Since the concept of surgical and nonsurgical facial rejuvenation has been introduced, scientists have developed a wide range of agents that can treat an aging face. With the high bill of surgical manoeuvres, most of the antiaging procedures are nonsurgical. A fair knowledge of nonsurgical facial rejuvenation is as important as the surgical tools to the practice of plastic surgeon or a dermatologist who offers cosmetic surgery. Nonsurgical facial rejuvenation has gained its popularity owing to the low-cost, quicker recovery and guaranteed results but with short-lasting effect. In this review article, the basics of different modalities of nonsurgical facial rejuvenation are reviewed regarding the concept behind them and their advantages and disadvantages. With the successful integration of each of these modalities, a complete facial regimen can be achieved, and patient satisfaction can be maximized.

Background Pulmonary embolism (PE) is a potentially life-threatening cardiovascular emergency with a high mortality rate; PE is a difficult diagnosis that may be missed because of nonspecific clinical presentation. However, multidetector computed tomography pulmonary angiography (MDCT-PA) is considered the gold standard in diagnosis. D-Dimer has high sensitivity to PE that if negative and clinical probability is low PE can safely be excluded without the need for further investigation. Objective The aim of this study was to evaluate demographic data, clinical, radiographic, and laboratory findings in patients with PE and the relationship of those findings with the embolism location, and the reason for severity of the embolism. Patients and methods This study was conducted on 100 patients diagnosed with PE based on MDCT-PA at Chest Diseases Department of Al-Azhar Assiut and Assiut University Hospitals, Egypt, from May 2013 to December 2015. All patients were subjected to complete history taking, clinical examination, routine investigations, D-dimer, O₂ saturation, arterial blood gases, ECG, Doppler ultrasound, chest radiography, MDCT-PA for all patients, and echocardiography in selected patients. Results There were significant differences between D-dimer from one hand and severity of PE, and also the site and extent of the embolus from the other hand, as D-dimer levels were higher in massive than submassive PE, and in main pulmonary artery embolus than segmental branches, and lastly subsegmental branches. ECG findings in PE were nonspecific but could aid in the diagnosis. The most common findings were sinus tachycardia followed by inverted T wave in anterior chest leads, whereas the typical S1Q3T3 was less common. Conclusion A practical and evidence-based approach is to combine a D-dimer result with a validated clinical risk score to help selection of suitable patients for computed tomography pulmonary angiogram. Recommendation A clinical probability assessment and D-dimer value should be combined and used to quantify the patient’s risk of PE as low, moderate, or high.

Background Hypertension is a common, asymptomatic, readily detectable, and usually easily treatable disease that leads to lethal complications if left untreated. Hypertension results from the net effect of environmental and genetic factors. These factors include excess dietary salt or alcohol intake, stress, age, genetics, physical inactivity, diet rich in saturated fats, and family history. Evidences indicate that vascular inflammation may be involved in both the initiation and development of hypertension. C-reactive protein is a plasma protein present in trace amounts in healthy patients the concentration of which increases in response to injury, infection or inflammation. Aim The aim of this article is to evaluate the relationship between serum high-sensitivity C-reactive protein (hs-CRP) levels and various stages of hypertension including prehypertension in the Egyptian people. Patients and methods This study included 130 patients with hypertension recruited from the cardiology outpatient clinic of the Assiut University Hospital in addition to 50 apparently healthy controls, in the period from September 2014 to April 2016. The patients were classified according to their levels of systolic and diastolic blood pressure into pre-hypertensive group and stages I, II, III hypertensive patients. They were classified according to the duration of hypertension into less than 1-year duration, between 1 and 5 years and more than 5 years. In addition, the patients were classified into two groups according to weather taking treatment or not. hs-CRP assay using the BT-1500 system based on turbidimetric measurement has been performed. Results The hs-CRP levels were significantly higher in prehypertensive, stages I, II, and III patients compared with controls. In addition, there was significant elevation when comparing prehypertension with both stages II and III; significant increase when comparing stages I with stages II and III and significant increase when comparing stages II with III. Conclusion Increased serum hs-CRP levels are associated with hypertension, especially in the early stages of the disease.

