Background Metabolic syndrome (MS) is characterized by several cardiovascular risk factors, such as insulin resistance, impaired glucose tolerance, diabetes mellitus, obesity, abdominal fat accumulation, dyslipidemia, and hypertension. Objective To find an association between plasma 25-cholecalciferol (vitamin D) level and the MS. Patients and methods A case–control study was conducted on 48 patients with MS who were compared with 48 age-matched and sex-matched healthy individuals (without MS). Results Although there was a significant increase in all parameters of MS in patient group over the control group, there was no statistically significant difference between them in vitamin D levels (P≥0.090). In both studied groups, there was no statistically significant correlation between vitamin D level and BMI (P≥0.299), waist circumference (P≥0.208), blood pressure (systolic P≥0.257 and diastolic P≥0.081), fasting blood sugar (P≥0.227), and serum triglycerides (P≥0.438). We found an inverse correlation between vitamin D and high-density lipoprotein-cholesterol (P≤0.001) in both groups. Only patients with MS showed an inverse correlation between vitamin D and lipid accumulation product (P≤0.001). Conclusion Although vitamin D level is not correlated with all MS parameters; it is negatively correlated with high-density lipoprotein-cholesterol and lipid accumulation product, which is considered an accurate index for MS.

Background and aim As most diabetic patients have high risk of cardiovascular hazards, the aim was to assess an indicator biomarker that can help us to estimate these hazards in patients with type 2 diabetes (T2D). Patients and methods A total of 80 participants were examined for T2D and divided into two groups: T2D group and control group. To estimate the 10-year risk of atherosclerotic cardiovascular disease, we utilized the Framingham risk score (FRS), the New Pooled Cohort Equation score, Tch/high-density lipoprotein (HDL) ratio, HDL/low-density lipoprotein (LDL) ratio, and serum growth differentiation factor-15 (GDF15). Results The T2D group had higher levels of systolic blood pressure and diastolic blood pressure and lower levels of weight and BMI than control. The T2D group had higher levels of random blood glucose (RBG), glycosylated hemoglobin, and urea. Both the total cholesterol/HDL and LDL/HDL were high significantly in the T2D, whereas FRS was high in the T2D group than control group. The level of serum GDF15 was higher in the T2D group (P=0.000). We found a positive correlation between level of serum GDF15 and BMI (r=0.336, P=0.017), systolic blood pressure (r=0.622, P=0.000), diastolic blood pressure (r=0.572, P=0.000), RBG (r=0.298, P=0.035), and FRS (r=0.415, P=0.003). Conclusion GDF15 can be used as an indicator for measuring cardiovascular hazards in patients with T2D.

Objective Stroke is one of the leading causes of disability and death worldwide. Intravenous thrombolytic therapy has been widely recommended as a standard treatment for acute ischemic stroke in most clinical practice guidelines. The authors aimed to report on the efficacy and safety of rt-plasminogen activator (PA) in the management of acute ischemic stroke in a sample of Egyptian patients. Patients and methods There were 58 patients treated with IV rt-PA within 4.5 h of stroke onset during the study period between 2014 and 2018 at the Stroke Units of Al-Azhar University Hospitals and Al-Maadi Military Hospital. Results The studied patients had an age of 62.55±9.94 years and comprised 36 men and 22 women. Treatment window was within the first 3 h of stroke onset in 24 (41.3%) patients, while it was within 3–4.5 h in 34 (58.7%) patients. Forty-six (79.3%) patients had an early improvement and the remaining 12 (20.7%) patients experienced early deterioration. Treatment complications included symptomatic intracranial hemorrhage (10.3%), asymptomatic intracranial hemorrhage (3.4%), and hematuria (3.4%). The in-hospital mortality rate was 10.3%. Comparison between patients with early improvement and those with early deterioration shows significant association between treatment within the first 3 h of stroke onset and early improvement. Conclusions The authors have been able to show that IV thrombolysis is feasible and safe in our hospitals. However, the number of stroke patients receiving rt-PA in the developing world is relatively low.

