Background High plasma iron in β-thalassemia major (BTM) leads to enhanced generation of reactive oxygen species, oxidative stress, and endocrine disorders. We aimed to assess thyroid function and trace elements [copper (Cu) and zinc (Zn)] in patients of BTM and to evaluate the relation, if any, of thyroid function with iron store in the form of ferritin levels. Patients and methods A total of 30 children with BTM and 30 healthy controls were enrolled and interviewed at the Al-Azhar University. Complete blood count, random blood sugar, liver enzymes, and creatinine were measured in all participants. Iron level, total iron-binding capacity, ferritin level, Zn level, and Cu level in sera were determined. Thyroid function was also assessed by evaluating free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels. Results There were significantly increased serum iron, ferritin, Cu, and Zn levels, whereas total iron-binding capacity was depleted in patients with BTM as compared with healthy controls. There were significant positive correlations between ferritin level and both serum Cu and Zn (r=0.536 and 0.513, respectively), with P value less than 0.05. Moreover, there were significant positive correlations between TSH level and both serum Cu and Zn (r=0.416 and 0.355, respectively), with P value less than 0.05. Thyroid function represented by FT3, FT4, and TSH did not correlate with serum ferritin level. Conclusion Careful monitoring of ferritin, Cu, Zn, TSH, FT4, and FT3 levels at regular intervals is recommended for early diagnosis of thyroid dysfunctions in patients with BTM.

Background Under the appropriated stimulus, it has been demonstrated that neutrophils, eosinophils, and monocytes may express tissue factor and therefore activate the extrinsic pathway of coagulation. Objective To assess the plasma d-dimer (DD) level in patients with chronic urticaria during exacerbation and remission and correlate this level with the severity of the disease. Patients and methods This case–control study included 30 patients with clinically proved Chronic Urticaria (CU) (group I) and 15 healthy control (group II). The plasma levels of DD were measured by enzyme-linked immunosorbent assay. Results The level of plasma DD in active patients ranged from 400 to 1950 ng/ml, with median of 1050 ng/ml. The level of DD in the plasma of controls ranged from 210 to 600 ng/ml, with median of 400 ng/ ml. There was a highly statistically significant difference between cases and control in DD level. Patients with active chronic urticaria had the highest plasma levels of DD (P<0.01) when compared with patients with CU under remission and the control group. Conclusion Plasma DD level could be an indicator of the severity of CU as it positively correlates with it. It is also a good prognostic marker as its level decreases after the treatment or remission.

Background Percutaneous tracheostomy is widely practiced in intensive care units. It had lower rate of complications. However, serious adverse events still liable to occur. Guidance is proposed to decrease such events. Aim of the work To examine the effect of ultrasound or bronchoscopy guidance on the clinical outcome and complication rate of percutaneous tracheostomy. Patients and methods Sixty patients were prospectively randomized to underwent bronchoscopy, ultrasound, or combined guidance (20 patients each) and data sheets of 20 patients were retrospectively analyzed. Then clinical outcome and rate of major or minor complications were document. Results Total rate of minor complications was significantly increased in none-guidance group (50.0%) when compared to ultrasound guided (25%) or combined guidance (20%) groups. But the difference was non significant when compared to bronchoscopy-guided group (40.0%). Individually, no complication showed significant difference between any of studied groups. The total procedure time was significantly prolonged in non-guided group when compared to each of guided groups, and in combined-guidance group when compared to other groups. Conclusion The combined guidance by both bronchoscopy and ultrasound was associated with significant reduction of overall complications rate. Ultrasound-guided is superior to bronchoscopy guided although the difference was non-significant.

