUND/OBJECTIVE:
The purpose of this study is to evaluate the cases of lower urinary tract injuries during cesarean section with or without hysterectomy in cases with morbid placental adherence.

METHODS:
This record based retrospective study was conducted at Ain Shams University Maternity Hospital in Cairo, Egypt during the period between January 2014 and December 2016. It included all patients who had urinary tract injuries during cesarean section with or without hysterectomy in the cases with morbid placental adherence and they were collected from files of pregnant women who were admitted at hospital planned for termination of pregnancy. Patients were enrolled in four groups, Group 1: cases without urinary tract injuries. Group 2: cases with injuries to the bladder. Group 3: cases with injuries of the ureter. Group 4: cases with injuries to the bladder and ureter.

RESULTS:
This study gave us new information about the incidence of urinary tract injuries during cesarean section with morbid adherence placenta was 21.7% (Bladder 11.7%, Ureter 4.7%, and bladder with ureter 5.3%). There were various types of repair of urinary tract injury, as the following, bladder repair 10.8%, ureteric catheterization 0.9%, ureterovesical repair or reimplantation 1.5%, bladder repair and ureterovesical 1.2%, bladder repair and ureteric catheterization 2.3%, ureteric catheterization and ureterovesical 1.5 and 6.4% of cases needed urologic consultations. There is a real relation between urinary tract injury and obesity (55.3%). Bladder invasion was found in only 26.9% of all cases according to sonography findings. Most of the cases were delivered by cesarean section in 67.5%, and the remainders were delivered by cesarean hysterectomy 32.5%. About 96.5% of cases needed a blood transfusion.

CONCLUSIONS:
The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications.

Author Info:
1
a Ain Shams Maternity Hospital, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
2
b Faculty of Medicine , Assiut University , Assiut , Egypt.
3
c Faculty of Medicine , Al Azhar University , Cairo , Egypt.
4
d Faculty of Medicine , Zagazik University , Zagazik , Egypt.
5
e Faculty of Medicine , Minia University , Minia , Egypt.


Title:
Efficacy And Safety Of Duplex-Guided Polidocanol Foam Sclerotherapy For Venous Malformations

Abstract:
BACKGROUND:
The aim of our study was to report our experience regarding the safety, efficacy of duplex-guided polidocanol (POL) foam sclerotherapy on the overall status of signs and symptoms in patients with venous malformations (VMs).

METHODS:
Thirty seven patients with symptomatic extratruncular VMs were treated with duplex-guided POL foam sclerotherapy using Tessari's method. Twenty five patients had limited VMs, while twelve had infiltrating VMs. Postsclerotherapy surveillance was done 6 months after the last sclerotherapy session and comprised both clinical and duplex evaluation. Clinical evaluation entailed a patient self-assessment questionnaire using a four-point scale to rate the degree of symptoms improvement as follows: disappeared, decreased, worsened, or recurred. Findings obtained by duplex scanning were divided into four groups: 1) disappeared group; 2) partially recanalized group; 3) totally recanalized group; and 4) worsened group.

RESULTS:
There were 20 males and 17 females with mean age of 22.8±5.5 years. There was a significant reduction in the total amount of POL (P=0.0037), the number of sclerotherapy sessions was significantly lesser (P=0.0019), and treatment success was significantly higher (P=0.0495) in patients with limited VMs in comparison to those with infiltrating VMs. No major complications related to sclerotherapy were encountered in both groups.

CONCLUSIONS:
Polidocanol foam sclerotherapy is effective, and safe for treatment of VMs, with high success rate and low risk of major complications. Although associated with relatively high recurrence rate compared with ethanol sclerotherapy, this can be overcome by additional treatment sessions, given the relative simplicity, speed, and safety.

Author Info:
1
Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt - haithamvascular@gmail.com.
2
Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt.
3
Vascular Surgery Department, Qena University Hospital, Qena, Egypt.


Authors:
Ali H1, Elbadawy A2, Saleh M2, Mahmoud O2.

Title:
Mid-term Results of Catheter Directed Foam Sclerotherapy Combined with Tumescent Local Anaesthesia for Treatment of Great Saphenous Vein Incompetence

Abstract:
OBJECTIVES:
The purpose of this prospective study was to evaluate the occlusion rate, clinical severity, disease specific health related quality of life (HRQoL), and safety in patients with great saphenous vein (GSV) reflux 3 years after a single treatment session of catheter directed foam sclerotherapy (CDFS) combined with peri-saphenous infiltration of tumescent local anaesthesia (TLA).

METHODS:
A total of 249 patients with symptomatic unilateral GSV incompetence underwent CDFS combined with TLA and were followed up for 3 years. The primary outcome was complete obliteration of the treated segment of the GSV. Secondary outcomes were changes in Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ) score, absence of above knee GSV reflux, and safety of treatment.

RESULTS:
Three years after CDFS, the estimated cumulative proportion of persistently obliterated above knee GSV was 81.5%. Freedom from above knee GSV reflux was demonstrated in 89.6% of patients. Both the VCSS and CIVIQ score improved significantly (p < .0001 and <.0001, respectively). No major adverse events were encountered. Thrombophlebitis, skin pigmentation/matting, and transient scotomata were reported in 2%, 7.8%, and 0.8% of cases, respectively.

CONCLUSION:
CDFS combined with TLA for treatment of GSV incompetence yields good mid-term results in terms of occlusion rate, clinical severity, patients' QoL, and safety.

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


Authors:
Ali MA1, Lacin S1, Abdel-Wahab R1,2, Uemura M1, Hassan M1, Rashid A3, Duda DG4, Kaseb AO1.

Title:
Nonalcoholic Steatohepatitis-Related Hepatocellular Carcinoma: Is There A Role For The Androgen Receptor Pathway?

Abstract:
The epidemic of insulin resistance, obesity, and metabolic syndrome has led to the emergence of nonalcoholic steatohepatitis (NASH) as the most common cause of liver disease in the US. Patients with NASH are at an increased risk for hepatic disease-related morbidity and death, and chronic inflammation in NASH patients can lead to hepatocellular carcinoma (HCC). The prevalence of HCC is higher in males than in females, and genetic studies have identified androgen and androgen receptors (ARs) as partially responsible for the gender disparity in the development of liver disease and HCC. Although many factors are known to play important roles in the progression of inflammation in NASH patients, the role of androgen and AR in the progression of NASH to HCC has been understudied. This review summarizes the evidence for a potential role of androgen and the AR pathway in the development of NASH-related HCC and in the treatment of HCC. It has been proposed that AR plays a role in the progression of HCC: inhibitory roles in early stages of hepatocarcinogenesis and tumor-promoting roles in advanced stages. AR can be activated by several pathways, even in the absence of androgen. While AR has been explored as a potential therapeutic target in HCC, several clinical trials have failed to demonstrate a clinical benefit of antiandrogen drugs in HCC. This review discusses the potential reason for these observations and discuss the potential future trials design in this important setting.

Author Info:
1
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2
Department of Clinical Oncology, Assiut University, Assiut, Egypt.
3
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
4
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.


Authors:
Ali MAS1, Lobos CM2, Abdelmegid MAF3, El-Sayed AM4.

Title:
The Frequency And Nature Of Medication Errors In Hospitalized Patients With Acute Coronary Syndrome

Abstract:
Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4-35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5-10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.

Author Info:
1
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt. mostafa.ali3@pharm.au.edu.eg.
2
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt.
3
Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Authors:
Ali MK1, Abbas AM1, Abdelmagied AM1, Mohammed GE2, Abdalmageed OS1.

Title:
A Randomized Clinical Trial Of The Efficacy Of Single Versus Double-Daily Dose Of Oral Iron For Prevention Of Iron Deficiency Anemia In Women With Twin Gestations

Abstract:
OBJECTIVE:
The study aims to assess the efficacy of single versus double-daily oral iron dose on prevention of iron deficiency anemia in women with twin gestations.

MATERIALS AND METHODS:
A randomized controlled trial (NCT02858505) conducted at Woman's Health Hospital, Assiut, Egypt, between August 2015 and June 2016 included 120 non-anemic pregnant women with twin gestations in the first trimester. Women were randomly assigned to either group I (27 mg elemental iron) or group II (54 mg elemental iron) daily starting from 12 weeks of pregnancy till 36 weeks. The primary outcomes included the mean level of hemoglobin, hematocrit and serum ferritin at 36 weeks' gestation.

RESULTS:
Both iron doses maintained the mean hemoglobin and hematocrit within the normal level from 12 weeks to 36 weeks (p = 0.378 and p = 0.244, respectively). However, the mean serum ferritin level was higher in group II than group I (p = 0.000) at 36 weeks' gestation. Moreover, women in group II reported more side effects than group I at 36 weeks' gestation.

CONCLUSIONS:
Doubling the prophylactic iron dose is comparable to single dose in the prevention of iron deficiency anemia among women with twin gestations with more side effects.

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


Authors:
Ali MK1, Amin ME2, Amin AF3, Abd El Aal DEM3.

Title:
Evaluation Of The Effectiveness Of Low-Dose Aspirin And Omega 3 In Treatment Of Asymmetrically Intrauterine Growth Restriction: A Randomized Clinical Trial

Abstract:
OBJECTIVE:
To test the effect of aspirin and omega 3 on fetal weight as well as feto-maternal blood flow in asymmetrical intrauterine growth restriction (IUGR).

STUDY DESIGN:
This study is a clinically registered (NCT02696577), open, parallel, randomized controlled trial, conducted at Assiut Woman's Health Hospital, Egypt including 80 pregnant women (28-30 weeks) with IUGR. They were randomized either to group I: aspirin or group II: aspirin plus omega 3. The primary outcome was the fetal weight after 6 weeks of treatment. Secondary outcomes included Doppler blood flow changes in both uterine and umbilical arteries, birth weight, time and method of delivery and admission to NICU. The outcome variables were analyzed using paired and unpaired t-test.

RESULTS:
The estimated fetal weight increased significant in group II more than group I (p=0.00). The uterine and umbilical arteries blood flow increased significantly in group II (p<0.05). The birth weight in group II was higher than that observed in group I (p<0.05).

CONCLUSION:
The using of aspirin with omega 3 is more effective than using aspirin only in increasing fetal weight and improving utero-placental blood flow in IUGR.

Author Info:
1
Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt. Electronic address: m_khairy2001@yahoo.com.
2
Department of Obstetrics & Gynecology, Hurghada Hospital, Egypt.
3
Department of Obstetrics & Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.


Authors:
Allam A1, Thomsen AR2, Gothwal M2, Saha D3, Maurer J4, Brunner TB5.

Title:
Pancreatic Stellate Cells In Pancreatic Cancer: In Focus

Abstract:
Pancreatic stellate cells are stromal cells that have multiple physiological functions such as the production of extracellular matrix, stimulation of amylase secretion, phagocytosis and immunity. In pancreatic cancer, stellate cells exhibit a different myofibroblastic-like morphology with the expression of alpha-smooth muscle actin, the activated form is engaged in several mechanisms that support tumorigenesis and cancer invasion and progression. In contrast to the aforementioned observations, eliminating the stromal cells that are positive for alpha-smooth muscle actin resulted in immune-evasion of the cancer cells and resulted in worse prognosis in animal models. Understanding the cancer-stromal signaling in pancreatic adenocarcinoma will provide novel strategies for therapy. Here we provide an updated review of studies that handle the topic "pancreatic stellate cells in cancer" and recent experimental approaches that can be the base for future directions in therapy.

Author Info:
1
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; Clinical Oncology and Nuclear Medicine Department, Assiut University Hospitals, Egypt.
2
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
3
Department of Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
4
Department of Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
5
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: thomas.brunner@uniklinik-freiburg.de.


Authors:
Aly MG1, Zhu L2, Weimer R3, Opelz G4, Morath C5, Kuon R6, Tohamy M7, Saadi G8, Soliman M7, Ibrahim W7, Daniel V9.

Title:
Low Utility Of Serum 25-Hydroxyvitamin D3 And 1, 25-Dihydroxyvitamin D3 In Predicting Peripheral Treg And Th17 Cell Counts In ESRD And Renal Transplant Patients

Abstract:
BACKGROUND:
Vitamin D has shown an immune-modulatory effect in different studies. Vitamin D stimulates Tregs and inhibits Th17 cells. The immune-modulatory role of vitamin D in chronic kidney disease (CKD) and renal transplant patients is unclear. We measured whether different serum levels of vitamin D were associated with an increased or decreased presence of lymphocyte subsets including Treg and Th17 cells in end-stage renal disease (ESRD) and renal transplant recipients.

METHODS:
Eighty-seven renal transplant recipients and 53 end-stage renal disease (ESRD) patients were enrolled in this study. The absolute counts of CD4+ and CD8+ T, CD16+ CD56+ NK, CD19+ B, CD4+ CD25+ CD127- Foxp3+ (Tregs), Helios+ Tregs, CD38+ Tregs, and CD4+ CD17+ (Th17) cells were analyzed in peripheral blood in both patient groups. In addition, serum 25 (OH) D3, 1, 25 (OH)2 D3, IL-6, IL-17, IL-23, and TGF-β1 were measured. The association between lymphocyte subset counts and 1, 25 (OH)2 D3 or 25 (OH) D3 was studied, as was the association between serum IL-6, IL-17, IL-23, or TGF-β1 and 1,25 (OH)2 D3 or 25 (OH) D3.

RESULTS:
Serum 25 (OH) D3 and 1,25 (OH)2 D3 levels were not independently associated with peripheral CD4+ T, CD19+ B, CD16+ CD56+ NK, Treg, or Th17 cell counts. In contrast to serum 25 (OH) D3, serum1, 25 (OH)2 D3 was positively associated with CD8+ T cells counts in renal transplant recipients.

CONCLUSION:
Our findings indicate low utility of serum 25 (OH) D3 and 1, 25 (OH)2 D3 levels in predicting a change in lymphocyte subset counts in ESRD and renal transplant patients.

Author Info:
1
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; Nephrology Unit, Internal Medicine Department, Assiut University, Egypt; Department of Internal Medicine, University of Giessen, Klinikstrasse 33, D-35385 Giessen, Germany. Electronic address: M_Gaafar1984@hotmail.com.
2
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany; Department of Hematology, Tongji Hospital, Huazhong University of Science and Technology, 430030 Wuhan, China. Electronic address: Li.Zhu@med.uni-heidelberg.de.
3
Department of Internal Medicine, University of Giessen, Klinikstrasse 33, D-35385 Giessen, Germany. Electronic address: Rolf.Weimer@innere.med.uni-giessen.de.
4
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany. Electronic address: Gerhard.opelz@med.uni-heidelberg.de.
5
Department of Nephrology, University of Heidelberg, Heidelberg, Germany. Electronic address: Christian.Morath@med.uni-heidelberg.de.
6
Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany. Electronic address: Ruben.kuon@med.uni-heidelberg.de.
7
Nephrology Unit, Internal Medicine Department, Assiut University, Egypt.
8
Kasr-El-Aini Nephrology and Dialysis Center, Cairo University, Egypt.
9
Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany. Electronic address: Volker.Daniel@med.uni-heidelberg.de.


Author Info:
1
1 Transplantation-Immunology, Institute of Immunology, University Hospital Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany. 2 Nephrology Unit, Internal Medicine Department, Assiut University, Egypt.


Authors:
Ashshi AM1, Alghamdi S1, El-Shemi AG1,2, Almdani S3, Refaat B1, Mohamed AM1,4, Ghazi HO5, Azhar EI6, Al-Allaf FA7.

Title:
Seroprevalence of Asymptomatic Dengue Virus Infection and Its Antibodies Among Healthy/Eligible Saudi Blood Donors: Findings From Holy Makkah City

Abstract:
BACKGROUND:
Threat to blood transfusion-transmitted dengue virus (DENV) and its antibodies has recently emerged worldwide. Dengue fever is an endemic disease in Saudi Arabia, particularly in its Western region. The aim of this study was to estimate the seroprevalence of asymptomatic DENV infection and its antibodies among eligible Saudi blood donors.

METHODS:
Serum samples from 910 healthy/eligible adult male Saudi blood donors, who reside in Holy Makkah City of Saudi Arabia, were collected between March 2015 and August 2016 and screened for the detection of DENV nonstructural protein 1 (NS1) antigen and anti-DENV IgM and IgG antibodies using commercial enzyme-linked immunosorbent assay kits (Panbio, Brisbane, QLD, Australia).

RESULTS:
Among the tested donors, 48 (5.3%) were seropositive for DENV-NS1 antigen, whereas 50 (5.5%) and 354 (38.9%) were seropositive for anti-DENV IgM and IgG antibodies, respectively. Seropositivity for DENV-NS1 antigen and/or anti-DENV IgM antibody among the tested donors reflects their ongoing asymptomatic viremic infectious stage with DENV during their donation time, whereas high prevalence of anti-DENV IgG seropositivity reflects the high endemicity of dengue disease in this region of Saudi Arabia.

CONCLUSIONS:
These results show high prevalence of asymptomatic DENV infection and its antibodies among Saudi blood donors, raising the importance of establishing blood screening for dengue disease at different blood donation services and units in Saudi Arabia to improve the guarantee of blood transfusions and to control DENV dissemination.

Author Info:
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
2
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Immunology Unit, Regional Laboratory of Holy Makkah, Holy Makkah, Saudi Arabia.
4
Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
5
Department of Medical Microbiology, College of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.
6
Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
7
Department of Human Genetics, College of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.


Authors:
Assal F1, El Kassas M2, Esmail E1, Elbadry AA3, Abousaif S1, Mahdy R4, Elfert A1.

Title:
Microwave Ablation In The Spleen Versus Partial Splenic Artery Embolisation: A New Technique For Hypersplenism In Cirrhosis

Abstract:
BACKGROUND AND STUDY AIMS:
Splenectomy has been associated with high perioperative morbidity and mortality. Partial splenic artery embolisation (PSE) was found to be an effective and safer method but with numerous complications. Local thermal ablative techniques such as microwave ablation (MWA) have been tried and were found to be safe and effective alternatives. This randomised controlled study aimed to compare the efficacy and safety of MWA versus PSE in the treatment of hypersplenism in patients with post-hepatitis C cirrhosis.

PATIENTS AND METHODS:
In total, 40 patients with post-hepatitis C cirrhosis complicated with hypersplenism were randomised into two groups: Group I: 20 patients treated with percutaneous MWA of splenic parenchyma under ultrasound guidance and Group II: 20 patients treated with PSE using Embosphere.

RESULTS:
There was a significant increase in haemoglobin levels in group I compared with group II after 3months of follow-up. However, White blood cell (WBC) count and platelets significantly increased more in group II than in group I after 1month. Postprocedure significant hyperbilirubinaemia, hypoalbuminaemia, decreased prothrombin concentration, and increased creatinine levels were encountered in group II only. There was a significant increase in postoperative complications in group II compared to group I, and a single case of mortality was reported in group II.

CONCLUSION:
MWA and PSE were comparably effective; however, MWA was safer than PSE, which caused serious adverse events and mortality. MWA appears to be a good alternative for the treatment of hypersplenism in patients with cirrhosis and portal hypertension.

Author Info:
1
Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
2
Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt. Electronic address: m_elkassas@yahoo.com.
3
Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
4
Internal Medicine Department, Assiut University, Assiut, Egypt.


Title:
Transcatheter Arterial Chemoembolization Of Hepatocellular Carcinoma In Patients With Celiac Axis Occlusion Using Pancreaticoduodenal Arcade As A Challenging Alternative Route

Abstract:
INTRODUCTION:
Celiac axis occlusion is a challenging condition when catheterization of the hepatic artery is required for chemoembolization of hepatocellular carcinoma (HCC). As a result, the hepatic artery has to be catheterized through the pancreaticoduodenal arcades (PDA) and the gastroduodenal artery (GDA) from the superior mesenteric artery (SMA) which is a tortuous course with acute angles and small caliber branches.

OBJECTIVE:
To assess new techniques for facilitating catheterization of the tortuous PDA and the GDA to reach the proper hepatic artery (PHA) and tumor-feeding branches in patients with celiac axis occlusion undergoing chemoembolization of HCC.

METHODS AND MATERIALS:
The study included eleven patients all admitted to do transcatheter arterial chemoembolization (TACE) for treatment of unresectable HCC. During angiography occlusion of the celiac axis was diagnosed and hypertrophied PDA and GDA was noted in SMA angiography. Catheterization of the PDA was performed by preshaping of the micro-guide wire into a wide curve. Catheterization of the PHA was a challenge and was achieved by reshaping of the micro-guide wire or by looping technique. TACE was done after super selective catheterization of the tumor feeding artery using a mixture of 50 mg of adriamycin, 7cc of lipiodol and gelfoam.

RESULTS:
In the eleven patients with celiac artery occlusion, DSA showed complete celiac axis occlusion in all patients. Collateral arteries supplying the liver were readily evident via PDA and GDA from SMA. Successful catheterization of the PHA was achieved in all patients. Chemoembolization was performed to all patients after super selective catheterization of the feeding artery. Follow-up triphasic CT was performed in all patients, 9 patients showed good lipiodol trapping with no residual tumor enhancement. Two patients required another session of TACE.

CONCLUSION:
Chemoembolization of HCC through the PDA and the GDA using micro-guide wire preshaping technique and the microcatheter looping technique in patients with celiac axis occlusion is a challenging but effective treatment for HCC.

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


Authors:
Awad SM1, Ismail SA2, Sayed DS2, Refaiy AE3, Makboul R3.

Title:
Suppression Of Transforming Growth Factor-Beta1 Expression In Keloids After Cryosurgery

Abstract:
The biological mechanism underlying cryosurgical treatment of keloids remains unclear. Transforming growth factor-beta1 (TGF-β1) has been implicated in the pathogenesis of keloids and was reported to be the target of several therapeutic modalities. However, the effect of cryosurgery on its expression in keloid tissue has not been yet investigated. In this study, 26 consecutive keloid patients were treated with cryosurgery for 2-6 sessions. Keloids were biopsied before starting cryosurgery and after two treatment sessions for the immunohistochemical evaluation of TGF-β1 expression. The average volume reduction, after two treatment sessions (in 22 patients completing the study) was 68.77 ± 15.82%. Dermal overexpression of TGF-β1 was demonstrated in all keloid specimens before treatment. Following therapy, significant reduction of that expression was detected in all keloid specimens (P = 0.016). In addition to attesting the clinical efficacy of cryosurgery, our findings indicate that cryosurgery effectively suppressed TGF-β1 expression, possibly contributing to keloid regression.

Author Info:
1
Department of Dermatology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: saramawad@gmail.com.
2
Department of Dermatology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Title:
Attitudes Of Physicians Providing Family Planning Services In Egypt About Recommending Intrauterine Device For Family Planning Clients

Abstract:
OBJECTIVES:
To assess the attitudes of physicians providing family planning services at the public sector in Egypt about recommending intrauterine device (IUD) for family planning clients, and to identify the factors that could affect their attitudes.

METHODS:
A descriptive cross sectional study, in which all the physicians providing family planning services in Assiut Governorate were invited to complete self-administered questionnaires. The study participants were recruited at the family planning sector monthly meetings of the 13 health directorates of Assiut Governorate, Upper Egypt. 250 physicians accepted to participate in the study. Bivariate and Multivariate regression analyses were performed to identify the most important predictors of recommending IUD to family planning clients when appropriate.

RESULTS:
Less than 50% of physicians would recommend IUD for clients with proper eligibility criteria; women younger than 20 years old (49.2%), women with history of ectopic pregnancy (34%), history of pelvic inflammatory diseases (40%) or sexually transmitted diseases (18.4%) and nulliparous women (22.8%). Receiving family planning formal training within the year preceding data collection and working in urban areas were the significant predictors of recommending IUD insertion for appropriate clients.

CONCLUSION:
Physicians providing family planning services in Upper Egypt have negative attitudes about recommending IUD for family planning clients. Continuous education and in-service training about the updated medical eligibility criteria, especially for physicians working in rural areas may reduce the unfounded medical restrictions for IUD use.

Author Info:
1
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt. Electronic address: miretteaziz@aun.edu.eg.
2
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt. Electronic address: Sabraa11@yahoo.com.
3
Al-Eman General Hospital, Assiut, Egypt. Electronic address: Boshrahussien@yahoo.com.


Authors:
Badary DM1, Abdel-Wanis ME2, Hafez MZ3, Aboulhagag NA4.

Title:
Immunohistochemical Analysis Of PTEN, HER2/Neu, And Ki67 Expression In Patients With Gastric Cancer And Their Association With Survival

Abstract:
BACKGROUND:
Considering the poor prognosis of patients with gastric cancer, molecular diagnostic and prognostic markers for this cancer should be established. The aims of our study were to assess the correlations between PTEN, HER2/neu, and Ki67 expressions and clinicopathological factors of gastric cancer patients in upper Egypt, as well as their influence on OS and DFS.

PATIENTS AND METHODS:
In this descriptive-analytic study, 42 patients with gastric carcinoma treated by postioerative chemoradiation between 2004 and 2014. Pathological review was done. Immunohistochemical staining and evaluation were performed.

RESULTS:
All the studied markers were significantly correlated with increased TNM stage. Her2/neu overexpression and positive Ki67 expression were significantly associated with histological grade. High percentage of positive Her2/neu and Ki67expression was found in gastric carcinoma tissue samples which lack PTEN expression. The one-year OS rate for the entire group (n=42) was 77.4%, whereas the DFS rate was 45%. Pathological T stage PTEN status significantly affected both OS (p=0.029 and 0.027 respectively) and DFS (p=0.006 and 0.012 respectively) rates. Multivariate Cox analyses showed that only pathological T stage was an independent prognostic factor affecting OS (P=0. 007, HR: 2.02; 95% CI: 1.2-3.38)and DFS(P<0.0001, HR: 2.69; 95% CI: 1.54-4.69).

CONCLUSION:
All the studied molecular markers, was significantly correlated with pathological T stage that significantly affected both OS and DFS rates. These findings indicate that these markers have an important role in gastric cancer growth and dissemination so these markers can be used as a prognostic biomarker. In addition, therapies targeting Her2 and PTEN may help develop novel therapeutics for gastric cancer.

Author Info:
1
Pathology Department, Faculty of Medicine, Assiut University, Egypt. Electronic address: hamasat82@yahoo.com.
2
Radiation Oncology Department, SECI, Egypt; South Egypt Cancer Institute (SECI), Al-Methaq Street, Assiut, Egypt. Electronic address: mostafawanis@yahoo.com.
3
Internal Medicine Department, Faculty of Medicine, Aswan University, Egypt; Internal Medicine Department, Aswan University, Aswan, Egypt. Electronic address: m.zain2014@gmail.com.
4
Pathology Department, Faculty of Medicine, Assiut University, Egypt; Pathology Department, Assuit University, Al-Gamaa Street, Assiut, Egypt. Electronic address: nohah74@yahoo.com.


Authors:
Bakir HY1, Ah Attia R1, Mahmoud AE1, Ibraheim Z2.

Title:
M-RNA Gene Expression of INF-Γ and IL-10 during Intestinal Phase of Trichinella Spiralis after Myrrh and Albendazole Treatment

Abstract:
BACKGROUND:
The protective response developed against Trichinella spiralis infection provokes immune and inflammatory responses mediated by cytokines released from T helper cells. We aimed to evaluate the effect of albendazole or myrrh on the expression of IFN-γ and IL-10 in BALB/c mice infected with T. spiralis.

METHODS:
This study was done at the Animal House of Faculty of Medicine, Assiut University (Assiut, Egypt) from April to December 2015. Mice were infected with 300 T. spiralis larvae and treated with albendazole (50 mg/kg per day) or myrrh (500 mg/kg per day) for 3 consecutive days post-infection (pi). The expression of INF-γ and IL-10 was detected in the intestinal tissue by reverse transcription (RT) PCR.

RESULTS:
The expression of IFN-γ in mice treated with albendazole and myrrh was detected on days 3 and 15 pi respectively. In the control group, it was found on days 5, 10, 15 and 20 pi with the highest expression on day 15 pi. The expression of IL-10 was detected on days 3, 20 pi in the albendazole and myrrh treated groups, respectively. In the control group, IL-10 expression appeared on days 5 and day 20 pi.

CONCLUSION:
The target of albendazole and myrrh on the profile of IFN-γ and IL-10 on these cytokines were encouraging to reinforce their therapeutic use against trichinellosis.

Author Info:
1
Dept. of Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Dept. of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.


Authors:
Barnard EP1, AbdElmagied AM2, Vaughan LE3, Weaver AL3, Laughlin-Tommaso SK1, Hesley GK4, Woodrum DA4, Jacoby VL5, Kohi MP6, Price TM7, Nieves A7, Miller MJ8, Borah BJ9, Gorny KR4, Leppert PC7, Peterson LG10, Stewart EA11.

Title:
Periprocedural Outcomes Comparing Fibroid Embolization And Focused Ultrasound: A Randomized Controlled Trial And Comprehensive Cohort Analysis

Abstract:
BACKGROUND:
Uterine fibroids are a common problem for reproductive-aged women, yet little comparative effectiveness research is available to guide treatment choice. Uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery are minimally invasive therapies approved by the US Food and Drug Administration for treating symptomatic uterine fibroids. The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study is the first randomized controlled trial to compare these 2 fibroid treatments.

OBJECTIVE:
The objective of the study was to summarize treatment parameters and compare recovery trajectory and adverse events in the first 6 weeks after treatment.

STUDY DESIGN:
Premenopausal women with symptomatic uterine fibroids seen at 3 US academic medical centers were enrolled in the randomized controlled trial (n = 57). Women meeting identical criteria who declined randomization but agreed to study participation were enrolled in a nonrandomized parallel cohort (n = 34). The 2 treatment groups were analyzed by using a comprehensive cohort design. All women undergoing focused ultrasound and uterine artery embolization received the same postprocedure prescriptions, instructions, and symptom diaries for comparison of recovery in the first 6 weeks. Return to work and normal activities, medication use, symptoms, and adverse events were captured with postprocedure diaries. Data were analyzed using the Wilcoxon rank sum test or χ2 test. Multivariable regression was used to adjust for baseline pain levels and fibroid load when comparing opioid medication, adverse events, and recovery time between treatment groups because these factors varied at baseline between groups and could affect outcomes. Adverse events were also collected.