Background Hepatic cirrhosis causes structural and functional myocardial changes. Parameters of left atrial (LA) function provided novel insights and have prognostic significance in many cardiac patients. 2D speckle tracking echocardiography and tissue Doppler imaging (TDI) technique supported a comprehensive method for examining the LA function. The aim of this study was to investigate phasic LA functions in end-stage hepatic cirrhosis using echo-Doppler and strain imaging techniques in participants with preserved left ventricular (LV) ejection fraction. Patients and methods This study included 50 patients with end-stage hepatic cirrhosis based on Child-Pugh score having normal LV systolic function, in addition to 35 healthy individuals as a control group. All the studied cases underwent LV conventional echo-Doppler imaging measurements and LA dimensions and volumetric measurements, together with TDI-derived left atrial strain (TDLA strain), speckle tracking echo-derived left atrial global strain (LAGST), and peak LA systolic myocardial velocity (LA Sm4) averaged from 4 LA myocardial sites. Results There was a highly significant increase of LVIDd and LVIDS and significant increase of MA vel in group I, whereas there was a highly significant decrease of ME vel and ME/A ratio in group I. Group I had highly significant increase in LA dimensions (anteroposterior and superior inferior) and significant increase in LA mediolateral diameter. Moreover, there was a significant increase in LA volumes and volumic indices (LAVmax, LAVI, LAVmin, LAVI min, LAV pre-A, and LAVI pre-A) in group I. Conclusion LA function is impaired in patients with end-stage liver disease. 2D strain and TDI-derived strain are useful echomodalities for assessment of LA function.

Aim The aim was to detect a possible correlation of some quantitative and qualitative dermatoglyphic variables with rheumatoid arthritis (RA) and to find out if dermatoglyphics can play an important role in the diagnosis of RA, which have not been extensively researched before in Upper Egypt. Patients and methods The study was carried out on 50 patients with RA. The age range was 20–55 years. All patients were Upper Egyptian women. A total of 30 apparently healthy age-matched and sex-matched women belonging to the same demographic profile were taken as a control group. Results The present study revealed that ulnar loops were significantly decreased, the radial loops showed no significant increase, and arches were significantly increased in both hands of patients with RA as compared with the control. Regarding whorls, significant increase was noticed only in left hand. The tables declared increase in the percentage frequencies of all patterns in the diseased group in comparison with control except for the ulnar patterns of both hands, which showed a statistically significant decrease. However, the increase in the percentage frequencies of the other patterns in RA did not reach the level of significance except for the arch patterns in both hands and whorl patterns of the left hand, which were found to be statistically significant. It was observed that ulnar loops had higher frequency in control, whereas whorls and arches were more common in patients than control. Conclusion It could be concluded that there are characteristic variations in dermatoglyphic patterns in RA as compared with normal persons.

Background Psoriasis is a chronic inflammatory skin disorder presented by light-pink or red thick skin plaques covered with whites scales, and it negatively affects patients’ quality of life. Aim The aim was to evaluate the serum level of elafin in patients with psoriasis and its correlation with the disease severity. Patients and methods This a case–control study that included 90 subjects classified into group I, which included 60 patients with moderate to severe psoriasis according to psoriasis area severity index (PASI), and group II, which included 30 apparent healthy age-matched and sex-matched participants as a control group. All patients were subjected to history taking, including age, duration, family history, and previous treatment; complete general examination, including weight, height, and blood pressure; complete dermatological examination; severity assessed by PASI score; and elafin serum level measured by enzyme-linked immunosorbent assay). Results The mean serum elafin level in the case group was 6.09±8.91, which was significantly higher than the level in the control group (0.40±0.35), with P less than 0.001. There was a positive significant correlation between elafin level and PASI in the case group (r=0.467 and P<0.001). Conclusion This positive expressiveness of elafin in patients with psoriasis could be a valuable tool in the diagnosis of psoriasis from other similar inflammatory skin diseases and in determining the accurate disease pathogenesis. Moreover, it can be helpful in the future for the development of new possible therapeutic options.