Objectives The aim of this study was to compare the diagnostic accurateness of ultrasound (US) with that of multidetector computed tomography (MDCT) for the diagnosis of appendicitis in patients with doubted acute appendicitis (AA). Patients and methods A retrospective study was carried out on 110 patients of all age groups in the period between November 2014 and January 2016. All patients presented to the emergency department in our institute with suspected diagnosis of AA using sonography and MDCT. Results US diagnosed correctly AA in 70/75 (93.3%) cases confirmed on histopathology. Computed tomography diagnosed correctly AA in 74/75 (98.6%) cases that confirmed on operation and by histopathology. Conclusion MDCT has mild superiority to US in the diagnosis of AA; however, US with expert hands and newer US machines have high sensitivity and specificity in the diagnosis, and without the hazards of radiation.

Background Vasopressors have traditionally been used for the prevention and management of neuraxial hypotension. Aim The primary outcome was to determine which is better, prophylaxis or treatment of spinal hypotension during cesarean delivery and to determine which drug is better, phenylephrine (PE) or norepinephrine (NE). The secondary outcome was to determine possible complications. Patients and methods According to the percentage degree of fall of systolic blood pressure (SBP) after spinal block, 100 full-term pregnant female patients were classified into either prophylaxis groups: received intravenous bolus of either PE 100 µg (group I) or NE 8 µg (group II) when mean arterial pressure (MAP) fell between 100 and 80% of baseline, or treatment groups: received same bolus of PE (group III) or NE (group VI) when MAP fell below 80% of baseline. Baseline and intraoperative SBP, SBP at first episode of decrease of SBP, time at first episode of decrease of SBP and response (%), incidence of hypertension, bradycardia, number of patients who required atropine, incidence of nausea, vomiting and need for antiemetic, and Apgar score at 1 and 5 min were recorded. Results The SBP at first episode of decrease of SBP was significantly lower in both treatment groups. The incidence of bradycardia was significantly higher in both PE groups but it did not occur in both NE groups (0%). The incidence of nausea and hypotension-induced nausea was significantly higher in both treatment groups than both prophylaxis groups. The Apgar score at both 1 min and 5 min was significantly lower in group III than in group I, in group IV than in group I, in group III than in group II, and in group IV than in group II. Conclusion First, spinal hypotension prophylaxis during elective cesarean section gave better results than treatment with less incidence of nausea and hypotension-induced nausea and better Apgar score at 1 and 5 min. Second, NE can be a suitable alternative to PE with no bradycardia and is readily available and less expensive.

Background Unilateral nasal lesions are a characteristics group that need special attention from ear, nose and throat surgeons. Inverted nasal papilloma is one of such lesions. However, its incidence and pattern are not well-defined in Egypt. Aim To estimate the incidence of inverted nasal papilloma among patients with unilateral nasal lesions. Patients and methods A prospective analysis of patients presented and treated owing to unilateral nasal lesion was conducted in a 2-year duration. Patient demographics, clinical presentation, and histopathological diagnoses were document. Results There were 117 (53 males and 64 female) patients with unilateral nasal lesions. The mean age was 44.14 (±10.80) years. Nasal obstruction was reported in 50.4%, nasal discharge in 17.1%, epistaxis in 12%, and facial pain in 5.1%. The lesion was inflammatory in 79.5% and neoplastic in 20.5%. The most common inflammatory lesion was chronic rhinosinusitis (44.4%), whereas the most common neoplastic lesion was inverted papilloma in 10.3%, and squamous cell carcinoma in 4.3%. However, males were significantly higher in neoplastic and inverted nasal papilloma. Nasal obstruction was increased in inflammatory lesions, whereas nasal discharge, facial pain, and epistaxis were increased in neoplastic group. Conclusion Inverted nasal papilloma was reported in 10.3%. It had male predilection and usually presented in the fifth decade, and nasal discharge, epistaxis, and facial pain were significantly associated with the disease.

Context Dropped lens fragments in the vitreous cavity after phacoemulsification can cause potentially serious complications. Aim This prospective noncomparative study aimed to evaluate the effect of same-setting pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments during phacoemulsification. Patients and methods A prospective study was conducted on all consecutive cases (seven patients) with PPV performed for retained lens fragment from January 2016 to December 2017. Statistical analysis Descriptive statistics were calculated using SPSS software (version 13.5). Values are expressed as mean±SD, and statistical significance was determined using the Student’s t test for paired data. Results The patients underwent PPV, at the same setting, implanting hard polymethyl methacrylate (PMMA) on the ciliary sulcus in five cases, three-piece acrylic foldable intraocular lens (IOL) in two cases and iris fixating verisyse behind the pupil in one case. The mean±SD improvement of visual acuity is 0.17±0.18, 0.20±0.16, 0.35±0.26, and 0.40±0.18 at first week, first, third, and sixth month, respectively. Conclusion The same-setting PPV for the dislocated lens fragment is of good visual prognosis and takes the advantage of surgery with a clear cornea and minimally inflamed eye that enable better removal of retained lens fragments with fewer complications.

