MRI has been a potential tool for lesion diagnostics in the human body. It is accurate owing to the sound biological principle behind it. It has an array of unique features but is not free from certain constraints that hinder the smooth progression of its course. This article throws light on the salient features and constraints pertaining to MRI, with an insight towards the future prospects of the same.

Background Testing for antinuclear antibodies (ANA) is useful for the diagnosis of autoimmune connective tissue diseases (CTD). Solid-phase assay such as the enzyme-linked immunosorbent (ELISA) assay has replaced the use of indirect immunofluorescence assay (IIF) for the detection of ANA. Patients and methods In this study, ELISA which is based on a qualitative screening of IgG class autoantibodies using commercially available kits from Orgetec Diagnostika GmbH was compared with IIF for the detection of ANA in patients with different connective tissue diseases. The study involved 73 patients with confirmed diagnosis (38 patients diagnosed as systemic lupus erythematosus (SLE), 27 patients with rheumatoid arthritis (RA), and eight patients with other connective tissue diseases: systemic sclerosis, mixed connective tissue diseases, and Sjögren’s syndrome). They were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department for follow-up and others were admitted patients of the Rheumatology Department at Assuit University Hospitals. Twenty-five apparently healthy participants served as the control group. Results ANA results by IIF: of the 73 patients, 39 (53.4%) had positive ANA results and 34 (46.6%) patients had negative ANA results. All healthy control group ANA results by IIF were negative (100%). ANA results by ELISA: from a total of 73 patients, 42 (57.5%) had positive ANA results, 27 (37%) patients had negative ANA results, and four (5.5%) patients had borderline ANA results. All control group ANA results by ELISA had negative ANA results. ELISA sensitivity was 86.8% compared with 84.2% by IIF in the SLE. In other CTD both tests had the same sensitivity (87.5%). The ELISA and IIF had the same high specificity (100%) in SLE and other CTD. Conclusion There is a comparable result between sensitivity, specificity, PPV, NPV, and accuracy of both ANA tests. So we can rely on the results of ELISA in our laboratories in Assuit University Hospitals as they can deal with large numbers of patients and it saves time. IIF is partly subjective, and therefore there is considerable variation in the interpretation of results between different observers, so we can avoid it. So ANA by ELISA tests can be used as a screening test and if we want to identify the ANA pattern we can use IIF on HEp-2 cells.

Background Blood eosinophilia was considered an indicator of sputum eosinophilia in asthmatic patients. Nevertheless, its role in chronic obstructive pulmonary disease (COPD) was not completely examined. Aim The aim was to investigate if peripheral blood eosinophilic cells represent an indicator (marker) of eosinophilia of the airway in stable cases. Patients and methods The trial was held at Al-Azhar University Hospital (Damietta), between October 2015 and March 2017. It included 264 persons with stable COPD. All cases were assessed for demographic features, smoking history, history of exacerbation in the last year, dyspnea, associated comorbidities, quality of life, lung functions, sputum, and peripheral blood eosinophilic cell counts. The included participants were allocated into two sets: group with eosinophilia (n=76) and patients without eosinophilia (n=188). Results There was proportional correlation between eosinophilia of the blood and sputum; and blood eosinophilia can differentiate between cases who had or had no sputum eosinophilia at a cutoff of 2.5%. In addition, eosinophil/lymphocyte ratio and eosinophil/neutrophil ratio were higher in eosinophilic COPD and are associated ELR with eosinophilia of the sputum ENR. Conclusion There is correlation between eosinophils of the peripheral blood and sputum in stable cases. Thus, the count of blood eosinophil may act as a dependable marker for eosinophilic COPD

Objective Inguinal hernia is a common surgical problem. Spermatic cord structures may be injured during open hernia repair, but it is uncommon after laparoscopic repair. Aim The aim was to study transabdominal preperitoneal (TAPP) inguinal hernioplasty and its effect on fertility in male patients. Patients and methods From July 2015 to November 2017, 30 male patients underwent laparoscopic TAPP inguinal hernioplasty and were included in this study. Testicular duplex and semen analysis were done preoperatively and 3 and 6 months postoperatively. Results Preoperative sperm count and motility were within normal ranges. Three months postoperatively, there was a decrease in sperm count in five (16.7%) patients and decreased sperm motility in three (10%) patients. Further three months later, sperm count returned to normal ranges in all patients, and sperm motility returned to normal ranges in two (6.7%) patients but still decreased in one (3.3%) patient. Regarding testicular duplex, arterial flow was normal in all patients preoperatively; 3 months later, there was a decreased arterial flow in two (6.7%) patients; and 6 months postoperatively, testicular arterial flow returned to normal. Conclusion Laparoscopic TAPP hernioplasty is feasible, is easy to learn, and has good results. Postoperatively, there was no significant affection of testicular perfusion or sperm characteristics.