RESULTS:
Of 83 women in the comprehensive cohort design who underwent treatment, 75 completed postprocedure diaries. Focused ultrasound surgery was a longer procedure than embolization (mean [SD], 405 [146] vs 139 [44] min; P <.001). Of women undergoing focused ultrasound (n = 43), 23 (53%) underwent 2 treatment days. Immediate self-rated postprocedure pain was higher after uterine artery embolization than focused ultrasound (median [interquartile range], 5 [1-7] vs 1 [1-4]; P = .002). Compared with those having focused ultrasound (n = 39), women undergoing embolization (n = 36) were more likely to use outpatient opioid (75% vs 21%; P < .001) and nonsteroidal antiinflammatory medications (97% vs 67%; P < .001) and to have a longer median (interquartile range) recovery time (days off work, 8 [6-14] vs 4 [2-7]; P < .001; days until return to normal, 15 [10-29] vs 10 [10-15]; P = .02). There were no significant differences in the incidence or severity of adverse events between treatment arms; 86% of adverse events (42 of 49) required only observation or nominal treatment, and no events caused permanent sequelae or death. After adjustment for baseline pain and uterine fibroid load, uterine artery embolization was still significantly associated with higher opioid use and longer time to return to work and normal activities (P < .001 for each). Results were similar when restricted to the randomized controlled trial.

CONCLUSION:
Women undergoing uterine artery embolization have longer recovery times and use more prescription medications, but women undergoing focused ultrasound have longer treatment times. These findings were independent of baseline pain levels and fibroid load.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT00995878.

Author Info:
1
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
2
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
4
Department of Radiology, Mayo Clinic, Rochester, MN.
5
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
6
Department of 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 Research Administration, Mayo Clinic, Rochester, MN.
11
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. Electronic address: stewart.elizabeth@mayo.edu.


Authors:
Bayoumy MA1, El-Sayed A2, Elkady HA2, Saleh WR2, Said HG2, Ali AM1.

Title:
Arthroscopic Treatment of Type 1B Triangular Fibrocartilage Complex Tear by "Outside-In" Repair Technique Using Transcapsular Transverse Mattress Suture.

Abstract:
Triangular fibrocartilage complex (TFCC) injuries are increasingly recognized as a cause of ulnar-sided wrist pain. Palmer grouped these tears into either traumatic or degenerative, with various subclassifications. Magnetic resonance imaging (MRI), arthrogram, and arthroscopy are the methods used to establish the diagnosis. Several arthroscopic methods of TFCC repair including outside-in, inside-out, and all-inside techniques have been described. The outside-in repair, which involves piercing the TFCC via the ulnar side of the wrist, has been described by several authors, but the technique varies among authors with respect to instrumentation and subtle surgical modifications. The purpose of this article was to present the technique of arthroscopic outside-in repair using transverse mattress suture for type 1B TFCC tear by modifying classic vertical mattress sutures into sutures that pass completely through the disc.

Author Info:
1
Orthopaedic and Traumatology Department, Al-Azhar University, Faculty of Medicine in Assiut Branch, Assiut, Egypt.
2
Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.


Authors:
Biglioli F1, Kutanovaite O2, Rabbiosi D1, Colletti G1, Mohammed MAS3, Saibene AM4, Cupello S5, Privitera A5, Battista VMA1, Lozza A6, Allevi F7.

Title:
Surgical Treatment Of Synkinesis Between Smiling And Eyelid Closure

Abstract:
Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.

Author Info:
1
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
2
Maxillo-Facial Surgery Department, Vilnius University Hospital Zalgiris Clinics, Zalgirio, Vilnius, Lithuania.
3
Plastic Surgery Department, Assiut University, Egypt.
4
Otolaryngology Department, San Paolo Hospital, University of Milan, Milan, Italy.
5
Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy.
6
Service of Neurophysiopathology - National Neurological Institute C. Mondino, Pavia, Italy.
7
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy. Electronic address: fabiana.allevi@gmail.com.


Authors:
Daef EA1, Makhlouf NA2, Ahmed EH1, Mohamed AI3, Abd El Aziz MH3, El-Mokhtar MA1.

Title:
Serological and Molecular Diagnosis of Occult Hepatitis B Virus Infection in Hepatitis C Chronic Liver Diseases

Abstract:
Occult Hepatitis B infection (OBI), defined as the presence of serum HBV DNA without detectable HBsAg, can be classified into seropositive OBI [anti-HBc and/or anti-hepatitis B surface (anti- HBs) positive] and seronegative OBI (anti-HBc and anti- HBs negative). We examined the role of anti-HBc as a screening test for OBI in HCV patients with chronic liver diseases and evaluated the possible impact of OBI on liver disease progression. 90 patients with hepatitis C related chronic liver diseases (CLD) and negative for HBsAg were divided into three equal groups; chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Patients were tested for anti-HBc by ELISA and by PCR for S-gene. Total anti-HBc was found in 26 patients (28.9%). 8 patients (8.9%) had positive serum HBV DNA. Of these, 2 were positive for anti-HBc and 6 negative for anti-HBc. No correlation between OBI and severity of HCV related CLD was observed. In conclusion, as OBI was not associated with total anti-HBc, it is invaluable surrogate marker for OBI detection.

Author Info:
1
Department of Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Microbiology & Immunology, Faculty of Medicine, Al-Azahar University, Assiut, Egypt.


Title:
A Rare Fundal Papillary Adenofibromatous Uterine Cyst ‎In A Postmenopausal Woman: A First Case Report

Author Info:
1
Obstetrics and Gynecology Department, Woman's Health Hospital, Assiut University, Assiut, Egypt; Pathology Department, Assiut University, Assiut, Egypt.
2
Obstetrics and Gynecology Department, Woman's Health Hospital, Assiut University, Assiut, Egypt; Pathology Department, Assiut University, Assiut, Egypt. Electronic address: m_khairy2001@yahoo.com.


Authors:
Darwish AM1, Khalifa EE1, Rashad E1, Farghally E1.

Title:
Total Dose Iron Dextran Infusion Versus Oral Iron For ‎Treating Iron Deficiency Anemia In Pregnant Women: A ‎Randomized Controlled Trial

Abstract:
STUDY OBJECTIVE:
To test safety, efficacy, and cost-effectiveness of total dose infusion (TDI) of low molecular weight (LMW) iron dextran for treatment of iron deficiency anemia (IDA) during pregnancy in comparison to oral ferrous fumarate.

DESIGN:
Prospective interventional randomized controlled trial (RCT). Design classification. Canadian Task Force II3.

SETTING:
Antenatal clinic and causality unit of a tertiary care referral facility and University Hospital.

PATIENTS:
A total 66 anemic pregnant women (hemoglobin level between 7-10 g/dl).

INTERVENTION:
Administration of a LMW iron dextran as a TDI (group A) or Oral iron ferrous fumarate 60 mg elemental iron three times daily (group B) followed by remeasurement of hemoglobin after 4 weeks.

MEASURES AND MAIN RESULTS:
The main outcome measure was clinical and laboratory improvement of anemia after 4 weeks of starting the therapy. Both groups showed a significant clinical improvement of anemia 4 weeks post-therapy. However, the first improvement of symptoms was significantly faster in group A. Complete blood count (CBC) as well as all iron indices were improved in both groups after 4 weeks of therapy, but were significantly better in group A than B. Side effects in group B were mainly gastrointestinal (GIT) while one case of mild hypersensitivity to TDI and another one case of local reaction at the site of injection were reported in group A.

CONCLUSIONS:
It is concluded that despite being equally effective in improving both clinical and laboratory evidence of IDA, TDI allows iron restoration with a single dose faster than oral iron therapy with a reasonable safety profile. It is a good example of office one-stop therapy. Nevertheless, noninvasive selfusage at home is a clear advantage of the cheaper oral iron therapy which makes it the first choice for treating IDA in the second and third trimesters of pregnancy in tolerable cases.

Author Info:
1
a Department of Obstetrics and Gynecology , Woman's Health University Hospital , Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
deMoraes LT1, Neto OM1, Generoso MB2, Taiar I3, Soares A3, Khedr EM4, Cordeiro Q3, Shiozawa P3.

Title:
Determining An Effective rTMS Protocol For Treating ‎Chronic Tinnitus: Focus On Inhibiting The Left ‎Temporoparietal Cortex

Author Info:
1
Department of Otolaryngology, Santa Casa School of Medicine, São Paulo, Brazil.
2
Clinical Neuromodulation Laboratory, Santa Casa School of Medicine, São Paulo, Brazil. marcelobrunogeneroso@gmail.com.
3
Clinical Neuromodulation Laboratory, Santa Casa School of Medicine, São Paulo, Brazil.
4
Department of Neurology, Assiut University Hospital, Assiut, Egypt.


Authors:
El Desoky ES1, Abdelhafez AT1, Cusato J2, Kamel SI3, Hussein AM1, De Nicolo A2, Di Perri G2, D'Avolio A2

Title:
The Role Of ITPA And Ribavirin Transporter Genes ‎Polymorphisms In Prediction Of Ribavirin-Induced ‎Anaemia In Chronic Hepatitis C Egyptian Patients

Abstract:
Few data are available concerning the roles of polymorphisms of inosine triphosphatase (ITPA) gene and ribavirin (RBV) transporter genes in the prediction of RBV-induced anaemia among Egyptians with chronic hepatitis C (CHC). Genotyping of three ITPA gene variants and two variants of RBV transporter genes has been performed in 123 patients under pegylated interferon-α/ribavirin treatment. The baseline haemoglobin and ITPA rs1127354 CA/AA have been found as predictors of anaemia at 4, 8 and 12 weeks of RBV therapy. In addition, ITPA rs7270101 AC/CC and age predicted anaemia after 12 weeks of therapy. In conclusion, the ITPA variant rs1127354C>A significantly predict RBV-induced anaemia during the first 3 months of treatment and it is recommended to be assessed before RBV administration.

Author Info:
1
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
3
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
El Saman AM1, Farag MA, Shazly SA, Noor M, Ali MK, Othman ER, Khalifa M, Farghly TA, El Saman DA.

Title:
Dual-Force Vaginoplasty for Treatment of Segmental Vaginal Aplasia

Abstract:
BACKGROUND:
Vaginal aplasia occurs in 1 in 5,000-10,000 female live births. In this report, we evaluated a novel dual-force vaginoplasty technique for treatment of 11 patients with segmental vaginal aplasia.

TECHNIQUE:
The principle of the approach is to thin the atretic part between two counteracting forces. The instrument was inserted laparoscopically into the proximal hematocolpos. Two balloon catheters, one for drainage and one for traction, were threaded over the inserter. The traction catheter was then threaded over a silicon tube, leaving the balloon in the proximal portion of the vagina and connecting across the vaginal septum to a fenestrated Teflon olive, which was positioned against the distal surface of the vaginal septum. This created a dual "pushing and pulling" force across the septum, which, over 3-4 days, pulls the upper vaginal pouch down while the vaginal dimple is pushed up. The aplastic segment becomes thin and easy to dilate and permits achievement of vaginal patency. The drainage of the hematocolpos is predominantly through the balloon catheter so postoperative wound management is facilitated.

EXPERIENCE:
Eleven menarchal girls were diagnosed with segmental vaginal aplasia. The dual-force vaginoplasty was performed on each and was tolerated well with no operative complications. They all reported establishment of the menstrual cycle and significant improvement of pain during follow-up.

CONCLUSION:
Creation of a dual pushing-pulling force on the atretic vaginal segment is a feasible short procedure for management of segmental vaginal aplasia.

Author Info:
1
Woman's Health Hospital, Department of Obstetrics and Gynecology, and the Faculty of Medicine, Assiut University, Assiut, the Department of Obstetrics and Gynecology, Banha University, Banha, and the Department of Obstetrics and Gynecology, Sohag University, Sohag, Egypt.


Authors:
El-Amin H1, Sabry AMM2, Ahmed RE1, Makhlouf NA3.

Title:
Types And Microbiological Spectrum Of Infections In ‎Patients With Cirrhosis: A Single-Centre Experience In ‎Upper Egypt

Abstract:
BACKGROUND AND STUDY AIMS:
Egypt has a high prevalence of hepatitis C virus (HCV) and high morbidity and mortality related to cirrhosis complications. Patients with cirrhosis have an increased risk of bacterial infections. Approximately 25-35% of cirrhotics had infections at admission or during hospitalisation. Data on infection among cirrhotics in Egypt are limited. This study aimed to determine the frequency and microbiological spectrum of infections in cirrhotics and possible risk factors.

PATIENTS AND METHODS:
This study was conducted at a tertiary care hospital. The frequency and microbiological spectrum of infections in cirrhotics were determined. The risk factors for infection were evaluated.

RESULTS:
Of the 100 patients with liver cirrhosis, 61% had infection. Ascitic fluid infection (AFI) was the most common infection (44.3%), followed by urinary tract infection (UTI) (21.3%), respiratory tract infection (RTI) (19.7%), gastroenteritis (6.6%) and skin infection (4.9%). The only risk factor for infection among cirrhotics was diabetes mellitus (DM) (p=0.047). The mean value of mid-arm muscle circumference was significantly lower in the infected group (p=0.047). Among all the cirrhotics, 32.0% had mild to moderate malnutrition and 52.0% had severe malnutrition. The frequency of infection was higher in severe malnutrition (71.2%).

CONCLUSIONS:
The frequency of infections among cirrhotics was 61%. Many types of infections including AFI, RTI, UTI and skin infections were present in patients with liver cirrhosis, but AFI was the most common. DM was the only risk factor for infection, and independent predictors for infection were elevated WBC count and C-reactive protein levels. The frequency of infection was related to the degree of malnutrition.

Author Info:
1
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Internal Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.
3
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: nahedmak@yahoo.com.


Authors:
El-DeeK SE1, Sayed AA1, Nassar AY1, Mohey-Eldeen ZM2, Eldeeb HM3, Meki A

Title:
Role Of Some Vasoactive Mediators In Scorpion ‎Envenomed Children: Possible Relation To Envenoming ‎Outcome

Abstract:
Scorpion envenomation causes an autonomic storm resulting in changes in the vasoactive mediators' levels which lead to myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary edema, multi-system-organ-failure and death. The study aimed to determine the circulating levels of adrenaline, noradrenaline, angiotensin converting enzyme (ACE), Angiotensin II (Ang II), kallikrein enzyme, nitric oxide (NO), aldosterone, and electrolytes Na+, K+ and Ca+2 in scorpion envenomed children and to evaluate the potential relation between these vasoactive mediators, the severity of scorpion envenoming and the clinical outcome of envenomed children. Forty envenomed children (22 mild and 18 severe cases) along with 10 healthy control children were enrolled in the study. The circulating levels of adrenaline, noradrenaline, Ang II, ACE, kallikrein enzyme, and NO were determined by ELISA, and spectrophotometric assays on admission and 24 h later. On admission, serum aldosterone, and electrolytes; Na+, K+ and Ca+2 were determined by RIA, Flame photometer and Flame atomic absorption respectively. All envenomed children showed significant surge of adrenaline, noradrenaline, ACE, Ang II, aldosterone, NO and Na+, that concomitantly faced by significant reduction in kallikrein, K+ and Ca+2 on admission. Twenty four hours later, all envenomed children continued to show significant elevation of ACE, Ang II and NO. The severely envenomed children showed considerable reduction in circulating levels of adrenaline, noradrenaline, ACE and Ang II, while dramatic increase in kallikrein activity was reported in comparison to mildly envenomed children after 24 h of medical care. Also, NO exhibited considerable accumulation in non survivors, on admission, that was persistent for the subsequent 24 h and was accompanied by high kallikrein, low catecholamines and Ang II levels compared to survivors. Finally, the hypertensive cases showed substantial higher levels of catecholamine, ACE and Ang II, 24 h after admission. These findings indicated that, disturbances of the studied vasoactive mediators were common in scorpion envenomed children and may account for several inflammatory manifestations and clinical outcome. ACE inhibitors could be considered as possible therapeutic agent in victims with prominent increase in ACE and Ang II while kallikrein inhibitor and antioxidants may be effective in the treatment of late hypotensive ones.

Author Info:
1
Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Pediatric Departments, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Medical Biochemistry Department, Faculty of Medicine, Al-Alzhar University, Assiut Branch, Egypt.
4
Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: meki202000@yahoomail.com.


Authors:
El-Fakharany EM1, El-Baky NA1, Linjawi MH2, Aljaddawi AA3, Saleem TH4, Nassar AY4, Osman A5, Redwan EM1,3.

Title:
Influence Of Camel Milk On The Hepatitis C Virus Burden ‎Of Infected Patients‎

Abstract:
Hepatitis C virus (HCV) infection represents a world health problem and no protective vaccine or effective drug currently exists. For economic reasons, many patients use traditional medicines to control the infection. In Egypt, camel milk is one of the traditional medicines widely consumed by patients infected with HCV. The present study aimed to evaluate the efficacy of camel milk in the treatment of patients infected with HCV. Whole camel milk from a local farm was administered to patients for 4 months (250 ml/day/patient). Patient sera were collected prior to and following camel milk drinking, and three markers were set-up for sera-evaluation. The three markers indicating the effect of camel milk on HCV infection were: Liver function assays [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)]; a viral load assay; and anti-HCV antibodies profile and isotyping against synthetic HCV epitopes. Camel milk demonstrated the ability to improve general fatigue, health and liver function (ALT and AST levels); ALT was reduced in ~88% of patients and AST was reduced in all patients subsequent to drinking camel milk for four months. The majority of patients responded positively to camel milk treatment; RNA viral load decreased in 13 out of the 17 patients (76.47%) and one patient exhibited undetected viremia following camel milk treatment. The anti-HCV antibodies profile and isotyping were significantly decreased (P<0.05) in immunoglobulin (Ig)G1 following treatment in 70-76% of patients. However, the treatment was ineffective in 23.53% of patients who experienced no reduction in RNA viral load following treatment with camel milk. In conclusion, whole camel milk treatment demonstrated efficacy in vivo; the viral load in the majority of patient sera was reduced and the IgG isotype profile was converted to Th1 immunity.

Author Info:
1
Protective and Therapeutic Protein Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg El-Arab, Alexandria 21394, Egypt.
2
Department of Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Makkah 21589, Saudi Arabia.
3
Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Makkah 21589, Saudi Arabia.
4
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut 71511, Egypt.
5
Department of Tropical Medicine, Faculty of Medicine, Assiut University, Assiut 71511, Egypt.


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

Title:
Comparative Proteome Analysis For Identification Of ‎Differentially Abundant Proteins In SIDS

Abstract:
Sudden infant death syndrome (SIDS) remains one of the most common causes of post-neonatal infant mortality in developed countries. Its pathogenesis is still poorly understood. The goal of the present study was to characterize changes in the proteome of SIDS compared to age-matched controls in heart and medulla tissues as well as in blood samples using two complementary quantitative proteomic techniques: 2D-DIGE and iTRAQ aiming to provide new insights into the mechanism of SIDS and to find diagnostic protein patterns. Our results revealed collectively 122 modulated proteins in SIDS of which 83 proteins were up-regulated. They are involved in metabolic processes, cellular processes, and localization. Gene expression patterns of selected proteins were further validated by reverse transcription quantitative real-time PCR (RT-qPCR). The role of hypoxia, inflammation, and apoptosis in SIDS was demonstrated by exploring some candidate proteins especially APOA1, GAPDH, S100B, zyxin, and complement component C4A. According to the results of this study, these proteins might be used as diagnostic biomarkers for SIDS. All of them were up-regulated in SIDS except for C4A that was down-regulated.

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


Authors:
El-Radi MA1, Marin-Peña OR2, Said HG1, Tey-Pons M3.

Title:
Basics In Hip Chondrolabral Lesions And State Of The ‎Art.

Abstract:
Chondrolabral complex is a weak point along an histological transition zone. Most cartilage and labral lesions in the femoroacetabular impingement syndrome are located in this area. Different classifications are used to evaluate the severity and predict the prognosis of chondrolabral complex injuries. Acetabular Labrum Articular Disruption (ALAD) and Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classifications are commonly used with a prognosis and treatment implication. Treatment of chondrolabral lesions detected on magnetic resonance imaging (MRI), should only be considered when clinical symptoms are presented. A wide range of treatment options include debridement with or without microfracture, repair or regenerate therapies. The future of hip joint preservation should be directed towards to the development of the treatment of chondrolabral injuries.

Author Info:
1
Orthopedic Surgery and Traumatology, University Hospital Assuit, Assiut, Egypt.
2
Orthopedic Surgery and Traumatology, University Hospital Infanta Leonor, Madrid, Spain.
3
Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain.


Authors:
El-Rashidy O1, El-Baz F1, El-Gendy Y1, Khalaf R1, Reda D1, Saad K2.

Title:
Ketogenic Diet Versus Gluten Free Casein Free Diet In ‎Autistic Children: A Case-Control Study

Abstract:
Many diet regimens were studied for patients with autism spectrum disorder (ASD) over the past few years. Ketogenic diet is gaining attention due to its proven effect on neurological conditions like epilepsy in children. Forty-five children aged 3-8 years diagnosed with ASD based on DSM-5 criteria were enrolled in this study. Patients were equally divided into 3 groups, first group received ketogenic diet as modified Atkins diet (MAD), second group received gluten free casein free (GFCF) diet and the third group received balanced nutrition and served as a control group. All patients were assessed in terms of neurological examination, anthropometric measures, as well as Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Test (ATEC) scales before and 6 months after starting diet. Both diet groups showed significant improvement in ATEC and CARS scores in comparison to control group, yet ketogenic scored better results in cognition and sociability compared to GFCF diet group. Depending on the parameters measured in our study, modified Atkins diet and gluten free casein free diet regimens may safely improve autistic manifestations and could be recommended for children with ASD. At this stage, this study is a single center study with a small number of patients and a great deal of additional wide-scale prospective studies are however needed to confirm these results.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt. ksaad8@yahoo.com.


Authors:
El-Sherry TM1, Abdel-Ghani MA1, Abou-Khalil NS2, Elsayed M3, Abdelgawad M3,4.

Title:
Effect Of PH On Rheotaxis Of Bull Sperm Using ‎Microfluidics.‎


Authors:
El-Tallawy HN1, Saleem TH2, El-Ebidi AM3, Hassan MH4, Gabra RH1, Farghaly WM1, Abo El-Maali N5, Sherkawy HS3.

Title:
Clinical And Biochemical Study Of D-Serine Metabolism ‎Among Schizophrenia Patients

Abstract:
BACKGROUND:
Schizophrenia is a typical N-methyl-d-aspartate receptor (NMDA-R) hypofunction disorder. Decreased d-serine (d-Ser) levels in the periphery occur in schizophrenia and may reflect decreased availability of d-Ser to activate NMDA-R in the brain.

OBJECTIVE:
The objective of this study was to investigate the role of d-Ser metabolism in the pathogenesis of schizophrenia via biochemical assays and correlates, the serum level of d-Ser, d-serine racemase (SR) (responsible for its formation from l-serine [l-Ser]) and d-amino acid oxidase (DAAO) (responsible for its catabolism), among different clinical types of schizophrenia patients.

PATIENTS AND METHODS:
This cross-sectional case-control study was carried out on 100 patients and 50 controls. They were recruited from the outpatients' psychiatric unit of the Neuropsychiatric Department of Assiut University Hospital, Upper Egypt. The type of schizophrenia was determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), while the severity of schizophrenia was determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Serum d-Ser levels were estimated using high-performance liquid chromatography (HPLC), while serum SR and DAAO were measured using commercially available enzyme-linked immunosorbent assay kits.

RESULTS:
There were significantly lower mean serum levels of d-Ser and SR and significantly higher mean serum levels of DAAO (P-value <0.01 for each) among schizophrenia patients when compared with the control group. Paranoid schizophrenia had the highest frequency, with a significantly lower serum levels of d-Ser and SR in the residual type and significantly higher serum levels of DAAO in undifferentiated and catatonic types. Combined receiver-operating characteristic curve for serum d-Ser, SR and DAAO indicated that the best serum level cutoff points at which schizophrenia manifestations started to appear were ≤ 61.4 mg/L for d-Ser, ≤ 15.5 pg/mL for SR and >35.6 pg/mL for DAAO.

CONCLUSION:
The present study confirms that disturbed d-Ser metabolism could be implicated in the pathogenesis of schizophrenia.

Author Info:
1
Department of Neuropsychiatry.
2
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut.
3
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Aswan University, Aswan.
4
Department of Medical Biochemistry and Molecular Biology, Qena Faculty of Medicine, South Valley University, Qena.
5
Department of Chemistry, Faculty of Science, Assiut University, Assiut, Egypt.


Authors:
El-Wahab NM1, Rashed HG1, El-Sherif WT1, Sayed SK1, Abd-Elmalek MO2, Refaiy A3, Fakhry H4, Mokhtar AA1.

Title:
Glypican-3 and Melanoma Antigen Genes 1 and 3 as Tumor Markers for Hepatocellular Carcinoma

Abstract:
Hepatocellular carcinoma (HCC) is the commonest liver cancer; its incidence and prevalence are continuously increased. Glypican3 (GPC3), melanoma antigen-1, 3 genes (MAGE1 and 3) are tumor markers used in HCC. We evaluated their role in HCC detection and assessed their relation to tumor parameters. Three groups, HCC group, liver cirrhosis group and a control group were studied. AFP, GPC3, and MAGE1 and 3 mRNA were determined in all study subjects. Tissue GPC3 was examined in patients with HCC only. Serum AFP and GPC3 were elevated in HCC group compared to other groups (P < 0.000 and P < 0.001, respectively). AFP at cutoff 44.4ng/ml and GPC3 at cutoff 5.6µg/L resulted in 81% and 90.1% sensitivity, 73.3% and 92.6% specificity, respectively. The combined measurement of both increased the sensitivity and the specificity to 100% and 93.3%, respectively. GPC 3 was detected in tissues of 81.0% of the cases. MAGE-1 and MAGE-3 genes expression were detected in 61.9% and 52.4%, respectively in HCC cases but not in other groups. GPC3, MAGE1and 3 were increased with advanced tumor stage, size, and nodule numbers. We concluded that GPC3 is a promising diagnostic marker for HCC, and MAGE 1 and 3 could be helpful in early detection of extrahepatic metastasis of HCC.

Author Info:
1
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Tropical medicine & Gastroentrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Title:
Effects of Pulsed Versus Conventional Versus Combined Radiofrequency for the Treatment of Trigeminal Neuralgia: A Prospective Study

Abstract:
BACKGROUND:
During radiofrequency bursts of energy are applied to nervous tissue. The clinical advantages of this treatment remain unclear.

OBJECTIVES:
We compared the effectiveness and pain relief for idiopathic trigeminal neuralgia (TN) after continuous radiofrequency (CRF), pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency (CCPRF) treatment of the Gasserian ganglion (GG).

STUDY DESIGN:
We conducted a randomized prospective study. Forty-three patients were included. Eleven patients were treated with PRF at 42°C for 10 minutes (PRF group), 12 patients received CRF for 270 seconds at 75 °C (CRF group), and 20 patients received PRF for 10 minutes at 42°C followed by CRF for at 60°C for 270 seconds (CCPRF group).

SETTING:
Assuit University Hospital, Pain and Neurology outpatient clinics.

METHODS:
Patients were assessed for pain, satisfaction, and consumption of analgesics at baseline and 7 days, one month, 6 months, 12 months, and 24 months after the procedure. The incidence of complications, anesthesia dolorosa, weakness of muscles of mastication, numbness, and technical complications, was evaluated after the procedure.

RESULTS:
Excellent pain relief was achieved after 6, 12, and 24 months, respectively in 95%, 85%, and 70% of patients with CCPRF; 75%, 75%, and reduced to 50% among patients with CRF; and 82%, reduced to 9.1%, and 0% of patients with PRF. No complications were recorded in 75% of patients in the CCPRF and PRF groups. There was one case of anesthesia dolorosa, 4 cases of masseter muscle weakness, and 5 cases of severe numbness recorded in the CRF group.

LIMITATION:
There was a small number of patients in each group.

CONCLUSION:
The best results were observed in the CCPRF group, followed by the CRF group, and then the PRF group.Key words: Pulsed, continuous, radiofrequency, trigeminal neuralgia, Gasserian ganglion.

Author Info:
1
Department of Anesthesia, Assiut University, Assiut, Egypt.
2
Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egyp.
3
Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt.


Authors:
Eldaly ZH1, Maasoud AA1, Saad MS1, Mohamed AA1.

Title:
Comparison Between Ologen Implant And Different ‎Concentrations Of Mitomycin C As An Adjuvant To ‎Trabeculectomy Surgery

Abstract:
CONTEXT:
Trabeculectomy is the most common surgical procedure for treatment of glaucoma. To improve success rates, adjuvants were utilized as Mitomycin C (MMC) and Ologen implant.

AIMS:
This study aims to establish efficacy and safety of Ologen implant versus MMC in trabeculectomy.

SETTING AND DESIGN:
A prospective, comparative clinical study was conducted at the Department of Ophthalmology, Assiut University, between December 2014 and April 2016.

SUBJECTS AND METHODS:
Patients with primary open-angle glaucoma (OAG), primary narrow-angle glaucoma and secondary OAG were assigned equally to trabeculectomy with Ologen, 0.4 mg/mL or 0.2 mg/mL MMC. The study outcome measures were reduction in intra-ocular pressure (IOP), success rates, survival analysis, and rate of complications.

STATISTICAL ANALYSIS USED:
SPSS software Version 17.0 (SPSS, Inc., IL, USA) was utilized.

RESULTS:
Thirty eyes were included in the study. Mean baseline IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 27.43 ± 2.97, 28.4 ± 3.24, and 27.56 ± 2.69 mmHg, respectively. At week 24 follow-up, mean IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 18.55 ± 3.18, 16.2 ± 3.22, and 16.93 ± 3.04 mmHg, respectively. No significant inter-group difference was noticed at any visits. Complete success was achieved in 10%, 40%, and 30%, whereas incomplete success in 70%, 50%, and 60%, respectively in Ologen, MMC 0.4 and MMC 0.2 groups. No treatment group difference was reported by Kaplan-Meier analysis. Shallow anterior chamber occurred more in Ologen and MMC 0.4 groups. A single case of serous choroidal effusion had occurred in MMC 0.4 group.

CONCLUSION:
Ologen implant is a promising alternative to MMC for improving the success rate of trabeculectomy.

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


Authors:
Eldeek HEM1, Ahmad AAR2, El-Mokhtar MA3, Abdel Kader ARMM4, Mandour AM2, Mounib MEM2.

