Introduction Neonatal jaundice remains an important neonatal issue, and the condition is mostly benign. Jaundice is a complex disease of high bilirubin levels in the body and yellowing of the skin and mucous membranes. Hyperbilirubinemia is associated with encephalopathy and kernicterus, resulting in permanent disability. Because babies are discharged early, detection and diagnosis of hyperbilirubinemia are delayed in some cases. Therefore, early diagnosis of jaundice and timely actions are necessary. Several methods have been used to determine the risk of neonatal hyperbilirubinemia. Alkaline phosphatase (ALP) is an intracellular enzyme found abundantly in red blood cells. It is a hydrolase enzyme and responsible for removing phosphate from many types of molecules. Our aim in this study was to investigate whether cord blood ALP level during the first 6 h of live of newborn could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Patients and methods This was a prospective study carried out during the period from June 2018 to December 2018 at El-Mania General Hospital. This study included a total of 60 neonates: 30 full-term infants and 30 preterm infants. A total of 60 babies were evaluated, starting from the sixth hour after birth, and cord blood ALP levels were analyzed. We performed an assessment of the complete medical history (maternal history and neonatal history). Third day of live measured transcutaneous bilirubin of neonate, and seventh day we measured serum bilirubin (total and direct). Results The present study showed that infants with high cord blood ALP levels are at risk of developing significant indirect neonatal hyperbilirubinemia that requires interventions with an accuracy of 82.2%, a sensitivity of 72%, a specificity of 85.71%, a positive predictive value of 83.43%, and a negative predictive value of 75.37%. Conclusion The cord blood ALP level can be used as a predictor of severe neonatal jaundice.

Introduction The study aimed to evaluate the role of speckle-tracking echocardiography (STE) in the assessment of left atrial (LA) function and its relation to the presence of left atrial appendage thrombus (LAAT) compared with the gold standard transesophageal echocardiography (TEE) among patients with nonvalvular paroxysmal atrial fibrillation (AF). Patients and methods Forty five patients with nonvalvular paroxysmal AF were included in the study. All patients underwent transthoracic echocardiography (TTE) immediately prior to or following clinically indicated TEE. LA deformation parameters such as left atrial global longitudinal strain-reservoir (LAGLS-RES), left atrial global longitudinal strain pump (LAGLS-pump), left atrial strain rate systolic (LA SR S), left atrial strain rate emptying (LA SR E), and left atrial strain rate atrial (LA SR A) were measured using 2D-STE. Through TEE, we assessed the presence of LAAT, left atrial appendage ejection fraction (LAA EF), left atrial appendage emptying (LAA E), and left atrial appendage filling (LAA F) velocities. Patients were divided into two groups according to the presence of LAAT. Results LAAT was detected in 14 (31%) patients of our study population. STE-derived LAGLS-RES, LAGLS-pump, and LA SR A values were found to be significantly lower in patients with LAAT. There was positive correlation between LAA E velocity and LAGLS-RES, LAGLS-pump, LA SR S, and LA SR A (r=0.358, P<0.02; r=0.433, P<0.002; r=0.378, P<0.01; and r=0.390, P<0.01, respectively). The area under the receiver operating characteristic curve of LAGLS-RES, LAGLS-Pump, and LA SR A to discriminate patients with LAAT from those without LAAT was 0.74, 0.73, and 0.79, respectively. From all variables examined in the study LASRA was the strongest variable associated with the presence of LAAT. Conclusion 2-D STE can be used for the assessment of LA mechanical function and discriminate patients with LAAT from those without LAAT compared with the gold standard TEE among patients with non-valvular paroxysmal AF.

Background Accidental injuries are the most common reason for death among children. Of all the types of traumatic injuries, brain injuries are the most cause of death or permanent disability. Aim The aim of this study is to evaluate posttraumatic hospital-admitted children to reach better management, outcome, and prognosis and to achieve the best possible care for closed-head injury patients. Patients and methods This prospective study (May 2018–May 2019), conducted at Luxor International Hospital and Al-Azhar University Hospital, includes all children aged 0–14 years with exclusion of children older than 14 years and penetrating head injuries. All the case records were reviewed and the pertinent data (clinical history, age, sex, mode of injury) were analyzed. We categorized them into mild, moderate, and severe head injuries based on the Glasgow coma scale (GCS) at the time of admission. Results Out of 30 children with traumatic brain injury (TBI), 17 (56.7%) were of mild, nine (30%) moderate, and four (13.3%) severe TBI. In the group of patients in the category of GCS less than or equal to 8, poor outcome was seen in 50%, followed by patients in group GCS 9–12 at 0%, succeeded by group of patients with GCS 13–15 at 0%, which was statistically significant. Conclusion This study has shown that the reason for TBI in children we managed was age dependent. Falls were widespread in toddlers, pedestrian accidents more common in preschool and school-age groups. This study has shown that the outcome of head injury in children we managed depended on the severity of the injury.