Background Numerous studies have demonstrated the effectiveness of vocal fold steroid injection for treating benign laryngeal lesions, including vocal nodules, polyp, cyst, and Reinke’s edema. Glucocorticoids are the most-effective anti-inflammatory agents available, as they offer symptom alleviation in a series of clinical manifestations. Objective This study was designed to investigate the clinical applicability, effectiveness, and adverse events of transnasal endoscopic steroid injection for benign vocal fold polyps. Patients and methods This study was conducted on 25 patients with vocal cord polyps, under monitoring using a high-resolution camera system. Injection was performed using a disposable 180 cm long flexible varices needle inserted into the operating channel of the fiberoptic nasolaryngoscope. Results Endoscopic evaluation revealed complete resolution of the polyps in five (20%) patients after 1 month and in 12 (48%) patients after 3 months. Polyp size was reduced in 18 (72%) patients after 1 month and in 11 (44%) patients after 3 months, whereas two cases had no change in polyp size after the procedure. The maximum phonation time before the procedure of an average of 10.2 s was prolonged to an average of 13.5 s after the procedure. The mean flow rate before the procedure was 225 ml/s, which was reduced to 172 ml/s after the procedure. Conclusion The transnasal endoscopic steroid injection has the advantages of allowing surgical manipulations under direct visual guidance, thus ensuring an accurate easy approach to the lesion. The procedure can be used for patients refusing or unfit for general anesthesia.

Background Many surgeons have practiced endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea in past decade and have gained popularity. There are several centers that adopt endoscopic repair as a first-line treatment for CSF rhinorrhea with high success rate. Objective The aim of this study was to detect the role of the transnasal endoscopic approach in the repair of the CSF rhinorrhea and assess its surgical outcome. Patients and methods A prospective study of 40 patients having CSF rhinorrhea was conducted. All patients were treated with endoscopic repair for CSF rhinorrhea at Neurosurgery Departments of Al-Azher University and specialized Hospital of Otorhinolaryngology and Neurosurgery from January 2016 to January 2018. The majority of them were men. The defects were closed in multilayers using fascia lata, septal cartilage graft, and nasal mucosa in most patients. Results The left cribriform plate area was found as the most common site of CSF leak. The spontaneous CSF leak was the most common cause of CSF rhinorrhea in this study, and post-traumatic (iatrogenic) CSF leak was the second most common cause. Our success rate of the first attempt at endoscopic repair was 90%, and in the second attempt was 97.5%. The causes that lead to recurrence of leak were large defect, failure of localization of the defect, and comorbid conditions such as bone erosion and chronic cough that developed postoperatively. Conclusion Endoscopic endonasal approach is a safe and effective way to repair CSF leaks of different causes. Multilayer repair technique is safe and effective, with low complications and preservation of nasal and neurological functions. However, more studies and long series are recommended.

Background and aims Meticulous airway management, with the support of satisfactory sedation while keeping up a patent airway and guaranteeing ventilation, is an integral part for conscious sedation for bronchoscopic fiberoptic intubation in pediatric patients. This randomized double-blinded, prospective, comparative, clinical study aimed to compare the effects of dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children experiencing bronchoscopic fiberoptic intubation. The primary outcome was intubation scores as assessed by (a) vocal cord movement, (b) coughing, and (c) limb movement. Secondary outcomes were intubation time and patient tolerance using fiberoptic intubation comfort score. Patients and methods A total of 60 patients having American Society of Anesthesiologist grade I aged between 7 and 14 years undergoing elective minor infraumbilical surgeries were included in the study. Patients were randomly allocated to one of two groups: group DK patients (n=30) received intravenous loading dose of dexmedetomidine (2 µg/kg) in 20 min, and then were maintained by 0.5 µg/kg/h infusion until successful placement of the tube in the trachea, and intravenous ketamine (0.5 mg/kg/h) after finishing the loading dose, and just before fiberoptic intubation, and group MK patients (n=30) received intravenous loading dose of magnesium sulfate (40 mg/kg) in 20 min, and then were maintained by 10 mg/kg/h until successful placement of the tube in the trachea, and ketamine (0.5 mg/kg) after finishing the loading dose, and just before fiberoptic intubation. Continuous data were summarized as mean±SD, whereas discrete (categorical) in percentage. The groups were compared by independent Student’s ‘t’ test. The discrete (categorical) variables were compared by χ²-test. Results Intubation scores were better in group DK than group MK for vocal cord movement (P=0.009) and limb movement (P=0.0016), but there was no statistically significant difference in coughing (P=0.89). Time required for intubation was significantly less in group DK, as compared with the group MK (76.4±13.25 and 89.83±20.069 s, P=0.043). There was better fiberoptic intubation comfort score in group DK (P=0.0032). All patients were successfully intubated through fiberoptic bronchoscope in both groups. There were no significant hemodynamic changes between the two groups. Conclusion Intravenous dexmedetomidine/ketamine improved awaken bronchoscopic fiberoptic intubation in children with better intubation scores, intubation tolerance, and less intubation time when compared with magnesium sulfate-ketamine.