Title:
Toxoplasma Genotyping In Congenital Toxoplasmosis In ‎Upper Egypt: Evidence Of Type I Strain

Abstract:
Toxoplasma gondii has subpopulation structures in different geographical regions caused by less frequent sexual recombination, population sweeps, and biogeography. The majority of strains isolated in North America and Europe fall into one of three clonal lineages, referred to as types I, II, and III. So far, little is known about genetics of Toxoplasma strains in Africa. The present study aimed to determine the genotype of Toxoplasma strains obtained directly from trophoblastic/placental tissues of 29 complicated pregnant women using multilocus nested-PCR-RFLP technique depending on four independent genetic loci (5' SAG2 and 3' SAG2), SAG3, GRA6, and BTUB genes. All samples gave positive amplicons at 5'-3' SAG2 and SAG3 genes. Meanwhile, no amplification products were observed in 12 (41.37%) and 10 (34.48%) samples with GRA6 and BTUB genes, respectively. The restriction pattern revealed the presence of genotype I in all samples, except one sample, which revealed atypical genotype with unusual restriction pattern at 3' SAG2 gene. The negative amplifications in some samples could be due to presence of mutations or polymorphisms in the primer binding sites of these isolates, raising the possibility of mixed or recombinant genotypes. To the best of our knowledge, this is the first time to perform genotype analysis study based on Multiplex nPCR-RFLP technique for genetic characterization of T. gondii in Egypt. Besides, it is the first time to prove that the most prevalent strain of T. gondii, responsible for congenital toxoplasmosis in Upper Egypt, is the highly virulent type I. Atypical genotype was detected as well.

Author Info:
1
Medical Parasitology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. hananhmo@yahoo.com.
2
Medical Parasitology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Medical Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Elgayar SAM1, Saad-Eldin HM1, Haussein OA1.

Title:
Morphology Of Cat Vomeronasal Organ Non-Sensory ‎Epithelium During Postnatal Development

Abstract:
The vomeronasal organ has an important role in mammal's social and sexual behaviours. In addition, it mediates defensive behavior through detection of protein pheromone homologues. In this work, a detailed morphological description of the postnatal development of the non-sensory epithelium (NSE) lining the vomeronasal duct (VND) of the female cat is provided using various histological techniques. The study focused on newborn, 2 weeks, 4 weeks, and 8 weeks of postnatal ages using four animals for each age. We report here for the first time that three types of NSE line the rostral segment of the VND; nonkeratinized stratified squamous epithelium, stratified cuboidal epithelium, and ciliated pseudo stratified columnar ciliated epithelium with goblet cells and that the VND undergoes 90° a change in its its axis from the vertical position caudally to the horizontal position rostral. The NSE which lines the lateral side of the VND middle segment is consists of cliated pseudostratified columnar epithelium without goblet cells. In addition to basal cells, the NSE contains ciliated and three types of nonciliated columnar epithelial cells (dark, light, and unstained). Mitotic figures were observed only in the basal cells layer during the first 2 weeks of postnatal development. Intraepithelial invading inflammatory cells were uncommon. Scanning electron microscopy revealed unevenly distributed long cilia intermingled with microvillar processes and intervening short microvillar processes. These projecting cilia and microvilli revealed a gradual increase in their height during development toward maturity.

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


Title:
Intrathecal Morphine Improves Hemodynamic Parameters and Analgesia in Patients Undergoing Aortic Valve Replacement Surgery: A Prospective, Double-Blind, Randomized Trial

Abstract:
BACKGROUND:
Intrathecal morphine (ITM) has been used in hopes of providing good postoperative analgesia in cardiac surgery. Little is known about its use in isolated aortic valve replacement surgery.

OBJECTIVES:
To evaluate the effects of 7 µ/kg ITM administration in aortic valve replacement in regards to hemodynamics, pain score, and postoperative complications when compared to general anesthesia alone.

STUDY DESIGN:
A randomized, double-blind trial.

SETTING:
Academic medical center.

METHODS:
Forty-four patients, who underwent aortic valve replacement, were randomly assigned to receive ITM, before the induction of general anesthesia (ITM group, n = 22) or no intrathecal injection i.e., general anesthesia alone (control group, n = 22). Induction of anesthesia was done with fentanyl, propofol, and isoflurane. Pain scores, determined by visual analog scale (VAS), were recorded immediately after extubation, at the first, sixth, twelfth, eighteenth, and twenty-fourth hour after extubation. Hemodynamics, heart rate, mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, and cardiac index were recorded intra-operatively and up to 24 hours post-operatively.

RESULTS:
VAS scores were lower in the ITM group at each measured time than control group (P < 0.01). The cumulative fentanyl consumption during the first 24 hours after extubation was significantly reduced by 35% in the ITM group (951 µg /first 24 hours) as compared to the control group (1463.6 µg /first 24 hours), (P < 0.001). The mean time to first request for rescue analgesia was significantly prolonged in the ITM group (20.11 ± 4.24 hours, P < 0.001) compared with the control group (0.60 ± 0.44 hours). The mean tramadol consumption dose was significantly reduced in the ITM group (279.33 ± 61.35 mg), compared with the control group (895 ± 106.42 mg), (P < 0.001). Hemodynamic parameters exhibited a significant decrease in HR and MAP in the ITM group, but no significant difference was found in regards to CVP, PCWP, and CI. Glyceryl trinitrate consumption in the first 24 hours was significantly reduced by 43% in the ITM group (28.3 mg /first 24 hours) when compared to the control group (145.5 mg /first 24 hours), (P < 0.001). Extubation time (4.5 ± 7.5 vs. 5.3 ± 1.0 hours, P < 0.05) and intensive care unit length of stay (3.7 ± 1.0 vs. 5.6 ± 1.6 days, P < 0.01) were shorter in the ITM group.

LIMITATIONS:
Small sample size.

CONCLUSIONS:
In valvular heart disease patients undergoing aortic replacement surgery, ITM is a good adjunct to general anesthesia as a safe and effective analgesic alternative. It provides better hemodynamic control, earlier tracheal extubation, and shorter ICU stay.

Author Info:
1
HAMAD Medical Corporation, Doha, Qatar; 2Anesthesia Dept. Assiut University Hospitals, Egypt.
2
Cardiology Dept. Assiut University Hospitals, Egypt.


Authors:
Elkhayat H1, Sallam M1, Farouk M1, Hussein K2, Zarief E3.

Title:
Uniportal VATS For Treatment Of Bullous Lung Disease

Abstract:
This tutorial shows the resection of a bulla by uniportal video assisted thoracoscopic surgery in bullous lung disease. This disease is a benign condition requiring treatment in cases of severe dyspnea, spontaneous secondary pneumothorax, repeated infection, hemoptysis, and an increase in bulla size. The uniportal VATS approach results in less pain, better cosmoses, and a quicker recovery for the patient.

Author Info:
1
Cardiothoracic Surgery Department Assiut University Heart Hospital Assiut University, Faculty of Medicine Assiut, Egypt.
2
Chest Disease Department Assiut University Heart Hospital Assiut University, Faculty of Medicine Assiut, Egypt.
3
Anesthesia and Intensive Care Department Assiut University Heart Hospital Assiut University, Faculty of Medicine Assiut, Egypt.


Authors:
Elsadek B1, Mansour A2, Saleem T3, Warnecke A4, Kratz F4.

Title:
The Antitumor Activity Of A Lactosaminated Albumin ‎Conjugate Of Doxorubicin In A Chemically Induced ‎Hepatocellular Carcinoma Rat Model Compared To ‎Sorafenib

Abstract:
BACKGROUND:
Worldwide, consistent survival benefit for chemotherapy in hepatocellular carcinoma (HCC) is a golden goal for concerned researchers. Nexavar® (sorafenib) is the only approved agent that achieved touchable successes in this regard. Thus, there is a pressing medical need for new promising drugs to improve HCC therapy.

AIMS:
our designed lactosaminated albumin conjugate of doxorubicin (L-HSA-DOXO) that rapidly and preferentially accumulates in the liver is compared, for the first time at its MTD, with doxorubicin and sorafenib, not only for antitumor efficacy but also for overall survival.

METHODS:
HCC was induced in male Wistar rats with N-nitrosodiethylamine added to drinking water (100mg/L) for 8 weeks. Endpoints were antitumor efficacy, tolerability and overall survival.

RESULTS:
L-HSA-DOXO proved to be superior at least over doxorubicin in the majority of assessed endpoints. Circulating AFP-L3% was diminished in L-HSA-DOXO (14.5%) and sorafenib (18.4%) groups compared to DENA (31.1%) and doxorubicin (29.5%) groups. This superiority was further confirmed by Western blot analyses of some novel HCC biomarkers. Survival study reinforced consistent benefits of both L-HSA-DOXO and sorafenib.

CONCLUSIONS:
L-HSA-DOXO shows at least comparable activity to sorafenib which clinically achieves only ∼3 months overall survival benefit. Combination of these two agents could act beneficially or synergistically via two different modes of action to fight HCC.

Author Info:
1
Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt. Electronic address: b_elkot@yahoo.com.
2
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt.
3
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Tumor Biology Center, Division of Macromolecular Prodrugs, Freiburg, Germany(1).


Title:
Dietary Zinc Modifies Diabetic-Induced Renal Pathology ‎In Rats

Abstract:
This study was conducted to investigate how far dietary zinc (Zn) modifies the histomorphological alterations induced by diabetes in rat kidneys. The animals were divided into negative control group (10 rats). Diabetes was induced in thirty animals by streptozotocin. After confirming diabetes, the animals were divided into three groups (n = 10). Group II served as the positive control group (fed on standard diet), group III was fed on Zn deficient diet, and group IV was fed on Zn supplemented diet. Caspase-3 immune staining was used to estimate the caspase activity. Stereological procedures were used to measure the quantity of the immune stain and the surface area of the Bowman's space. The renal cortices of group II rats revealed apparent widening of Bowman's spaces with few apoptotic figures. The filtration barrier showed thickening of the basement membrane. The proximal convoluted tubules showed patchy loss of the apical microvilli with swollen mitochondria. The distal convoluted tubules revealed area of irregular basal enfolding. The picture was aggravated by Zn deficiency in group III besides areas of cortical interstitial fibrosis. The histopathological alterations were minimal in the cortices of group IV. A significant increase of the Bowman's space surface area in group II and IV while decrease in group III compared with group I. The expression of Caspase-3 density was significantly increased in group II and III compared with group I while in group IV was non significant. In conclusion, dietary Zn modulated renal cortical changes caused by diabetes in rats.

Author Info:
1
a Anatomy & Embryology Department , Faculty of Medicine, Taibah University , Madinah , Saudi Arabia.
2
b Anatomy & Embryology Department , Faculty of Medicine, Mansoura University , Mansoura , Egypt.
3
c Anatomy &Embryology Department , Faculty of Medicine, Assiut University , Assiut , Egypt.


Title:
Effect Of Chronic Administration Of Sildenafil Citrate ‎‎(Viagra) On The Histology Of The Retina And Optic ‎Nerve Of Adult Male Rat

Abstract:
BACKGROUND:
Abnormal vision has been reported by 3% of patients treated with sildenafil citrate (Viagra). Although many men use Viagra for an extended period for treatment of erectile dysfunction, the implications of the long term-daily use of it on the retina and optic nerve are unclear.

AIM OF THE WORK:
To investigate the effect of chronic daily use of sildenafil citrate in a dose equivalent to men preferred therapeutic dose on the histology of the retina and optic nerve of adult male rat.

MATERIAL & METHODS:
Eighteen adult male Wistar rats were equally divided into three groups. Group I: control. Group II: treated with sildenafil citrate orally (10mg/kg/day) for 8 weeks. Group III (withdrawal): treated as group II and then left for 4 weeks without treatment. Specimens from the retina and optic nerve were processed for light and electron microscopy.

RESULTS:
In sildenafil citrate treated group, the retina and optic nerve revealed vacuolations and congested blood capillaries with apoptotic endothelial and pericytic cells, and thickened basal lamina. Caspase-3 (apoptotic marker) and CD31 (endothelial marker) expression increased. Glial cells revealed morphological changes: Müller cells lost their processes, activated microglia, astrocytic clasmatodendrosis, degenerated oligodendrocytes surrounded by disintegrated myelin sheathes of the optic nerve fibers. The retina and optic nerve of the withdrawal group revealed less vacuolations and congestion, and partial recovery of the glial cells.

CONCLUSION:
Chronic treatment with sildenafil citrate (Viagra) caused toxic effect on the structure of the retina and optic nerve of the rat. Partial recovery was observed after drug withdrawal.

Author Info:
1
Histology and Cell Biology Department, Faculty of Medicine, Assiut University, Egypt. Electronic address: sohair_eltony@yahoo.com.
2
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Egypt.


Title:
Histological Study On The Effect Of Nicotine On Adult ‎Male Guinea Pig Thin Skin

Abstract:
Tobacco smoking has been identified as an important factor in premature skin aging to detect the histological changes occurred in adult male guinea pig thin skin under the influence of low and high doses of nicotine; which constitutes approximately 0.6%-3.0% of the dry weight of tobacco. Fifteen adult male pigmented guinea pigs were equally divided into three groups: group I, control; group IIA, low dose nicotine treated; 3 mg/kg subcutaneously for 4 weeks; and group IIB, high dose nicotine treated; 6 mg/kg subcutaneously for 4 weeks. Specimens from the back thin skin were processed for light and electron microscopy. Nicotine administration revealed flattened dermo-epidermal junction and reduced rete ridges formation. Collagen bundles were disorganized with increased spaces between them. A reduction in the amount of elastic fibers in the dermis were also observed compared to group I. Ultrastructurally, keratinocytes had hyperchromatic nuclei, intracytoplasmic vacuoles, disruption of desmosomal junctions, irregular tonofilaments distribution, and increased inter-cellular spaces. These changes were more pronounced with high dose nicotine administration. The epidermal thickness was reduced in low dose nicotine administration. But, high dose nicotine administration revealed increased epidermal thickness compared to the control group. Nicotine induced structural changes of adult male guinea pig thin skin. These changes were more pronounced with high dose nicotine administration.

Author Info:
1
Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Elzeny H1, Zhang F2, Ali EN1, Fathi HA1, Zhang S3, Li R2, El-Mokhtar MA4, Hamad MA5, Wooley KL6, Elsabahy M7.

Title:
Polyphosphoester Nanoparticles As Biodegradable ‎Platform For Delivery Of Multiple Drugs And si RNA

Abstract:
Delivery of multiple therapeutics and/or diagnostic agents to diseased tissues is challenging and necessitates the development of multifunctional platforms. Among the various strategies for design of multifunctional nanocarriers, biodegradable polyphosphoester (PPE) polymers have been recently synthesized via a rapid and simple synthetic strategy. In addition, the chemical structure of the polymer could be tuned to form nanoparticles with varying surface chemistries and charges, which have shown exceptional safety and biocompatibility as compared to several commercial agents. The purpose of this study was to exploit a mixture of PPE nanoparticles of cationic and neutral surface charges for multiple delivery of anticancer drugs (ie, sorafenib and paclitaxel) and nucleic acids (ie, siRNA). Cationic PPE polymers could efficiently complex siRNA, and the stability of the nanoparticles could be maintained in physiological solutions and upon freeze-drying and were able to deliver siRNA in vivo when injected intravenously in mice. Commercially available cationic polyethylenimine polymer had LD50 of ca. 61.7 mg/kg in mice, whereas no animal died after injection of the cationic PPE polymer at a dose of >130 mg/kg. Neutral PPE nanoparticles were able to encapsulate two hydrophobic drugs, namely, sorafenib and paclitaxel, which are commonly used for the treatment of hepatocellular carcinoma. Mixing the neutral and cationic PPE nanoparticles did not result in any precipitation, and the size characteristics of both types of nanoparticles were maintained. Hence, PPE polymers might have potential for the delivery of multiple drugs and diagnostic agents to diseased tissues via simple synthesis of the individual polymers and assembly into nanoparticles that can host several drugs while being mixed in the same administration set, which is of importance for industrial and clinical development.

Author Info:
1
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
2
Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX, USA.
3
School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
4
Department of Microbiology and Immunology, Faculty of Medicine.
5
Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX, USA; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA.
7
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut; Misr University for Science and Technology, 6th of October City, Egypt.


Authors:
Erdem H1,2, Inan A3, Guven E4, Hargreaves S5, Larsen L6, Shehata G7, Pernicova E8,9, Khan E10, Bastakova L11, Namani S12, Harxhi A13, Roganovic T14, Lakatos B15, Uysal S16, Sipahi OR17, Crisan A18, Miftode E19, Stebel R11, Jegorovic B20, Fehér Z21, Jekkel C15, Pandak N22, Moravveji A23, Yilmaz H24, Khalifa A25, Musabak U26, Yilmaz S27, Jouhar A25, Oztoprak N28, Argemi X29, Baldeyrou M29, Bellaud G30, Moroti RV31, Hasbun R32, Salazar L32, Tekin R33, Canestri A30, Čalkić L34, Praticò L35, Yilmaz-Karadag F36, Santos L37, Pinto A37, Kaptan F38, Bossi P39, Aron J39, Duissenova A40, Shopayeva G40, Utaganov B40, Grgic S41, Ersoz G42, Wu AKL43, Lung KC43, Bruzsa A15, Radic LB44, Kahraman H17, Momen-Heravi M45, Kulzhanova S46, Rigo F47, Konkayeva M46, Smagulova Z46, Tang T48, Chan P49, Ahmetagic S50, Porobic-Jahic H50, Moradi F51, Kaya S52, Cag Y53, Bohr A54, Artuk C55, Celik I56, Amsilli M57, Gul HC55, Cascio A58, Lanzafame M47, Nassar M59.

Title:
The Burden And Epidemiology Of Community-Acquired ‎Central Nervous System Infections: A Multinational ‎Study

Abstract:
Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Author Info:
1
Principal Coordinator of ID-IRI, Ankara, Turkey. hakanerdem1969@yahoo.com.
2
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, 06010, Etlik, Ankara, Turkey. hakanerdem1969@yahoo.com.
3
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
4
Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey.
5
International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, UK.
6
Department of Infectious Diseases Q, Odense University Hospital, Odense, Denmark.
7
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
8
Avenier, Centres for Vaccination and Travel Medicine, Prague, Czech Republic.
9
Faculty Hospital Brno, Department of Infectious Diseases, Brno, Czech Republic.
10
Shifa International Hospital, Islamabad, Pakistan.
11
Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic.
12
Infectious Diseases Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo.
13
Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania.
14
Infectious Diseases Clinic, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina.
15
Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary.
16
Department of Infectious Diseases and Clinical Microbiology, Seyfi Demirsoy State Hospital, Buca, İzmir, Turkey.
17
Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey.
18
Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
19
Hospital of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
20
Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
21
Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary.
22
General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia.
23
Social Determinants of Health Research Center, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran.
24
Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
25
Department of Neurology, Damascus Hospital, Damascus, Syria.
26
Department of Immunology and Allergy, Losante Hospital, Ankara, Turkey.
27
Gulhane Medical Academy, Blood Bank, Clinical Microbiology Division, Ankara, Turkey.
28
Antalya Education and Research Hospital, Antalya, Turkey.
29
Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France.
30
Department of Infectious Diseases, Tenon University Hospital, Paris, France.
31
Carol Davila University of Medicine and Pharmacy and Matei Bals National Institute for Infectious Diseases, Bucharest, Romania.
32
Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA.
33
Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
34
Department of Infectious Diseases, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina.
35
University Division of Infectious and Tropical Diseases, Piazza Spedali Civili, 25123, Brescia, Italy.
36
Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey.
37
Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal.
38
Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey.
39
Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France.
40
Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
41
Clinic for Infectious Diseases, University Hospital of Mostar, Mostar, Bosnia and Herzegovina.
42
Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey.
43
Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
44
Department of Infectious Diseases, General Hospital Dubrovnik, Dubrovnik, Croatia.
45
Department of Infectious Diseases, Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran.
46
Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan.
47
Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
48
Infectious Diseases Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
49
Neurology Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
50
University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
51
Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
52
Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
53
School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey.
54
Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
55
Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey.
56
Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey.
57
Infectious Diseases Unit, CHU Bicètre, Paris, France.
58
Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
59
Infection Control Department, Saudi German Hospital Group, Jeddah, Saudi Arabia.


Authors:
EzzEl-Din AM1, Galal SH1, Ahmed AO1, Kamel SI2, Kamal DT1.

Title:
Toll Like Receptor 3 Polymorphisms in Hepatitis B Virus Infection

Abstract:
Hepatitis B virus (HBV) is the one of the major causes of chronic liver disease. Individuals exposed to HBV show wide spectrum outcomes including immunized persons, asymptomatic carrier, chronic active hepatitis, cirrhosis and HCC. The outcome of HBV infection and the severity of associated liver diseases are determined by the nature and strength of host immune responses against the virus. There is accumulating evidence that the innate branch of the host immune system plays an important role in the control of HBV infection. Various components including toll-like receptor (TLR) contribute to this nonspecific innate immune response .TLR3 play an important role in innate immune response against viral pathogens. Single nucleotide polymorphisms (SNPs) in the TLR3 could be considered as factors for the susceptibility to viral pathogens including HBV. This study aimed to investigate the distribution of six SNPs of the TLR3 gene in patients infected with HBV and to determine the relation between these SNPs and the clearance of hepatitis B virus. These SNPs were tested by direct sequencing. Three groups were investigated: chronic HBV carrier (25 patients), chronic active HBV carrier (16 patients) and 13 persons who were previously exposed to HBV and became immunized. These 3 groups were examined for six SNPs (rs5743311, rs5743312, rs5743313, rs5743314, rs5743315, and rs78726532). The analysis showed high frequencies of GCTCCA haplotype and CCA haplotype in the immunized group when compared to chronic hepatitis B groups (P < 0.05). These findings indicate that genetic variations in the TLR3 gene could affect the outcome of HBV infection.

Author Info:
1
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Tropical Medicine & Gastroentrology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Farghaly HS1, Metwalley KA2, Ahmed FA1, Raafat DM1, El-Asheer O1, Ali AM1, Bahdawy A1, Zahran AM3.

Title:
Visfatin Level In Children And Adolescents With ‎Autoimmune Thyroiditis

Abstract:
BACKGROUND:
This study aims to assess the levels of visfatin in children and adolescents with autoimmune thyroiditis (AIT) and its relationship with disease-related variables.

METHODS:
The study included 84 children and adolescents with AIT and 84 healthy subjects. Measurements of fasting glucose, insulin, thyroid-stimulating hormone (TSH), free thyroxin (FT4), antithyroid peroxidase antibodies (TPOAb) and antithyroglobulin antibody (TgAb) were completed, with assessment of visfatin levels.

RESULTS:
Overt hypothyroidism was diagnosed in 58 cases, while subclinical hypothyroidism was diagnosed in 26 of the studied patients. Total studied cases, overt and subclinical subgroups had significantly higher levels of TSH, HOMA-IR, TPOAb, TgAb and visfatin and significantly lower FT4 level compared with the control. Spearman correlation analysis revealed that visfatin was correlated positively with BMI, homeostasis model assessment (HOMA-IR), TSH and TPOAb, while inversely correlation with FT4. In logistic regression analysis, visfatin was correlated only with TPOAb.

CONCLUSIONS:
This preliminary study provides evidence of significantly higher level of visfatin in children and adolescents with AIT. Visfatin might have a potential role in the pathogenesis of AIT, which needs to be validated by measuring immunological responses in children and adolescents with AIT.

Author Info:
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Professor of Pediatrics, Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.


Title:
Diaphragm Ultrasound As A New Method To Predict ‎Extubation Outcome In Mechanically Ventilated Patients

Abstract:
AIM:
To evaluate role of diaphragmatic thickening and excursion, assessed ultrasonographically, in predicting extubation outcome.

METHODS:
Fifty-four patients who successfully passed spontaneous breathing trial (SBT) were enrolled. They were assessed by ultrasound during SBT evaluating diaphragmatic excursion, diaphragmatic thickness (Tdi) at end inspiration, at end expiration and diaphragmatic thickness fraction (DTF%). Simultaneously traditional weaning parameters were recorded. Patients were followed up for 48h after extubation.

RESULTS:
Out of 54 included patients, 14 (25.9%) failed extubation. Diaphragmatic excursion, Tdi at end inspiration, at end expiration and DTF% were significantly higher in the successful group compared to those who failed extubation (p<0.05). Cutoff values of diaphragmatic measures associated with successful extubation were ≥10.5mm for diaphragmatic excursion, ≥21mm for Tdi at end inspiration, ≥10.5mm for Tdi at end expiration, ≥34.2% for DTF% giving 87.5%, 77.5%, 80% and 90% sensitivity respectively and 71.5%, 86.6%, 50% and 64.3% specificity respectively. Combining diaphragmatic excursion ≥10.5mm and Tdi at end inspiration ≥21mm decreased sensitivity to 64.9% but increased specificity to 100%. Rapid shallow breathing index (RSBI) <105 had 90% sensitivity but 18.7% specificity.

CONCLUSION:
Ultrasound evaluation of diaphragmatic excursion and thickness at end inspiration could be a good predictor of extubation outcome in patients who passed SBT. It is recommended to consider the use of these parameters with RSBI consequently to improve extubation outcome.

Author Info:
1
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: shereen_hssn@yahoo.com.
2
Chest Department, Faculty of Medicine, Assiut University Hospital, Egypt. Electronic address: aabdelazeem@yahoo.com.


Authors:
Farouk O1, Mahran DG2, Said HG1, Alaa MM1, Eisa A1, Imam H3, Said GZ1.

Title:
Osteoporosis Among Hospitalized Patients With ‎Proximal Femoral Fractures In Assiut University Trauma ‎Unit, Egypt.‎

Abstract:
The study was done to investigate osteoporosis prevalence in 275 hip fracture admissions at the Trauma Unit of Assiut University Hospitals and associated factors, which are understudied in our locality. Prevalence was 74.9%. Female sex, older age, low body mass index, and fall on the ground were associated with osteoporosis.

PURPOSE:
This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture.

METHODS:
A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50 years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors.

RESULTS:
Mean age was 70.82 ± 11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score ≤ -2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis.

CONCLUSIONS:
Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are needed to decrease hip fracture rates.

Author Info:
1
Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
2
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt. daliaym2001@yahoo.com.
3
Diagnostic Radiology Department, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.


Authors:
Fathalla AM1, Sebaity DM, Mohamed TA, Hussein MS.

Title:
Simultaneous Clear Lens Extraction and Silicon Oil Removal in Vitrectomized Myopic Eyes

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


Authors:
Fawzy M1, AbdelRahman MY2, Zidan MH3, Abdel Hafez FF4, Abdelghafar H2, Al-Inany H5, Bedaiwy MA6.

Title:
Humid Versus Dry Incubator: A Prospective, ‎Randomized, Controlled Trial

Abstract:
OBJECTIVE:
To evaluate the efficacy of a dry versus humidified incubator on human embryo development ex vivo.

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

SETTING:
Private fertility centers.

PATIENT(S):
A total of 297 women undergoing in vitro fertilization randomized into two groups.

INTERVENTION(S):
From days 0 to day 5 or 6 of culture, intervention group embryos exposed to dry culture and control group embryos exposed to humidified culture.

MAIN OUTCOME MEASURE(S):
Subsequent ongoing pregnancy rate.

RESULT(S):
After transfer of embryos, there were statistically significantly lower rates of clinical and ongoing pregnancy in the dry culture arm than in the humidified culture arm (odds ratio [OR] 0.57; 95% confidence interval [CI], 0.36-0.91; versus OR 0.54; 95% CI, 0.34-0.85). On day 3 of culture, embryo quality and compaction were lower in the dry culture group (OR 0.38; 95% CI, 0.32-0.45) than in the group exposed to humidified culture (OR 0.23; 95% CI, 0.19-0.27). On day 5 of culture, embryos in dry culture had a lower rate of blastocyst formation (OR 0.39; 95% CI, 0.33-0.46), quality (OR 0.34; 95% CI, 0.29-0.40), and cryopreservation (OR 0.41; 95% CI, 0.35-0.48).

CONCLUSION(S):
In this study, human embryos cultivated ex vivo in a dry incubator had statistically significantly decreased implantation and clinical and ongoing pregnancy rates. Our findings indicate the need for larger multicenter, randomized, controlled trials.

CLINICAL TRIAL REGISTRATION NUMBER:
NCT01695096.

Author Info:
1
IVF Laboratory, IbnSina IVF Center, IbnSina Hospital, Sohag, Egypt. Electronic address: drfawzy001@me.com.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Gannah IVF Hospital, Cairo, Egypt.
4
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
5
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
6
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.


Authors:
Fawzy M1, Emad M2, AbdelRahman MY3, Abdelghafar H3, Abdel Hafez FF4, Bedaiwy MA5.

Title:
Impact Of 3.5% O2 Culture On Embryo Development And ‎Clinical Outcomes: A Comparative Study.‎

Abstract:
OBJECTIVE:
To evaluate the effect of culturing human embryos in vitro in 3.5% oxygen (O2) concentration.

DESIGN:
Comparative study.

SETTING:
Private IVF center.

PATIENT(S):
The study included 558 women in two groups.

INTERVENTION(S):
After intracytoplasmic sperm injection (ICSI), women's oocytes were assigned to undergo cultivation in either 3.5% O2 concentration (intervention) or 5% O2 level (control group), continuously, from day 0 through day 5 or 6.

MAIN OUTCOME MEASURE(S):
Clinical pregnancy rate (PR) after ET.

RESULT(S):
There were significantly higher fertilization and cleavage rates in the 3.5% O2 group (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.53-1.93) and (OR 3.74, 95% CI 2.30-6.07) than in the 5% O2 group. The compaction rate on day 3, and the number of formed, high-quality and cryopreserved blastocysts on day 5 were significantly lower in 3.5% O2 than in 5% O2 concentration ([OR 0.81, 95% CI 0.69-0.91], [OR 0.40, 95% CI 0.36-0.46], [OR 0.32, 95% CI 0.28-0.37] and [OR 0.47, 95% CI 0.40-0.54]), respectively. Culturing embryos in 3.5% O2 concentration led to significantly lower rates of biochemical pregnancy, clinical PR, and implantation ([OR 0.66, 95% CI 0.47-0.92], [OR 0.60, 95% CI 0.43-0.84] and [OR 0.61, 95% CI 0.46-0.81]), respectively.

