Introduction Essential hypertension is associated with multiple metabolic abnormalities; one of the most important is hyperinsulinemia. On the contrary, euglycemic state has been elicited in hypertensive patients. Aim To explore the pathogenic role of hyperinsulinemia in essential hypertensive patients even with euglycemia. Patients and methods A total of 60 euglycemic patients (30 hypertensive patients and 30 normotensive controls) were recruited in a case–control study. Blood pressure, insulin level, lipid profiles, BMI, and waist circumference (WC) were estimated for both groups. In addition, the severity of hypertension was classified according to the European hypertension guidelines. Results Significant increases of fasting insulin level, BMI, WC, and dyslipidemia (increase total cholesterol, triglycerides, and low-density lipoprotein-cholesterol) and a significant decrease of high-density lipoprotein-cholesterol in hypertensive patients than the controls were found. Moreover, a highly significant correlation was detected between the severity of hypertension and the parameters of fasting insulin level, BMI, WC, and triglycerides level. Conclusion The study showed a significant increase in fasting insulin level in hypertensive patients than the control group. Besides, there was a highly significant increase of fasting insulin level with hypertension severity; therefore, this supports a possible pathogenic role of hyperinsulinemia (through insulin resistance) in the onset of hypertension even when the fasting blood sugar is within the normal limits (euglycemic).

Objective To study the efficacy, safety, and feasibility of angioplasty and drug-eluting stents (DESs) in the treatment of vertebral artery stenosis. Patients and methods The study was carried out on 20 patients (17 patients with vertebral artery endovascular stenting and three patients with angioplasty alone). The success rate, perioperative complications, and long-term effectiveness were evaluated. Results A total of 17 DESs were implanted and three patients with angioplasty alone. The success rate was 100%. The degree of stenosis decreased from 78.25±10.17 to 11.50±7.45% (P<0.01). Complications were absent during the perioperative period. Follow-up was performed for 6 months. Two patients developed transient ischemic attack and one of them developed stroke and no cerebral ischemic events were noted in the remaining patients, suggesting a favorable outcome. Conclusion Angioplasty and DESs is a safe and effective strategy for the treatment of symptomatic vertebral artery stenosis.

Background Infection with Toxoplasma gondii is one of the most common parasitic infections in humans worldwide. Nearly one-third of individuals worldwide have been exposed to this parasite. Diabetes mellitus is an important factor that increases the susceptibility and risk of various infestations in the host. Objective This study aimed to shed light on and evaluate the seroprevalence of T. gondii infection in diabetic patients. Patients and methods T. gondii antibodies were tested serologically in 50 patients with diabetes mellitus and 50 apparently healthy individuals as controls using the enzyme-linked immunosorbent assay technique. Results The seropositivity for anti-Toxoplasma immunoglobulin (Ig)G antibodies in the study groups was 46% in diabetic patients (group I) and 24% in the control group (group II), with P value of 0.03 indicating a statistically significant difference between the two groups. Only one patient in the diabetic group (group I) was positive for anti-Toxoplasma IgM, with P value of 0.98, showing no statistically significant difference between the two groups. Conclusion The seropositivity for anti-Toxoplasma antibodies in diabetic patients was found to be higher than that in nondiabetic patients. Anti-Toxoplasma IgG antibodies 46 versus 24% (P=0.03).

Background The precise etiology and pathogenesis of systemic lupus erythematosus (SLE) remain unclear. Unpredictable flares and remissions and diverse serological and clinical manifestations are observed among patients with SLE and the challenge for the evaluation of disease activity and administration of appropriate treatment. Assessment of Tenascin-C (TNC) may reflect disease activity and/or early tissue damage in SLE. Aim The aim of this study was to examine whether TNC levels are useful as a predictive biomarker in SLE and to reflect their activity. Patients and methods In all, 50 patients with SLE (25 patients with active SLE, 25 patients with inactive SLE), and 25 age-matched and sex-matched healthy controls were enrolled in the study. Patients undergo clinical and laboratory assessment. Serum TNC was assessed by enzyme-linked immunosorbent assay. Our results The results have shown that patients with active SLE had a higher TNC level compared with inactive patients and healthy volunteers. Also the study showed a statistically significant positive correlation between TNC level and Systemic Lupus Erythematosus Disease Activity Index score. On the other hand, the TNC level correlated negatively with white blood cells, platelet counts, C3 and C4 levels, hemoglobin level, and disease status. Conclusion The increased serum tenascin level was found in patients with SLE and was correlated with certain clinical and laboratory immunoinflammatory parameters. So the estimation of serum Tenascin levels seems beneficial in the assessment of disease activity and progress in SLE patients as well as in the assessment of the efficacy of various treatment regimens used.