Background After low anterior resection for rectal cancer, construction of a stoma for coverage of anastomosis is sometimes mandatory. Although loop ileostomy may be easily constructed and easily closed, it may have some complications related to fluid and electrolyte imbalance, especially in comorbid vulnerable patients. Aim This study aims to compare loop ileostomy and loop transverse colostomy as a covering stoma technique after resection of middle and low rectal cancer. Patients and methods This double-blind prospective study was done in a single institute on 70 patients diagnosed as having primary middle and low rectal cancer who underwent low anterior resection and ultra-low anterior resection and covering stoma was decided. Cases underwent surgery between October 2016 and January 2019. Patients were allocated to group A (ileostomy group) and group B (colostomy group). Results A total of 33 patients were in group A (ileostomy group) and 37 patients were in group B (colostomy group). Significantly higher rates of stoma-related complications were encountered in the loop ileostomy group (75.6(%than in loop transverse colostomy group (43.2%). Peristomal dermatitis was the highest occurring complication. Moreover, significantly higher rates of stoma reversal-related complications were encountered in the loop ileostomy group (45.4(%than in loop transverse colostomy group (13.5%). Diarrhea was the highest occurring complication. Conclusion Regarding stoma-related complications and stoma reversal perioperative complications, loop transverse colostomy was significantly better than loop ileostomy.

Background Anogenital warts (AGWs) are always resistant to traditional treatment options. Recently, vitamin D3 injection have proven its efficacy in the treatment of extragenital warts. To the best of our knowledge, there are no studies on using intralesional vitamin D3 in the treatment of genital warts. Aim To evaluate the efficacy of intralesional vitamin D3 injection in the treatment of AGWs. Patients and methods Twenty patients with AGWs were included in this study. Vitamin D3 (7.5 mg/ml) was injected into the base of the warts every 2 weeks for 2 months. Results Only two (11.11%) patients showed complete resolution; six (33.33%) patients showed moderate response, while 10 (55.55%) patients showed mild response. Recurrence has been obtained in moderate and mild responders; no adverse effects were observed. Conclusion The efficacy of using intralesional vitamin D3 in the treatment of AGWs is not as effective as its role in extragenital warts.

Background Beta-thalassemia is one of the common genetic disorders in our community. Therefore, it is deemed necessary to study and probe it to encompass all aspects of this disorder. Aim The aim of this study was to determine the adherence of management of β-thalassemia major in Minia General Hospital to an established Standard for the Clinical Care of Children with Thalassemia in the UK. Patients and methods This study included 100 children with β-thalassemia major who were receiving regular blood transfusion; data of the patients were collected and analyzed for audit against established Standards for the Clinical Care of Children with Thalassemia in the UK; values were expressed in terms of percentage. Results The diagnosis of β-thalassemia major in our study was made mainly on the basis of the clinical background confirmed by complete blood count, hemoglobin electrophoresis, and serum ferritin level; the frequency of investigations in our study showed that abdominal ultrasound was performed regularly in most of our patients (93%), followed by liver function (74%), serum ferritin (65%), hepatitis marker (57%), echocardiography (47%), and assessments of weight and height − sitting and standing (43%), follicle-stimulating hormone, luteinizing hormone (7%), thyroid-stimulating hormone, triiodothyronine, thyroxine (7%), fundus examination (7%), audiometry (3%), oral glucose tolerance test (3%), vitamin D level (3%), and DEXA scan (1%); the assessment of puberty was not performed. The most common complication in our study was splenomegaly (80%), followed by bone deformities (76%), slowed growth rates (69%), and infection (47%), followed by bone osteoporosis (27%), heart problems (24%), chronic hepatitis, or liver fibrosis (19%). Iron-chelation therapy was used by 53% of our patients. Deferasirox is the main line (38%); hydroxyurea was used by 41% of our patients. Conclusion As a conclusion, we found that lines of management of β-thalassemia major in Minia General Hospital were not enough and not performed systematically in comparison with Standards for the Clinical Care of Children with Thalassemia in the UK.