CONCLUSION(S):
Culturing human embryos, continuously from day 0 to 5 or 6, in 3.5% O2 concentration is associated with significantly lower blastocyst formation rate and clinical outcomes parameters, but rather with significantly higher rates of fertilization and cleavage. Whether these findings hold true for other patient populations and culture media brands remain unknown.

Author Info:
1
IbnSina IVF Center, IbnSina Hospital, Sohag, Egypt. Electronic address: drfawzy001@me.com.
2
IbnSina IVF Center, IbnSina Hospital, Sohag, Egypt.
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt.
4
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
5
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.


Title:
Prevalence Of Psychological Stress, Depression And ‎Anxiety Among Medical Students In Egypt

Abstract:
Poor psychological health in medical students has been reported nationwide. This study estimated the prevalence of depression, anxiety and stress symptoms among medical students who were enrolled in a public university in Upper Egypt and determine the association of these morbidities with the students' basic socio-demographic variables. This cross-sectional study included 700 students. A self-administered, questionnaire for the socio-demographic characteristics, Depression Anxiety Stress Scale (DASS 21) and Pittsburgh Sleep Quality Index (PSQI) questionnaire were used for assessment. High frequencies of depression (65%), anxiety (73%) and stress (59.9%) were reported. Stress scores were significantly higher than depression and anxiety (P=0.001). 55.7% were poor sleepers. In univarate analysis, females, those living in the University campus/students' residence facility, in the preclinical years and with lower academic achievement had higher scores of DASS and PSQI compared to their comparative partners. Significant correlations were reported between stress with depression, anxiety and PQSI scores (P=0.0001). In multivariate analysis, stress scores were significantly associated with female sex, depression and anxiety scores. We conclude that depression, anxiety and stress symptoms are common in medical students of Assiut University relative to other schools and female gender was significantly correlated with these findings.

Author Info:
1
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
2
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt. Electronic address: hamed_sherifa@yahoo.com.


Authors:
Fawzy MS1,2, Toraih EA3, Ibrahiem A4, Abdeldayem H5, Mohamed AO6, Abdel-Daim MM7,8.

Title:
Evaluation of miRNA-196a2 And Apoptosis-Related ‎Target Genes: ANXA1, DFFA and PDCD4 Expression In ‎Gastrointestinal Cancer Patients: A Pilot Study

Abstract:
Previous reports have suggested the significant association of miRNAs aberrant expression with tumor initiation, progression and metastasis in cancer, including gastrointestinal (GI) cancers. The current preliminary study aimed to evaluate the relative expression levels of miR-196a2 and three of its selected apoptosis-related targets; ANXA1, DFFA and PDCD4 in a sample of GI cancer patients. Quantitative real-time PCR for miR-196a2 and its selected mRNA targets, as well as immunohistochemical assay for annexin A1 protein expression were detected in 58 tissues with different GI cancer samples. In addition, correlation with the clinicopathological features and in silico network analysis of the selected molecular markers were analyzed. Stratified analyses by cancer site revealed elevated levels of miR-196a2 and low expression of the selected target genes. Annexin protein expression was positively correlated with its gene expression profile. In colorectal cancer, miR-196a over-expression was negatively correlated with annexin A1 protein expression (r = -0.738, p < 0.001), and both were indicators of unfavorable prognosis in terms of poor differentiation, larger tumor size, and advanced clinical stage. Taken together, aberrant expression of miR-196a2 and the selected apoptosis-related biomarkers might be involved in GI cancer development and progression and could have potential diagnostic and prognostic roles in these types of cancer; particularly colorectal cancer, provided the results experimentally validated and confirmed in larger multi-center studies.

Author Info:
1
Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
2
Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.
3
Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
4
Department of Pathology, Faculty of Medicine, Mansoura University, Mansours, Egypt.
5
Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
6
Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
7
Department of Pharmacology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.
8
Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan.


Authors:
Fetih AN1, Habib DM1, Abdelaal II1, Hussein M1, Fetih GN2, Othman ER1.

Title:
Adding Sildenafil Vaginal Gel To Clomiphene Citrate In ‎Infertile Women With Prior Clomiphene Citrate Failure ‎Due To Thin Endometrium: A Prospective Self-‎Controlled Clinical Trial

Abstract:
We aimed to investigate the effect of adding sildenafil vaginal gel to clomiphene citrate (CC) in infertile women with prior CC failure.

METHODS:
This is a self- controlled clinical trial. Women with CC failure (in prior 5 cycles) and thin endometrium were recruited (N = 42). In their 6th (CC only) cycle, women continued on CC 100 mg/ day for 5 days, and had measurement of endometrial thickness and Doppler assessment of uterine arteries on day of HCG administration. In the 7th cycle, women (N = 36) were given usual dose of CC supplemented with sildenafil vaginal gel (5 gm, containing 50 mg sildenafil) twice daily from cycle day 8 to day of HCG administration. Endometrial thickness and uterine artery Doppler were measured on the day of HCG injection.

RESULTS:
In the 7th (CC + sildenafil vaginal gel) cycle, endometrial thickness was significantly higher than in the 6th (CC only) cycle (9.3 mm +/- 3.1mm versus 6.6 mm +/- 1.4 mm, respectively, P = < 0.001). Uterine artery pulsatility index dropped from 2.4 +/- 0.8 in 6th cycle to 1.6 +/- 1.3 in 7th cycle (P = 0.002). Clinical pregnancy rate increased but numbers were too small (only 3 pregnancies).

CONCLUSION:
Sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow, and may improve pregnancy rate in patients with CC failure due to thin endometrium. Mucoadhesive vaginal gel formulation allowed shorter duration of sildenafil application, and less frequent daily dosing.

Author Info:
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt.
2
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Egypt.


Authors:
Gamal Y1, Badawy A2, Swelam S3, Tawfeek MS2, Gad EF2.

Title:
Glomerular Glucocorticoid Receptors Expression and Clinicopathological Types of Childhood Nephrotic Syndrome

Abstract:
Glucocorticoids are primary therapy of idiopathic nephrotic syndrome (INS). However, not all children respond to steroid therapy. We assessed glomerular glucocorticoid receptor expression in fifty-one children with INS and its relation to response to steroid therapy and to histopathological type. Clinical, laboratory and glomerular expression of glucocorticoid receptors were compared between groups with different steroid response. Glomerular glucocorticoid expression was slightly higher in controls than in minimal change early responders, which in turn was significantly higher than in minimal change late responders. There was significantly lower glomerular glucocorticoid receptor expression in steroid-resistance compared to early responders, late responders and controls. Glomerular glucocorticoid expression was significantly higher in all minimal change disease (MCD) compared to focal segmental glomerulosclerosis. In INS, response to glucocorticoid is dependent on glomerular expression of receptors and peripheral expression. Evaluation of glomerular glucocorticoid receptor expression at time of diagnosis of NS can predict response to steroid therapy.

Author Info:
1
a Pathology Department , Assiut University Faculty of Medicine , Assiut , Egypt.
2
b Pediatric Department , Assiut University Faculty of Medicine , Assiut , Egypt.
3
c Pediatric Department , Minia University Faculty of Medicine , El Minia , Egypt.


Authors:
Gomaa AM1, Abou Khalil NS, Abdel-Ghani MA.

Title:
The Protective Role Of Folic Acid Against Testicular ‎Dysfunction In Lead-Intoxicated Rat Model

Abstract:
There is an increasing concern over male reproductive toxicity caused by lead exposure. Folic acid (FA) is supposed to be a promising therapeutic strategy against lead toxicity. Therefore, the aim of this experimental study was to shed light on the potential protective role of FA on lead-induced testicular dysfunction in rats and its possible underlying mechanistic pathways. Rats (n = 24) were divided into four groups: Control, FA, Lead, and FA+Lead group. After 4 weeks, lead intoxication resulted in a marked reduction in the relative testicular weight and the serum level of testosterone, an impairment in the characters of semen analysis, and an increased content of lead, malondialdehyde and both interleukin-6 and -10 and a decreased antioxidant enzyme levels in the testicular tissue homogenate. Furthermore, marked degenerative histological changes and an increased expression of NF-κB were also noticed in the testicular tissue of Lead group. Supplementation of FA in association with lead considerably alleviated these adverse outcome responses most probably owing to its cytoprotective ability as emerged from combating the oxidative stress and inflammatory reactions. We concluded that FA could act as a highly effective fighting approach against lead-associated testicular toxicity.

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


Title:
Vitamin D Reduces High-Fat Diet Induced Weight Gain ‎And C-Reactive Protein, Increases Interleukin-10, And ‎Reduces CD86 And Caspase-3.‎

Abstract:
Obesity can be associated with dysfunction of the immune system. An increased risk of obesity has been reported among individuals with low levels of vitamin D. However, much is still unknown about the link between vitamin D and dysfunction of the spleen and immune system in obesity. Therefore, the objectives of this study were to evaluate the effects of a high-fat diet (HFD) on the spleen and immune system and to determine the protective effects of chronic treatment with vitamin D in reversing the detrimental effects of HFD. Body weight (BW) gain, the serum levels of calcium, C-reactive protein (CRP), and interleukin-10 (IL-10), and the expression of both CD86 and caspase-3 in the spleen were investigated. Twenty-four adult male Wistar rats were divided into three equal groups: the control (C) group received a control diet for 10 weeks, the HFD-C group received a HFD for 10 weeks, and the HFD-treated group received a HFD co-administered with oral vitamin D (1μg/kg) daily for 10 weeks. Administration of vitamin D in combination with HFD significantly decreased BW gain, decreased the serum levels of both calcium and CRP, increased the serum level of IL-10, improved the general histological appearance of the spleen, and decreased the expression of both CD86 and caspase-3 in the spleen in comparison with results seen in the HFD-C group. Our data suggest that vitamin D supplementation holds promise as an adjunct treatment to alleviate the dysfunction of the spleen and immune system commonly seen in HFD-induced obesity.

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:
Greish K1, Taha S2, Jasim A2, Elghany SA2, Sultan A2, AlKhateeb A2, Othman M3,4, Jun F5, Taurin S6, Bakhiet M2.

Title:
Styrene Maleic Acid Encapsulated Raloxifene Micelles ‎For Management Of Inflammatory Bowel Disease

Abstract:
BACKGROUND:
Inflammatory bowel disease (IBD) comprises a group of disorders that manifest through chronic inflammation of the colon and small intestine. Although the exact cause of IBD is still unclear, dysfunctional immunoregulation involving overproduction of inflammatory cytokines such as TNF-α, and IL-6 have been implicated in pathogenesis. Current therapy relies on immunosuppression, cytotoxic drugs, and monoclonal antibodies against TNF-α. These classes of drugs have severe side-effects, especially when used for long duration. Our previous work with raloxifene, a selective estrogen receptor modulator, has shown that the drug, and to a greater extent its micellar formulation, has a significant suppressive effect on NF-κB, an essential immune-regulator. This finding directed the current work towards testing the anti-inflammatory and immunomodulatory effects of raloxifene using cell lines, as well as testing the potential use of the styrene maleic acid (SMA) micelles loaded with raloxifene (SMA-Ral) against dextran sulfate sodium (DSS) induced colitis in an in vivo model of IBD.

RESULTS:
Treatment of MCF-7 cells with TNF-α was shown to protect the cells from the cytotoxic effect of raloxifene (42 vs. 10% cell death, with TNF-α. Treating CaCo-2 cells with both free and SMA-Ral improved cell survival after exposure to 2% DDS with significantly higher protection with SMA-Ral. Treatment of U-937 with SMA-Ral and free-Ral resulted in down-regulation of TNF-α, IL-1β, IL-6, and MIP1α, with greater inhibition of the SMA-Ral, compared to free Ral. Balb/c mice treated with raloxifene and SMA-Ral showed weight gain at 14 days, compared to the control group (122, and 115% respectively). Treatment with raloxifene prevented DSS-induced diarrhea in 6/6 of free raloxifene treated mice and in 5/6 mice treated with SMA-Ral. Control group of DSS-treated mice showed average colon length of 7.4 cm compared to 13 cm in the control group. The average colon length was 12.3 and 11.5 cm for raloxifene and SMA-Ral treated groups, respectively. Furthermore, inflammatory cytokines such as IL-6 and TNF-α were reduced in serum of animals treated with free-Ral and SMA-Ral.

CONCLUSIONS:
Raloxifene and its micellar formulation warrants further studies to understand their effect on the treatment of colitis. Graphical abstract SMA-Raloxifene preparation and its in vivo and in vitro effect on colitis.

Author Info:
1
Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain. khaledfg@agu.edu.bh.
2
Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain.
3
Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
4
Department of Histology, Faculty of Medicine, Assiut University, Asyut, Egypt.
5
Department of Pharmacology and Oncology, Sojo University, Kumamoto, Japan.
6
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, USA.


Authors:
Hamed S1, Metwalley KA2, Farghaly HS2, Sherief T3.

Title:
Serum Levels of Neuron-Specific Enolase in Children With Diabetic Ketoacidosis

Abstract:
Neuron-specific enolase is a sensitive marker of neuronal damage in various neurologic disorders. This study aimed to measure serum neuron-specific enolase levels at different time points and severities of diabetic ketoacidosis. This study included 90 children (age 9.2 ± 3.4 years) with diabetic ketoacidosis. Neuron-specific enolase was measured at 3 time points (baseline and after 12 and 24 hours of starting treatment). Among patients, 74.4% had diagnosis of new diabetes, 60% had Glasgow Coma Scale score <15, and 75.6% had moderate/severe diabetic ketoacidosis. Compared with controls (n = 30), children with diabetic ketoacidosis had higher neuron-specific enolase levels at the 3 time points ( P = .0001). In multiple regression analysis, the factors associated with higher neuron-specific enolase levels were younger age, higher glucose, lower pH, and bicarbonate values. This study indicates that serum neuron-specific enolase is elevated in diabetic ketoacidosis and correlated with the severity of hyperglycemia, ketosis, and acidosis. This study indicates that diabetic ketoacidosis may cause neuronal injury from which the patients recovered partially but not completely.

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


Title:
Brain Injury With Diabetes Mellitus: Evidence, ‎Mechanisms And Treatment Implications

Abstract:
Diabetes mellitus is a risk for brain injury. Brain injury is associated with acute and chronic hyperglycaemia, insulin resistance, hyperinsulinemia, diabetic ketoacidosis (DKA) and hypoglycaemic events in diabetic patients. Hyperglycemia is a cause of cognitive deterioration, low intelligent quotient, neurodegeneration, brain aging, brain atrophy and dementia. Areas covered: The current review highlights the experimental, clinical, neuroimaging and neuropathological evidence of brain injury induced by diabetes and its associated metabolic derangements. It also highlights the mechanisms of diabetes-induced brain injury. It seems that the pathogenesis of hyperglycemia-induced brain injury is complex and includes combination of vascular disease, oxidative stress, neuroinflammation, mitochondrial dysfunction, apoptosis, reduction of neurotrophic factors, acetylcholinesterase (AChE) activation, neurotransmitters' changes, impairment of brain repair processes, impairment of brain glymphatic system, accumulation of amyloid β and tau phosphorylation and neurodegeneration. The potentials for prevention and treatment are also discussed. Expert commentary: We summarize the risks and the possible mechanisms of DM-induced brain injury and recommend strategies for neuroprotection and neurorestoration. Recently, a number of drugs and substances [in addition to insulin and its mimics] have shown promising potentials against diabetes-induced brain injury. These include: antioxidants, neuroinflammation inhibitors, anti-apoptotics, neurotrophic factors, AChE inhibitors, mitochondrial function modifiers and cell based therapies.

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


Title:
The Auditory And Vestibular Toxicities Induced By ‎Antiepileptic Drugs

Abstract:
Epilepsy is a chronic medical disease in one third of patients and is associated with comorbid adverse somatic conditions due to epilepsy itself or its long-term treatment with antiepileptic drugs (AEDs). Data from experimental, cross-sectional and prospective studies have evidence for the deleterious effect of some AEDs on the auditory and vestibular systems. These abnormalities may be reversible or irreversible. Areas covered: This article review the evidence that long-term treatment with some antiepileptic drugs (AEDs) [e.g. carbamazepine, phenytoin, valproate, lamotrigine, gabapentin, vigabatrin and oxcarbazepine] (even in therapeutic drug doses) may result in tinnitus, phonophobia, sensorineural hearing loss, dizziness, ataxia, disequilibrium, imbalance, nystagmus, abnormalities in saccadic and pursuit eye movements and delayed conduction within the cochlea, auditory nerve and brainstem auditory pathways evidenced by abnormalities in Brainstem auditory evoked potentials and nystagmography recordings indicating auditory and central and/or peripheral vestibular dysfunctions. Expert opinion: Identification of monitoring of patients at high risk for developing audio-vestibular manifestations is necessary for appropriate preventive and therapeutic measures.


Title:
The Effect Of Antiepileptic Drugs On The Kidney ‎Function And Structure

Abstract:
Long-term use of antiepileptic drugs (AEDs) is associated with number of somatic conditions. Data from experimental, cross-sectional and prospective studies have evidence for the deleterious effect of some AEDs on the kidney. Areas covered: This review summarized the current knowledge of the effect of AEDs on the kidney including evidence and mechanisms. Fanconi syndrome was reported with valproate (VPA) therapy in severely disabled children with epilepsy. Renal tubular acidosis and urolithiasis were reported with acetazolamide, topirmate and zonisamide, drugs with carbonic anhydrase inhibition properties. Increased levels of urinary N-acetyl-beta-D-glucosaminidase (NAG) to urinary creatinine (U-NAG/UCr), urinary excretion of α1-micrglobulin, β-galactosidase activity; and urinary malondialdehyde to creatinine (MDA/Cr), markers of renal glomerular and tubular injury, were reported with chronic use of some AEDs (VPA, carbamazepine and phenytoin). The mechanism(s) of kidney dysfunction/injury induced by AEDs is unknown. Experimental and clinical studies have shown that VPA induces oxidative stress, mitochondrial deficits, carnitine deficiency and inflammation and fibrosis in renal tissue in mice and in vitro studies. Expert commentary: It seems reasonable to monitor kidney function during treating patients with epilepsy at high risk of kidney injury (e.g. on combined therapy with more than one AED, severely disabled children, etc).


Title:
The Relationship Between Valproate Induced Tremors ‎And Circulating Neurotransmitters: A Preliminary Study

Abstract:
Patients with epilepsy and on valproate (VPA) therapy may develop tremors as a common adverse effect; however, its exact mechanisms are unknown. We hypothesize that VPA-induced tremors may be related to the disturbances in dopamine (DA) and catecholamines (norepinephrine (NE) and epinephrine (E)) concentrations (which are also involved in VPA anticonvulsant effect). We aimed to determine the frequency and type of VPA-induced tremors and their risk factors and to investigate whether or not they are related to the plasma DA, NE and E concentrations. This study included 75 adults with primary epilepsy (mean age: 31.90 ± 5.62 years) and on VPA therapy for 10.57 ± 3.55 years and 40 matched healthy controls. Patients were divided according to the absence or presence of tremors. Blood samples were analyzed for DA, NE and E. Intermittent action tremors in both hands were reported in 31 (41.33%). Chronic standard VPA therapy, older age, longer treatment duration and higher serum concentrations of VPA are risk factors for tremors. None of the patients on controlled release VPA had tremors. Compared to controls, patients (without and with tremors) had lower DA (p = 0.0001) and NE (p = 0.01) concentrations. Compared to patients without tremors, patients with tremors had lower levels DA (p = 0.045) and NE (p = 0.01). Significant correlations were identified between DA with NE (r = 0.540, p = 0.001) concentrations and serum VPA with DA (r = -0.285, p = 0.045) and NE (r = -0.358, p = 0.01) plasma levels. We conclude that benign action tremors are common with standard VPA. Mechanisms underlying VPA-induced tremors may involve abnormalities of DA and NE neurotransmitters.

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


Title:
Topiramate Induced Peripheral Neuropathy: A Case ‎Report And Review Of Literature

Abstract:
Drug-induced peripheral neuropathy had been rarely reported as an adverse effect of some antiepileptic drugs (AEDs) at high cumulative doses or even within the therapeutic drug doses or levels. We describe clinical and diagnostic features of a patient with peripheral neuropathy as an adverse effect of chronic topiramate (TPM) therapy. A 37-year-old woman was presented for the control of active epilepsy (2010). She was resistant to some AEDs as mono- or combined therapies (carbamazepine, sodium valproate, levetiracetam, oxcarbazepine and lamotrigine). She has the diagnosis of frontal lobe epilepsy with secondary generalization and has a brother, sister and son with active epilepsies. She became seizure free on TPM (2013-2017) but is complaining of persistent distal lower extremities paresthesia in a stocking distribution. Neurological examination revealed presence of diminished Achilles tendon reflexes, stocking hypesthesia and delayed distal latencies, reduced conduction velocities and amplitudes of action potentials of posterior tibial and sural nerves, indicating demyelinating and axonal peripheral neuropathy of the lower extremities. After exclusion of the possible causes of peripheral neuropathy, chronic TPM therapy is suggested as the most probable cause of patient's neuropathy. This is the first case report of topiramate induced peripheral neuropathy in the literature.


Title:
Vestibular Function in Adults With Epilepsy of Unknown Etiology

Abstract:
OBJECTIVE:
This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period.

BACKGROUND:
Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients' quality of life.

METHODS:
This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients' mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG).

RESULTS:
Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities.

CONCLUSION:
Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.

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


Title:
Impact Of Secondhand Smoking On Disease Activity In ‎Women With Rheumatoid Arthritis

Abstract:
Smoking is an established risk factor for the development and severity of rheumatoid arthritis (RA) with prominent production of cytokines. The aim of the work was to study the possible effect of secondhand exposure on disease activity in non-smoking female RA patients. This cross-sectional study include 100 women with RA attending the rheumatology outpatient clinic and were grouped according to the non-smoking status into those not exposed to smoking and those considered secondhand smokers (SHS). Disease activity score in 28 joints (DAS28) was calculated and the patients' global assessment (PGA) score were assessed. The mean age of the patients was 45.2 ± 12.1 years and disease duration was 8.3 ± 6 years. Their DAS28 score was 4.3 ± 0.93 with a PGA score of 1.47 ± 1.36. Forty-seven of the patients were SHS and 53 were non-exposed. The secondhand smokers were significantly younger (41.6 ± 11.7 years) than the non-smokers (48.3 ± 11.6 years) (p = 0.005), and the DAS28 was significantly higher (4.6 ± 0.84 versus 4.1 ± 0.97; p = 0.02) compared to non-smokers. The disease duration and medications received were comparable. There is evidence pointing to the important role of secondhand smoking on disease activity in RA female patients. Studying the effect of secondhand smoking in view of the cytokine milieu could help confirm the relation to the disease pathogenesis. Taking into consideration the risk of cardiovascular disease and interplay with other potential factors should be well thought of. It is essential to draw patients' attention to the expected hazardous effect of passive smoking.

Author Info:
1
Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Asyut, Egypt. hammam@ualberta.ca.
2
Faculty of Rehabilitation, University of Alberta, Edmonton, Alberta, Canada. hammam@ualberta.ca.
3
Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Giza, Egypt.


Authors:
Hasanain AFA1, Zayed AAH2, Mahdy RE3, Nafee AMA4.

Title:
Cholecalciferol For Prophylaxis Against Antituberculosis ‎Therapy-Induced Liver Disorders Among Naïve Patients ‎With Pulmonary Tuberculosis: A Randomized, ‎Comparative Study

Abstract:
BACKGROUND:
Patients in countries endemic for chronic viral hepatitis are more vulnerable to antituberculosis therapy-induced liver disorders (ATT-LDs). The aim of this study was to explore the role of cholecalciferol in prophylaxis against ATT-LD among patients with pulmonary tuberculosis (TB) receiving ATT.

MATERIAL AND METHODS:
We conducted a hospital-based, prospective, randomized, comparative study which included 300 consecutive, naïve patients with pulmonary TB eligible for ATT. The patients were randomly allocated to Group A (150 patients who received ATT) and Group B (150 patients who received ATT with cholecalciferol) who had clinical evaluation, laboratory investigations, and imaging studies. Statistical analysis used student's t-test and Chi-square test were used as appropriate to compare the variables between the study groups.

RESULTS:
The study population mean age was 35.6 ± 15.3 years. The overall incidence rate of ATT-LD among the study population was 9.3%; the incidence rate was significantly higher among Group A patients compared to those of Group B (13.3 vs. 5.3%;P = 0.001). The onset of ATT-LD was significantly earlier among patients of Group A compared to those of Group B (31.4 vs. 58.7 days,P = 0.027), while the duration of ATT-LD was significantly longer among patients of Group A compared to those of Group B (34.8 vs. 16.9 days,P = 0.009). No adverse effects related to cholecalciferol use were observed.

CONCLUSIONS:
Adjuvant cholecalciferol supplementation may be protective against ATT-LD without extra adverse effects. Before recommending the routine use of cholecalciferol supplementation for prevention of ATT-LD, larger scale studies are recommended.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
2
Department of Chest Diseases, Assiut University, Assiut, Egypt.
3
Department of Internal Medicine, Assiut University, Assiut, Egypt.
4
Department of Microbiology, Assiut University, Assiut, Egypt.


Authors:
Hasanain AFA1, Mahdy RE2, Mahran AMA3, Safwat ASM4, Mohamed AO5, Abdel-Aal SM6.

Title:
Erectile Dysfunction In Patients With Nonalcoholic Fatty ‎Liver Disease

Abstract:
BACKGROUND AND STUDY AIMS:
There is a lack of studies on erectile dysfunction (ED) in patients diagnosed with nonalcoholic fatty liver disease (NAFLD). The present study aimed to estimate the prevalence of ED in patients with NAFLD and to determine the independent predictors of ED in these patients.

PATIENTS AND METHODS:
We conducted a prospective, hospital-based study of 192 consecutive male patients with NAFLD. All patients underwent clinical evaluation; abdominal ultrasonography; test for viral hepatitis markers; and estimation of liver chemistry panel, complete blood count, prothrombin time, serum lipids panel, serum testosterone, and fasting serum levels of glucose, insulin, and C-peptide.

RESULTS:
The mean age of the study population was 42.4±7.7years (79.1%≥40years). Of the 192 patients with NAFLD, 88 (45.8%) had ED, 28 (14.6%) had metabolic syndrome, 25 (13%) had type-2 diabetes mellitus (DM), and 131 (68.2%) had insulin resistance (IR). The mean level of serum testosterone was 3.17±2.94ng/mL, while the mean insulin resistance index was 2.9±1.7. Mild ED (38.6%) was the most frequent grade of ED. Age≥40years (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.7-24.1; p- 0.006), IR (OR 5.9; 95% CI 1.7-20.6; p- 0.005), and low serum testosterone (OR 5.1; 95% CI 1.5-17.1; p- 0.009) were the predictors of ED.

CONCLUSIONS:
ED is a common disorder in male patients with NAFLD; both IR and low serum testosterone contribute to its development. Treatment of IR may carry a dual benefit of improving erectile function and decreasing the grade of hepatic steatosis.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Egypt. Electronic address: a.fh@outlook.com.
2
Department of Internal Medicine (Gastroenterology Unit), Faculty of Medicine, Assiut University, Egypt.
3
Department of Dermatology and Andrology (Andrology Unit), Faculty of Medicine, Assiut University, Egypt.
4
Department of Urology, Faculty of Medicine, Assiut University, Egypt.
5
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Egypt.
6
Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Egypt.


Authors:
Hasler PW1, Soliman W2, Sander B3, Haamann P3, Larsen M3,4.

Title:
The Grey Fovea Sign Of Macular Oedema Or Subfoveal ‎Fluid On Non-Stereoscopic Fundus Photographs

Abstract:
PURPOSE:
To describe the grey fovea sign of fovea-involving macular oedema or subretinal fluid accumulation in red-free fundus photography.

METHODS:
A test set of 91 digital fundus photographs of good quality from 100 consecutive eyes in 72 patients with diabetic retinopathy or central serous chorioretinopathy was composed by one of the investigators and evaluated by four masked observers. The photographs were graded as to whether a normal dark fovea was present or absent. The reference method was foveal thickness measurement using optical coherence tomography (OCT).

RESULTS:
Eyes graded as having a grey fovea on fundus photographs (n = 67) had a median foveal thickness of 279 μm (interquartile range 130 μm), whereas eyes graded as having a normal dark fovea (n = 24) had a median foveal thickness of 238 μm (interquartile range 44.5 μm, p = 0.025).

CONCLUSION:
The absence of a dark fovea on red-free greyscale fundus photographs is a sign of foveal thickening or detachment that can be reliably recognized by graders when using OCT as the reference diagnostic method. Awareness of the grey fovea sign may facilitate fundus photographic screening for maculopathy because its absence is a reliable sign that no foveal oedema or detachment is present. Its presence may indicate that such conditions are present, but it can also be induced by various other conditions, for which reason it should prompt further investigations by OCT.

Author Info:
1
Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.
2
Department of Ophthalmology, University of Assiut, Assiut, Egypt.
3
Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
4
Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.


Title:
Demographic Features And Prevalence Of Myocarditis In ‎Patients Undergoing Transarterial Endomyocardial ‎Biopsy For Unexplained Cardiomyopathy

Abstract:
BACKGROUND:
The diagnosis of myocarditis is still a challenge. The true incidence of the disease is unknown due to great variation in clinical manifestations.

OBJECTIVE:
The aim of this study was to identify the demographic features and in-hospital prevalence of myocarditis in patients undergoing transarterial endomyocardial biopsy (EMB) for unexplained cardiomyopathy.

PATIENTS AND METHODS:
This was a prospective observational study. We recruited all patients with unexplained cardiomyopathy presented at Assiut University Hospital from January 2014 till December 2014. The inclusion criteria were namely acute symptoms of heart failure, worsening of ejection fraction (EF) despite optimized therapy, hemodynamically significant arrhythmias, heart failure with concurrent rash, fever, or peripheral eosinophilia and new-onset cardiomyopathy in the presence of known amyloidosis. We excluded patients with uncontrolled hypertension, diabetes mellitus, ischemic, congenital, rheumatic heart disease, peripartum cardiomyopathy, cardiotoxic exposure, alcoholic and familial cardiomyopathies. All patients were subjected to full examination with ECG, echocardiography and coronary angiography, and then 3 EMB samples via femoral artery were taken from the LV. The histopathological examination of all biopsies was done.