Background Homocysteine (HCY) may play a role in activation of immune system in some chronic diseases, like asthma and chronic obstructive pulmonary disease. Aim The aim was to study the plasma HCY values in patients with bronchial asthma and its correlation to asthma severity. Patients and methods A total of 80 patients were enrolled, and their ages ranged from 20 to 40 years. The study populations were categorized into three groups: high reversibility asthma (n=30), low reversibility asthma (n=30), and healthy nonasthmatics (Controls n=20). For all patients, full history taking, clinical examination, chest radiography, routine laboratory investigations, pulmonary function tests, and the HCY and immunoglobulin E levels were estimated. Results The HCY measurements were found to be 8.7±0.6 µmol/l in the control group, 5.5±0.2 µmol/l in patients with high reversibility asthma, and 6.1±0.8 µmol/l in patients with low reversibility asthma. So, there was a significant variance between studied groups regarding HCY levels, but both high and low reversibility groups had low HCY when compared with control group. Moreover, the high reversibility asthma had low HCY levels when compared with low reversibility groups but without significant difference. Conclusion Plasma HCY levels, instead of being increased, may be in the low normal range or decreased in patients with asthma, most probably owing to hypoxia and in the absence of factors leading to increased HCY levels.

Background Otitis media with effusion (OME) is a common disease among preschool children. However, its pathophysiology is not well known, and gastroesophageal reflux diseases were proposed to play a role. Aim of the work To estimate the prevalence of Helicobacter pylori in OME and to measure pepsin/pepsinogen levels in effusion fluid. Patients and methods A total of 60 children, 1–6 years, who presented with OME were included in the study. Myringotomy was performed in all cases with effusion in the middle ear, and a tympanostomy tube was placed for the patient. Samples were collected, and levels of pepsinogen were measured, and H. pylori was detected. Results H. pylori infection was detected in 26.7% of studied patients (16 patients). In addition, there was a statistically significant increase of pepsinogen in ear fluid aspirate when compared with serum values. There was a significant increase of adenoidectomy and/or tonsillectomy in positive when compared with negative H. pylori groups (100.0 vs. 75.0%, respectively), and there was a significant increase of pepsinogen in ear fluid aspirate in positive when compared with negative cases (272.75±26.42 vs. 253.59±23.49, respectively). Conclusion H. pylori was isolated from middle ear fluid aspirate in 26.7% of preschool children with OME. Gastroesophageal reflux was proposed to transmit this bacterium from the stomach through passage in Eustachian tube.

Background Psoriasis is an immune-mediated genetically determined common dermatological disorder. Psoriasis has the potential for significant psychological and social morbidity. Depression and anxiety are the most common psychiatric disorders that are associated with psoriasis. Objective The aim was to evaluate some of the psychiatric disorders especially depression and anxiety among psoriatic patients attending Assiut University Hospital. Patients and methods This was a cross-sectional study. The sample consisted of 100 psoriatic patients that met the inclusion criteria. All eligible patients were subjected to the following tools: Beck depression inventory, Zung self-rating anxiety scale, psoriasis disability index, and short form-36 quality of life questionnaire. Results The overall prevalence of depression was 76% among psoriatic patients; 60% of the patients presented with moderate and severe depression and the overall prevalence of anxiety was 79% among psoriatic patients; 66% of the patients presented with marked to severe and most extreme anxiety. There was a significant negative correlation between depression/anxiety and quality of life. There was a significant positive correlation between depression/anxiety and duration of psoriasis. Female sex and long duration of the disease were found to be risk factors for the occurrence of depression and anxiety among psoriatic patients. Conclusion Depression and anxiety are significantly high among psoriatic patients.