Background Endoscopic sinus surgery (ESS) is a common operation for the management of sinonasal pathologies. The surgeons dealing with ESS should understand the crucial complex anatomy of the anterior cranial base to avoid the intracranial violation during ESS. Objective The aim of this work was to investigate the relationship between degree of septal deviation angle and the dimensions of cribriform plate (CP) and ethmoid roof by evaluation of the paranasal computed tomography. Patients and methods A total of 40 patients, comprising 20 females and 20 males, with age ranging from 18 to 60 years, were selected according to inclusion and exclusion criteria from the outpatient ENT clinics of El-Hussein and Bab-El-She’reya Hospitals from November 2017 to January 2019. Results The severity of deviation did not affect the dimensions of the ethmoid roof and CP in terms of depth and width, except right ethmoid roof width (direct proportion) and the left cribriform width (inverse proportion). There was a significant direct relationship between ipsilateral and contralateral ethmoid roof (ER) width and between ipsilateral and contralateral ER depth. This study showed no significant relation between ipsilateral and contralateral CP width. High rate of asymmetry between CP and ethmoid roof in this study (100%) was noted. Conclusion In cases of deviated nasal septum, the increase in the severity of septum deviation raises the possibility of the increasing right ethmoid roof width and of decreasing the left cribriform width, and this possibility should be taken into consideration to avoid iatrogenic injury during ESS.

Background Chronic hepatitis C virus infection is one of the most important health problems in Egypt. Since November 2015, generic sofosbuvir (SOF) with daclatasvir (DCV)±ribavirin (RBV) became the standard treatment in all National Committee for Control of Viral Hepatitis centers. Yet, the long-term efficacy, safety, and late complications of generic direct-acting antiviral drugs have not been studied. Aims Evaluation of the efficacy and safety of generic DCV-containing regimens in the treatment of chronic hepatitis C patients after 72 weeks of close follow-up. Patients and methods A total of 150 chronic hepatitis C virus patients were classified into easy-to-treat group (naïve patients with no evidence of cirrhosis) and difficult-to-treat group (treatment experienced or have any evidence of cirrhosis) and treated for 12 weeks with generic medications: DCV 60 mg and SOF 400 mg±RBV in easy and difficult-to-treat groups, respectively. A close follow-up of up to 72 weeks was done to assess the efficacy and safety of the generic drugs. Results Overall sustained virologic response (SVR12) was 94.0%, while the end of treatment response rate was 94.7%. SVR12 rates in easy-to-treat and difficult-to-treat groups were 97.06 and 91.46%, respectively. Multivariate analysis revealed that absence of cirrhosis, higher baseline albumin, lower baseline international normalized ratio, higher baseline platelet count, lower baseline alpha-fetoprotein, normal splenic size, and naivety to previous antiviral therapy were associated with SVR12. PCR after 72 weeks for those who achieve SVR12 is still undetectable. Three cases died during the follow-up period and were related to their advanced liver disease. No serious adverse events were reported. Conclusion Generic DCV, SOF±RBV regimen is safe and effective for treatment of chronic hepatitis C with minimal adverse events and SVR12 is efficient to predict persistent viral clearance.

Background Asthma–chronic obstructive pulmonary diseases overlap syndrome (ACOS) carries a higher risk than either condition alone, with more symptoms, more exacerbations, higher cost, and increased mortality, so the diagnosis and accurate treatment of patients with ACOS is very important in the clinical setting. Aim To study the prevalence of ACOS among patients with asthma and those with COPD and to detect the predictive factors of ACOS. Patients and methods We conducted an observational cross-sectional study involving 100 patients with bronchial asthma and 100 patients with COPD. We recorded demographic data, spirometric data, chest radiograph finding, peripheral blood eosinophil and neutrophils, and response to inhaled corticosteroids. Results Among the 200 studied patients, 16% of patients with asthma and 20% of patients with COPD fulfilled the ACOS criteria. Male sex and prebronchodilator forced expiratory volume in first second/forced vital capacity% are predictors of ACOS development in asthmatic patients and that blood eosinophil are predictors of ACOS development in patients with COPD using odds ratio. Conclusion ACOS should be considered as an independent subgroup distinguished by demographic data, symptoms, spirometric indices, and granulocytic pattern.