RESULTS:
Out of the 1100 patients admitted to our department, 15 patients (1.4%), who had unexplained cardiomyopathy were included in our study. Seventy-three percent were males with mean age 37.8 ± 17 y. 87% were from rural areas, and 73.3% presented with dyspnea grade III to IV for a duration period that varied from 2 to 8 weeks. 33% had an EF > 40%. 33 EMB samples from 11 patients were examined. 7 out of 11 patients (63.6%) proved to have myocarditis on pathological examination, 5 of them had active myocarditis, 1 had chronic myocarditis and 1 had borderline myocarditis. Three patients (27.3%) had no pathological evidence of inflammation and one patient (9.1%) had cardiac amyloidosis. Four out of 15 patients (26.7%) did not undergo EMB because of LV thrombus or bleeding tendency. None of our patients had any complication from EMB.

CONCLUSION:
The in-hospital prevalence of myocarditis is high among patients with unexplained cardiomyopathy. EMB via femoral artery is safe and essential in confirming the diagnosis.

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


Authors:
Hassan AKM1, Abd-El Rahman H1, Mohsen K1, Dimitry SR1.

Title:
Impact Of In-Hospital Blood Pressure Variability On ‎Cardiovascular Outcomes In Patients With Acute ‎Coronary Syndrome

Abstract:
To evaluate the impact of blood pressure variability (BPV) on cardiovascular outcomes in patients with acute coronary syndrome, short-term BPV was estimated by using weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings. The primary outcome was in-hospital major adverse cardiac events (MACE). Overall, 200 patients (mean age, 58.6 years; 27.5% women; 38% with diabetes mellitus; and 47% smokers) were divided into low and high BPV groups based on the median value (9.45). Patients in the high BPV group were more likely to have in-hospital MACE compared with patients with low BPV (47% vs 27%, P = .003). Multivariate binary logistic regression analysis of incidence of MACE showed that BPV (odds ratio, 2.4; confidence interval, 1.2-4.5 [P = .008]) and presence of type II diabetes mellitus (odds ratio, 2.6; confidence interval, 1.2-5.3 [P = .008]) were the only independent predictors of in-hospital MACE derived mainly by hypertensive emergencies. BPV could be an important risk factor for in-hospital MACE in patients with acute coronary syndrome.

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


Authors:
Hassan MM1, Botrus G2, Abdel-Wahab R3, Wolff RA2, Li D2, Tweardy D4, Phan AT5, Hawk E6, Javle M2, Lee JS7, Torres HA8, Rashid A9, Lenzi R2, Hassabo HM2, Abaza Y2, Shalaby AS2, Lacin S10, Morris J11, Patt YZ12, Amos CI13, Khaderi SA14, Goss JA14, Jalal PK15, Kaseb AO2.

Title:
Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma

Abstract:
BACKGROUND & AIMS:
Environmental factors have been identified that affect risk of hepatocellular carcinoma (HCC), but little is known about the effects of sex hormones on liver cancer development or outcome. The authors investigated whether menopause hormone therapy (MHT) affects risk, age at onset, or outcome of HCC.

METHODS:
We performed a case-control study of 234 female patients treated for HCC at a tertiary medical center and with 282 healthy women (controls) from January 1, 2004 through May 31, 2015. We collected detailed information on environmental exposures, ages of menarche and menopause, hysterectomies, and uses of birth control and MHT. We performed multivariable logistic and Cox regression analyses to determine the independent effects of factors associated with women on risk and clinical outcome in HCC. The primary outcomes were effect of MHT on HCC risk, the relationship between MHT with hepatitis virus infection on HCC development, and effect of MHT on age at HCC onset or survival after diagnosis of HCC.

RESULTS:
The estimated adjusted odds ratio (AOR) for HCC in women who ever used estrogen was 0.53 (95% confidence interval [CI], 0.32-0.88). This association was supported by the older age of HCC onset among estrogen users (mean, 64.5 ± 0.9 years) vs nonusers (mean 59.2 ± 1.1 years; P = .001) and the reduced risk of HCC among long-term users (more than 5 years) (AOR, 0.36; 95% CI, 0.20-0.63). Users of estrogen also had a reduced risk for hepatitis-associated HCC: AOR for users, 4.37 (95% CI, 1.67-11.44) vs AOR for nonusers, 17.60 (95% CI, 3.88-79.83). Estrogen use reduced risk of death from HCC (hazard ratio, 0.55; 95% CI, 0.40-0.77; P = .01). Median overall survival times were 33.5 months for estrogen users (95% CI, 25.7-41.3 months) and 24.1 months for nonusers (95% CI, 19.02-29.30 months; P = .008).

CONCLUSION:
In a case-control study of women with HCC vs female control subjects at a single center, we associated use of estrogen MHT with reduced risk of HCC and increased overall survival times of patients with HCC. Further studies are needed to determine the benefits of estrogen therapy for women and patients with HCC, and effects of tumor expression of estrogen receptor.

Author Info:
1
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: mhassan@mdanderson.org.
2
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
4
Division of Internal Medicine, the University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Houston Methodist Hospital, Houston, Texas.
6
Division of Cancer Prevention and Population Science, the University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of System Biology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
8
Department of Infectious Diseases, the University of Texas MD Anderson Cancer Center, Houston, Texas.
9
Department of Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Medical Oncology, Hacettepe University, Ankara, Turkey.
11
Department of Biostatistics, the University of Texas MD Anderson Cancer Center, Houston, Texas.
12
University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
13
Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
14
Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Texas Children's Hospital, Houston, Texas.
15
Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas.


Authors:
Helmy H1, Abdel-Galeel A1, Taha Kishk Y1, Mohammed Sleem K2.

Title:
Correlation Of Corrected QT Dispersion With The ‎Severity Of Coronary Artery Disease Detected By ‎SYNTAX Score In Non-Diabetic Patients With STEMI

Abstract:
INTRODUCTION:
Determination of the QT interval dispersion by means of a standard ECG at rest has been widely used for cardiovascular risk assessment during the last 15 years as one of the recent explanations for the development of life threatening ventricular arrhythmias. However, little is known about the relation between QT dispersion and the severity of coronary artery atherosclerosis as defined by SYNTAX score.

AIM OF WORK:
The present study was done to assess the correlation between QTc dispersion and the severity of coronary artery disease in acute ST elevation myocardial infarction (STEMI) detected by SYNTAX score.

PATIENTS AND METHODS:
It included 50 patients who were non-diabetic, non-hypertensive and diagnosed as acute STEMI within 6 months undergoing coronary angiography in the cath. lab. of Assiut University Hospital. QT dispersion was calculated as the difference between the longest (QT max) and the shortest QT (QTmin) interval recorded by standard 12 lead ECG. The QT interval was corrected by using Bazett's formula (QTc = QT/square root of R-R interval in seconds). Corrected QT dispersion (QTcd) was defined as the difference between the maximum and minimum QTc for a given heart rate. The SYNTAX score is calculated by syntax calculator, a new tool to grade the complexity of coronary artery disease.

RESULTS:
Out of 50 participating patients, there were 43 (86%) males with mean age 53.9 ± 12.1 years. The mean QTc dispersion was 83.1 ± 20.3 ms, while mean SYNTAX score was 11.6 ± 6.1. There is a strong positive correlation between QTc dispersion and SYNTAX score. This was not related to age, gender, risk factors or family history of ischemic heart disease. Of note, there was a relationship between QTc dispersion and serum creatinine.

CONCLUSIONS:
Our study concluded that there is a significant positive correlation between corrected QT dispersion and severity of coronary artery disease as assessed by SYNTAX score.

Author Info:
1
Department of Cardiology, Assiut University, Egypt.
2
Assiut Policemen Hospital, Egypt.


Authors:
Hetta DF1, Kamal EE2, Mahran AM2, Ahmed DG1, Elawamy A3, Abdelraouf AM3.

Title:
Efficacy Of Local Dexmedetomidine Add-On For ‎Spermatic Cord Block Anesthesia In Patients ‎Undergoing Intrascrotal Surgeries: Randomized ‎Controlled Multicenter Clinical Trial

Abstract:
STUDY OBJECTIVE:
The objective of this study was to evaluate the effect of adding dexmedetomidine (DEX) to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia.

DESIGN:
This is a randomized, double-blind study.

SETTING:
This study was performed in an educational and research hospital.

PATIENTS:
One hundred twenty adult males were scheduled for intrascrotal surgeries.

INTERVENTIONS:
Patients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX) for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously.

MEASUREMENTS:
Time to first analgesic request, analgesic consumption, and visual analog scale (VAS) pain score in the first 24 hours postoperatively were assessed.

MAIN RESULTS:
Time to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile) range, 7 (6-12) hours versus 6 (5-7) hours, (p=0.000), the mean cumulative morphine consumption (mg) in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI) of -4.57 (-6.06 to -3.07) (p=0.000); also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8), VAS 6 hours (2.62±1.5 vs 3.93±1.2), VAS 12 hours (2.40±1.1 vs 3.57±0.65), VAS 24 hours (1.90±0.68 vs 2.53±0.62) (p=0.000).

CONCLUSION:
The addition of 50 µg of DEX to bupivacaine 0.25% in spermatic cord block for intrascrotal surgeries resulted in delay of first analgesic supplementation, reduction of postoperative analgesic consumption as well as improvement of the success rate of the block.

Author Info:
1
Department of Anesthesiology and Pain Management, South Egypt Cancer Institute.
2
Department of Dermatology and Andrology.
3
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Hetta HF1, Elkady A2, Morsy KH3, Mohamed IS1, Ibrahim MA1.

Title:
Serum Level of IL17a among Cirrhotic Hepatitis C Virus Infected Patients with Incidence of Diabetes Mellitus

Abstract:
IL17a is the key inflammatory cytokine of TH17 and contributes to the pathogenesis of diabetes mellitus which is a common endocrine disorder associated with HCV infection. Herein, 183 cirrhotic HCV infected patients were screened for ANA by ELISA and positive cases (n=40) were screened for ICA by Immunofluorescence and IL17a serum levels were measured by ELISA and compared to a control group (n=24). Out of 40 cirrhotic HCV, ANA (+) infected patients, 16 patients (40 %) were type 2 diabetic and 13 (32.5%) were non-diabetic. On the other hand, 17 positive ICA (42.5%) and 23 negative ICA (57.5%) patients were reported. IL17a serum level was significantly elevated in cirrhotic HCV infected patients who were positive for ICA than negative ICA (P < 0.0001) and was significantly higher in type 2 diabetic than both non-diabetic patients (P=0.04) and controls (P=0.0005). In conclusion, IL17 serum levels were elevated in diabetic HCV infected patients.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Sohag general Hospital, Sohag University, Sohag, Egypt.
3
Department of Tropical Medicine & gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt.


Authors:
Hussein A1, Farghaly H1, Askar E1, Metwalley K1, Saad K2, Zahran A3, Othman HA4.

Title:
Etiological Factors Of Short Stature In Children And ‎Adolescents: Experience At A Tertiary Care Hospital In ‎Egypt

Abstract:
BACKGROUND:
Accurate anthropometric measurements and critical analysis of growth data allow the clinician to promptly recognize children with short stature. The aim of this study was to determine the frequency of etiological factors causing short stature among children referred to the pediatric endocrinology clinic of Assiut University Children's Hospital, the main tertiary care center in Upper Egypt.

METHODS:
We conducted this descriptive observational study from May 2012 to December 2015, to analyze 637 children (boys 354, girls 283) with short stature. Evaluation included: detailed medical history, physical examination, laboratory tests, bone age and chromosomal analysis.

RESULTS:
Endocrinological causes accounted for 26% of short stature [of them, 11.8% had growth hormone deficiency (GHD)], 63.6% had normal variants of growth [of them, 42% had familial short stature (FSS), 15.8% had constitutional growth delay (CGD) and 5.5% a combination of both]. Interestingly, celiac disease (CD) constituted 6.6% of children with short stature in our cohort.

CONCLUSIONS:
Although potentially treatable causes such as GHD, hypothyroidism and CD accounted for a considerable percentage of short stature in our study, the majority of short stature in children had normal variations of growth. Growth hormone treatment in children, however, should be promptly initiated with specific clinical indications. CD is a not uncommon cause of short stature.

Author Info:
1
Pediatric Department, Faculty of Medicine, Assiut University, Egypt.
2
Associate Professor of Pediatrics, Faculty of Medicine, University of Assiut, Assiut 71516, Egypt.
3
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
4
Department of Clinical Pathology, Faculty of Medicine, Aswan University, Aswan, Egypt.


Authors:
Hussein A1, Askar E2, Badawy A3, Saad K2, Zahran A4, Elderwy AA5.

Title:
Impact Of Cytokine Genetic Polymorphisms On The Risk ‎Of Renal Parenchymal Infection In Children

Abstract:
BACKGROUND:
Acute pyelonephritis is associated with renal scarring in up to 30% of patients. Renal scarring may cause significant long-term morbidity. The pathogenesis of acute pyelonephritis remains unclear, although it involves interaction among uroepithelium, the immune system cells, and the locally produced cytokines. That some UTI-prone children develop acute pyelonephritis, and eventually renal parenchymal scarring, suggests a genetic role. Interleukin-6, interleukin-8, chemokine receptor-1 (CXCR1), and tumor necrosis factor-alpha (TNFα), the key regulators of the host immune responses, are proteins whose secretion is controlled by genes. We postulated that functional polymorphic variants of their genes might have a role in APN susceptibility.

OBJECTIVES:
We sought to investigate a possible association of the common functional polymorphisms in genes encoding IL-6, IL-8, CXCR1, and TNFα with the risk of APN in children.

METHODS:
Urine culture was used to diagnose 300 children with UTI, of mean age of 51.31 ± 37.4 months (2-180 months). 99Tc-DMSA scans diagnosed 86 children with APN. Follow-up scans identified new renal scars in 18 children. Six functional single-nucleotide polymorphisms (SNPs) in genes encoding IL-6, IL-8, CXCR1, and TNFα were genotyped in all subjects (IL-6 rs1800795 (-174G/C), IL-6 rs1800796 (-572G/C), IL-8 rs2227306 (781C/T), IL8 rs4073 (-251A/T), CXCR1 rs2234671 (2607G/C), and TNFα rs1800629 (-308G/A)).

RESULTS:
TT genotype of IL-8 -251A/T polymorphism was significantly higher in APN patients (26.7%) than those with lower UTI (11.7%, p = 0.01) and control individuals (12.2%, p = 0.002). T allele was significantly more common in APN than in lower UTI (p = 0.025) and was significantly more common in APN (46%) than in the controls (p = 0.001). Similarly, TT genotype of IL-8 781C/T polymorphism was significantly more common in APN patients (31.4%) than those with lower UTI (17.3%, p = 0.003) and the controls (14.3%, p = 0.001). T allele was significantly more common in APN (55%) than lower UTI (40%, p = 0.005) and controls (37%, p = 0.001). However, IL-8 -251A/T and +781C/T SNPs did not qualify as an independent risk for parenchymal infection (OR 1.9, 95% CI 0.68-2.6, p = 0.13 and OR 2.3, 95% CI 0.89-3.7, p = 0.091, respectively). Lower UTI did not differ from the controls. The frequency of the genotypes and alleles of IL-6, CXCR1, and TNFα SNPs did not differ significantly among the different groups of the study.

CONCLUSION:
IL-8 -251A/T and +781C/T SNPs are associated with susceptibility to renal parenchymal infection in children and could be implicated in APN risk. However, none of these variants could clearly and independently predict this risk.

Author Info:
1
Pediatric Nephrology, Children's Hospital, Assiut University, Egypt; Genetic Unit, Children's Hospital, Assiut University, Egypt. Electronic address: almontaser.bella@gmail.com.
2
Children's Hospital, Assiut University, Egypt.
3
Pediatric Nephrology, Children's Hospital, Assiut University, Egypt.
4
Clinical Pathology, SECI, Assiut University, Egypt.
5
Pediatric Urology, Assiut University, Egypt.


Authors:
Ismail EA1, Sayed JA1, Bakri MH1, Mahfouz RZ2.

Title:
Comparison Of Intrathecal Versus Intra-Articular ‎Dexmedetomidine As An Adjuvant To Bupivacaine On ‎Postoperative Pain Following Knee Arthroscopy: A ‎Randomized Clinical Trial

Abstract:
BACKGROUND:
Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery.

METHODS:
Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels.

RESULTS:
Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group.

CONCLUSIONS:
Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.

Author Info:
1
Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.


Title:
Dexamethasone Alone Versus In Combination With Intra-‎Operative Super-Hydration For Postoperative Nausea ‎And Vomiting Prophylaxis In Female Patients Undergoing ‎Laparoscopic Cholecystectomy: A Randomized Clinical ‎Trial

Abstract:
BACKGROUND:
Dexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC).

METHODS:
A total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer's lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated.

RESULTS:
Group DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002).

CONCLUSIONS:
In female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer's lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.

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


Authors:
Ismail SA1, Abbas AM2, Habib D2, Morsy H3, Saleh MA4, Bahloul M2.

Title:
Effect Of Female Genital Mutilation/Cutting; Types I And ‎II On Sexual Function: Case-Controlled Study

Abstract:
BACKGROUND:
The existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women.

METHODS:
We recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM.

RESULTS:
Female sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%). FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control.

CONCLUSION:
In this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.

Author Info:
1
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt. saharsotohy@gmail.com.
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Kadar A1, Morsy M2, Sur YJ3, Laungani AT4, Akdag O5, Moran SL6.

Title:
The Vascular Anatomy of the Capitate: New Discoveries Using Micro-Computed Tomography Imaging

Abstract:
PURPOSE:
To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types.

METHODS:
Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points.

RESULTS:
The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line.

CONCLUSIONS:
This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis.

CLINICAL RELEVANCE:
This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.

Author Info:
1
Division 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
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt.
3
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Republic of Korea.
4
Division of Plastic Surgery, Mayo Clinic, Rochester, MN.
5
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey.
6
Division of Plastic Surgery, Mayo Clinic, Rochester, MN. Electronic address: moran.steven@mayo.edu.


Authors:
Khairy SA1, Neves RJ2, Hartung O3, O'Sullivan GJ4.

Title:
Factors Associated with Contralateral Deep Venous Thrombosis after Iliocaval Venous Stenting

Abstract:
BACKGROUND:
The majority of iliac venous obstructions occur on the left side, and endovascular therapy has become the first line treatment for this condition. A left common iliac venous stent will protrude into the inferior vena cava (IVC) to some extent, thereby covering the contralateral common iliac vein (CIV) outflow. This may increase the risk of thrombosis of the contralateral iliac vein. The aim of this paper was to determine the rate of, and factors associated with, contralateral lower limb venous thrombosis after stenting, and to evaluate the results of salvage revascularisation.

METHODS:
A total of 376 patients (102 from UCH, Galway, Ireland, 2008-16, and 274 from, CHU Nord, Marseille, France, 2000-15) with symptomatic acute or chronic left iliocaval venous obstruction were retrospectively evaluated. Either duplex ultrasound scanning (DUS) or computed tomographic venography (CTV) was used for pre- and post-operative imaging. Data were collected from the PACS system (IMPAX, Agfa, BE) of the Radiology Department, UCH, Galway, and from the electronic medical records of Vascular Surgery department, CHU Nord, Marseille.

RESULTS:
The median age of stented patients was 46 (range 15-86 years), 80% were female (301/376). Following left CIV stent placement, 10 patients later presented with a right (contralateral) iliac deep venous thrombosis (DVT) resulting in a cumulative incidence of contralateral DVT of 4% according to Kaplan-Meier analysis. Acute DVT (p=.001), non-compliance with the prescribed 6 months anticoagulation (p = 0.05), pre-operative contralateral internal iliac vein (IIV) thrombosis (p = 0.001), and pre-existing IVC filter placement (p = 0.003) were all statistically significantly associated with contralateral DVT. All patients with symptomatic contralateral iliac DVT underwent clot removal in the acute phase. The primary patency of these limbs was 100% at 3 years.

CONCLUSION:
Stent placement across the iliocaval confluence from the left CIV is associated with a low but definite rate of contralateral iliac vein thrombosis. Acute DVT, pre-operative contralateral IIV thrombosis, pre-existing IVC filters, and anticoagulation non-compliance are significant risk factors.

Author Info:
1
Department of Vascular and Endovascular Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
2
Department of Angiology and Vascular Surgery and Department of Biomedical Sciences, Hospital São João, EPE, Porto, Portugal.
3
Department of Vascular Surgery, CHU Nord, Marseille, France.
4
Department of Interventional Radiology, University College Hospital of Galway, National University of Ireland, Galway, Ireland. Electronic address: gerard.osullivan2@hse.ie.


Authors:
Khedr EM1, Omran EAH2, Ismail NM2, El-Hammady DH3, Goma SH2, Kotb H4, Galal H5, Osman AM4, Farghaly HSM6, Karim AA7, Ahmed GA8.

Title:
Effects Of Transcranial Direct Current Stimulation On ‎Pain, Mood And Serum Endorphin Level In The ‎Treatment Of Fibromyalgia: A Double Blinded, ‎Randomized Clinical Trial

Abstract:
BACKGROUND:
Recent studies have shown that novel neuro-modulating techniques can have pain-relieving effects in the treatment of chronic pain. The aim of this work is to evaluate the effects of transcranial direct current stimulation (tDCS) in relieving fibromyalgia pain and its relation with beta-endorphin changes.

MATERIAL AND METHODS:
Forty eligible patients with primary fibromyalgia were randomized to receive real anodal tDCS or sham tDCS of the left motor cortex (M1) daily for 10 days. Each patient was evaluated using widespread pain index (WPI), symptom severity of fibromyalgia (SS), visual analogue scale (VAS), and determination of pain threshold as a primary outcome. Hamilton depression and anxiety scales (HAM-D and HAM-A) and estimation of serum beta-endorphin level pre and post-sessions were used as secondary outcome. All rating scales were conducted at the baseline, after the 5th, 10th session, 15 days and 1 month after the end of the sessions.

RESULTS:
Eighteen patients from each group completed the follow-up schedule with no significant difference between them regarding the duration of illness or the baseline scales. A significant TIME × GROUP interaction for each rating scale (WPI, SS, VAS, pain threshold, HAM-A, HAM-D) indicated that the effect of treatment differed in the two groups with higher improvement in the experimental scores of the patients in the real tDCS group (P = 0.001 for WPI, SS, VAS, pain threshold, and 0.002, 0.03 for HAM-A, HAM-D respectively). Negative correlations between changes in serum beta-endorphin level and the changes in different rating scales were found (P = 0.003, 0.003, 0.05, 0.002, 0002 for WPI, SS, VAS, HAM-A, and HAM-D respectively).

CONCLUSION:
Ten sessions of real tDCS over M1 can induce pain relief and mood improvement in patients with fibromyalgia, which were found to be related to changes in serum endorphin levels. ClinicalTrials.gov Identifier: NCT02704611.

Author Info:
1
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assuit, Egypt. Electronic address: emankhedr99@yahoo.com.
2
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Helwan University, Cairo, Egypt.
4
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assuit, Egypt.
5
Department of Clinical Pathology, Faculty of Medicine, Assuit University, Assuit, Egypt.
6
Department of Pharmacology, Faculty of Medicine, Assuit University, Assuit, Egypt.
7
Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Tübingen, Germany; Department of Prevention, Health Psychology and Neuro-rehabilitation, SRH University of Riedlingen, Riedlingen, Germany.
8
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University, Sohag, Egypt.


Authors:
Khedr EM1, Sharkawy ESA2, Attia AMA2, Ibrahim Osman NM2, Sayed ZM2.

Title:
Role Of Transcranial Direct Current Stimulation On ‎Reduction Of Postsurgical Opioid Consumption And ‎Pain In Total Knee Arthroplasty: Double Randomized ‎Clinical Trial‎

Abstract:
BACKGROUND:
Postoperative pain control is an important factor in determining recovery in total knee arthroplasty (TKA).The aim of the study was to assess the efficacy of 4 sessions of transcranial direct current stimulation (tDCS) over primary motor cortex (M1) in patients undergoing unilateral TKA.

MATERIALS:
Fifty patients undergoing TKA were included in the study. They were divided randomly into two groups (25 patients for each, using closed envelopes): real tDCS (2 mA, 20 min, with anodal stimulation applied over M1 postoperative for 4 consecutive days) and sham tDCS. Opioid consumption was titrated by an anaesthesiologist during the study period and was used as primary outcome. As a secondary outcome, patients were evaluated using Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline, then the 1st, 2nd, 3rd and 4th days after operation.

RESULTS:
There was no significant difference between real and sham tDCS in any rating scales at baseline. The opioid consumption and LANSS scores decreased more in patients who received real tDCS over the course of the treatment than sham tDCS. Real tDCS was associated with 59% reduction in the titrated analgesia. There was no significant difference between groups (time × groups interaction) in the VAS.

CONCLUSION:
Since the VAS was constant, repeated sessions of anodal tDCS over M1 with an extra-cephalic cathodal electrode can achieve the same degree of analgesia with less opioid consumption over the postoperative days after TKA. Thus, tDCS is a promising tool in the field of postoperative analgesia.

SIGNIFICANCE:
The data of the present study suggest that four sessions of transcranial direct current brain stimulation over motor cortex could reduce morphine consumption and pain perception during the postoperative period in total knee arthroplasty.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT02704182.

Author Info:
1
Neuropsychiatry Department, Assiut University Hospital, Egypt.
2
Anesthesiology Department, Assiut University Hospital, Egypt.


Authors:
Kiserud T1,2, Piaggio G3,4, Carroli G5, Widmer M6, Carvalho J4, Neerup Jensen L7, Giordano D5, Cecatti JG8, Abdel Aleem H9, Talegawkar SA10, Benachi A11, Diemert A12, Tshefu Kitoto A13, Thinkhamrop J14, Lumbiganon P14, Tabor A7, Kriplani A15, Gonzalez Perez R16, Hecher K12, Hanson MA17, Gülmezoglu AM6, Platt LD18,19.

Title:
The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

Abstract:
BACKGROUND:
Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use.

METHODS AND FINDINGS:
We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown-rump length measured at 8-13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25-31), median height was 162 cm (IQR 157-168), median weight was 61 kg (IQR 55-68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487-2,222). The median pregnancy duration was 39 wk (IQR 38-40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8-16). The median birthweight was 3,300 g (IQR 2,980-3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts.

CONCLUSIONS:
This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.

Author Info:
1
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
2
Department of Clinical Science, University of Bergen, Bergen, Norway.
3
Medical Statistics Department, London School of Hygiene &Tropical Medicine, London, United Kingdom.
4
Statistika Consultoria, São Paulo, Brazil.
5
Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
6
Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
7
Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
8
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
9
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
10
Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, United States of America.
11
Service de Gynecologie Obstetrique, Hôpital Antoine-Béclère, AP-HP, Université Paris Sud, Clamart, France.
12
Department for Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
13
École de Santé Publique, Faculté de Medecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
14
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
15
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
16
División de Obstetricia y Ginecología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
17
Institute of Developmental Sciences, University of Southampton, Southampton, United Kingdom.
18
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America.
19
Center for Fetal Medicine and Women's Ultrasound, Los Angeles, California, United States of America.


Authors:
Lee CF1, Lu JC2, Zidan A1,3, Lee CS4, Wu TH1, Chan KM1, Lee WC1.

Title:
Microscope-Assisted Hepatic Artery Reconstruction In ‎Adult Living Donor Liver Transplantation-A Review Of ‎‎325 Consecutive Cases In A Single Center‎

Abstract:
BACKGROUND:
Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature.

METHODS:
Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed. Under microscope assistance, all hepatic artery anastomosis were performed in a risk-free and back-wall first manner. We collected donors' and recipients' demographics, operative procedures, and outcome.

RESULTS:
A total of 325 adult LDLTs were enrolled in the study. Of these, 297(91.4%) were right liver graft. The mean diameter of the hepatic arteries of the graft was 1.9 ± 0.3 mm. A single HA anastomosis was performed in 310 patients (95.4%). The 1-, 3-, and 5-year overall patient survival rates were 84.8%, 76.8%, and 75.2%, respectively. Only one (0.3%) episode of HAT was encountered in our series. The patient was treated successfully with nonsurgical management.

CONCLUSION:
Our study showed that the occurrence of HAT is avoidable. Identifying risk factors associated with HAT, meticulous surgical techniques, and careful routine flow monitoring are mandatory to avoid disastrous complications.

Author Info:
1
Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
2
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
3
Assiut University Hospital, Assiut, Egypt.
4
Department of Gastroenterology, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.


Authors:
Mahran A1,2, Soriano A1, Safwat AS2, Hijaz A1,3, Mahajan ST1,3, Trabuco EC4, Siegel SW5, El-Nashar SA6,7,8.

Title:
The Effect Of Sacral Neuromodulation On Pregnancy: A ‎Systematic Review

Abstract:
INTRODUCTION AND HYPOTHESIS:
To evaluate the effects of sacral neuromodulation (SNM) on pregnancy and the impact of delivery on SNM function.

METHODS:
A systematic search was conducted through January 2016. We selected studies including women who had SNM and a subsequent pregnancy.

RESULTS:
Out of 2,316, eight studies were included, comprising 22 patients (26 pregnancies). SNM indications were Fowler's syndrome in 11, urinary retention in 6, fecal incontinence in 1, fecal and urinary urgency in 1, overactive bladder in 1, intractable interstitial cystitis in 1, and myelodysplasia in 1. SNM stayed on in 8 pregnancies. In the remaining 18 pregnancies in which the device was deactivated, 7 had recurrent urinary tract infections, including 1 with pyelonephritis and 2 who requested reactivation owing to recurrent symptoms. Outcomes were reported in 25 pregnancies, 16 had Cesarean section (CS) and 9 had vaginal delivery, including 2 operative deliveries. Out of 25, two infants had pilonidal sinus and motor tic disorder (exhibited at the age of 2 years), both from the same mother. After delivery, SNM was functioning in 15 (60%), 4 required reprogramming, and 3 required replacement (1 had recurrence of fecal incontinence after her operative delivery with evidence of displaced leads and 1 patient reported decreased SNM effects after her two CS), and 3 decided to remove the device (2 out of 3 patients were free of symptoms after SNM deactivation and requested removal).

CONCLUSION:
Within the current limited evidence, the decision regarding SNM activation or deactivation should be individualized. A registry for those patients is recommended.

Author Info:
1
Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.
2
Department of Urology, Assiut University, Assiut, Egypt.
3
Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
4
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
5
Metro Urology Centers for Continence Care and Female Urology, St. Paul, MN, USA.
6
Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA. sherif.el-nashar@uhhospitals.org.
7
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt. sherif.el-nashar@uhhospitals.org.
8
Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA. sherif.el-nashar@uhhospitals.org.