Background Tracheal intubation results in an alteration of the laryngeal mucosa. Coughing during emergence from general anesthesia is a common clinical problem. Inflation of the endotracheal tube cuff with lidocaine would create a reservoir of local anesthetic, which might diffuse across the cuff membrane to anesthetize the mucosa and attenuate stimulation during tracheal extubation. Aim To evaluate the efficacy of intracuff lidocaine 2% for the prevention of postoperative cough and sore throat. Patients and methods This prospective, randomized, controlled, double-blind study included 80 healthy patients scheduled for elective surgery of less than 2 h under general anesthesia with orotracheal intubation. These 80 patients were randomized through a computer-generated and sealed opaque envelope method into four equal groups, with 20 patients each. After induction of general anesthesia and tracheal intubation, the tracheal tube cuff was filled with 2 ml of 2% lidocaine solution (40 mg) or 0.9% saline. Twenty minutes before extubation, the participants received 1.5 mg/kg intravenous lignocaine or saline. In this way, four groups were formed: lidocaine cuff–lidocaine group (lidocaine in cuff and lidocaine intravenous), lidocaine cuff–saline group (lidocaine in the cuff and saline intravenous); saline cuff–lidocaine group (saline in cuff and lidocaine intravenous), and saline cuff–saline group (saline in cuff and saline intravenous). The primary outcome was the incidence of coughing at extubation. The secondary outcomes were sore throat scores and hemodynamic change. The incidence and severity of sore throat was recorded at 15, 60 min, and 24 h after extubation. Hemodynamic change was assessed at before induction (baseline), 5-min interval after induction, at intubation, 10 min after intubation, 10 min before extubation, at extubation, and 10 min after extubation. Result There was a statistically significant reduction of postoperative cough and sore throat in lidocaine cuff groups in comparison to saline cuff groups. Intravenous lidocaine was not effective to reduce either cough or sore throat severity. However, there was no significant difference among all groups regarding hemodynamic change. Conclusion Intracuff lidocaine 2% reduces incidence of cough and the severity of postoperative sore throat in surgery of less than 120 min. Intravenous lidocaine was not effective to reduce either cough or sore throat severity. There was no significant difference among all groups regarding hemodynamic change.

Background Chronic urticaria is a common immunological disorder, with a prevalence of 15–25%. Several exogenous and endogenous causes have been proposed as causative agents; one of them is infection of the gastrointestinal tract. Despite thorough investigation, the etiology remains unresolved in more than 80% of the cases. Objective The aim of the present study was to assess the prevalence of chronic idiopathic urticarial (CIU) patients presented with Helicobacter pylori infection and to study the effect of H. pylori eradication on the skin lesion in patients with CIU. Methodology This prospective study was carried out at the outpatient clinic of Dermatology Department of Al Azhar Assuit University Hospital on 30 patients with chronic urticaria (20 women and 10 men); their ages ranged from 16 to 65 years. The duration of the disease ranged from 6 weeks to 18 years. A primary diagnosis of CIU was made when an etiological factor accounting for the majority of the lesions could not be elucidated during the history-taking and physical examination. All the patients were subjected to careful history-taking at initial visit; physical examination to assess the number of urticaria wheals, size, and distribution, and associated angioedema; gastroscopy to obtain gastric mucosal biopsy from the antrum; and histopathological assessment of the gastric mucosal biopsy using hematoxylin and eosin, and Giemsa stains. The patients were scored according to the severity of disease (number of wheals, area of distribution, and the duration of the disease; itching and style of life; history of angioedema). The patients were treated for 2 weeks with amoxicillin (1 g/twice daily), metronidazole (500 mg/three doses daily), and omeprazole (20 mg/twice daily). All patients were followed up during the study duration of 3 months. To assess eradication efficacy, a repeated H. pylori stool antigen test was carried out for each patient 6 weeks after the end of anti-H. pylori therapy. Statistical analysis of the data was performed by using the SPSS_16 software. Results Fourteen patients (46.7%), aged less than 30 years, and 16 patients (53.3%), aged equal to or more than 30 years, were included in the present study. The mean of the ages of all patients was 34.9 years, and their age ranged from 16 to 65 years. There were 10 men (33.3%) and 20 women (66.7%). The mean of the duration of disease in all cases was 4 years, and ranged from 2 to 15 years. Nineteen patients presented with gastric symptoms. Seven patients (23.3%) had mild urticaria, 15 (50.0%) had moderate urticaria, and the remaining 8 (26.7%) had severe urticaria. Treatment results showed that 13 patients (43.3%) had complete remission, 12 patients (40.0%) had partial remission, and five patients (16.7%) showed no response. There was no statistically significant difference between age, sex, duration of illness, and gastric symptoms on the prognosis of urticaria after treatment. In addition, the results showed a highly statistically significant (P<0.01) difference between age categories and the gastric symptoms. The results also showed a statistically significant (P<0.05) difference between duration of disease and the gastric symptoms. Conclusion H. pylori infection is considered as a main cause of CIU, specifically in patients with gastric symptoms, and the eradication of H. pylori may help in the treatment of CIU.