Introduction Recurrence of nephrolithiasis is common. The knowledge of its incidence and risk factors is the base for proper prophylaxis and preservation of renal function. Objective The aim was To study the recurrence rate and risk factors of nephrolithiasis in Egyptian patients. Patients and methods Files of 974 patients with nephrolithiasis (634 males and 340 females, aged 7–70 years) were reviewed. They were managed between 2008 and 2009, with a 10-year follow-up period since the first stone episode for recurrence. Stone characteristics (sizes, sites, and multiplicity), treatment type, post-treatment residual stones, family history, BMI, and recurrence rate were included. Results Of the 974 patients, stone recurrence rate was 44.45% within 10 years of follow-up. Recurrence was significantly higher in young age group of less than 20 years, male sex, average BMI, and positive family history (61.14, 52.99, 50.99, and 55.82%, respectively) within 10 years. Recurrence was significantly higher with stone size greater than 2 cm (24.20%) at the second 5-year follow-up. Recurrence was significantly higher with multiple (56.59%), pelvicalyceal (59.83%), and bilateral (66.95%) renal stones within 10 years. It was significantly higher with shock wave lithotripsy (20.89%) within the second 5-year follow-up, and with presence of residual stones (32.66%) within the first 5-year follow-up. Conclusion Stone recurrence rate increases with increase in observation time. Risk factors for recurrence are young age of onset; male sex; normal BMI; positive family history; large size, multiple, bilateral, and pelvicalyceal stone; shock wave lithotripsy treatment; and presence of residual stones.

Backgroundand aim To evaluate surgical liver resection in comparison with radiofrequency in the treatment of early hepatocellular carcinoma (HCC) regarding intraoperative blood loss and transfusion, time of respectability, time of operation, ICU stay, hospital stay, postoperative morbidity, mortality, and overall survival. Introduction Surgical resection and radiofrequency ablation (RFA) in the treatment of HCC are different modalities for the treatment of HCC. Patients and methods This is a prospective study that included 60 patients with HCC randomized into hepatic resection and RFA groups at Al-Zahraa University Hospital from 2016 to 2019. Demographic and biochemical characteristics, intraoperative data, postsurgical complications, and overall survival rate were compared between groups. Results Surgical resection group had longer operative time, resection time, blood loss and blood transfusion, hospital stay, and ICU stay than RFA group. Postoperative hemorrhage, bile leak, and chest infection were markedly decreased in RFA group than surgical resection group. Wound infection and ascites are similar in the two patient groups. Regarding the median follow-up during the 3 years, there were no significant differences between the treatment groups in 1- and 3-year overall survival. Conclusion Surgical resection is considered the primary solution if the patient’s liver function and general conditions are good enough to undergo surgical intervention. RFA is considered superior to hepatic resection in the treatment of HCC in terms of operation duration and other complications like hemorrhage and bile leak. RFA revealed similar overall survival to surgical resection. RFA is accessible and a promising liver resection method with very good results.

Context Blood is a fundamental and vital component of the human circulatory system. Blood transfusion is essential to save lives or improve health in different parts of the world. Despite the increased number of voluntary blood donors worldwide, the demand for blood transfusion continues to rise. Aims To assess the practice of blood donation and its demographic variations between donors and nondonors among primary health care’s (PHC) visitors of the Ministry of Health PHCs, in Jeddah city, Kingdom of Saudi Arabia, from December 2018 to February 2019. Settings and design A multistage sampling technique was used to choose the selected five PHCs. The target sample size was calculated based on Raosoft software. Patients and methods A cross-sectional analytic study was conducted from December 2018 to February 2019 at Ministry of Health PHCs in Jeddah on a total sample of 400 patients (200 males and 200 females) who were recruited by a multistage random sampling technique. Data were collected by using self-administered questionnaire about sociodemographic data and practices of blood donation among the study participants. Results The participants were equally taken from both sexes (50% males and 50% females). Overall, 95% of the participants were from Jeddah, and 80% of the participants were Saudi nationals. There was a significant relation between donors and other independents variables such as PHC, age, and sex (P≤0.05). Conclusion We concluded that the prevalence of blood donation among Saudi population is relatively low. Older married males with high educational level and low monthly income were the most common socio-demographic factors among the studied group.