Authors:
Mahran AM1, Elgamal DA2, Ghafeer HH2, Abdel-Maksoud SA2, Farrag AA2.

Title:
Histological Alterations In Leydig Cells And ‎Macrophages In Azoospermic Men

Abstract:
The study aimed to compare the histological features of Leydig cells and macrophages in the testicular interstitium of obstructive versus nonobstructive azoospermia. Thirty-nine azoospermic men undergoing testicular sperm extraction during intracytoplasmic sperm injection were allocated into obstructive azoospermia group (GI) and nonobstructive azoospermia group (GII) which was subdivided into Sertoli cell-only syndrome (GIIA), germ cell arrest (GIIB) and hypospermatogenesis (GIIC) subgroups. Serum LH, FSH and testosterone levels were measured. Ultrastructural changes and the mean number of CD68-positive cells were estimated in the different groups. In GIIA, Leydig cells' processes came in contact with macrophages and showed smooth endoplasmic reticulum dilatation. In GIIB, Leydig cells showed apoptotic changes. Macrophages were commonly encountered in their vicinity demonstrating large number of lysosomes. In GIIC, Leydig cells showed euchromatic nuclei. Macrophages showed expulsion of their lysosomal contents in the interstitium surrounded by apoptotic bodies. The mean count of total CD68-positive macrophages was higher in cases of obstructive azoospermia with nonsignificant differences compared to nonobstructive azoospermia groups. Significant increase in FSH level was detected in GIIA compared to GI. It is concluded that structural interactions might take place between Leydig cells and macrophages in the interstitial tissue of azoospermic men.

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


Title:
Long Term Follow up and Patient Satisfaction after Reduction Mammoplasty: Superomedial versus Inferior Pedicle

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

METHODS:
This study was carried out on 60 cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and 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 statistical significant difference. No statistical significant difference was observed between patients undergone either types of operations concerning breast symmetry, nipple symmetry and sensation. The mean score of satisfaction was higher among patients undergone superomedial pedicle than inferior pedicle.

CONCLUSION:
The superomedial pedicle shows better long term cosmetic result in reduction mammoplasty.

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


Authors:
Makhlouf NA1, Moustafa E2, Zakaria M3, Imam HM4.

Title:
Fascioliasis: A Report On A Case Presenting With ‎Abdominal Pain

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: nahedmak@yahoo.com.
2
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: Ehab_mostafa99@yahoo.com.
3
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: mztropical2015@aun.edu.eg.
4
Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address: hishimimam@aun.edu.eg.


Authors:
Malek E1,2, Abdel-Malek MA2,3,4, Jagannathan S2,3, Vad N2,3, Karns R5, Jegga AG5, Broyl A6, van Duin M6, Sonneveld P6, Cottini F7,8, Anderson KC7,8, Driscoll JJ2,3,9.

Title:
Pharmacogenomics And Chemical Library Screens ‎Reveal A Novel SCFSKP2 Inhibitor That Overcomes ‎Bortezomib Resistance In Multiple Myeloma

Abstract:
While clinical benefit of the proteasome inhibitor (PI) bortezomib (BTZ) for multiple myeloma (MM) patients remains unchallenged, dose-limiting toxicities and drug resistance limit the long-term utility. The E3 ubiquitin ligase Skp1-Cullin-1-Skp2 (SCFSkp2) promotes proteasomal degradation of the cell cycle inhibitor p27 to enhance tumor growth. Increased SKP2 expression and reduced p27 levels are frequent in human cancers and are associated with therapeutic resistance. SCFSkp2 activity is increased by the Cullin-1-binding protein Commd1 and the Skp2-binding protein Cks1B. Here we observed higher CUL1, COMMD1 and SKP2 mRNA levels in CD138+ cells isolated from BTZ-resistant MM patients. Higher CUL1, COMMD1, SKP2 and CKS1B mRNA levels in patient CD138+ cells correlated with decreased progression-free and overall survival. Genetic knockdown of CUL1, COMMD1 or SKP2 disrupted the SCFSkp2 complex, stabilized p27 and increased the number of annexin-V-positive cells after BTZ treatment. Chemical library screens identified a novel compound, designated DT204, that reduced Skp2 binding to Cullin-1 and Commd1, and synergistically enhanced BTZ-induced apoptosis. DT204 co-treatment with BTZ overcame drug resistance and reduced the in vivo growth of myeloma tumors in murine models with survival benefit. Taken together, the results provide proof of concept for rationally designed drug combinations that incorporate SCFSkp2 inhibitors to treat BTZ resistant disease.

Author Info:
1
Department of Hematology and Oncology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
2
The Vontz Center for Molecular Studies, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
3
Division of Hematology and Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
4
Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
6
Department of Hematology, Erasmus Medical Center and University, Rotterdam, The Netherlands.
7
Department of Medicine, Harvard Medical School, Boston, MA, USA.
8
Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
9
University of Cincinnati Cancer Institute, Cincinnati, OH, USA.


Authors:
Marin-Peña O1, Tey-Pons M2, Perez-Carro L3, Said HG4, Sierra P5, Dantas P6, Villar RN7.

Title:
The Current Situation In Hip Arthroscopy

Abstract:
Hip arthroscopy is an evolving surgical technique that has recently increased in popularity.Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy.Good clinical results in the medium term will allow improvements in this technique and increase its indications. Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041.

Author Info:
1
Orthopedic Surgery and Traumatology, University Hospital Infanta Leonor, Madrid, Spain.
2
Hospital del Mar, Barcelona, Spain.
3
Clinica Mompia Santander, Spain.
4
Assiut University Hospital, Assiut, Egypt.
5
Madrid. University Hospital Torrejon, Madrid, Spain.
6
Hospital CUF Descobertas, Lisboa, Portugal.
7
Spire Cambridge Lea Hospital, Cambridge, UK.


Authors:
Mekkawy AI1, El-Mokhtar MA2, Nafady NA3, Yousef N3, Hamad MA4, El-Shanawany SM5, Ibrahim EH5, Elsabahy M6.

Title:
In Vitro And In Vivo Evaluation Of Biologically ‎Synthesized Silver Nanoparticles For Topical ‎Applications: Effect Of Surface Coating And Loading Into ‎Hydrogels

Abstract:
In the present study, silver nanoparticles (AgNPs) were synthesized via biological reduction of silver nitrate using extract of the fungus Fusarium verticillioides (green chemistry principle). The synthesized nanoparticles were spherical and homogenous in size. AgNPs were coated with polyethylene glycol (PEG) 6000, sodium dodecyl sulfate (SDS), and β-cyclodextrin (β-CD). The averaged diameters of AgNPs were 19.2±3.6, 13±4, 14±4.4, and 15.7±4.8 nm, for PEG-, SDS-, and β-CD-coated and uncoated AgNPs, respectively. PEG-coated AgNPs showed greater stability as indicated by a decreased sedimentation rate of particles in their water dispersions. The antibacterial activities of different AgNPs dispersions were investigated against Gram-positive bacteria (methicillin-sensitive and methicillin-resistant Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli) by determination of the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs). MIC and MBC values were in the range of 0.93-7.5 and 3.75-15 µg/mL, respectively, which were superior to the reported values in literature. AgNPs-loaded hydrogels were prepared from the coated-AgNPs dispersions using several gelling agents (sodium carboxymethyl cellulose [Na CMC], sodium alginate, hydroxypropylmethyl cellulose, Pluronic F-127, and chitosan). The prepared formulations were evaluated for their viscosity, spreadability, in vitro drug release, and antibacterial activity, and the combined effect of the type of surface coating and the polymers utilized to form the gel was studied. The in vivo wound-healing activity and antibacterial efficacy of Na CMC hydrogel loaded with PEG-coated AgNPs in comparison to the commercially available silver sulfadiazine cream (Dermazin®) were evaluated. Superior antibacterial activity and wound-healing capability, with normal skin appearance and hair growth, were demonstrated for the hydrogel formulations, as compared to the silver sulfadiazine cream. Histological examination of the treated skin was performed using light microscopy, whereas the location of AgNPs in the skin epidermal layers was visualized using transmission electron microscopy.

Author Info:
1
Department of Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Sohag University, Sohag.
2
Department of Microbiology and Immunology, Faculty of Medicine.
3
Department of Botany and Microbiology, Faculty of Science.
4
Department of Surgery, Faculty of Medicine.
5
Department of Pharmaceutics, Faculty of Pharmacy.
6
Department of Pharmaceutics, Faculty of Pharmacy; Assiut International Center of Nanomedicine, Al-Rajhi Liver Hospital, Assiut University, Assiut, Egypt; Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX, USA; Misr University for Science and Technology, 6th of October, Egypt.


Authors:
Mmari K1, Blum RW2, Atnafou R2, Chilet E3, de Meyer S4, El-Gibaly O5, Basu S6, Bello B7, Maina B8, Zuo X9.

Title:
Exploration of Gender Norms and Socialization Among Early Adolescents: The Use of Qualitative Methods for the Global Early Adolescent Study

Abstract:
PURPOSE:
The Global Early Adolescent Study (GEAS) was launched in 2014 with the primary goal of understanding the factors in early adolescence that predispose young people to subsequent sexual risks, and conversely, those that promote healthy sexuality across different cultural contexts. The present article describes the methodology that was used for the first phase of GEAS, which consisted of conducting qualitative research to understand the gendered transitions into adolescence and the role that gender norms play within the key relationships of adolescents. Researchers from each of the sites that had completed data collection were also elicited for their feedback on the key strengths, challenges, and lessons learned from conducting research among 11- to 14-year-old adolescents. The purpose of this article is to present the description of each of the methods that were used in GEAS, as well as the researchers' perspectives of using the methods among early adolescents in their sites.

METHODS:
The GEAS is being implemented through a collaboration of university and nongovernmental institutions from 15 cities: Assiut (Egypt) Baltimore (U.S.), Blantyre (Malawi), Cape Town (South Africa), Cochabomba (Bolivia), Cuenca (Ecuador), Edinburgh (Scotland), Ghent (Belgium), Hanoi (Vietnam), Ile-Ife (Nigeria), Kinshasa (DRC), Nairobi (Kenya), New Delhi (India), Ouagadougou (Burkina Faso), and Shanghai (China). Approximately 30 in-depth interviews among adolescents and 30 in-depth interviews with their parent/guardian were conducted at each site, with adults and adolescents interviewed separately. To build trust and increase engagement among the adolescent participants, we used two different visual research methods: (1) timeline exercise which was small group based and (2) the Venn diagram exercise which was conducted individually and used at the start of the in-depth interview.

RESULTS:
The visual aspects of both the timeline and the Venn diagrams not only helped to produce data for the purposes of the study, but also were a successful way of engaging the adolescent participants across sites. While the narrative interviews produced extremely rich data, researchers did notice that there were a few challenges among the younger adolescents. Challenges were related to the length of the interview, comprehension of questions, as some of the questions were either too abstract or asked adolescents about an experience they had not yet had and therefore could not address or articulate.

CONCLUSIONS:
Conducting the first phase of GEAS revealed important insights for research with participants who are in this developmental phase of early adolescence. Methods that involve greater engagement and those that are visual were shown to work well irrespective of the cultural setting.

Author Info:
1
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: kmmari@jhsph.edu.
2
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
3
Faculty of Medical Sciences of University of Cuenca, Ecuador and Public Health Department, Miguel Hernandez University, Alicante Spain and CIBERESP, Madrid, Spain.
4
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
5
Public Health & Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
6
Population Council, New Delhi, India.
7
Population and Reproductive Health Programme, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
8
African Population and Health Research Center (APHRC), Kenya APHRC Campus, Nairobi, Kenya.
9
Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China.


Authors:
Moaddab A1, Nassr AA2, Belfort MA1, Shamshirsaz AA3

Abstract:
The introduction of routine fetal ultrasound and the technical improvements in ultrasound equipment have greatly increased our ability to diagnose fetal anomalies. As a consequence, congenital anomalies are diagnosed today earlier and in a greater number of patients than ever before. The development of fetal intervention and fetal surgery techniques, improved anesthesia methodology, and sophisticated perinatal care at the limits of viability, have now made prenatal management of some birth defects or fetal malformations a reality. The increasing number of indications for fetal therapy and the apparent desire of parents to seek out these procedures have raised concern regarding the ethical issues related to the therapy. While fetal therapy may have a huge impact on the prenatal management of some congenital birth defects and/or fetal malformations, because of the invasive nature of these procedures, the lack of sufficient data regarding long-term outcomes, and the medical/ethical uncertainties associated with some of these interventions there is cause for concern. This chapter aims to highlight some of the most important ethical considerations pertaining to fetal therapy, and to provide a conceptual ethical framework for a decision-making process to help in the choice of management options.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States.
2
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States. Electronic address: alirezashamshirsaz@yahoo.com.


Authors:
Moeen AM1, Safwat AS1, Elderwy AA1, Behnsawy HM1, Osman MM1, Hameed DA1.

Title:
Management Of Neobladder Complications: Endoscopy ‎Comes First

Abstract:
OBJECTIVE:
The aim of this study was to report the functional outcome after endoscopic management of neobladder complications.

MATERIALS AND METHODS:
Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment.

RESULTS:
The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation.

CONCLUSIONS:
Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

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


Title:
Dexamethasone and Dexmedetomidine as an Adjuvant to Intraarticular Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery: A Randomized Trial

Abstract:
BACKGROUND:
Knee arthroscopy causes minimal trauma, however, good analgesia is required for early rehabilitation and return to normal life in the patients.

OBJECTIVE:
We aimed to compare the analgesic effects of intraarticular dexamethasone and dexmedetomidine added to bupivacaine with those of bupivacaine alone.

STUDY DESIGN:
This study uses a double-blind, randomized, controlled design with allocation concealment in a 3-armed parallel group format among patients undergoing arthroscopic meniscal surgery.

SETTING:
The study was conducted at Assiut University Hospital in Asyut, Egypt. The study duration was from July 2016 to February 2017.

METHODS:
After the ethics committee approval, 60 patients, with the American Society of Anesthesiologists (ASA) physical status of I or II, 20 - 50 years old, and scheduled for arthroscopic meniscal surgery were randomized in a double-blind manner to receive 18 mL intraarticular bupivacaine 0.25% with either dexamethasone 8 mg (group I), dexmedetomidine 1 ug/kg (group II), or 2 mL of normal saline (group III). The total volume of injectate used in each group was 20 mL. All of the patients received spinal anesthesia. Postoperatively, oral paracetamol 1000 mg was given every 8 hours, and oral tramadol 50 mg was administered, as needed, for rescue analgesia. The visual analog scale (VAS) pain scores, time to first analgesic request, and total dose of postoperative analgesics were recorded for 3 days postoperatively.

RESULTS:
The VAS scores were lower in groups I and II compared with group III. The time to the first analgesic was significantly shorter in group III compared with groups I and II (P = 0.001). The total dose of rescue paracetamol was higher in group III compared with groups I and II (P = 0.001). No need for tramadol rescue analgesia was recorded in any of the groups. No significant differences between groups I and II were noticed.

LIMITATIONS:
The limitations of this study include the lack of previous research to compare the effect of both intraarticular dexamethasone and dexmedetomidine added to bupivacaine for postoperative analgesia in arthroscopic knee surgery. Additionally, there was a short observation period for the detection of chondrotoxicity, if occurred.

CONCLUSION:
The addition of dexamethasone or dexmedetomidine to a solution of bupivacaine 0.25% provided better analgesia than using bupivacaine alone.

CLINICAL TRIAL REGISTRATION:
NCT02818985.

Author Info:
1
Department of Anesthesiology and Intensive Care, Assiut University, Asyut, Egypt.
2
Department of Orthopedic Surgery, Assiut University, Asyut, Egypt.


Title:
Intrathecal Dexamethasone Vs. Meperidine For ‎Prevention Of Shivering During Transurethral ‎Prostatectomy: A Randomized Controlled Trial

Abstract:
BACKGROUND:
Shivering is a common complication after spinal anesthesia. Also, during transurethral prostatectomy a large amount of irrigating fluids is used which may cause hypothermia and shivering. We hypothesized that intrathecal dexamethasone could effectively attenuate post-spinal shivering following transurethral prostatectomy as intrathecal meperidine.

METHODS:
Ninety male patients, ASA II-III, 50-75 years old were included in this prospective and randomized double-blind study. Patients were divided into three equal groups; Group D received 8 mg dexamethasone, Group M received 0.2 mg/kg meperidine, and Group C received 2 ml of normal saline, each in addition to intrathecal hyperbaric bupivacaine 0.5%. Shivering incidence, intensity and recurrence, dose of IV meperidine required to treat shivering, and adverse events were recorded for 150 min after the start of spinal anesthesia.

RESULTS:
The number of patients with shivering was higher in Group C (13) than in Group D (2) and Group M (3) with no differences between Group D and M; P = 0.001. Intensity and recurrence of shivering and dose of IV meperidine used to treat shivering were higher in Group C compared to Group D and Group M; P = 0.01, P = 0.064, and P = 0.004, respectively. Adverse events were not different between groups except sedation and pruritus which occurred only in Group M compared to Group D and Group C; P = 0.005 and P = 0.001, respectively.

CONCLUSION:
Intrathecal dexamethasone was as effective as intrathecal meperidine in attenuation of shivering compared to placebo in patients scheduled for prostate surgery under spinal anesthesia with less adverse events.

Author Info:
1
Department of Anesthesiology and Intensive Care, Assiut University, Asyut, Egypt.
2
Asyut Urology and Nephrology Hospital, Assiut University, Asyut, Egypt.


Title:
Reply To Xin, Juan; Zhang, Yabing; Zhou, Xiaoshuang; ‎Liu, Bin, Regarding Their Comment 'Acupuncture May Be ‎An Effective Supplement Treatment For Dexamethasone ‎In Pediatric Tonsillectomy'

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


Authors:
Mohamad MF1, Mohammad MA1, Hetta DF1, Ahmed EH2, Obiedallah AA3, Elzohry AAM1.

Title:
Thoracic Epidural Analgesia Reduces Myocardial Injury ‎In Ischemic Patients Undergoing Major Abdominal ‎Cancer Surgery

Abstract:
BACKGROUND AND OBJECTIVES:
Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.

PATIENTS AND METHODS:
One hundred and twenty patients (American Society of Anesthesiologists grade II and III) of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each) to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV) infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group) or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group) for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS). All patients were screened for occurrence of myocardial injury (MI) by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT), pulmonary embolism, pneumonia, and death were recorded.

RESULTS:
There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest) in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison to PCIA at all measured time points. Regarding perioperative hemodynamics, there was a significant reduction in intra-operative mean arterial pressure (MAP); and heart rate in PCEA group in comparison to PCIA group at most of measured time points while there was not a significant reduction in postoperative MAP and heart rate in the second and third postoperative days. The incidence of other postoperative complications such as DVT, pneumonia and in hospital mortality were decreased in PCEA group.

CONCLUSION:
Perioperative thoracic epidural analgesia in patients suffering from coronary artery disease subjected to major abdominal cancer surgery reduced significantly postoperative major adverse cardiac events with better pain control in comparison with perioperative IV analgesia.

Author Info:
1
Department of Anesthesia, ICU and Pain Relief.
2
Department of Clinical Pathology, South Egypt Cancer Institute.
3
Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt.


Authors:
Mohamed AA1,2, Yosef AH2,3, James C4, Al-Hussaini TK2, Bedaiwy MA3, Amer SAKS1.

Title:
Ovarian Reserve After Salpingectomy: A Systematic ‎Review And Meta-Analysis

Abstract:
INTRODUCTION:
Although there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserve.

MATERIAL AND METHODS:
A detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% CI. Two groups of studies were analyzed separately: group 1 (six studies, n = 464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n = 169) vs. healthy controls (n = 154).

RESULTS:
Pooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10 ng/mL; 95% CI -0.19 to 0.00, I2 = 0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11 ng/mL; 95% CI -0.37 to 0.14, I2 = 77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants' age (<40 years) still showed no statistically significant changes in circulating AMH.

CONCLUSION:
Salpingectomy does not seem to compromise ovarian reserve in the short-term. However, the long-term effect of salpingectomy on ovarian reserve remains uncertain.

Author Info:
1
Department of Obstetrics and Gynecology, University of Nottingham, Royal Derby Hospital, Derby, UK.
2
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada.
4
Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.


Authors:
Mohamed AM1,2, Ahmed MA3,4, Ahmed SA4, Al-Semany SA5,6, Alghamdi SS1, Zaglool DA7,8.

Title:
Predominance And Association Risk Of Blastocystis ‎Hominis Subtype I In Colorectal Cancer: A Case Control ‎Study

Abstract:
BACKGROUND:
Blastocystis, a genetically diverse intestinal parasite with controversial pathogenic potential, has increasingly been incriminated for diarrheal illness in immunocompromised individuals including colorectal cancer (CRC) patients. The aim of the current study was to assess the possible association between Blastocystis infection and CRC condition in Makkah, Saudi Arabia (KSA).

METHODS:
Stool samples were collected from 80 non-cancer (NC) and 138 cancer subjects including 74 CRC patients and 64 patients with other cancers outside gastrointestinal tract (COGT). Molecularly confirmed Blastocystis isolates were genetically grouped and subtyped using multiplex polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) and sequence-tagged site primers-based PCR (PCR-STS), respectively.

RESULTS:
Blastocystis hominis were confirmed in 29.7, 25 and 15% among CRC, COGT and NC patients, respectively. Obtained Blastocystis isolates were initially categorized into 2 groups (A and C), which were subsequently subtyped into 3 different subtypes; subtype-I (38%), subtype-II (44%) and subtype-V (22%). Interestingly, subtype-I was the most predominantly detected subtype (54.5%) among CRC patients with a significant association risk (COR 7.548; 95% CI: 1.629-34.987; P = 0.004).

CONCLUSION:
To the best of our knowledge, the current study is the first to provide genetic insights on the prevalence of Blastocystis hominis among CRC patients in Makkah, KSA. Moreover, the study suggests for a possible association between subtype-I of Blastocystis hominis and CRC, which could indicate a potential influence of Blastocystis on CRC condition. Further studies are required to confirm this association risk and to investigate the possible underlying mechanism of postulated carcinogenic influence of Blastocystis hominis subtype-I.

Author Info:
1
Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, 7607 Saudi Arabia.
2
Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
3
Medical Parasitology, King Abdullah Medical City, Makkah, Saudi Arabia.
4
Parasitology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
5
Oncology, King Abdullah Medical City, Makkah, Saudi Arabia.
6
Department of Internal Medicine, Medical Oncology, Mansoura University, Mansoura, Egypt.
7
Medical Parasitology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
8
Parasitology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Mohamed AM1, Refaat BA2, El-Shemi AG3, Kensara OA4, Ahmad J2, Idris S2.

Title:
Thymoquinone Potentiates Chemoprotective Effect Of ‎Vitamin D3 Against Colon Cancer: A Pre-Clinical Finding

Abstract:
Prevention of colon cancer among high-risk group has been long lasting research goal. Emerging data have evidenced the anticancer activities of Vitamin D3 (Vit.D) and Thymoquinone (TQ). The aim of the current study was to evaluate the synergistic potential of Thymoquinone and Vitamin D3 in the control of colon cancer progression using azoxymethane-induced rat model. Vit.D and TQ were given individually or in combination 4 week prior to induction and continued for a total of 20 week. At the end of the study, all animals were euthanized and their resected colons were examined macroscopically and microscopically for tumor growth. Colonic tissue preparations were used for measuring gene expression and/or protein levels of selected pro and anti-tumor biomarkers using quantitative RT-PCR, ELISA and immunohistochemistry. Compared with their individual supplementation, combined Vit.D/TQ showed prominent anti-tumor effect manifested by significant reduction (P < 0.05) of the numbers of grown tumors and large aberrant crypts foci. Mechanistically, gene expression and/or protein quantification studies revealed that combined Vit.D/TQ supplementation induced significant reduction (P < 0.01 and P < 0.05) of pro-cancerous molecules (Wnt, β-catenin, NF-κB, COX-2, iNOS, VEGF and HSP-90) as well as significant increase (P < 0.01 and P < 0.05, respectively) of anti-tumorigenesis biomarkers (DKK-1, CDNK-1A, TGF-β1, TGF-β/RII and smad4) as compared to un-supplemented or individually supplemented groups, respectively. In conclusion, TQ augmented the chemopreventive effect of Vit.D during the initiation phase of colon cancer in rat model, with the potential to suppress progression of pre-neoplastic lesions in colon carcinogenesis.

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


Authors:
Mohamed ER1, Aly SA2, Halby HM1, Ahmed SH2, Zakaria AM3, El-Asheer OM4.

Title:
Epidemiological Typing Of Multidrug-Resistant Klebsiella ‎Pneumoniae, Which Causes Paediatric Ventilator-‎Associated Pneumonia In Egypt

Abstract:
PURPOSE:
Multidrug-resistant Klebsiella pneumoniae is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (VAP). This study aimed to define the clonal relatedness of K. pneumoniae strains isolated from paediatric VAP in addition to those isolated from environmental samples.

METHODOLOGY:
This study included 19 clinical and 4 environmental K. pneumoniae isolates recovered from the paediatric intensive care unit (PICU) in Assiut University Children's Hospital. The K. pneumoniae isolates were confirmed by biotyping using API strips and subjected to antimicrobial susceptibility testing. The genes coding K1 and K2 capsular types were detected by PCR. The clonal relationships between the K. pneumoniae isolates were determined by pulsed-field gel electrophoresis (PFGE).

RESULTS:
Ten resistotypes were detected among all the K. pneumoniae isolates, while PFGE identiﬁed seventeen K. pneumoniae pulsotypes. Similar PFGE patterns were found between environmental and clinical isolates and between isolates recovered from different patients, suggesting the circulation of K. pneumoniae pathogens in the PICU and the role of the environment in the spread of infection. No correlation was found between the resistotypes and pulsotypes of the K. pneumoniae isolates. PFGE showed higher discriminatory power for the typing of nosocomial K. pneumoniae [Simpson's diversity index (DI)=0.96] than resistotyping (DI=0.72).

CONCLUSION:
As far as we know, this is the first report of the isolation of the same multidrug-resistant (MDR) K. pneumoniae pulsotype from patients and environmental samples in the same hospital ward in Egypt. This study provides a step on the way to understanding the genotyping and epidemiology of MDR K. pneumoniae for enhanced prevention of bacterial transmission.

Author Info:
1
1​Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Egypt.
2
2​Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt.
3
3​Biotechnology Research Institute, Suez Canal University, Ismailia, Egypt.
4
4​Department of Pediatric Medicine, Faculty of Medicine, Assiut University, Egypt.


Authors:
Mohamed HB1, El-Shanawany SM1, Hamad MA2, Elsabahy M3,4,5,6.

Title:
Niosomes: A Strategy toward Prevention of Clinically Significant Drug Incompatibilities

Abstract:
Drug incompatibilities are considered as one of the most critical problems in intensive care units. In the current study, the ability of nanomaterials to prevent drug incompatibilities in clinical settings has been investigated. As a proof-of-concept, the ability of niosomes to prevent physical and chemical incompatibilities that occur upon mixing acyclovir and vancomycin during management of acute meningitis has been explored. Nanosized spherical particles loaded separately with either vancomycin or acyclovir, with high entrapment efficiency (ca. 46-56%), could be prepared, and sustained release of their entrapped cargoes have been demonstrated over time. We have shown that precipitation, degradation and loss of biological activity of drugs occurred upon mixing solutions of the free drugs. On the contrary, drugs loaded separately inside niosomal structures exhibited high stability, exceptional physical and chemical compatibilities for up to 48 h with complete preservation of the antimicrobial activity of vancomycin. This study opens a venue for a new spectrum of applications of nanomaterials in preventing clinically significant drug incompatibilities, aiming at the reduction of adverse reactions, cost and hospitalization period, and improvement of patient compliance and therapeutic outcomes.

Author Info:
1
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt.
2
Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt. mahmoud.elsabahy@chem.tamu.edu.
4
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt. mahmoud.elsabahy@chem.tamu.edu.
5
Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, Texas, USA. mahmoud.elsabahy@chem.tamu.edu.
6
Misr University for Science and Technology, 6th of October City, Giza, Egypt. mahmoud.elsabahy@chem.tamu.edu.


Authors:
Mohamed NK1, Hamad MA2, Hafez MZ3, Wooley KL4,5, Elsabahy M1,5,6,7.

Title:
Nanomedicine In Management Of Hepatocellular ‎Carcinoma: Challenges And Opportunities

Abstract:
Hepatocellular carcinoma is the second leading cause of cancer deaths worldwide. It is characterized by unique features that can be utilized for selective and targeted therapy, which aids in preserving healthy tissues from deteriorating effects of traditional chemotherapeutics. In this minireview, a brief overview of recent drug delivery attempts for the management of hepatocellular carcinoma with the aid of nanomedical structures is presented. The beneficial impact of nanomaterials in terms of prolonged retention in blood and target sites, controlled biodistribution and improved stability of the encapsulated payloads, will be described, together with the possibility of incorporating more than one cargo into the same nanostructure. Incorporation of stimuli-responsive components, decoration with targeting moieties and the use of molecularly targeted drugs for treatment of hepatocellular carcinoma are also highlighted.

Author Info:
1
Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Egypt.
2
Department of Surgery, Faculty of Medicine, Assiut University, Egypt.
3
Department of Internal Medicine, Faculty of Medicine, Aswan University, Egypt.
4
Departments of Chemistry, Chemical Engineering and Materials Science and Engineering, Texas A&M University, College Station, TX.
5
Laboratory for Synthetic-Biologic Interactions, Department of Chemistry, Texas A&M University, College Station, TX.
6
Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Egypt.
7
Misr University for Science and Technology, 6th of October City, Egypt.


Authors:
Mohamed RT1,2, El-Bali MA3, Mohamed AA3,4, Abdel-Fatah MA4,5, El-Malky MA3,6, Mowafy NM3,7, Zaghlool DA8,9, Bakri RA3, Al-Harthi SA3.

Title:
Subtyping Of Blastocystis Sp. Isolated From ‎Symptomatic And Asymptomatic Individuals In Makkah, ‎Saudi Arabia

Abstract:
BACKGROUND:
Blastocystis is a group of cosmopolitan gastrointestinal parasite of humans and a wide variety of animals. These anaerobic protozoans include more than 17 specific small-subunit ribosomal RNA subtypes, of which nine are found in humans with a variable geographical distribution. Until now, no study has described the Blastocystis subtypes present in Saudi Arabia.