Background Obesity is associated with insulin resistance (IR), type 2 diabetes, dyslipidemia, and cardiovascular diseases. Apelin and chemerin were identified as adipose tissue markers. Several adipokines are known to influence food intake, including apelin, whose expression is regulated by insulin and chemerin. Because oxidative stress (OS) is involved in the complications associated with obesity, the antioxidant activity of Lepidium sativum may be of benefit, as L. sativum showed maximum antioxidant activity by inhibiting hazardous effects of many oxidants. Objective To clarify the pathophysiology of obesity by studying the nature of correlation between serum and liver levels of apelin and chemerin and oxidative parameters in obese rats with and without antioxidant. Materials and methods A total of 30 adult male albino rats were divided into three equal groups: group I was control, group II received high-fat diet (HFD), and group III received HFD as well as L. sativum. At the end of the experiment, blood samples were collected for estimation of the serum levels of chemerin, apelin, fasting glucose, insulin, IR, lipid profile, glutathione (GSH) and malondialdehyde (MDA). Levels of MDA, catalse (CAT), chemerin and apelin were estimated in liver homogenate. Results After 8 weeks, HFD group showed a significant increase in serum levels of apelin, chemerin, fasting glucose, insulin, IR, total cholesterol, very low-density lipoprotein, triglycerides, low-density lipoprotein cholesterol, and MDA and a significant decrease in high-density lipoprotein cholesterol and GSH. HFD also caused a significant increase in the tissue levels of MDA, CAT, and chemerin with a significant decrease in apelin, compared with control group. However, addition of L. sativum to HFD caused a significant decrease in serum levels of apelin, chemerin, fasting glucose, insulin, IR, total cholesterol, very low-density lipoprotein, triglycerides, low-density lipoprotein cholesterol, and MDA and a significant increase in high-density lipoprotein cholesterol and GSH. L. sativum also caused a significant decrease in tissue levels of MDA, chemerin, and CAT and a significant increase in apelin, compared with HFD group. Conclusion This study showed a significant positive correlation between liver and serum chemerin and between liver and serum MDA. On the contrary, it showed a significant negative correlation between liver and serum apelin as well as between liver CAT and serum GSH.

Objective Many regional techniques have been developed as safe and practical methods for adequate postoperative analgesia for unilateral lower abdominal surgery in children. The aim of the study was to compare the effectiveness of analgesia by using quadratus lumborum (QL) block, transversus abdominis plane (TAP) block, and caudal analgesia in children undergoing unilateral lower abdominal surgery. Patients and methods This prospective, randomized, single-blinded study was conducted at Al-Hussein Hospital. Two hundred and forty pediatric patients aged 2–7 years were enrolled to undergo lower abdominal surgeries and were allocated into four groups (60 each). Group A : received QL block, group B: received TAP block, group C: received caudal block, with ultrasound guidance in the three groups, and group D: the control group. The primary outcome was postoperative pain control which was assessed by using Children’s Hospital Eastern Ontario Pain Scale and objective pain score. Intraoperative hemodynamics, postoperative complication, satisfaction of the parents, and postoperative analgesic requirements were the secondary outcomes. Results There was no significant difference between groups in mean intraoperative arterial blood pressure and heart rate. There was significant difference between groups A and C in pain scores assessment (P<0.05), but no significant difference between groups A and B. Postoperative analgesia requirements were significantly higher in group B compared with group A (P<0.05). Parent satisfaction was markedly observed in groups A and B. Conclusion This study’s outcomes demonstrated that for pediatric patients who are experiencing unilateral lower abdominal surgery, QL block and TAP block under ultrasound guidance proved to be safe with no recorded complications either intra- or postoperatively, with QL block superiority as evidenced by decreased rescue postoperative analgesia and lower pain scores. The QL block offered more effective for postoperative analgesia than the TAP block and caudal block.

Background Autoimmune thyroid diseases are multifactorial conditions that result from genetic predisposition in combination with environmental risk factors. Some bacteria and viruses are suspected of being able to mimic the antigenic profile on the thyroid membrane and play an important role in the onset of autoimmune diseases. Aim The aim of this study was directed to investigate the association between Helicobacter pylori infection and Hashimoto’s thyroiditis (HT). Patients and methods The present study included 100 patients divided into two groups: patient group included 70 patients, newly diagnosed as having HT and control group included 30 age-matched and sex-matched apparently healthy individuals. All participants were subjected to assay of serum thyroid-stimulating hormone, free T3, free T4, thyroperoxidase antibodies, thyroglobulin antibodies, serum H. pylori Ab IgG, and fecal H. pylori antigen. Results In the present work, there was abnormal elevation of thyroid-stimulating hormone in 60 (85.7%) patients, compared with just one (3.3%) patient of control group, with statistically significant difference between groups. In the present work, there was significant and proportional (positive) correlation between H. pylori IgG and each of thyroperoxidase and anti-thyroglobulin values. Conclusion There is a significant association between HT and H. pylori infection. This association might be related to the disease severity and might reflect the need of adding anti-H. pylori medications as additional choice in management of HT.