Aim To compare amniotic membrane graft versus conjunctival autograft for the management of primary pterygium. Design A prospective, randomized study. Patients and methods Fifty eyes of 50 patients with primary pterygium were prospectively included in this study and were randomized into two groups. Group I included 25 patients who underwent surgical excision and limbal-conjunctival autograft transplantation; group II included 25 patients who underwent surgical excision and human amniotic membrane graft transplantation. Recurrence rate, refractive changes, and complications were evaluated and compared between both groups. Results Recurrence after surgical excision was observed in eight patients with an overall recurrence rate of 16% (8/50) in both groups. The recurrence was slightly higher in the amniotic membrane group, about 20% (five cases) than the conjunctival autograft group which was about 12% (three cases). The recurrence was higher in the first 3 months postoperatively which was about 62% (5/8) in both groups and increased to about 100% (8/8) at 6 months postoperatively. No recurrence was observed in either group after 6 months. Visual acuity improved in 22 and 23 patients while it remained unchanged in three and two patients in group I and group II, respectively. Conclusion Conjunctival autograft should be considered as the first choice for pterygium excision even in recurrent pterygia. Amniotic membrane graft can be considered as a first choice for patients with advanced and diffuse conjunctival involvement or for those who probably will need the conjunctiva for glaucoma-filtering procedure in the future.

Background Mutations in the tumor protein 53 (TP53) gene can lead to expression of mutant p53 proteins that accumulate in cancer cells and can induce circulating p53 antibodies in patients with cancer. Neoplastic transformation leads to elevated plasma sialic acid concentration through shedding or secreting of sialic acid from tumor cell surfaces. Our work aims to evaluate the presence and prognostic role of these antibodies and sialic acid in patients with lung cancer. Patients and methods A total of 30 patients with lung cancer (five patients were presented with stage I, 10 patients with stage II, 10 patients with stage III, and five patients with stage IV) and 60 with nonmalignant disorders (30 smokers and 30 apparently healthy individuals) were evaluated for p53 antibodies by enzyme-linked immunosorbent assay and sialic acid by colorimetric methods. Results Anti-p53 antibodies and sialic acids levels in patients with bronchogenic carcinoma were significantly higher than smokers, and both levels were significantly higher than healthy controls (P<0.001). There was no statistically significant difference between stages III and IV of bronchogenic carcinoma of serum anti-p53 antibodies and sialic acid, but there was a statistically significant difference between stages I, II, and III, where the levels in stage III of bronchogenic carcinoma were significantly higher than stage II, and both levels were significantly higher than in stage I. There was a positive correlation between serum levels of anti P53 autoantibodies and the smoking index of the same patients. There was a positive correlation between serum levels of sialic acid and anti-p53 antibodies in the same patients with bronchogenic carcinoma. Conclusion Anti-p53 antibodies and sialic acid can be considered as sensitive for the biochemical changes associated with smoking and lung cancer. They may be used as markers for early diagnosis of lung cancer, and presence of them in smokers with primary lung cancer correlates with the severity and bad prognostic outcome of the disease.

Background This study attempts to determine the importance of histopathology of all gastric remnants after sleeve gastrectomy (SG). Patients and methods Data were collected on patients undergoing SG between 8 January 2017 and 6 June 2018 in Al-Azhar University Hospitals. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond the standard follow-up. Age, comorbidities, sex, and Helicobacter pylori titers were analyzed and compared with pathology specimens. Results Full pathologic evaluation was available for 60 patients. No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology. Other comorbidities had no association. Conclusions These results suggest that full pathologic evaluation of the gastric remnant following SG is unnecessary, particularly when gross pathology is not noted at initial operation.