METHODS:
In total, 1,262 faecal samples were collected from patients with gastrointestinal complaints and asymptomatic individuals visiting two major hospitals. All samples were analysed by F1/R1 diagnostic PCR, microscopy and culture methods. The subtypes of Blastocystis sp. isolates were determined by the sequenced-tagged site (STS)-based method.

RESULTS:
One-hundred-thirty-three positive cases were detected by F1/R1 diagnostic PCR, of which 122 were also positive by the culture method and 83 by direct microscopy. The sensitivities of direct microscopy and the culture method were 62% and 92%, respectively. Subtype (ST3) was the most prevalent (80.5%), followed by ST1 (14.5%) and ST2 (5%). ST4, ST5, ST6 and ST7 were not detected in this study. ST3 infections were significantly predominant (P < 0.05) among symptomatic patients.

CONCLUSIONS:
To our knowledge, this study provides the first run-through information on Blastocystis sp. epidemiology in Makkah city, revealing a rather moderate prevalence of 10.5% and the presence of three subtypes, ST1, ST2, and ST3. ST3 was the most predominant, particularly among symptomatic patients.

Author Info:
1
Department of Medical Parasitology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. rtmakhlof@uqu.edu.sa.
2
Department of Medical Parasitology, Faculty of Medicine, El-Minia University, El-Minia, Egypt. rtmakhlof@uqu.edu.sa.
3
Department of Medical Parasitology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
4
Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
5
Microbiology Laboratory, King Abdellah Medical City, Makkah, Saudi Arabia.
6
Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
7
Department of Medical Parasitology, Faculty of Medicine, El-Minia University, El-Minia, Egypt.
8
Laboratory and Blood Bank Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
9
Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Mohamed TA1, Soliman W1, El Sebaity DM1, Fathalla AM1.

Title:
Refractive Lens Exchange Combined with Primary Posterior Vitrectorhexis in Highly Myopic Patients

Abstract:
Purpose. To evaluate efficacy and safety of primary vitrectorhexis for posterior capsulotomy in highly myopic patients undergoing refractive lens exchange. Methods. The study is a prospective nonrandomized interventional study. The study comprised 60 eyes of 60 myopic patients. All patients underwent refractive lens exchange (RLE) and foldable IOL implantation combined with primary posterior capsulotomy. We used a 23-gauge vitrectomy probe for the creation of the posterior capsule opening. We followed the patients for one year. Results. During surgery, the IOLs remained well centered in the capsular bag after creation of the capsulotomy. Postoperatively, we did not report any complications related to lens centration or changes in the posterior capsulotomy size. No eye required YAG laser posterior capsulotomy and no cases of retinal detachment (RD) occurred during the follow-up period. Conclusion. Primary posterior vitrectorhexis during RLE is an efficient method in preventing the occurrence of posterior capsular opacification (PCO) and the need for YAG laser posterior capsulotomy with its possible complications.

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


Authors:
Mohammed RAA1, Makboul R, Elsers DAH, Elsaba TMAM, Thalab AMAB, Shaaban OM.

Title:
Pattern of HER-2 Gene Amplification and Protein Expression in Benign, Borderline, and Malignant Ovarian Serous and Mucinous Neoplasms

Abstract:
Amplification of HER-2 gene and overexpression of HER-2 receptor play a significant role in the progression of a number of malignancies such as breast cancer. Trastuzumab (anti-HER-2 therapeutic agent) has been used successfully in treatment of breast cancer. The aim of this study was to assess the pattern of HER-2 gene amplification and of HER-2 receptor expression in a spectrum of serous and mucinous ovarian tumors to determine whether HER-2 is altered in these neoplasms similar to that occurring in breast cancer. Formalin-fixed paraffin-embedded microarray tissue sections from 212 specimens were stained with HER-2 antibody using immunohistochemistry and with anti-HER-2 DNA probe using chromogenic in situ hybridization. Specimens consisted of 65 benign tumors (50 serous and 15 mucinous), 26 borderline (13 serous and 13 mucinous), 73 malignant tumors (53 serous carcinoma and 20 mucinous carcinoma), 18 metastatic deposits (13 serous and 5 mucinous), in addition to 30 normal tissues (16 ovarian surface and 14 normal fallopian tube). HER-2 protein-positive expression was not detected in the normal or the benign tissues. Borderline neoplasms showed positive staining, but no overexpression. HER-2 overexpression was seen only in 4 carcinoma specimens: 1/53 (1.8%) primary serous carcinomas and 3/20 (15%) primary mucinous carcinomas. HER-2 gene amplification was seen in 4 specimens: 2 primary mucinous carcinomas and 2 malignant deposits of these 2 mucinous carcinomas. In conclusion, alteration of HER-2 was not detected in ovarian serous neoplasms; however, in mucinous carcinoma, HER-2 amplification and overexpression occur.

Author Info:
1
Departments of Pathology (R.A.A.M., R.M., D.A.H.E.)Obstetrics and Gynecology (O.M.S.), Faculty of Medicine, Assiut UniversityDepartment of Pathology (T.M.A.M.E.), South Egypt Cancer Institute, Assiut, EgyptDepartment of Pathology (R.A.A.M.), Faculty of Medicine, Taibah University, El-Madina Almounawwarah, Kingdom of Saudi ArabiaDepartment of Pathology (A.M.A.B.T.), Faculty of Medicine, Hadhramout University, Al Mukalla, Yemen.


Authors:
Mohan AT1, Zhu L, Sur YJ, Morsy M, Michalak GJ, Lachman N, Rammos CK, Saint-Cyr M.

Title:
Application of Posterior Thigh Three-Dimensional Profunda Artery Perforator Perforasomes in Refining Next-Generation Flap Designs: Transverse, Vertical, and S-Shaped Profunda Artery Perforator Flaps

Abstract:
BACKGROUND:
This study aimed to delineate and compare the hot spots and three-dimensional vascular territories of dominant profunda artery perforators in the posterior thigh region, and modifications in flap design are discussed.

METHODS:
Twenty-nine posterior thigh flaps were raised in fresh cadaveric specimens, and profunda artery perforators were documented. Dominant perforators were injected with iodinated contrast to assess perforasomes using computed tomographic angiography. Analysis with three-dimensional rendering and volume calculations of perfusion patterns was performed.

RESULTS:
In total, 316 perforators were mapped and 33 perforators were injected for analysis. The hot spot for dominant perforators was the proximal medial quadrant, 5 to 10 cm from the inferior gluteal crease, with two smaller hot spots in the upper lateral and distal posterior midline. Although 69 percent were musculocutaneous, distal perforators were predominantly septocutaneous in the posterior midline, 5 to 8 cm from the popliteal crease. Proximal perforators were classified into first (most proximal) and second perforators, and their median perforasome was 233 and 286.4 cm, respectively (p = 0.86). There were no significant differences between proximal and distal perforators in perforasome surface areas, percentage areas perfused, and perforasome volumes. Large linking vessel networks were attributed to a broader perforasome and greater overlap between adjacent or distal perforators.

CONCLUSIONS:
Dominant linking vessels and recurrent flow through the subdermal plexus contribute to the robust vascular supply of profunda artery perforator flaps. Posterior thigh region perforator hot spots and their perfusion characteristics can inform the potential limits, orientation, and modifications of flap or skin paddle designs.

Author Info:
1
Rochester Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt From the Division of Plastic Surgery, the Division of Radiology, Biomedical Resource Imaging, and the Department of Anatomy, Mayo Clinic; the Restoration of Appearance and Function Charitable Trust; the Department of Surgery, University of Cambridge; the 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 H1, Taha EA1, Nigm DA2, Shahin R3, Youssef EMK1.

Title:
Serum IL-17 In Patients With Erythema Multiforme Or ‎Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis ‎Drug Reaction, And Correlation With Disease Severity

Abstract:
BACKGROUND:
There is strong evidence that drug-induced cutaneous eruptions have an immunological component. Interleukin (IL)-17, a proinflammatory cytokine that is predominantly produced by T helper 17 cells, has been linked to various autoimmune and inflammatory diseases.

AIM:
To measure serum IL-17 levels in patients with cutaneous drug reactions [erythema multiforme (EM) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)] in order to study the associations between IL-17 and disease severity.

METHODS:
In total, 32 patients (13 with EM and 19 with SJS/TEN) and 15 age- and sex-matched healthy controls (HCs) were enrolled. Patients with SJS/TEN were assessed clinically using the SCORe of Toxic Epidermal Necrosis (SCORTEN) scale. Serum IL-17 levels were determined by ELISA.

RESULTS:
Serum IL-17 levels were significantly higher compared with HCs (16.46 ± 5.21 pg/mL) in the EM (35.1 ± 23.89 pg/mL, P < 0.02) and SJS/TEN (68.19 ± 35.42 pg/mL, P = 0.001) groups. IL-17 levels were also significantly higher in the SJS/TEN group than in the EM group (P = 0.004). Mean affected body surface area percentage was 0.9 ± 0.21 in the EM group and 22.8 ± 10.67 in the SJS/TEN group. The SJS/TEN SCORTEN ranged from 1 to 5, with a mean of 2.5 ± 1. Serum IL-17 level correlated positively with both percentage surface area of detached skin and SCORTEN.

CONCLUSIONS:
Serum IL-17 levels may have prognostic and diagnostic value in patients with EM or SJS/TEN reactions, and can provide a valuable approach in managment.

Author Info:
1
Department of Dermatology, Venereology and Andrology , Assiut University, Egypt.
2
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Egypt.
3
Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Egypt.


Title:
Vascularized Second Metatarsophalangeal Joint Transfer for Salvage of Failed Centralization in Radial Longitudinal Deficiency: Case Report

Abstract:
Management of recurrent radial deviation after centralization for radial longitudinal deficiency patients usually involves some form of wrist fusion. We report on a child with recurrence after centralization, where correction and successful maintenance of a good functional and cosmetic position were obtained by vascularized second metatarsophalangeal joint transfer.

Author Info:
1
From the *Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; †Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt; and ‡Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.


Authors:
Morsy SG1,2, Tonne JM1, Zhu Y1, Lu B1, Budzik K1, Krempski JW1, Ali SA3, El-Feky MA3, Ikeda Y4,5.

Title:
Divergent Susceptibilities To AAV-Sacas9-Grna Vector-‎Mediated Genome-Editing In A Single-Cell-Derived Cell ‎Population

Abstract:
OBJECTIVE:
Recombinant adeno-associated virus (AAV)-based vectors are characterized by their robust and safe transgene delivery. The CRISPR/Cas9 and guide RNA (gRNA) system present a promising genome-editing platform, and a recent development of a shorter Cas9 enzyme from Staphylococcus aureus (SaCas9) allows generation of high titer single AAV vectors which carry both saCas9- and gRNA-expression cassettes. Here, we used two AAV-SaCas9 vectors with distinct GFP-targeted gRNA sequences and determined the impact of AAV-SaCas9-gRNA vector treatment in a single cell clone carrying a GFP-expression cassette.

RESULTS:
Our results showed comparable GFP knockout efficiencies (40-50%) upon a single low-dose infection. Three consecutive transductions of 25-fold higher doses of vectors showed 80% GFP knockout efficiency. To analyze the "AAV-SaCas9-resistant cell population", we sorted the residual GFP-positive cells and assessed their permissiveness to super-infection with two AAV-Cas9-GFP vectors. We found the sorted cells were significantly more resistant to the GFP knockout mediated by the same AAV vector, but not by the other GFP-targeted AAV vector. Our data therefore demonstrate highly efficient genome-editing by the AAV-SaCas9-gRNA vector system. Differential susceptibilities of single cell-derived cells to the AAV-SaCas9-gRNA-mediated genome editing may represent a formidable barrier to achieve 100% genome editing efficiency by this vector system.

Author Info:
1
Department of Molecular Medicine, Mayo Clinic, College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
2
Cancer Biology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4
Department of Molecular Medicine, Mayo Clinic, College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA. ikeda.yasuhiro@mayo.edu.
5
Center for Regenerative Medicine, Mayo Clinic, College of Medicine, Rochester, MN, 55905, USA. ikeda.yasuhiro@mayo.edu.


Title:
Scanning And Transmission Electron Microscopy Of The ‎Cells Forming The Hepatic Sinusoidal Wall Of Rat In ‎Acetaminophen And Escherichia Coli Endotoxin-Induced ‎Hepatotoxicity

Abstract:
Drugs and xenobiotics as well as bacterial endotoxins may reach the liver either systematically or after intestinal absorption. Therefore, cells lining the sinusoidal wall form the last barrier before blood constituents get in contact with the parenchymal cells. In this work, the ultrastructure of the cells forming the sinusoidal wall was studied after acetaminophen and Escherichia coli endotoxin treatments. Rats received acetaminophen at a dose of 1000 mg/kg body weight by intraperitoneal injection once in acute and four times with a 1-week interval in chronic treatments, and E. coli endotoxin at a dose of 5 mg/kg of body weight by intraperitoneal injection once in acute and four times with a 1-week interval in chronic treatments. Tissue samples were collected for scanning and transmission electron microscopy. Swelling of sinusoidal endothelial cells was noticed in both acute intoxicated groups with narrowing of the fenestrae, whereas large gaps were formed in chronic toxicity. Activation of Kupffer cells was a prominent common feature between the four toxicity groups. Interestingly, hepatic stellate cell activation was evident in both chronic acetaminophen and chronic endotoxin groups. Large amounts of collagen fibers were seen surrounding the hepatic stellate cells and in Disse space.

Author Info:
1
Department of Pathology, Faculty of Veterinary Medicine, Assiut University, 71516 Assiut, Egypt.
2
Electron Microscope Unit, Assiut University, 71516 Assiut, Egypt.
3
Department of Histology, Faculty of Medicine, Assiut University, 71516 Assiut, Egypt.


Authors:
Nassr AA1,2,3, Shazly SAM1,2, Abdelmagied AM1,2, Araujo Júnior E4, Tonni G5, Kilby MD6, Ruano R7.

Title:
Effectiveness Of Vesicoamniotic Shunt In Fetuses With ‎Congenital Lower Urinary Tract Obstruction: An Updated ‎Systematic Review And Meta-Analysis

Abstract:
OBJECTIVE:
To evaluate the effect on perinatal and postnatal survival of vesicoamniotic shunt (VAS) as treatment for fetal lower urinary tract obstruction (LUTO).

METHODS:
An electronic search of Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus using relevant search terms was conducted from inception to June 2015 to identify studies comparing outcomes of VAS vs conservative management for treatment of LUTO. Cohort studies and clinical trials were considered eligible. Single-arm studies and studies that did not report survival were excluded. Sample size and language were not criteria for exclusion. Two reviewers extracted independently data in a standardized form, including study characteristics and results. Primary outcomes were perinatal and postnatal survival. Secondary outcome was postnatal renal function. Data on fetal survival were expressed as odds ratio (OR) and 95% CI.

RESULTS:
Of the 423 abstracts retrieved, nine studies were eligible for inclusion. These studies included 112 fetuses treated with VAS and 134 that were managed conservatively. There was heterogeneity in study design. Although the data demonstrated a difference in effect estimates between the study arms in terms of perinatal survival (OR, 2.54 (95% CI, 1.14-5.67)), there was no difference in 6-12-month survival (OR, 1.77 (95% CI, 0.25-12.71)) or 2-year survival (OR, 1.81 (95% CI, 0.09-38.03)). In addition, there was no difference in effect on postnatal renal function between fetuses that underwent intervention and those that did not (OR, 2.09 (95% CI, 0.74-5.94)).

CONCLUSIONS:
Available data seem to support an advantage for perinatal survival in fetuses treated with VAS compared with conservative management. However, 1-2-year survival and outcome of renal function after VAS procedure remain uncertain. Further studies are necessary to evaluate the effectiveness of fetal intervention for LUTO based on different severity of the disease, due to the very low quality of the studies according to GRADE guidelines.

Author Info:
1
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
2
Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
4
Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil.
5
Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Reggio Emilia, Italy.
6
Centre for Women's and Children's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
7
Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic, Rochester, MN, USA.


Authors:
Nassr AA1,2, Shazly SA3, Morris SA4, Ayres N4, Espinoza J1, Erfani H1, Olutoye OA5, Sexson SK4, Olutoye OO6, Fraser CD Jr7, Belfort MA1, Shamshirsaz AA1.

Title:
Prenatal Management Of Fetal Intrapericardial Teratoma: ‎A Systematic Review

Abstract:
OBJECTIVES:
The purpose of this systematic review is to provide a comprehensive overview on the clinical course, perinatal outcome, and effectiveness of prenatal management options for pericardial teratoma.

METHODS:
A comprehensive search including Ovid MEDLINE, Ovid EMBASE, and Scopus was conducted from inception to September 2016. All studies that reported the prenatal course of pericardial teratoma in singleton or twin gestations were considered eligible. Standardized forms were used for data abstraction by two independent reviewers.

RESULTS:
Out of 217 screened abstracts, 59 studies reporting 67 fetuses with pericardial teratoma were included. Twenty-three singleton fetuses and 3 fetuses in twin gestations underwent prenatal treatment, and 20 (76.9%) of them were hydropic at the time of intervention. Of those, 15/20 (75%) had a favorable outcome. In the non-intervention group (n = 41), 26 (63.4%) developed hydrops, and out of those, 8 (30.8%) had a favorable outcome.

CONCLUSION:
Prenatal fluid drainage and other prenatal techniques have been utilized in the treatment of intrapericardial teratoma. While most fetuses tolerated pericardiocentesis, the neonatal benefit of this procedure is still uncertain, and outcomes of other interventions had variable success. Prenatal intervention for pericardial teratoma may be an option in specialized units but, given the maternal and fetal risks, needs careful consideration.

Author Info:
1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
2
Women's Health Hospital, Assiut University, Assiut, Egypt.
3
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
4
Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
5
Division of Pediatric Anesthesia, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
6
Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
7
Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Heart Center, Houston, TX, USA.


Authors:
Nassr AA1, Shamshirsaz AA2, Belfort MA2, Espinoza J2.

Title:
Spontaneous Resolution Of Mirror Syndrome Following ‎Fetal Interventions For Fetal Anemia As A Consequence ‎Of Twin To Twin Transfusion Syndrome

Author Info:
1
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, Assiut University, Egypt. Electronic address: Ahmed.nassr@bcm.com.
2
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.


Authors:
Ohta Y1, Darwish M1,2, Hishikawa N1, Yamashita T1, Sato K1, Takemoto M1, Abe K1.

Title:
Therapeutic Effects Of Drug Switching Between ‎Acetylcholinesterase Inhibitors In Patients With ‎Alzheimer's Disease

Abstract:
AIM:
To evaluate the therapeutic effects of switching from one acetylcholinesterase inhibitor (ChEI), donepezil, galantamine or rivastigmine, to another in Alzheimer's disease patients.

METHODS:
We retrospectively enrolled 171 Alzheimer's disease patients, whose ChEI medication was changed. The patients were evaluated on three major aspects of dementia - cognitive, affective and activities of daily living (ADL) measures - at 6 months (M) before the drug switch, at the time of drug switch (baseline), and at 3 M and 6 M after the drug switch.

RESULTS:
The doses of the three ChEI were significantly lower at 6 M after the switch compared with the pre-switch doses. Improvements in apathy were found at 3 M when switching from donepezil to galantamine, but not to rivastigmine, but this switch had adverse effects on ADL. Improvements in cognitive scores at 3 M were also found when switching from galantamine to rivastigmine, but not to donepezil. However, both of these changes improved Abe's Behavioral and Psychological Symptoms of Dementia scores (ABS), except ADL. Switching from rivastigmine to donepezil worsened ABS at 6 M, but preserved cognitive and ADL scores.

CONCLUSIONS:
The present study suggests that despite a relatively lower dose of ChEI after the switch, switching from donepezil or rivastigmine preserved cognitive functions for at least 6 M. Switching from galantamine to rivastigmine improved Mini-Mental State Examination and ABS at 3 M, but did not improve ADL scores. Geriatr Gerontol Int 2017; 17: 1843-1848.

Author Info:
1
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
2
Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.


Authors:
Okasha H1, Elkholy S2, El-Sayed R3, Wifi MN, El-Nady M, El-Nabawi W4, El-Dayem WA3, Radwan MI3, Farag A, El-Sherif Y5, Al-Gemeie E6, Salman A, El-Sherbiny M, El-Mazny A, Mahdy RE7.

Title:
Real Time Endoscopic Ultrasound Elastography And ‎Strain Ratio In The Diagnosis Of Solid Pancreatic ‎Lesions

Abstract:
AIM:
To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).

METHODS:
A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.

RESULTS:
SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.

CONCLUSION:
Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.

Author Info:
1
Mohamed Naguib Wifi, Mohamed El-Nady, Ali Farag, Ahmed Salman, Mohamed El-Sherbiny, Ahmed El-Mazny, Internal Medicine Department, Cairo University, Cairo 11311, Egypt.
2
Mohamed Naguib Wifi, Mohamed El-Nady, Ali Farag, Ahmed Salman, Mohamed El-Sherbiny, Ahmed El-Mazny, Internal Medicine Department, Cairo University, Cairo 11311, Egypt. shaimaa.elkholy@cu.edu.eg.
3
Department of Tropical Medicine, Zagazig University, Elsharkiah 44519, Egypt.
4
Internal Medicine Department, Beni Suef University, Beni Suef 71515, Egypt.
5
Tropical Medicine Department, El Manial Specialized Hospital, Cairo University, Cairo 11311, Egypt.
6
Pathology Department, National Cancer Institute, Cairo University, Cairo 11311, Egypt.
7
Internal Medicine Department, Assiut University, Assiut 71515, Egypt.


Authors:
Othman ER1, Ali MK2, Fayez MF1, Abd El Aal DEM1, Mohamed HSE1, Abbas AM1.

Title:
Reply To: Misoprostol During Cesarean Delivery: At ‎Which Time And By Which Route?‎

Author Info:
1
Woman's Health Hospital, Assiut University, Assiut, Egypt.
2
Woman's Health Hospital, Assiut University, Assiut, Egypt. Electronic address: m_khairy2001@yahoo.com.


Title:
Pancreatic Pseudocyst Dilemma: Cumulative Multicenter Experience in Management Using Endoscopy, Laparoscopy, and Open Surgery

Abstract:
BACKGROUND:
Pancreatic pseudocyst (PP) is the commonest cystic lesion of the pancreas. Internal drainage of PPs can be accomplished by traditional open or recently by minimally invasive laparoscopic or endoscopic approaches. We aimed to evaluate and compare the clinical outcomes after endoscopic, laparoscopic, and open drainage.

METHODS:
Seventy-one patients with PP underwent endoscopic (n = 35), laparoscopic (n = 4), and open surgical drainage (n = 32). The primary outcome was the success rate. The secondary outcomes were the estimated blood loss, operative time, opioid requirement, morbidity and mortality, length of hospital stay, and recurrence rate.

RESULTS:
The primary success rate was significantly higher for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups. There were no significant differences in the morbidity, mortality, requirement of blood transfusion, reinterventions, and recurrence rate between the groups. Endoscopic drainage revealed significantly lower blood loss, operative time, opioid requirement, and hospital stay in comparison to open and laparoscopic drainage.

CONCLUSION:
Minimally invasive therapeutic techniques, whether endoscopic or laparoscopic for treatment of PP could be considered valuable, competitive, and promising alternatives for open surgery. Moreover, it is less invasive with less hospitalization and rapid return to work.

Author Info:
1
1 Department of General Surgery, Sohag University , Sohag, Egypt .
2
2 Department of General Surgery, Assiut University , Assiut, Egypt .
3
3 Department of General Surgery, Qena Faculty of Medicine, South Valley University , Qena, Egypt


Authors:
Saad K1, Zahran AM2, Elsayh KI3, Abdel-Rahman AA4, Al-Atram AA5, Hussein A3, El-Gendy YG6.

Title:
Frequency of Dendritic Cells and Their Expression of Costimulatory Molecules in Children with Autism Spectrum Disorders

Abstract:
The aim of our study was to evaluate the frequencies of myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) in children with ASD. Subjects were 32 children with ASD and 30 healthy children as controls. The numbers of mDCs and pDCs and the expression of CD86 and CD80 on the entire DCs were detected by flow cytometry. ASD children had significantly higher percentages of mDCs and pDCs when compared to controls. We found significant inverse relationships between serum 25-hydroxyvitamin D levels and the frequencies of mDCs and pDCs in autistic children. Our data suggested that DCs could play a role in the clinical course of ASD. The relationship of DCs to immune disorders in ASD remains to be determined.

Author Info:
1
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt. ksaad8@yahoo.com.
2
Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
3
Pediatric Department, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.
4
Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Psychiatry, College of Medicine, Almajmaah University, Almajmaah, Kingdom of Saudi Arabia.
6
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.


Authors:
Saad K1, El-Hamed MAA2, Abo-Elela MGM3, Ahmed AE3, Abdel-Baseer KA3, Aboul-Khair MD4, Metwalley KA1, El-Houfey AA5, Hasan GM1, El-Shareef AM6.

Title:
Neurologic Complications in Children With Scorpionism: A Retrospective Study in Upper Egypt

Abstract:
Scorpion envenomation is a life-threatening health problem in tropical and subtropical regions, particularly among children. The aim of this study was to describe the epidemiologic characteristics, clinical profile, and prognosis of neurologic complications among children with scorpionism in Upper Egypt. In this retrospective study, the neurologic complications of scorpionism in 2 university hospitals were analyzed from the points of epidemiologic and clinical picture and outcomes. The neurologic manifestations were found at a high percentage (85%). Irritability was the main manifestation (83.4%), followed by sweating (81.5%), hyperthermia (33.6%), and priapism (48.2% of males). Moreover, convulsion and coma were found in 14.7% and 11% of children, respectively. Neurologic manifestations were common in children with scorpionism and they correlated with poor outcome. Identification of epidemiologic and clinical features of central nervous system complications of scorpionism in children provide important data, helping in development of management policies aiming at preventive control of scorpionism and decrease its mortality.

Author Info:
1
1 Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
2 Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
3
3 Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
4
4 Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
5
5 Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt.
6
6 Department of Neurology, Faculty of Medicine, Menofiya University, Menofiya, Egypt.


Authors:
Sabra TA1,2, Okajima H1, Yoshizawa A1, Okamoto T1, Anazawa T1, Ygi S1, Hata K1, Yasuchika K1, Taura K1, Hatano E1, Kaido T1, Uemoto S1.

Title:
Portal Vein Reconstruction Using Vein Grafts In Pediatric ‎Living Donor Liver Transplantation: Current Status

Abstract:
PV reconstruction is an important aspect of LDLT, with post-transplant outcomes depending on PV reconstruction methods. However, it is unclear whether the preferential selection of these techniques is dependent on preoperative recipient characteristics. This retrospective study assessed whether preoperative recipient factors differed in pediatric patients who did and did not receive VGs for PV reconstruction. Of 113 pediatric patients who underwent LDLT from January 2010 to July 2015, 31 (27%) underwent PV reconstruction with VGs and the other 82 (73%) without VGs. The presence of collateral vessels (P<.0001) and ascites (P=.02); PV size (P<.001), thrombosis (P=.01) and the direction of flow (P=.01), Child-Pugh class A vs B/C liver function (P=.01), Alb concentration (P=.02), primary diagnosis: BA vs non-BA (P=.03), and previous abdominal surgery (P<.005) differed significantly in patients who did and did not receive VGs for PV reconstruction. PV complications, patient survival, and graft survival did not differ significantly in patients with and without VGs at 1-year follow-up. VGs should be harvested for recipients with pretransplant hypoplastic PV, intense collaterals, hepatofugal flow, poor liver status, or previous abdominal surgery.

Author Info:
1
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
2
Department of General Surgery, Graduate School of Medicine, Assiut University, Assiut, Egypt.


Authors:
Sadek A1, Sheneef A2, Sabet EA3, Yousef LM4, Ali AH2, Nor-El-Din AK3, Mahmoud AM5.

Title:
The Role of Bcl-2 and Bax as Markers of Disease Progression in Hepatitis C Virus Infected Patients

Abstract:
Many apoptotic markers have been linked to hepatic cell injury in HCV-related liver diseases, and hence could be used as potential markers for early detection of the disease. The present study aimed to assess the role of apoptotic markers Bcl-2 and Bax in the pathogenesis of chronic HCV-related liver diseases. A total of 85 participants were enrolled into the study; 70 chronic HCV patients (35 non-cirrhotic and 35 cirrhotic), and 15 healthy controls. The serum levels of Bcl-2 and Bax were assayed in all participants by ELISA. Bcl-2 and Bcl-2/Bax ratio were significantly higher in non-cirrhotic patients than the cirrhotic and controls (P < 0.001). Bax was significantly higher in cirrhotic patients compared to the other groups (P < 0.001). Positive and negative correlations were found between serum Bcl-2, Bax, Bcl-2/Bax ratio and HCV viral load in non-cirrhotic and cirrhotic patients respectively. These findings provide an evidence that apoptosis is dysregulated in patients with chronic HCV.

Author Info:
1
Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
Department of Medical Microbiology & Immunology, Faculty of Medicine, Sohag University, Sohag, Egypt.
3
Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt.
4
Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt.
5
Department of Physiology, Faculty of Medicine, Sohag University, Sohag, Egypt.


Abstract:
BACKGROUND:
Although hypothyroidism has an insidious onset and relatively asymptomatic, exertional dyspnea and fatigue can be the presenting complaints.

OBJECTIVES:
The aim is to assess functional lung impairment in hypothyroid patients both at rest and during exercise.

METHODS:
A case-control study was carried out on 42 patients with newly diagnosed hypothyroidism and 12 control subjects. Hypothyroidism was diagnosed based on high value of thyroid stimulating hormone (TSH) ≥6 μIU/ml, and low value of free thyroxin (FT4) ≤0.8 ng/dl, both groups had chest X-ray, spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), arterial blood gases (ABGs) and symptom-limited exercise testing using treadmill.

RESULTS:
Both groups were comparable as regard age, sex, and body mass index. Although ABG and spirometry were within normal in both groups, forced vital capacity %, and forced expiratory flow (FEF25-75) % were significantly reduced in the hypothyroid group (P = 0.014, 0.000, respectively), DLCO significantly reduced in hypothyroidism (P = 0.005). As regard exercise testing parameters, maximum oxygen consumption %, minute ventilation, tidal volume, and oxygen pulse were significantly reduced in hypothyroidism (0.005, 0.000, 0.000, and 0.02 respectively). TSH significantly negatively correlated with forced expiratory volume in 1 s %, FEF25-75%, and DLCO while they significantly positively correlated with FT4.