Background Pain is a significant problem for many patients after major surgery. The transversus abdominis plane (TAP) block is a new technique that provides analgesia following abdominal surgery. TAP block can be done blindly or by using ultrasound that include posterior and subcostal approach. Aim The primary aim was to study the clinical utility of TAP block as analgesia after lower abdominal surgeries in morbidly obese. The secondary aim was to assess the advantages and disadvantages of the same. Patients and methods A total of 60 patients fulfilling inclusion criteria who were undergoing elective lower abdominal surgeries were divided into two equal groups. Group T (TAP group), which received bilateral ultrasound-guided subcostal TAP block at the end of the surgery before emergence, and group C (control group) that received general anesthesia, with no further narcotic administration. Postoperative mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough, PaCO₂, time to first request of analgesia, average frequency of analgesia, average total analgesics consumption, average total local anesthetic (bupivacaine) consumption, postoperative complications, and frequency of antiemetic were recorded. Bromage score was assessed at 20 min postoperatively. Results There were significant decrease in mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough in group T than group C at 10, 20 min. There wasa high significant decrease in peak expiratory flow rate and significant increase in PaCO₂ in group C than group T at 2, 6 h postoperatively. There was a high significant increase in the time to first request of analgesia, and a high significant decrease of both frequency of analgesia and average total consumption of analgesia. A high significant increase was observed in local anesthetic consumption in the first 24 h postoperatively in group T than group C. There were significant differences in nausea, vomiting, and frequency of antiemetic, whereas they did not occur in group T. There were no significant differences in the grade of motor block between two groups at 20 min or any other time. Conclusion TAP block was safe, and easy to perform, and more effective in the early postoperative period with significant reductions in opioid requirement, pain score, and complications, and did not produce motor block.

Background The aim was to evaluate the refractive and corneal topographic changes occurring in the eyes after horizontal rectus muscle surgery, either unilateral recess–resect procedure or bilateral rectus muscle recession. Patients and methods A total of 31 eyes of 20 patients were included in this study. The patients underwent strabismus surgery for concomitant horizontal strabismus (exotropia). The patients were divided into two groups. Group A included nine patients (nine eyes), who were subjected to lateral rectus muscle recession and medial rectus resection in the same eye (R&R group). Group B included 11 patients (22 eyes) who were subjected to lateral rectus recession in both eyes (bilateral lateral rectus recession group). A full ophthalmic examination including cycloplegic automated refraction was carried out. Refraction and keratometry were assessed at 1–2 weeks preoperatively and 1 week, 1 month, and 3 months postoperatively. Corneal topography was performed before and 3 months after the operation. Preoperative and postoperative refraction was compared in terms of spherical equivalent (SE) and cylindrical power. Results The SE showed a transient statistically insignificant change toward the myopic side in the first week in both groups; these changes persisted for 2 months postoperatively and stabilized at the third month. However, the difference in SE from the preoperative values was statistically insignificant in both groups. Also, the changes in the refractive status that occurred when two muscles were operated in the same eye (R&R group) were greater than when only one muscle was operated. Conclusion Refractive status changed postoperatively, but this change was small and reversible.

Background Although recurrence of basal cell carcinoma (BCC) is uncommon, it may pose a prognostic problem that cannot be fully predicted. Aim The aim was to assess the clinical, histologic, and immunohistochemical features of recurrent BCC among Egyptian patients. Materials and methods A retrospective study that included 18 patients who had recurrent BCC during the period from 2010 to 2015 was carried out. Clinical data and histological features were analyzed, and an immunohistochemical study was carried out for primary and recurrent lesions. Results The study included 11 (61.1%) women and seven (38.9%) men with a mean age of 53±8.3 years. Most of the lesions were located on the scalp (33.3%) and cheeks (27.8%). The mean duration of the lesions was 4.1±1.7 years and the mean size of the lesions was 10.6±3.4 mm. Recurrence time ranged from 13 to 47 months, with a mean of 25.3±9.9 months. Out of 18 cases, only three (16.7%) were surgically excised, whereas 15 (83.3%) were treated by nonsurgical methods. Histological examination of recurrent lesions showed a change in histological type in 38.9%, whereas in 61.1% of cases, it was similar to the primary lesion. Immunostaining showed significant changes with Ki-67, whereas other markers (p53, bcl-2, CD10, and CD34) showed no significant differences between primary and recurrent lesions. Conclusions Our results proposed an increased risk of BCC recurrence after nonsurgical treatment and still surgical treatment is the best therapeutic method associated with low recurrence rates. We believe that increased awareness of clinical, histological, and molecular risk factors help in minimizing recurrence of BCC.