Background Atherosclerosis (AS) is a chronic condition in which dyslipidemia had been contributed to its development, along with evidence proving an inflammatory cause. Objective The aim was to determine the relation between dietary hypercholesterolemia and AS with a trial to evaluate the role of inflammation in development of AS in male albino rats. Materials and methods A total of 30 adult male albino rats were divided into two main groups: control group (n=6) and high-cholesterol diet (HCD)-fed group (n=24), which was subdivided into four subgroups (n=6): HCD-fed, HCD-fed with methotrexate, HCD-fed with cholestyramine, and HCD-fed with statin groups. Serum total cholesterol (TC), triglycerides, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, low-density lipoprotein (LDL)-cholesterol, very LDL-cholesterol, atherogenic index, LDL/HDL ratio, and inflammatory markers such as inerlukin-6, tumor necrotic factor-α, and highly sensitive C-reactive protein were estimated. Carotid artery histopathology was done. Results HCD produced marked disturbance in lipid profile and increased inflammatory markers and atherosclerotic changes in carotid artery. Administration of statin and cholestyramine significantly improved this dyslipidemia. Elevated inflammatory markers were significantly decreased by administration of methotrexate and statin. Atherosclerotic changes in carotid artery decreased significantly in rats pretreated with methotrexate and statin. Conclusion Atherosclerotic condition is closely associated with excessive intake of cholesterol-rich diet; however, inflammation has a central role in the pathogenesis of the atherosclerotic process, as atherosclerotic changes could be reduced despite disturbed lipid profile by anti-inflammatory medication. Further studies are recommended for more evaluation of the role of anti-inflammatory drugs in reduction of clinical outcomes in atherosclerotic conditions.

Background Inguinal hernia occurs in ∼1.5% of the general population and in 5% of male individuals. The bilateral type affects about 12% of patients, the direct and the combined ones being more frequent than the indirect. Simultaneous or sequential repair has been debated especially after tension-free repairs. Aim This study was carried out to compare Stoppa procedure with bilateral Lichtenstein hernioplasty for the treatment of primary bilateral inguinal hernia. Patients and methods This trial included 80 male patients with primary bilateral inguinal hernias. They were divided randomly into two equal groups. Group A underwent bilateral Lichtenstein hernioplasty and group B underwent Stoppa repair. Preoperative, operative, and postoperative characteristics were recorded for each patient in the study. Patients were followed up at 3, 6, and 12 months postoperatively. Results As regards preoperative data, there was no statistically significant difference between both groups. The Stoppa operation took a significantly shorter time than the bilateral Lichtenstein technique; the mean operative time for Stoppa and bilateral Lichtenstein was 84.0±8.6 and 96.4±6.2 min, respectively. Visual analogue scoring of pain 12 h postoperatively was significantly lower in the Stoppa group than in the bilateral Lichtenstein group. As regards operative and postoperative complications, there was no significant difference between both groups. Hospital stay, return to normal daily activities, and inguinodynia rates were similar in both groups. There was no recorded recurrence in both groups up to 1 year of follow-up. Conclusion Bilateral primary inguinal hernias can be operated upon in one setting without an increase in morbidity or recurrence rate. The Stoppa technique can be a good alternative to bilateral Lichtenstein procedure for the treatment of bilateral inguinal hernia, with comparable outcome.