CONCLUSION:
Even with the presence of normal chest X-ray, arterial blood gases, and spirometry in patients with hypothyroidism DLCO and exercise testing parameters can be significantly reduced.

Author Info:
1
Department of Chest, Faculty of Medicine, Assiut University Hospital, Assuit, Egypt.
2
Department of Internal Medicine and Endocrinology, Assiut University Hospital, Assuit, Egypt.


Title:
Editorial Comment To Two-Year-Old Girl With Impacted ‎Ureteral Stone Successfully Treated With A Single ‎Session Of Combined Percutaneous Nephrostomy And ‎Ureteroscopy

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


Authors:
Saleh M1, Ali H2, Elbadawy A1, Hasaballah A1.

Title:
Balloon Angioplasty With Selective Stenting Strategy In ‎Treatment Of Hemodialysis Related Central Vein ‎Occlusive Lesions

Abstract:
BACKGROUND:
The aim of this study was to evaluate the safety and efficacy of balloon angioplasty and selective stenting in treatment of symptomatic central vein occlusive lesions (CVOL) in patients with upper extremity hemodialysis access.

METHODS:
Seventy-four hemodialysis patients with symptomatic CVOL underwent endovascular therapy between March 2014 and November 2015. Both the primary and secondary patency rates were analyzed by the Kaplan-Meier plot method.

RESULTS:
Forty males and thirty-four females manifesting with arm venous hypertension symptoms were enrolled. The mean age of patients was 49.7 years. Venography showed 29 complete occlusions (39.1%), and 45 stenotic lesions (60.9%). Percutaneous transluminal angioplasty (PTA) alone was performed in 46 cases and bare metal stenting was performed in 17 cases. The primary patency rates were (87±4.9)%, (67.4±6.9)%, and (51.7±7.4)% in the PTA group, and (94.1±5.7)%, (82.4±9.2)%, and (70.6±11.1)% in the stenting group at 3 months, 6 months, and 1 year, respectively. The secondary patency rate was (67.2±6.9)% in the PTA group, and (82.4±9.3)% in the stenting group at 1 year.

CONCLUSIONS:
Balloon angioplasty with selective stenting is safe and effective treatment modality for CVOL in short term. Enhanced follow-up, and repeated interventions are required to maintain patency.

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


Authors:
Saleh MG1, OʼDonnell JL, Davis RP, Wilson D, Lin P.

Title:
CLINICAL PATHOLOGIC CORRELATION OF SARCOIDOSIS-ASSOCIATED MULTIFOCAL CHORIORETINITIS IN AN ELDERLY PATIENT

Abstract:
BACKGROUND/PURPOSE:
To describe a case of histopathologic clinical correlation of sarcoidosis-related multifocal chorioretinitis in an elderly individual.

METHODS:
This is a single case report and review of the pertinent literature. A 72-year-old white woman with a history of asthma was referred with bilateral asymmetric low-grade chronic panuveitis with advancing peripheral punched-out chorioretinal lesions despite systemic corticosteroid treatment.

RESULTS:
Coalescent chorioretinal punched-out lesions on fundus examination in the more severely affected right eye did not respond to corticosteroid treatment, and the refractory nature resulted in a suspicion of intraocular lymphoma despite a previous inconclusive diagnostic vitrectomy result. A transvitreal chorioretinal biopsy in the vitrectomized eye demonstrated a chorioretinal noncaseating granuloma centered on the choriocapillaris and invading Bruch membrane and the outer retina. This case illustrates an example of the second peak of incidence in sarcoidosis that can occur in ages >50 in Caucasians and Japanese patients, as well as a tendency to develop chronic disease in Caucasians, and to have extrapulmonary sarcoidosis in the elderly.

CONCLUSION:
This case emphasizes the differences in presentation of ocular sarcoid in older Caucasian women as well as the histopathologic findings in multifocal peripheral chorioretinitis associated with sarcoidosis.

Author Info:
1
*Department of Ophthalmology, Assiut University, Assiut, Egypt; †Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; ‡Department of Ophthalmology, Christchurch Hospital and Canterbury Health Laboratories, Christchurch, New Zealand; and §Department of Ophthalmology, Kaiser Permanente, Portland, Oregon.


Authors:
Scherz LF1, Abdel-Rahman EA2,3, Ali SS3, Schlüter AD1, Abdel-Rahman MA4.

Title:
Design, Synthesis And Cytotoxic Activity Of Water-‎Soluble Quinones With Dibromo-P-Benzoquinone Cores ‎And Amino Oligo(Ethylene Glycol) Side Chains Against ‎MCF-7 Breast Cancer Cells‎

Abstract:
A series of novel quinones was synthesized by reacting tetrabromo-p-benzoquinone with amino oligo(ethylene glycol) dendrons of generation numbers g = 0-2. According to the performed shake-flask experiments, their aqueous solubility (S = 18 mg l-1-1.6 g ml-1) and partition coefficients (log Poct/wat = 2.53-0.21) can be tuned in a wide range as a function of g. In vitro cytotoxicity assays of tetrabromo-p-benzoquinone and its derivatives against MCF-7 human breast cancer cells showed a concentration- and generation-specific biological activity with IC50-values as low as 0.8 μM. Further investigations revealed a considerable selectivity against cancer cells, as indicated by a weak cytotoxicity against human skin fibroblast cells (>80% survival) within the studied range of concentrations. The results demonstrate that these novel amino oligo(ethylene glycol) dendrons depict versatile tools to ameliorate physical and pharmacological characteristics of extremely hydrophobic molecules and make them susceptible to biological applications.

Author Info:
1
Institute of Polymers , Department of Materials , ETH Zürich , 8093 Zürich , Switzerland.
2
Pharmacology Department , Faculty of Medicine , Assiut University , 71515 Assiut , Egypt.
3
Center for Aging and Associated Diseases , Helmy Institute of Medical Science , Zewail City of Science and Technology , 12588 Giza , Egypt.
4
Chemistry Department , Polymer Lab. 109 , Faculty of Science , Assiut University , 71516 Assiut , Egypt . Email: mona.ali1@aun.edu.eg.


Authors:
Shaaban OM1, Abbas AM1, Mahmoud HR2, Yones EM2, Hassen SG2, Zakherah MS1.

Title:
Counseling And In-Advance Provision Of Levonorgestrel ‎Emergency Contraceptive Pills Decrease The Rate Of ‎Unplanned Pregnancy During Breastfeeding: A ‎Randomized Controlled Trial‎

Abstract:
OBJECTIVE:
To evaluate the effect of counseling and in-advance provision of levonorgestrel emergency contraceptive pills (LNG-ECPs) during postpartum counseling on the incidence of occurrence of unplanned pregnancy during breastfeeding.

MATERIALS AND METHODS:
The current study is an open-label, parallel, randomized controlled trial carried out in a university hospital in Egypt. All women who delivered and planning to birth-space and breastfeed for at least 1 year were approached for participation during a postpartum hospital stay. Eligible participants were randomly allocated to receive adequate lactational amenorrhea method (LAM) counseling Group 1 (LAM-only) or the above LAM counseling in addition to counseling and in advance provision of one packet of 0.75-mg LNG-ECPs Group 2 (LAM + EC). The two study groups were followed 6 months and the primary outcome was the unplanned pregnancy rate.

RESULTS:
The study included 2708 women randomized into two groups; LAM-only and LAM + EC groups. Demographic characteristics were homogenous between the groups at the time of recruitment. Unplanned pregnancy was significantly higher in LAM-only group 70 (5.3%) as compared with 5 (0.4%) in LAM-EC group (p = .0001). Also, 619 women (46.6%) used LNG-ECPs with minor side effects like nausea in 175 (28.3%) women, headache in 94 (15.2%) women, vomiting in 24 (3.9%) women.

CONCLUSION:
In-advance counseling and provision of LNG-ECPs for those opt to use LAM during postpartum family planning counseling can decrease the rate of unplanned pregnancy during breastfeeding and increase the initiation of long-term use of contraception.

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


Authors:
Shaaban OM1, Abbas AM1, Zahran KM1, Fathalla MM1, Anan MA2, Salman SA1.

Title:
Low-Molecular-Weight Heparin for the Treatment of Unexplained Recurrent Miscarriage With Negative Antiphospholipid Antibodies: A Randomized Controlled Trial.

Abstract:
BACKGROUND:
Recurrent miscarriage (RM) is one of the most common clinical problems in reproduction with no definite cause in about 50% of the cases. The study aims to evaluate the effect of low-molecular-weight heparin (LMWH) in the treatment of women with RM negatively tested for antiphospholipid antibodies (APAs).

METHODS:
An open-labeled registered randomized controlled study (NCT 01608347) included women who attended the outpatient clinic in Assiut Women Health Hospital and Nag-Hamady Central Hospital, Egypt, with 3 or more unexplained RM. Eligible participants were randomly assigned into 2 groups. The study group included 150 patients receiving LMWH (Tinzaparin sodium 4500 IU) subcutaneous daily injection with 500 µg folic acid once daily orally started once positive pregnancy test till the 20th week of gestation. The control group included 150 patients receiving the same dose of folic acid alone. The primary outcome of the study was the rate of continuation of a viable pregnancy after 20 weeks of gestation.

RESULTS:
There was no significant difference between both groups as regards age, parity, or number of previous miscarriages. There was a significant increase in women who continued their pregnancy beyond 20 weeks in the study group compared to the control group (73.3% vs 48%, respectively; P = .002). The take-home baby rate was also significantly higher in the LMWH group compared to the control group ( P = .001).

CONCLUSION:
Early start of LMWH decreases the incidence of miscarriage in the first 20 weeks of pregnancy in women with unexplained RM negative for APAs.

Author Info:
1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2
2 Department of Obstetrics and Gynecology, Nag-Hamady Hospital, Qena, Egypt.


Title:
A Rare Giant Chronic Polypoidal Endocervicits In A ‎Premenopausal Woman; Case Report

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


Authors:
Shady NW1, Sallam HF1, Elsayed AH1, Abdelkader AM2, Ali SS2, Alanwar A3, Abbas AM2.

Title:
The Effect Of Prophylactic Oral Tranexamic Acid Plus ‎Buccal Misoprostol On Blood Loss After Vaginal ‎Delivery: A Randomized Controlled Trial‎

Abstract:
OBJECTIVE:
The objective of this study is to evaluate the effect of prophylactic oral tranexamic acid (TA) plus buccal misoprostol on the amount of blood loss after vaginal delivery in women at low risk for post-partum hemorrhage (PPH).

MATERIALS AND METHODS:
The study was a randomized open label clinical trial conducted in a tertiary University Hospital between January 2016 and June 2017. We included women who delivered vaginally with a singleton pregnancy. They were randomized into three groups: group I (women received 10 IU oxytocin IV after delivery of the baby), group II (women received 600 µg buccal misoprostol after delivery of the baby), and group III (women received 1000 mg oral TA at the end of the first stage of labor plus 600 µg buccal misoprostol after delivery of the baby). In each group, pre- and post-delivery pulse rate, blood pressure, temperature, and hemoglobin level were evaluated. Additionally, the amount of blood loss, need for blood transfusion, need for additional uterotonics, and side effects of the study medications were recorded.

RESULTS:
There was a statistically significant lower hemoglobin level and higher blood loss in the misoprostol group compared with oxytocin group and TA plus misoprostol group (p = .0001). There was a statistically significant higher hemoglobin level and lower blood loss in the TA plus misoprostol group compared with the oxytocin group (p = .004 and .043, respectively). PPH occurred in 16.7% of women in the misoprostol group compared 1.7% in the oxytocin group and no cases of PPH in the TA plus misoprostol group (p = .0001).

CONCLUSIONS:
In settings like rural area or home delivery in which oxytocin is not available, alternative oral TA plus buccal misoprostol may be considered as an effective line in prevention of PPH.

Author Info:
1
a Department of Obstetrics & Gynecology, Faculty of Medicine , Aswan University , Aswan , Egypt.
2
b Department of Obstetrics & Gynecology , Faculty of Medicine, Assiut University , Assiut , Egypt.
3
c Department of Obstetrics & Gynecology , Faculty of Medicine, Ain Shams University , Cairo , Egypt.


Authors:
Shahat A1, Safwat AS2, Elderwy A1, Abdelkawi IF1, Abonnoor AEI1, Abdelhafez MF1, Moeen A1, Hammouda H1.

Abstract:
OBJECTIVE:
To present our experience with concealed epispadias and to estimate its actual share in the isolated male epispadias cases and its effect on the surgical outcome.

MATERIALS AND METHODS:
Consecutive patients with isolated male epispadias treated in our center between 2008 and 2015 were classified into concealed and classic epispadias. The 2 groups were compared regarding age at presentation, meatal location, incontinence, dorsal curvature, success rate, and complications.

RESULTS:
Out of 51 patients with isolated male epispadias, 11 (21.6%) were concealed: 7 balanic and 4 penile shaft epispadias. Concealed epispadias cases were found to have significantly delayed age at presentation, more distal meatal location, and less incontinence rate than classic epispadias cases. None of the surgical outcome parameters showed significant difference between the 2 groups.

CONCLUSION:
Concealed epispadias represents about one-fifth of isolated male epispadias cases. Impediment and delay of diagnosis are its main clinical impacts, with insignificant effect on the surgical outcome.

Author Info:
1
Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
2
Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt. Electronic address: assafwat@gmail.com.


Authors:
Shamshirsaz AA1, Fox KA2, Erfani H2, Clark SL2, Salmanian B2, Baker BW3, Coburn M4, Shamshirsaz AA2, Bateni ZH2, Espinoza J2, Nassr AA5, Popek EJ6, Hui SK6, Teruya J6, Tung CS7, Jones JA4, Rac M2, Dildy GA2, Belfort MA2.

Title:
Multidisciplinary Team Learning In The Management Of ‎The Morbidly Adherent Placenta: Outcome ‎Improvements Over Time

Abstract:
BACKGROUND:
Morbidly adherent placenta (MAP) is a serious obstetric complication causing mortality and morbidity.

OBJECTIVE:
To evaluate whether outcomes of patients with MAP improve with increasing experience within a well-established multidisciplinary team at a single referral center.

STUDY DESIGN:
All singleton pregnancies with pathology-confirmed MAP (including placenta accreta, increta, or percreta) managed by a multidisciplinary team between January 2011 and August 2016 were included in this retrospective study. Turnover of team members was minimal, and cases were divided into 2 time periods so as to compare 2 similarly sized groups: T1 = January 2011 to April 2014 and T2 = May 2014 to August 2016. Outcome variables were estimated blood loss, units of red blood cell transfused, volume of crystalloid transfused, massive transfusion protocol activation, ureter and bowel injury, and neonatal birth weight. Comparisons and adjustments were made by use of the Student t test, Mann-Whitney U test, χ2 test, analysis of covariance, and multinomial logistic regression.

RESULTS:
A total of 118 singleton pregnancies, 59 in T1 and 59 in T2, were managed during the study period. Baseline patient characteristics were not statistically significant. Forty-eight of 59 (81.4%) patients in T1 and 42 of 59 (71.2%) patients in T2 were diagnosed with placenta increta/percreta. The median [interquartile range] estimated blood loss (T1: 2000 [1475-3000] vs T2: 1500 [1000-2700], P = .04), median red blood cell transfusion units (T1: 2.5 [0-7] vs T2: 1 [0-4], P = .02), and median crystalloid transfusion volume (T1: 4200 [3600-5000] vs T2: 3400 [3000-4000], P < .01) were significantly less in T2. Also, a massive transfusion protocol was instituted more frequently in T1: 15/59 (25.4%) vs 3/59 (5.1%); P < .01. Neonatal outcomes and surgical complications were similar between the 2 groups.

CONCLUSION:
Our study shows that patient outcomes are improved over time with increasing experience within a well-established multidisciplinary team performing 2-3 cases per month. This suggests that small, collective changes in team dynamics lead to continuous improvement of clinical outcomes. These findings support the development of centers of excellence for MAP staffed by stable, core multidisciplinary teams, which should perform a significant number of these procedures on an ongoing basis.

Author Info:
1
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Electronic address: alirezashamshirsaz@yahoo.com.
2
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
3
Department of Anesthesiology and Obstetric and Gynecologic Anesthesiology, Texas Children's Hospital, Houston, TX.
4
Department of Urology, Baylor College of Medicine, Houston, TX.
5
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut Egypt.
6
Department of Pathology & Transfusion Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
7
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.


Authors:
Shawky A1, Elnady B2, El-Morshidy E2, Gad W2, Ezzati A3.

Title:
Longus Colli Tendinitis. A Review Of Literature And Case ‎Series

Abstract:
PURPOSE:
To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented.

METHODS:
Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized.

RESULTS:
The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years.

CONCLUSIONS:
LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.

Author Info:
1
Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt - Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany.
2
Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt.
3
Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany.


Authors:
Shehata RH1, Abdelmoneim SS, Osman OA, Hasanain AF, Osama A, Abdelmoneim SS, Toraih EA.

Title:
Deregulation of miR-34a and Its Chaperon Hsp70 in Hepatitis C virus-Induced Liver Cirrhosis and Hepatocellular Carcinoma Patients

Abstract:
BACKGROUND:
MicroRNA deregulation may occur during hepatocellular carcinoma (HCC) genesis and progression stages. MicroRNA-34a (miR-34a) functions as a tumor suppressor and is down-regulated or silenced in a variety of human cancers, while heat shock proteins (Hsps) play important roles in assisting protein folding and preventing both protein aggregation and transport across membranes. The present study aimed to evaluating serum expression of miR-34a and its target Hsp70 for early detection of HCC in patients with liver cirrhosis (LC), focusing on correlations with clinicopathological features.

METHODS:
A total of 180 patients were included: 120 with HCC on top of LC (60 with either early or late HCC) and 60 patients with HCV-related LC. In addition, 60 healthy individuals were considered as controls. Real-time polymerase chain reactions were performed for expression profiling of serum miR-34a and Hsp70 and for allelic discrimination of the promotor variant (rs2763979, C/T). In addition, in silico analysis was carried out.

RESULTS:
All participants were heterozygote for the promotor polymorphism. miR-34a serum levels were significantly under-expressed in LC and especially HCC patients as compared to controls. Associations with a high Child-Turcotte- Pugh (CTP) score, advanced cancer stage, and number of masses were noted. In contrast the target Hsp70 was significantly overexpressed in cancer patients but not in LC group and inversely correlated with miR-34a levels.

CONCLUSION:
Utility of circulating miRNAs as biomarkers for early detection of HCC was raised. Future large-scale studies are warranted to confirm the current findings.

Author Info:
1
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Email: rashahamed1985@gmail.com, emantoraih@gmail.com


Authors:
Shiha G1,2, Ibrahim A3, Helmy A4, Sarin SK5, Omata M6, Kumar A7, Bernstien D8, Maruyama H9, Saraswat V10, Chawla Y11, Hamid S12, Abbas Z13, Bedossa P14, Sakhuja P15, Elmahatab M16, Lim SG17, Lesmana L18, Sollano J19, Jia JD20, Abbas B21, Omar A22, Sharma B23, Payawal D24, Abdallah A25, Serwah A26, Hamed A27, Elsayed A28, AbdelMaqsod A29, Hassanein T30, Ihab A31, GHaziuan H32, Zein N33, Kumar M5.

Title:
Asian-Pacific Association For The Study Of The Liver (APASL) Consensus Guidelines On Invasive And Non-Invasive Assessment Of Hepatic Fibrosis: A 2016 Update

Abstract:
Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated. The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The first consensus guidelines of the APASL recommendations on hepatic fibrosis were published in 2009. Due to advances in the field, we present herein the APASL 2016 updated version on invasive and non-invasive assessment of hepatic fibrosis. The process for the development of these consensus guidelines involved review of all available published literature by a core group of experts who subsequently proposed consensus statements followed by discussion of the contentious issues and unanimous approval of the consensus statements. The Oxford System of the evidence-based approach was adopted for developing the consensus statements using the level of evidence from one (highest) to five (lowest) and grade of recommendation from A (strongest) to D (weakest). The topics covered in the guidelines include invasive methods (LB and hepatic venous pressure gradient measurements), blood tests, conventional radiological methods, elastography techniques and cost-effectiveness of hepatic fibrosis assessment methods, in addition to fibrosis assessment in special and rare situations.

Author Info:
1
Internal Medicine Department, El-Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. g_shiha@hotmail.com.
2
Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt. g_shiha@hotmail.com.
3
Department of Internal medicine, University of Benha, Benha, Egypt.
4
Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
5
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
6
Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
7
Department of Gastroenterology & Hepatology, Ganga Ram Institute for Postgraduate Medical Education & Research of Sir Ganga Ram Hospital, New Delhi, India.
8
Division of Hepatology, North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York, USA.
9
Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Chiba Prefecture, Japan.
10
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
11
Post Graduate Institute of Medial Education & Research, Chandigarh, India.
12
Department of Medicine, The Aga Khan University & Hospital, Stadium Road, Karachi, Pakistan.
13
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
14
Department of Pathology, Physiology and Imaging, University Paris Diderot, Paris, France.
15
Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India.
16
Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
17
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
18
Department of Medicine, University of Indonesia, Depok, Indonesia.
19
University of Santo Tomas, España Blvd, Manila, Philippines.
20
Liver Research Centre at the Beijing Friendship Hospital, Capital University in Beijing, Beijing, China.
21
Department of Internal Medicine, Military Medical Academy, Cairo, Egypt.
22
Tropical Medicine Department, Cairo Medical School, Cairo, Egypt.
23
Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
24
Section of Gastroenterology, Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines.
25
Pediatric Hospital, Mansoura University, Mansoura, Egypt.
26
College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia.
27
Hepatology and Diabetes Unit, Military Medical Academy, Cairo, Egypt.
28
Hepatology & GIT Department, AHF Center Abu Dhabi, Abu Dhabi, United Arab Emirates.
29
Internal Medicine Department, Faculty of Medicine Cairo University, Liver Transplant Unit Manial Hospital and Liver ICU French Hospital, Cairo University, Cairo, Egypt.
30
Chula Vista Medical Center, Chula Vista, CA, USA.
31
Molecular Pathology Unit & Research Group, German University in Cairo, Cairo, Egypt.
32
Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
33
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, USA


Authors:
Siddhanamatha HR1, Heung E2, Lopez-Olivo MLA1, Abdel-Wahab N3, Ojeda-Prias A4, Willcockson I5, Leong A6, Suarez-Almazor ME7.

Title:
Quality Assessment Of Websites Providing Educational Content For Patients With Rheumatoid Arthritis

Abstract:
OBJECTIVE:
We performed an environmental scan of currently available websites providing educational information about rheumatoid arthritis (RA) and evaluated the quality of these websites.

METHODS:
We searched three separate search engines, Google, Bing, and Ask.com, on August 27, 2015, using two search terms, "arthritis" and "rheumatoid." Only patient education websites were included. Two independent investigators evaluated the accuracy, completeness, technical elements, design and esthetics, readability, usability, and accessibility of the websites. The navigation experience was also evaluated by an adult training expert.

RESULTS:
We identified 46 websites. Nearly all websites (98%) provided accurate information. However, no website covered all essential RA topics. Common essential topics not covered included epidemiology, pathogenesis, treatment and disease monitoring, complications, self-management, risks and benefits of treatment, prognosis, treatment adherence, questions for patients to ask their doctors, and costs. For the technical elements, all websites disclosed their ownership, but the date that the content was last updated was mentioned in only 10 websites, ranging from 2007 to 2015. The mean reading level was grade 12.1 (standard deviation ±2.3). Most websites (78%) were easy to navigate but only 33% were friendly for people with visual and/or hearing impairments. The navigation experience was rated fair or poor in 41% of the websites.

CONCLUSION:
Current patient information on the Internet does not comprehensively address all educational needs of patients with RA, and is often outdated. The findings from our study highlight potential areas for improvement in online education materials for patients with RA.

Author Info:
1
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
2
Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Worcester, MA.
3
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Rheumatology & Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
4
The University of Houston, Houston, TX.
5
Lonestar College, Montgomery, TX.
6
Healthy Motivation, Santa Barbara, CA.
7
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: msalmazor@mdanderson.org.


Title:
Thermosensitive Bioadhesive Gels For The Vaginal Delivery Of Sildenafil Citrate: In Vitro Characterization And Clinical Evaluation In Women Using Clomiphene Citrate For Induction Of Ovulation

Abstract:
OBJECTIVE:
The objective of this study is to develop and characterize in situ thermosensitive gels for the vaginal administration of sildenafil as a potential treatment of endometrial thinning occurring as a result of using clomiphene citrate for ovulation induction in women with type II eugonadotrophic anovulation. While sildenafil has shown promising results in the treatment of infertility in women, the lack of vaginal pharmaceutical preparation and the side effects associated with oral sildenafil limit its clinical effectiveness.

METHODS:
Sildenafil citrate in situ forming gels were prepared using different grades of Pluronic® (PF-68 and PF-127). Mucoadhesive polymers as sodium alginate and hydroxyethyl cellulose were added to the gels in different concentrations and the effect on gel properties was studied. The formulations were evaluated in terms of viscosity, gelation temperature (Tsol-gel), mucoadhesion properties, and in vitro drug release characteristics. Selected formulations were evaluated in women with clomiphene citrate failure due to thin endometrium (Clinicaltrial.gov identifier NCT02766725).

RESULTS:
The Tsol-gel decreased with increasing PF-127 concentration and it was modulated by addition of PF-68 to be within the acceptable range of 28-37 °C. Increasing Pluronic® concentration increased gel viscosity and mucoadhesive force but decreased drug release rate. Clinical results showed that the in situ sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow with no reported side effects. Further, these results were achieved at lower frequency and duration of drug administration.

CONCLUSION:
Sildenafil thermosensitive vaginal gels might result in improved potential of pregnancy in anovulatory patients with clomiphene citrate failure due to thin endometrium.

Author Info:
1
a Department of Pharmaceutics, Faculty of Pharmacy , Assiut University , Assiut , Egypt.
2
b Department of Pharmaceutics, Faculty of Pharmacy , University of Tabuk , Tabuk , Saudi Arabia.
3
c Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt.


Authors:
Soliman MK1, Gauldin D2, Uwaydat SH2, Sallam AB2,3

Title:
Projectile Propagation Of Dexamethasone Implant In Air- And Balanced Salt Solution-Filled Vitrectomized Eyes

Author Info:
1
Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt.
2
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
3
Ophthalmology Department, Gloucestershire Hospitals NHS Trust, Cheltenham, UK.


Authors:
Suarez-Almazor ME1, Kim ST1, Abdel-Wahab N2, Diab A1.

Title:
Review: Immune-Related Adverse Events With Use of Checkpoint Inhibitors for Immunotherapy of Cancer

Author Info:
1
The University of Texas MD Anderson Cancer Center, Houston.
2
The University of Texas MD Anderson Cancer Center, Houston, and Assiut University Hospitals, Assiut, Egypt.


Authors:
Taha O1,2,3, Abdelaal M4,5,6, Abozeid M2,7, Askalany A1,2,3, Alaa M2.

Title:
Outcomes of Omega Loop Gastric Bypass, 6-Years Experience of 1520 Cases

Abstract:
BACKGROUND:
Omega loop gastric bypass (OLGB) has been viewed with skepticism after the failure of the "old Mason loop." During the past 15 years, a growing number of authors worldwide approved that OLGB is a safe and effective procedure, which appears clearly from the operative outcome and long-term follow-up of consecutive cohort studies of patients who underwent OLGB. The aim of this study is to evaluate the outcomes of OLGB at the bariatric center of our university hospital between 2009 and 2015.

METHODS:
The data of 1520 patients who underwent OLGB from November 2009 to December 2015 at our center were reviewed. Mean age was 37.15 years, mean preoperative BMI was 46.8 ± 6.6 kg/m2, mean preoperative weight was 127.4 ± 25.3 kg, and 62.7% were women. Diabetes mellitus (DM) affected 683 (44.9%) of the 1520 patients, whereas 773 of the 1520 patients (50.9%) presented with hypertension. The mean operative time was 35 min.

RESULTS:
The 1-year postoperative BMI mean decreased to 29.6 ± 3.1 kg/m2, and at the 3-year follow-up, it was 27.5 ± 3.4 kg/m2. The mean of weight decreased to 81.3 ± 16.7 kg and to 78.9 ± 16.9 kg at the 1-year and the 3-year follow-up, respectively. Mortality rate was 0.1%. Overall complications were 9.3%; 0.8% required reoperations. Early complications were encountered in 50 patients (3.3%), and the late complications rate was (6.1%).

CONCLUSIONS:
In this study, greater excess weight loss was observed with OLGB which appeared to be a short, simple, low-risk, effective, and durable bariatric procedure.

Author Info:
1
Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.
2
Overweight Clinics, Cairo, Egypt.
3
Bariatric Unit, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt.
4
Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt. mahmoud.abdel-aal@ucdconnect.ie.
5
Overweight Clinics, Cairo, Egypt. mahmoud.abdel-aal@ucdconnect.ie.
6
Bariatric Unit, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt. mahmoud.abdel-aal@ucdconnect.ie.
7
General Surgery Department, Ain Shams University Hospital, Ain Shams University, Cairo, Egypt.


Authors:
Takeuchi S1,2, Rohren EM2,3, Abdel-Wahab R4,5, Xiao L6, Morris JS6, Macapinlac HA2, Hassan MM3, Kaseb AO7,8

Title:
Refining Prognosis In Patients With Hepatocellular Carcinoma Through Incorporation Of Metabolic Imaging Biomarkers

Abstract:
PURPOSE:
18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC.

METHODS:
We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system.

RESULTS:
The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system.

CONCLUSION:
Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.

Author Info:
1
Department of Medical Oncology, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, Japan.
2
Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1483, Houston, TX, 77030, USA.
3
Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
4
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 426, Houston, TX, 77030, USA.
5
Clinical Oncology Department, Assiut University Hospital, Al Hamraa Ath Thaneyah, Qesm Than Asyut, Assiut, Egypt.
6
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1411, Houston, TX, 77030, USA.
7
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 426, Houston, TX, 77030, USA. akaseb@mdanderson.org.
8
Department of Gastrointestinal Medical Oncology, The Un