Background Febrile seizures (FS) are the single most common type of seizures seen in children between 6 and 60 months of age. There has been a conflict about the role of zinc in FS. Aim The aim of this study was to determine whether there are any changes in serum zinc level in children with FS. Patients and methods This study included 100 infants and children aged between 6 and 60 months who were divided into two groups: group I included 50 patients with FS as a case group (study group) and group II included 50 patients with fever without seizures as a control group. Both groups were age and sex matched. Serum zinc level was estimated in all patients by colorimetric test kit. Statistical analysis Data were analyzed using the statistical package for social sciences, version 17. P value less than 0.05 was significant. Results FS levels were significantly reduced in case group when compared with control group (76.72±10.99 vs. 133.80±33.44 μg/dl, respectively). P value was less than 0.001. Conclusion Serum zinc level was significantly reduced among children with FS compared with febrile children without seizures. Zinc deficiency can be considered as a risk factor for FS and expected to have a role in the pathogenesis of FS.

Aim of the work To identify the role of ultrasonography in diagnosis of painful shoulder syndrome in rheumatoid arthritis (RA). Patients and methods A total of 45 patients with RA who fulfilled the ACR/EULAR 2010 criteria for RA were included, involving 65 shoulders. There were seven male and 38 female patients, and their mean age was 48.02±15.41 years. Their mean disease duration was 15.5±11.25 years. They were subjected to full history taking, thorough clinical examination, laboratory investigations, plain radiography, and shoulder ultrasonography. Results The 65 RA shoulders were divided according to the disease activity score 28 (DAS28) into group A (with high DAS28), which included 15 (23%) shoulder joints, and group B (with moderate DAS28), which included 50 (77%) shoulder joints. Ultrasound findings of groups A and B revealed bicipital tenosynovitis in 47 and 22%, rotator cuff (RC) tendinopathy in 66.7 and 24%, humeral head erosions in 80 and 48%, effusion in 66.7 and 18%, subacromial/subdeltoid (SA/SD) bursitis in 66.7 and 28%, and positive power Doppler signals (PDS) in 60 and 14%, respectively. There was a highly significant difference in effusion and a significant difference in RC tendinopathy and SA/SD bursitis between both groups. There was a significant to highly significant difference in SA/SD bursitis, RC tendinopathy, and bicipital tenosynovitis between patients with positive and negative PDS. Conclusion Ultrasonography is a useful tool in the diagnosis of shoulder pain in RA that can distinguish between various causes, helping in proper decision making regarding the treatment strategy. Bicipital tenosynovitis, SA/SD bursitis, glenohumeral joint effusion, humeral head erosions, and positive PDS were significant predictors of inflammatory nature of the painful shoulder syndrome.

Background Leptospirosis is considered as the most common zoonosis in the world. Leptospirosis has a multiorgan affection that can affect nearly any organ in a classical, rare or unusual presentation and complications. This may include hepatic, renal, pulmonary, meninges and cardiac affections. Aim The purposes of this study were estimating leptospiral infection prevalence among people living in Shabramant village at El-Giza Governorate and identifying associated environmental and behavioral risk factors for the infection. Patients and methods This study was designed to be a cross-sectional study conducted during the period from June 2013 to May 2014. Our study included 100 participants based on history taking and laboratory investigations; a structured questionnaire was administered to collect information on individuals’ potential risk factors for leptospiral infection. Microagglutination test was performed using five Leptospira serovars: Leptospira int. icterohaemorrhagiae, Leptospira int. canicola, Leptospira int. pomona, Leptospira int. grippotyphosa and Leptospira int. wolffi to determine the presence of leptospiral antibodies and their titers in the sera of investigated patients. Results Our study found leptospirosis disease to be common among studied cases (44%), and L. icterohemorrhagiae was the only serovar detected among the studied cases. Middle-aged female patients were predominantly affected (52.6%); hence, age and sex can be regarded as risk factors of leptospirosis. Coinfections by other pathogens were also noted in this study; 22.2% of the 44 cases included had positivity for hepatitis C virus antibodies, which can be regarded as a risk factor for acquiring this disease. Also, living close to places inhabited by rodents and animals was considered as an important risk factor for exposure to such infections, and measures should be developed to minimize exposure to these animals. Conclusion It can be concluded that leptospirosis is an important neglected zoonotic disease despite its high prevalence. We recommend adding Leptospira infection to the list of possible diseases among febrile patients and increasing the awareness of the fever hospital clinicians about leptospirosis.