Background Vascular rings (VRs) are rare congenital anomalies of the aortic arch. Along with clinical data, several imaging techniques help to suspect VR. Flexible fiberoptic bronchoscopy (FFB) is also considered the main tool for diagnosis. Aim The aim of the study is to describe the clinical, radiological, and bronchoscopic features of pediatric aortic VRs. Patients and methods A total of 61 patients with VR were included in the study on the basis of computed tomography (CT) angiography. The included children were subjected to history taking, clinical examination, chest radiograph, CT chest with angiography, and FFB. Results This study included 61 children with vascular aortic rings. The median age of diagnosis in this study was 8.5 months (range, 2–23 months). Recurrent chest infection was the most common clinical manifestation (81.96%) followed by monophonic wheeze (60.65%) and stridor (57.37%). Double aortic arch was the most common type (34.4%) followed by innominate artery compression syndrome (18%) and left arch with aberrant right subclavian artery (14.7%). Chest radiography showed the correct diagnosis in seven (11.4%) cases, while CT angiography proved correct in 50 (81.9%) patients and FFB in 56 (91.8%) patients. Conclusion Prolonged or recurrent respiratory difficulties and/or dysphagia should alert the pediatrician to the possibility of a VR. Preferably, those children should be submitted to bronchoscopy.

Background The diagnosis of the etiology of exudative pleural effusion is a great challenge in clinical practice. Aims To evaluate the diagnostic value of medical thoracoscope in unexplained exudative effusions and the frequency of various diagnoses in a multicenter study in Egypt. Patients and methods A retrospective analysis was done of all thoracoscopies done at our centers for diagnosis of the cause of the exudative pleural effusion. Results Among 542 thoracoscopies performed at our centers, definite diagnosis was reached in 476 (87.8%) cases. Malignancy was the most common diagnosis (60.7%) followed by tuberculosis (24.5%). Conclusion Thoracoscopy was a safe and efficient tool for diagnosis. Malignancy and tuberculosis were the most common etiologies.

Background Gestational diabetes mellitus (GDM) is a serious disease, which may cause complications such as preeclampsia, increased cesarean rates, and macrosomia in mothers and neonates. Objective The aim of the study was to examine whether women who have a first trimester prediabetes − glycated hemoglobin (HbA1C) range of 5.7–6.4% are more likely to have an abnormal second trimester oral glucose tolerance test (OGTT) compared with women who have a normal first trimester HbA1C. Patients and methods The study was conducted at the Obstetrics and Gynecology Department of Sayed Galal University Hospital, Al-Azhar University, during the period between August 2018 and August 2019. The study included 121 pregnant women who regularly attended the outpatient clinic in the first trimester for antenatal care and who were subjected to personal, menstrual, obstetric, past, medical, and family history; general and abdominal examination; ultrasonography and measurement of HbA1C and OGTT. Results The present study showed a statistically significant difference between women with HbA1C value in relation to prepregnancy BMI, pregnancy BMI, gestational age, method of screening, development of GDM, and at 0 h and after 1 h according to fasting value from OGTT result. Conclusion HbA1C level is a good test for identifying patients at high risk of development of GDM. It has a prognostic value in the obese population. Its value has been demonstrated when it is done during the first trimester and up to 20 weeks of gestation. This information may help in GDM screening and treatment.

Background It usually takes several days or even weeks to establish full enteral feeding (FEF) in preterm infants because of feeding intolerance (FI) related to gastrointestinal hypomotility. Clinical trials on prokinetic agents in preterm neonates, especially erythromycin, have reported conflicting results. There are limited data on prokinetic effect of erythromycin in preterm infants. Objective The authors aimed to evaluate the effect of oral administration of erythromycin in the treatment of preterm infants born at 30 weeks of gestation or more. Patients and methods A clinical trial was conducted on 60 preterm neonates born equal or more than 30 weeks of gestational age and admitted to the neonatal ICU at Kafr El-Shiekh General Hospital. Infants with FI were randomly divided into two groups: group A received oral erythromycin and group B did not receive treatment with erythromycin. Time to achieve FEF was considered as a primary outcome measure. Duration of parenteral nutrition (PN) expressed in number of days; number of days that feeds were withheld owing to FI; and duration of hospitalization were the other outcomes. Results Erythromycin group attained FEF earlier than the group without treatment with erythromycin. Therefore, PN duration was shorter in erythromycin group than the group without treatment. Moreover, the duration of hospitalization was shorter in erythromycin group than the other group. Conclusion This data suggest that oral erythromycin effectively reduces the time required to reach FEF, duration of PN, and length of hospital stay in stable preterm infants.