Introduction Microalbuminuria is considered an early marker of glomerular injury in patients with diabetes, but tubular injury can precede glomerular injury and cannot be detected by microalbumin. We need a new and early marker of kidney injury in normoalbuminuric diabetic patients. Urinary heme oxygenase-1 (uHO-1) is an enzyme that is produced in tubules in response to oxidative stress and can be a marker of tubular injury. Aim To investigate the clinical implication of uHO-1 as an early diagnostic marker in diabetic nephropathy (DN). Patients and methods A total of 65 diabetic patients, comprising 20 microalbuminuric patients and 45 normoalbuminuric patients, and 20 healthy participants as a control group were included in this study. Level of uHO-1 was detected by enzyme-linked immunosorbent assay. Results uHO-1 was highly significantly elevated (P<0.000) in microalbuminuric group compared with normoalbuminuric group and control group, respectively. Normoalbuminuric group was highly significantly elevated (P<0.000) in uHO-1 compared with the control group. uHO-1 was positively correlated with albumin–creatinine ratio but was not correlated with estimated glomerular filtration rate. Receiver operating characteristic curve analysis of uHO-1 levels for early diagnosis of DN revealed that the cutoff value of uHO-1 was 5.8 ng/ml (sensitivity 80% and specificity 71%) for early diagnosis of DN. Conclusion The findings of this study indicate that elevated levels of uHO-1 can be detected in normoalbuminuric diabetic patients and revealed renal tubular damage. uHO-1 may be used as an early biomarker for DN.

Background Thalassemia is a challenging health problem all over the world, especially in Mediterranean areas. Its effect on pulmonary function has not been well studied. Aim of the work To describe pulmonary function changes in patients with β-thalassemia major. Patients and methods This study included 60 patients with β-thalassemia major who received regular blood transfusion (40 males and 20 females) and 30 control children (20 males and 10 females). All participants were subjected to full history taking, clinical examination, and laboratory investigations (complete blood count, serum iron, and serum ferritin). In addition, all underwent pulmonary function tests. Results Forced expiratory volume at first second, forced vital capacity, and forced expiratory flow 25–75% were significantly decreased in males and females in the patient group when compared with those in the control group. However, forced expiratory volume at first second/forced vital capacity was significantly increased in male and female patients when compared with those in the control group. Transfusion and chelation therapy seems to be the cause of reduced pulmonary function. Conclusion Children with β-thalassemia had reduced pulmonary function, and this could be attributed to chelation therapy that affects serum iron and ferritin.

Background Inguinal hernia repairs consume an important part of health care resources because of the high incidence of the problem. It is estimated that twenty million inguinal hernia repairs are performed globally every year. Lichtenstein tension-free hernia repair is considered as a gold standard technique for open inguinal hernia repair in the European guidelines on inguinal hernia. Objective The aim of this study is to evaluate the light-weight composite mesh of monocryl-prolene in bilateral inguinal hernia repair (Lichtenstein technique) regarding outcome and complications. Patients and methods A prospective interventional study was conducted on 25 patients with bilateral inguinal hernia. Complete physical examination (general and local), including PR examination; routine laboratory tests; ECG; chest radiography; and abdominopelvic ultrasound were done for all patients. Bilateral Lichtenstein procedure using monocryl-prolene mesh was planned for all patients. Patients were followed up for 12 months. Intraoperative findings (operative time and complications), hospital stay, and postoperative complications including pain and recurrence were thoroughly assessed. Results There were no intraoperative or postoperative mesh-related complications (infection or foreign body sensation), and the mesh was well accepted by all patients. No patient had significant pain related to hernia repair. No significant scrotal complications were encountered. No recurrence after 1 year of follow-up was noted. Conclusion Lichtenstein-style bilateral inguinal hernia repair using light-weight monofilament Ultrapro mesh appears quite acceptable, practical, effective, and safe for increased physical quality of life. There was no significant pain or infection in all patients, as well as no recurrence.

Objectives The aim of this study is to evaluate the outcome of total thyroidectomy (TT) for the management of benign thyroid disease. Background The extent of thyroid resection in benign thyroid disease is controversial revolving around the potential risk of hypoparathyroidism and nerve injury. The potential advantage of TT is one stage removal of incidental thyroid cancer and low risk of goiter recurrence. Patients and methods This prospective study was done at Al-Azhar University Hospitals from October 2016 to April 2019. One hundred patients who underwent TT for clinically benign thyroid disease were enrolled. All patients were subjected to clinical evaluation, neck ultrasonography, vocal cord examinations, and investigations. Follow-up was done for all patients for 6 months. Results Of the 100 patients who were included in the study, 27 have Graves’ disease versus 73 have non-Graves’ disease, the age group range from 35 to 65 years old. The rate of transient hypocalcemia and temporary recurrent laryngeal nerve palsy was 25.9 versus 6.8% and 3.7 versus 2.7%, respectively. One patient suffered from postthyroidectomy bleeding in Graves’ group, and incidental thyroid cancer was found in two cases. Conclusion TT for benign thyroid disease can avoid reoperation for incidental thyroid cancer, recurrent nodular goiter, recurrent toxic goiter, and can eliminate any subsequent risk of malignant change in the residual thyroid gland.