Background objective To assess the efficacy of laparoscopic common bile duct exploration (LCBDE) (in conjunction with laparoscopic cholecystectomy) as a single-stage operation to manage CBD stones failed to be extracted by endoscopic retrograde cholangiopancreatography (ERCP) and to evaluate the possible complications related to CBD stones. Patients and methods The study includes 30 patients diagnosed as having CBD stones proved clinically and through laboratory investigations in the form of obstructive jaundice and confirmed radiologically using hepatobiliary ultrasound and magnetic resonant cholangiopancreatography. All patients had a failed trial of ERCP stone extraction. They had a mean age of 51.067±11.32 years, and 40% of patients were males versus 60.0% were female. Results Postoperative follow-up was done after 1 week in the study group. Regarding postoperative ultrasound, 93.3% of patients had clear duct. Moreover, there was no pancreatitis in 96.7% of patients. Regarding cholangiogram, 93.3% had no stone. The mean hospital stay was 2.60 days, and 46.7% of the patients had a duration of staying at hospital of 2 days and 33.3% of patients had 3 days. Conclusion Laparoscopic bile duct exploration has achieved acceptance among the surgeons as a substitution to ERCP for management of CBD stones. Although its safety and successfulness are already confirmed among young patients in the elective setting, this study points to the rising proof of its safety among the elderly patients, in both elective and emergency settings. In centers that are capable of offering LCBDE to patients with CBD stones, LCBDE should be attempted in elderly patients observed to be fit for laparoscopic cholecystectomy.

Introduction Recurrent pregnancy loss is identified by an ultrasound or histopathological test as two or more losses. Mean platelet volume (MPV) is the calculation of the average size of platelets and platelet activation. Aim The aim was to illuminate the etiopathogenesis of recurrent abortion, the study investigated the relationship between mean platelet size and recurrent abortion. Materials and methods This prospective research was performed at Al Zahraa University Hospital in Gynecology and Obstetrics Department and the General Kafer Alzyat Hospital. This study included 120 pregnant women in first trimester coming for antenatal care. All patients were tested with diagnostic testing for etiology of repeated abortion. All patients were evaluated for complete blood count parameters, including hemoglobin number, distance of distribution of red cells, mean corpuscular volume, white blood cells, platelets, and MPV. Results This analysis revealed that there is no statistically important difference between the groups analyzed regarding the mean age, BMI, blood pressure, and gestational age, as the mean age of studied group was 27.25±4.73 years compared with 26.77±5.26 years in the control group, and BMI in the studied group was 26.86±3.21 compared with 28.95±8.88 in the control group. There is a highly significant difference between studied and control groups regarding MPV. Conclusion In this research, the MPV values in women with repeated pregnancy loss were significantly higher than in the control group, which supports the importance of thromboembolic events.

Background and aim Preterm birth is a global health care problem associated with significant neonatal morbidity and mortality and substantial health care costs. The authors aimed in this study to evaluate the role of trappin-2/elafin protein level in cervicovaginal fluid as a predictor in high-risk women for spontaneous preterm labor (SPTB). Patients and methods This is a prospective study that included 50 women who are 13 weeks of gestation and had a high risk for preterm birth attending obstetric clinic of Al-Azhar (Assiut) University Hospital during the period from November 2018 to December 2019. Results In the present study, 19 cases developed SPTB from all studied 50 cases. Moreover, the results showed that cases that developed SPTB had significantly (P≤0.01) higher trappin-2/elafin level as compared with those not (107.2 vs 68.7 pg/ml). At a cutoff point of greater than or equal to 93.4 (pg/ml), trappin-2/elafin levels have a high sensitivity (89.5%) and high specificity (90.3%) in prediction of SPTB. The present results revealed that 32 (64.0%) cases had cervical shortening from all studied cases. Moreover, the results showed that trappin-2/elafin level increased significantly (P≤0.01) in cases with cervical shortening compared with those without (112.5 vs 75.4 pg/ml). At a cutoff point of greater than or equal to 83.7 (pg/ml), trappin-2/elafin level has a high sensitivity (84.4%) and high specificity (83.3%) in relation to cervical shortening. Conclusion Trappin-2/elafin protein level in cervicovaginal fluid is a sensitive and specific marker in prediction of SPTB in high-risk women.