Context Diabetes mellitus (DM) is a worldwide common disease that causes many complications in the male genital system including the prostate gland. Many studies have shown that extracts of Ginkgo biloba have antioxidant and free radical eliminating effects. Aim The present study aims to explore the histological effects of DM on the ventral prostate gland in rats and the possible protective role of Ginkgo extracts. Materials and methods Forty-five adult albino male rats were chosen for this study and they were classified into three equal groups. The control group was divided into two subgroups: the subgroup 1 rats received distilled water for 6 weeks; the subgroup 2 rats were injected intraperitoneally by a single dose of 0.15 ml 0.1 mol/l citrate buffer. To induce diabetes rats in the diabetic and protective groups were administered 60 mg/kg streptozotocin intraperitoneally, a week later rats in the protective group received Ginkgo extract orally in a dose of 100 mg/kg/day for 6 weeks. Six weeks after diabetes induction, samples from the ventral prostate from all groups were obtained for histological examination. Results No structural differences between the two control subgroups were observed. The diabetic group showed focal epithelial stratification with pyknotic nuclei resting on the disrupted basement membrane. By electron microscope (EM) the cells had irregular nuclei, few mitochondria, many cytoplasmic vacuoles, dilated rough endoplasmic reticulum (rER) cisternae, and few apical microvilli. In other areas, the cells were destructed with dissolved cytoplasm; many fragmented rounded bodies were observed in the lumen. The Ginkgo was found to improve most of the prostatic changes associated with DM. Conclusion Ginkgo extracts improve the prostatic changes produced by DM.

Objective The long-term durability of the open bypass is better than that of endovascular treatment (EVT) for Trans-Atlantic Inter-Society Consensus (TASC) D aortoiliac lesions, but many recently developed devices and a variety of access options have increased the success rates of EVT, with less operative mortality and complication rates. In this study, we aimed to compare the technical success rates, primary patency rate, clinical outcomes, and complication for TASC D aortoiliac lesions treated by endovascular and surgical procedures. Patients and methods Data from 89 patients with chronic iliac artery stenosis and/or occlusion who were treated with endovascular or surgical treatment were retrospectively reviewed in the period between January 2003 and December 2017. Results The procedure time was longer for the surgical group than for the EVT group. The total complication rate was higher in the surgical group than in the EVT group. The mortality rate associated higher with the surgical group. There was no statistically significant difference between the groups regarding 2-year primary patency rates. Conclusion This study revealed that patients with severe aortoiliac occlusive disease (TASC D) can be treated with EVT or surgically with satisfactory results, with better technical success in the surgical group than in the EVT group. Furthermore, the 2-year patency rate for both groups was acceptable.

Background and aim Regional anesthesia in eye surgery is a preferred technique and widely used in all eye surgery centers. It is safe, inexpensive, simple, and reliable and provides efficient ocular anesthesia. It is associated with less complications than general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block owing to lesser incidence of complications such as retrobulbar hemorrhage, globe perforation, and brain stem anesthesia, but it has some disadvantages such as incomplete orbital and eyelid akinesia and decrease time of analgesia in which the patient need pain relief postoperatively, so many adjuvant drugs have been added to local anesthetic to overcome these disadvantages. Dexmedetomidine is a central-acting drug, a highly selective α₂-agonist, that has been used as an additive to local anesthetic, whereas the mechanism of action of ultra-low-dose naloxone includes inhibition of impulses of the excitatory opioid receptors and release of encephalin. The goal of this study was to assess the effect of ultra-low-dose naloxone and dexmedetomidine as adjuvants for local anesthetic on duration of analgesia as primary outcome and akinesia of the globe and eyelid and occurrence of complications as a secondary outcome. Patients and methods A total of 60 patients were included in this prospective randomized double-blind clinical study scheduled for elective cataract surgery, who were randomly divided into two groups: N group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine, and 100 ng naloxone in 1 ml normal saline. D group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine and 25 μg of dexmedetomidine in one-ml normal saline. The assessment includes duration of analgesia (h), which is the time from injection till visual analog scale of more than 4 or request of analgesia by the patient, akinesia of the globe and eyelid assessed every 2 min using a three-point scale, and occurrence of complications (pain during injection, chemosis, diplopia, bradycardia, and hypotension). Results A total of 60 cataract surgery patients were included in the study. Regarding primary outcome (duration of analgesia), we found a highly statistically significant difference in duration of analgesia, with longer duration of analgesia in N group of patients compared with D group (P<0.01). Regarding secondary outcomes, we found a highly statistically significant difference in onset of globe akinesia, with a rapid onset of globe akinesia in D group compared with N group (P<0.01), and a highly statistically significant difference in bradycardia, with increased incidence of bradycardia in D group (P=0.0004). Conclusion The addition of ultra-low-dose naloxone to local anesthetic in cataract surgery shows longer duration of analgesia.