Background In recent years, shoulder arthroscopy has been used as a diagnostic and therapeutic maneuver. With the introduction of ultrasound, peripheral nerve block has increasingly been performed by the anesthesiologist, because it increases the success rate of the block. Interscalene block is suitable for arthroscopic shoulder surgery, but many complication may affect the respiratory system. Ultrasound-guided supraclavicular with suprascapular nerve block may be a safe alternative for arthroscopic shoulder surgery. Levobupivacaine is a local anesthetic. It is the S enantiomer of bupivacaine with long duration of action, motor block, and onset time. Aims The primary outcome of the study is the quality of the block (sensory and motor), whereas the postoperative analgesia and patient satisfaction are the secondary outcomes in arthroscopic rotator cuff surgery. Settings and design This was a prospective randomized comparative clinical study. Patients and methods A total of 60 patients between 25 and 55 years were included in this study. The patients scheduled for elective arthroscopic rotator cuff surgery were randomized into two groups: group A patient received ultrasound-guided interscalene brachial plexus block with levobupivacaine, and group B patient received ultrasound-guided supraclavicular with suprascapular brachial plexus block with levobupivacaine. Results The mean age of all arthroscopy patients was 43.1±8.8 years, and most patients were males (60%), whereas 40% were females. On comparing the two groups, we found no statistically significant difference regarding basic preoperative, hemodynamic, and intraoperative data. Regarding the primary outcome, there was a significant increase in success rate (block quality) in group B (93.3%) compared with group A patients (70%) (P=0.02) and nonsignificant difference regarding sensory and motor block onset (P>0.05). Regarding secondary outcomes, there was a highly significant decrease in rescue analgesia in B group (average 1.9±0.7 ampoules) compared with group A patients (average 2.5±0.7 ampoules) (P=0.008), a significant decrease in complications rate in group B (0%) compared with group A patients (26.7%) (P=0.026), and a highly significant increase in patient satisfaction rate in group B (100%) compared with group A patients (70%) (P=0.004). Conclusions Suprascapular brachial plexus block can be performed as an alternative to interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery.

Objective This prospective study compared the sensitivity, specificity, and accuracy of intravesical protrusion of prostate (IPP), prostate volume (PV), detrusor wall thickness (DWT), and post-voiding residual urine (PVR) for diagnosis of bladder outlet obstruction (BOO) and predicted acute urinary retention (AUR) in patients with benign prostatic hyperplasia. Patients and methods Eighty patients of 50 years or older with obstructed lower urinary symptoms owing to prostate enlargement were included in this study. Of them, 20 patients presented with acute retention of urine. All patients underwent the following: international prostatic symptoms score, quality-of-life question, digital rectal examination, free uroflowmetry (Q_max), and transabdominal ultrasound, which measured DWT, PV, IPP, and PVR. Pressure flow study (PFS) was done to differentiate obstructed from the nonobstructed bladder. IPP, PV, DWT, Q_max, and PVR were used as index tests. To differentiate the effectiveness of these index tests, the area under the curve was calculated for each index. Results Eighty patients were classified into four groups according to their presentation and PFS finding: group I included 30 patients with no BOO [bladder outlet obstruction index (BOOI) < 40], group II included 30 patients with BOO (BOOI >40), group III included 20 patients who presented with AUR, and group IV included 20 normal men as a control group. There were significant differences in PV, IPP, DWT, Q_max, and PVR between obstructed and nonobstructed patients, with a significant correlation with the BOOI. There was no significant difference regarding age and international prostatic symptoms score. There was a significant correlation between IPP and DWT with PFS in the diagnosis of BOO in patients complaining from benign prostatic hyperplasia. IPP more than 7.5 mm had the best accuracy (90.5%) in the diagnosis of BOO. IPP more than 7.5 mm and DWT more than 2 mm diagnosed acute retention of urine in 90% of patients. Conclusion IPP measurement is the best noninvasive test in detecting BOO in comparison with other index tests. Combined IPP and DWT were more accurate in predicted BOO and AUR than other index tests.