Background Spinal anesthesia avoids the hazards of airway management during general anesthesia. Shivering is a frequent risk factor in patients undergoing lower half operations under spinal anesthesia. Premedication with intravenous serotonin receptor antagonists such as granisetron has been used to overcome this problem. Ketamine increases arterial pressure and heart rate and may decrease core-to-peripheral redistribution of heat. Moreover, pethidine which is considered as a time-tested drug for control of shivering can be of value for shivering prophylaxis. Objective This study evaluates the efficacy of granisetron, ketamine, and pethidine on shivering in patients undergoing lower half operation under spinal anesthesia. Patients and methods A total of 60 patients were assigned to three equal groups: group G received 3 mg granisetron, group K received 25 mg ketamine, and group P received 25 mg pethidine 5 min before spinal anesthesia. The incidence of shivering episodes was recorded at baseline monitoring, intraoperatively, and postoperatively. Moreover, propagation and regression of motor and sensory block were assessed. Results Regarding mean arterial blood pressure, there was significant decrease in group P in comparison with groups G and K. Regarding decreased incidence of shivering, there was no significant difference between the study groups. Regarding incidence of nausea and vomiting, there was significant decrease incidence in group G compared with groups K and P. Moreover, there was significant difference regarding faster time to regression of sensory block in group G in comparison with groups K and P. Conclusion In patients undergoing lower half surgery under spinal anesthesia, prophylactic intravenous administration of 3 mg granisetron, 25 mg ketamine, or 25 mg pethidine 5 min before induction of spinal anesthesia significantly reduced the severity of shivering. Regression of sensory block was faster with granisetron than ketamine and pethidine. Moreover, prophylactic granisetron also reduces nausea and vomiting and the need of antiemetics.

Background Sphenoid wing en plaque meningioma is a subgroup of meningiomas defined by its particular sheet-like dural involvement and its disproportionately large bone hyperostosis. Sphenoid wing en plaque meningiomas are also called spheno-orbital meningiomas and pterioneal meningiomas en plaque. It represents 2–9% of all meningiomas and they are mainly located in the sphenoid wing. Objective The aim of this study was to analyze the outcome, surgical results, and recurrence rate in a series of 20 patents. Patients and methods This respective descriptive analytical study includes 20 patients with sphenoid wing en plaque meningiomas, who were surgically treated between 2010 and 2014. Results There were 14 women and 6 men, the mean age was 45 years (range: 20 and 70 years), six patients presented by extension of the dural component into the orbit, seven patients with cavernous sinus infiltration, adjuvant radiation therapy was performed for five patients after the surgery. After follow-up at 4 years, seven patients developed tumor recurrence, three patients submitted to surgical treatment, and four patients to radiation therapy. Patients without tumor extension to the orbit or cavernous sinus had the best prognosis, while patients with tumor extension, the recurrent rate was high. Conclusion Postoperative radiation therapy is indicated in cases with residual tumor in cavernous sinus and superior orbital fissure involvement is frequent and should be considered within surgical limits.

Background and Aim Coronary artery disease (CAD) is the leading cause of death worldwide. After acute myocardial infarction (AMI), CAD is a serious and common ailment that can influence a patient’s prognosis and quality of life. Aim of the study The aim of this study was to assess the effect of elective percutaneous coronary intervention (PCI) on left ventricular (LV) functions after 3 months in patient with significant chronic left coronary system lesions by echo and tissue doppler imaging (TDI). Patients and methods The study was conducted on 30 patients with chronic significant (more than 70%) left coronary system stenosis as proved by diagnostic coronary angiography with or without other coronary artery affections. Resuts Left ventricular ejection fraction (EF) was statistically significant different between the patient’s pre-& post-PCI (mean ± SD was = 0.4893 ± 0.06963 pre-PCI, 0.4550 ± 0.05158 post-PCI with P value of 0.0341. twenty two of patients (73.3%) were males and 8 (26.7%) were females, with age ranged from 40 to 67 years and mean age or 55.92 years. Conclusion PCI for a significant coronary lesion has a beneficial effect on LV functions, improvement in regional and global LV functions & myocardial contractility after revascularization that can be predicted by conventional echo and TDI.