Background Stenosis and associated thrombosis is a continual complication of hemodialysis arteriovenous fistulas (AVFs). Early management of stenosis may avoid AVF occlusion and extend its use. Objective The objectives were to evaluate effectiveness, safeness, and durability of percutaneous transluminal angioplasty (PTA) in treatment of failing native hemodialysis AVFs. Patients and methods A total of 20 patients (12 females and eight males) with chronic renal failure dependent on hemodialysis underwent PTA for their failing native AVFs. The indications for these procedures were significant stenosis (>50% decrease of the vessel diameter). Results A total of 20 PTA procedures were performed in 20 fistulas of 20 patients with end-stage renal disease. These interventions were performed on 14 (70%) brachiocephalic and six (30%) radiocephalic fistulas. PTA succeeded technically in 18 (90%) procedures, and clinical success was accomplished after 17 (85%) procedures. The authors found the commonest site (65%) of AVF stenosis is in the juxtaanastomotic segment. Recurrent stenosis occurred in three (15%) patients; the three cases were subjected to a second successful PTA. The primary patency rates were 70% after 6 months and 50% after 12 months. The primary assisted patency rate was 100% after 12 months. A total of 12 (60%) patients required no further reintervention and continued hemodialysis from their fistulas till the end of the study. Conclusion PTA for treatment of failing native hemodialysis AVFs is a successful efficient technique to prolong the patency of the fistulas. By preserving the existing fistulas, venous segments can be saved for future AVF creation.

Background The role of bacterial pathogens in exacerbations of bronchial asthma is unclear as that of viral infections. Aim To identify sputum bacteria and antibiotic sensitivity in patients with bronchial asthma exacerbation. Patients and methods A descriptive cross-sectional study was conducted on 50 patients with acute bronchial asthma exacerbation. Spirometeric pulmonary function tests, total and differential leukocyte count, sputum Gram stain, culture, and sensitivities were done for all patients. Results Of the studied patients, 50% have growth of normal flora, 12% have fungal growth, and 38% have bacterial growth (63.6 and 36.4% of them have Gram-negative and Gram-positive bacteria, respectively). The most predominant bacteria were Klebsiella pneumoniae (31.8%) and Streptococcal pneumoniae (18.2%), while Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii complex, and Enterobacter aerogenes are equally distributed (9.1%). There was a significant decrease of vital capacity %, forced vital capacity %, and forced expiratory volume in the 1 s % in bronchial asthma with Gram-negative bacteria compared with those with Gram-positive bacteria. The total and differential leukocytic counts nonsignificantly differed between both subgroups. Among the studied patients with bacterial growth, Amikacin, Quinupristin/Dalfopristin, Linezolid, Vancomycin, and Tigecycline were the most common sensitive antibiotics (100%), followed by Tobramycin, Ciprofloxacin, Levofloxacin, and Gentamicin (95.5%). On the other hand, Benzylpenicillin and Oxacillin were the most common resistant antibiotics (100%), followed by Ampicillin (92.3%). Conclusion Bacterial organisms were responsible for only about one-third of bronchial asthma exacerbation, with predominance of Gram-negative organisms. Amikacin, Quinupristin/Dalfopristin, Linezolid, Vancomycin, and Tigecycline, Tobramycin, Ciprofloxacin, Levofloxacin, and Gentamicin were the most common sensitive antibiotics. Benzylpenicillin, Oxacillin and Ampicillin were the most common resistant antibiotics.