Background Gastric ultrasound is a simple bedside test that can be used for assessment of patients at risk of aspiration. Aim To compare gastric volume and content in obese with nonobese patients after 8-h fasting using gastric ultrasonography. Patients and methods This study was conducted on 100 patients, comprising 50 obese and 50 nonobese, of either sex, having American Society of Anesthesiologists status I–III, with age of at least 21 years, and with no other causes for delayed gastric emptying. Gastric ultrasound was performed by our co-author radiologist. Quantitative and qualitative assessment of antrum, time taken to complete the examination, and number of patients at risk were compared between the two groups. Moreover, we compared residual volume in supine position with right lateral decubitus in the same group. Results Obese patients had significantly higher gastric volume and total number of patients at higher risk of aspiration; however, both groups were comparable regarding volume/kg. In qualitative assessment, obese patients included lower number of patients with empty stomach and higher number with particulate or solid contents. In both groups, right lateral decubitus volume estimation was higher than supine position volume estimation. Conclusion A considerable percentage of fasted preoperative obese patients have risky gastric content, and ultrasound scanning is recommended.

Background and aims Primary hyperhidrosis is a disorder of excessive sweating of unknown etiology, associated with emotional, psychological, and educational problems. This study described our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS) with and without intradermal botulinum toxin type A (BTX-A) injections. Patients and methods This retrospective study included 50 patients treated by ETS with either BTX-A (20 patients) or not (ETS only; 30 patients) in security forces hospital, Saudi Arabia, between January 2014 and February 2017. Information was obtained from computerized medical records and a telephone survey about postoperative complications. Results A total of 50 patients were operated and included in this study. The mean age was 23.55±6.12 years. The majority (70%) had axillary and palmar hyperhidrosis and 30% had palmar hyperhidrosis. In ETS, surgical technique was done at T2–T3 level in 56% of patients. Mean ETS procedure time was 39.6±14.29 min, with no conversion. Mean hospital stay was 1.5±0.85 days. Success rates of ETS in patients with axillary and palmar were 95 and 96.7%, respectively, whereas success rates of BTX-A+ETS in patients with axillary and palmar were 100 and 100%, respectively. Compensatory sweating was recorded in 20% among every group, with minimal other postoperative and postinjection complications being recorded, with no significant difference between studied groups (P=0.316). Conclusion BTX-A injection followed by ETS is safer and effective and has minimal postoperative complications.

Background Postoperative pain relief is a major concern for the anesthesiologist after shoulder surgeries. Aim The aim of the study was to compare the efficacy of preoperative ultrasound-guided interscalene brachial plexus block (ISPB) and postoperative intravenous morphine for postoperative analgesia in shoulder surgeries. Patients and methods This prospective, randomized study was performed on 40 patients who were scheduled for different types of shoulder surgery under general anesthesia, with ASA physical status between I and II. The patients were divided equally and randomly into two groups to receive ISPB or intravenous morphine. Results Patient demographic characteristics, operative data, and ASA classification were similar between the groups. The mean pain score was significantly lower in ISPB compared with the intravenous morphine group at 3, 6, and 12 h postoperatively (P<0.05). Additionally, the ISPB group was associated with statistically significant lower morphine consumption (P<0.001) and the number of patients who required additional analgesia 3 h postoperatively was 3 (20%) versus 17 (75%) in the morphine group (P=0.000). Conclusion The present randomized trial shows that ultrasound-guided ISPB provides better postoperative analgesia and reduces the need for postoperative morphine than opioids alone among patients scheduled for open shoulder surgery.

Background To assess the effectiveness of ranibizumab in the treatment of chronic central serous retinopathy (CCSR). Patients and methods This prospective study included 10 eyes of 10 patients with CCSR treated by a single dose of ranibizumab injected intravitreally. After injection, the patients were re-evaluated at the second day, then after 1 week, and then monthly up to 6 months. Changes in vision and macular thickness were detected before and after injection. Results The main best-corrected visual acuity increased from 0.82±0.08 logMAR before injection to 0.56±0.09 logMAR after 3 months and to 0.24±0.09 logMAR after 6 months in patients with CCSR less than 6 months, and increased from 0.78±0.16 logMAR before injection to 0.64±0.15 logMAR after 3 months and to 0.36±0.09 logMAR after 6 months in those with CCSR more than or equal to 6 months (P<0.05). The mean central macular thickness decreased from 342±36.14 μm before injection to 252±7.02 μm after 3 months and to 204±17.13 μm after 6 months in patients with CCSR less than 6 months, and decreased from 322±51.42 μm before injection to 259±26.06 μm after 3 months and to 214±18.13 μm after 6 months (P<0.05) in those with CCSR more than or equal to 6 months. The mean age of patients was 39±9.6 years. Conclusion The use of ranibizumab for treatment CCSR was more clinically effective and generally well tolerated.