Background Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). It can be diagnosed clinically in patients complaining of severe abdominal pain with rising of serum amylase and lipase more than three-folds of high normal levels within 24 h of the procedure. Aim The aim of this work was to determine if there is an association between Helicobacter pylori infection and low somatostatin level and its relation to PEP. Patients and methods A total of 80 patients with obstructive jaundice requiring ERCP were enrolled in this study and were, divided according to H. pylori infection into the following: 37 H. pylori positive patients (group A) and 43 H. pylori negative patients (group B). All patients were subjected to full history taking; clinical examination, serum bilirubin, serum amylase and serum lipase just before and 24 h after ERCP; histological examination of gastric biopsies to detect H. pylori and serum somatostatin level with follow-up for 24 h for any symptom or signs suggestive of PEP. Results The percentage of PEP was 10.8% in group A and 9.3% in group B, with an overall percentage of 10%. Patients who experienced PEP had a statistically significant lower somatostatin level than patients who did not experience PEP. Significant increase in somatostatin level was registered in H. pylori-infected patients. Certain ERCP-related maneuvers, such as difficult ampullary cannulation, repeated pancreatic duct cannulation and precut sphincterotomy, carry the risk of PEP. Conclusion No association between H. pylori infection and PEP was seen. Low somatostatin level can be useful in prediction of PEP.

Background Breast cancer (BC) is the most common cancer among Egyptian women, and its early detection is accompanied with decreased mortality rates. MicroRNAs (miRNAs) are small noncoding RNA molecules that regulate gene expression and affect cancer development. The expression level of miRNA-155 is up-regulated in BC and correlates with its invasive properties, offering a great potential as a noninvasive biomarker for BC screening. Objective The aim of this study is to evaluate the role of miRNA-155 as an early diagnostic serum-based biomarker of BC. Patients and methods This study was conducted on 30 patients newly diagnosed with BC and associated 20 healthy women as a control group. Serum level of miRNA-155 was measured for all studied cases using real-time quantitative PCR technique. Results MiRNA-155 expression was up-regulated in serum of patients with BC compared with control group (P<0.001). Serum miRNA-155 expression significantly differed with cancer stage and its expression directly increased with advancing cancer stage. A comparative study of the miRNA-155 expression between control group and positive and negative metastatic lymph nodes (LNs) subgroups demonstrates a highly significant difference. MiRNA-155, in terms of fold change, is highest in positive LNs metastatic subgroup, with a mean of 19.63, followed by 4.29 in negative LNs metastasis subgroup, and lowest in the control group, with a mean of 1.06 (P<0.001). Conclusion The results validate miRNA-155 as a promising diagnostic and even a prognostic marker in cases of BC.

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common nosocomial pathogen that causes infections among healthcare workers. Objective The aim of this study was to detect the prevalence of MRSA among medical residents in different departments of Al-Azhar University Hospital, Damietta branch. Patients and methods Eighty-four medical residents were subjected to a questionnaire that included questions on personal data, occupational experience, antimicrobial intake, infection-control training, and implementation of infection-control programs in the hospital, and a check list that indicated individual adherence to infection-control measures and bacteriological study for isolation and identification of MRSA. Nasal swabs were obtained from 84 residents. The isolates were identified as S. aureus on the basis of morphology, Gram stain, catalase test, coagulase test, mannitol salt agar fermentation, and cefoxitin disc diffusion. Results The overall bacteria-carriage rate among residents was 41 (48.8%). The highest rate was found in ICU [seven (8.3%)], surgery [six (7.1%)], orthopedics [four (4.7%)], and gynecology [four (4.7%)] departments. Nineteen (22.6%) of all infections were S. aureus, 20 (23.8%) were coagulase-negative Staphylococcus, and two (2.4%) were Streptococcus; 15 (17.9%) S. aureus were MRSA strains, whereas four (4.7%) were methicillin-susceptible S. aureus strains. Thus, the nasal carriage rate of MRSA among the participating residents was 15 (17.2%). The overall MRSA carriage rate among residents was 15 (17.8%). The highest rate was found in neurosurgery [three (3.5%)], ICU [two (2.3%)], surgery [two (2.3%)], cardiothoracic [two (2.3%)], and gynecology [two (2.3%)] departments. There was an insignificant association between age, residence, frequency of antibiotic intake, duration of work, and carriage rate of MRSA among the participating healthcare workers. Conclusion We concluded that it is important to detect the carriers of bacteria and ensure decolonization to reduce the transmission of S. aureus in the hospital.