Background and aims The highest prevalence of chronic hepatitis C virus (HCV) genotype 4 infection is reported in Egypt. Fortunately, the oral anti-HCV therapy (OAT) has been available with more than 95% reported 12-week sustained virologic response (SVR) after treatment for 84 days. The current study goals included evaluation of 12-week SVR after treatment with sofosbuvir (SOF) plus daclatasvir (DCV) with or without ribavirin for 12 weeks. An additional goal was to study the correlation between post-OAT HCV serologic relapse and diabetes mellitus, liver fibrosis, and pretreatment viral loads. Patients and methods Patients with chronic HCV infection (n=590) were retrospectively enrolled in the current study. They were subjected to OAT for 12 weeks. Single daily dose of SOF (400 mg) plus DCV (60 mg) constituted the baseline therapy in all study cases, and ribavirin (RBV) was coadministered in 262 patients. Responses to OAT were assessed 12 weeks after end of treatment by single-step reverse transcription polymerase chain reaction (SRT-PCR). Results We found that overall 12-week SVR was 98% (579/590), which showed insignificant advantages on adding ribavirin (99%) compared with solitary directly acting antivirals regimen (97%) (P>0.05). The SVR in normoglycemic and/or none or early hepatic fibrosis (F0–F2) (>99.0%) was significantly higher compared with diabetic and/or late fibrotic (F3–F4) (94%) patients (P<0.05). Pretreatment detection of HCV loads by SRT-PCR was significantly lower in F0 compared with F4 hepatic fibrosis (P<0.001), with insignificant changes when compared with F1–F3 (P>0.05). Conclusion SOF plus DCV with or without ribavirin regimens achieved 12-week SVR in 98% of the patients with chronic HCV infection. Hepatic fibrosis and diabetes mellitus have negative effects on 12-week SVR. Despite F4 hepatic fibrosis being associated with the highest pre-treatment HCV-SRT-PCR values, baseline viral loads do not affect anti-HCV oral therapy outcomes.

Background S100A12, a proinflammatory protein secreted by granulocytes, is known to be elevated in different diseases of inflammatory origin, including inflammatory bowel disease. Aims To evaluate the role of serum S100A12 as a diagnostic marker in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease. Patients and methods A cross-sectional study was conducted on 70 persons who fulfilled the designed inclusion criteria and were classified into four groups: group I included 10 healthy persons; group II included 20 patients known to have IBS; group III included 20 patients known to have ulcerative colitis (UC) in remission; and group IV included 20 patients known to have UC in active state. Serum S100A12 level was measured in all patients using a highly sensitive enzyme-linked immunosorbent assay. Results The mean serum S100A12 level for UC patients in exacerbation was 83.93±30.78 pg/ml, UC patients in remission 64.03±19.87 pg/ml, the mean value of serum S100A12 was 47.73±11.15 pg/ml in the IBS group, and the mean value for the control group was 45.32±8.60 pg/ml. So, there is a significant high level of serum S100A12 in UC groups compared with the IBS group and the control group. Serum S100A12 levels were significantly higher in active UC patients compared with IBS/healthy controls (P<0.01). Serum S100A12 levels were significantly higher in UC in remission compared with the IBS and control groups (P<0.05). Serum S100A12 levels were significantly higher in active UC compared with UC in remission (P<0.05). There is no significant difference between the IBS group and the control group regarding serum S100A12 levels (P>0.05). The performed analysis also focused on the determination of a cutoff for UC prediction that would exhibit the highest possible sensitivity and specificity. This optimal cutoff was estimated at 52.8 pg/ml with a sensitivity and a specificity of 80 and 75%, respectively. Conclusions Serum S100A12 can be used as a noninvasive marker to distinguish UC from IBS.

Background Adenoid hypertrophy is known to be the most common cause of nasal obstruction in children; thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the pediatric population. The widely used conventional curette adenoidectomy was first described. Dissatisfaction with this technique led to the use of other methods, including powered-shaver adenoidectomy, bipolar electrocautery, coblation, and LASER. Aim This study aimed to compare the endoscopic-assisted coblation adenoidectomy to conventional adenoidectomy (by cold instruments) in terms of safety, efficacy, results, and complications. Patients and methods Eighty patients were diagnosed depending on history, clinical examination, and radiology. The patients were operated on by either conventional or coblation adenoidectomy and divided into two groups: the patients in group A underwent conventional adenoidectomy, whereas the patients in group B underwent coblation adenoidectomy. The intraoperative parameters studied were operative time, intraoperative bleeding, and completeness of removal of adenoid. Postoperative parameters included assessment of postoperative pain, resolution time, and complications. Results It was found that although coblation has a longer operative time, it is a safe and effective alternative to curette adenoidectomy, it is more complete and accurate, there is less intraoperative blood loss, less postoperative pain, and fast resolution time, and fewer complications. Conclusion Coblation adenoidectomy proved to be safe and effective; however, reducing the cost is mandatory before considering it as the modality of choice for adenoidectomy.