Background Urge surfing is a brief mindfulness-based instruction used in alcoholic to avoid relapse and improve anxiety. Atopic dermatitis (AD) is a chronic psychodermatology disease with unsatisfactory pharmacotherapy. Objective The aim was to examine the effectiveness of urge surfing in patients with chronic AD. Patients and methods All patients with chronic AD who were referred to psychiatric clinic from January 1, 2018 to July 30, 2018 were included in the study. The authors used Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) to assess the patients at baseline (T1), then at 12 weeks (T2) and lastly after 24 weeks (T3). Results The mean±SD age of the patients was 33±13.7 years, range 17–70 years, 70% were married, and 40% had completed high education. The mean±SD duration of illness was 23.1±17.8 years. The mean (EASI) score at T1 was 46. This decreased significantly to 32 at T2 (t=7.43, d.f.=0.33, P<0001). The mean DLQI at T1 was 13, decreasing significantly to 6 at T2 (t=7.98, d.f.=0.33, P<0001). A linear regression analysis was performed to assess the association between EASI and DLQI and was statistically significant (b=0.20, P=0.004). Conclusion There was a significant reduction in eczema severity and improvement in quality of life following urge surfing in resistant eczema.

Background Up to 50% of renal transplant recipients can experience diabetes mellitus (DM) and insulin resistance (IR). Both metabolic complications significantly increase the risk of progressive loss of renal function, cardiovascular morbidity, and death. On the contrary, the current body of evidence shows that changes in adiponectin, a cytokine of adipose tissue, is significantly associated with the development of DM and other components of metabolic syndrome. In the present study, the authors aimed to characterize the association between post-transplantation changes in adiponectin level and both IR and new-onset diabetes mellitus (NODM). Patients and methods The authors recruited 30 patients who received a living-donor kidney at least 6 months before study’s enrollment. Most patients were males (70%), with age ranged from 25 to 55 years. The following data were collected before the transplantation and at the end of follow-up: blood glucose profile, glycated hemoglobin, serum insulin, homeostasis model assessment-insulin resistance (HOMA-IR), lipid profile, and serum adiponectin. Results Six months after the transplantation, seven (23.3%) patients developed NODM. There was a negative correlation between serum adiponectin and HOMA-IR before and after kidney transplantation. Low adiponectin levels before and after transplantation was associated with a greater incidence of new onset diabetes after transplantation (NODAT). Patients who developed NODAT had lower levels of adiponectin compared with patients who did not develop NODAT before and after transplantation. Conclusion Low adiponectin level is associated with increased risk of NODM in renal transplant recipients. In addition, there is a negative correlation between serum adiponectin and IR before and after kidney transplantation.

Introduction Obesity-associated acanthosis nigricans (AN) is the most common type of AN. Objective To detect leptin receptor expression in the skin lesion affected by obesity-associated AN. Patients and methods A total of 20 patients with obesity-associated AN were included in this prospective study. Complete history taking, thorough general examination, and calculation of BMI were done for all patients. Leptin receptor expression was investigated in skin lesion and perilesional skin by immunohistochemistry. Results The mean age of the patients was 19.5±7.561 years and the mean duration of the disease was 8.6±6.44 years. A total of 14 patients were females and six patients were males. The mean BMI of the examined patients was 31.5±4.4. The expression of leptin receptors was significantly higher in skin lesions than perilesional skin of the patients. Conclusion Leptin receptor expression was significantly higher in skin lesions affected by obesity-associated AN.

Introduction The ERBE BiClamp appears to be a secure and efficient technique of vaginal hysterectomy (VH). In this study, it provided proficient operative times, and minimum loss of blood and morbidity during the procedure with satisfactory outcomes. Its utilization plays a part in the enhancement of minimally invasive gynecology and it should be promoted. Objective The aim was to evaluate the applicability of VH without suture ligation. Materials and methods A retrospective cohort study was carried out during the period between September 2017 and May 2019 in the Obstetrics and Gynecology Department, Al-Azhar University Hospital, New Damietta. A total of 62 patients posted for VH for benign conditions were enrolled after informed consent. The patients were divided into two groups: the first included 32 cases for the BVS (BiClamp) and the second control group included 30 cases with conventional suture ligation. Results The use of an electrosurgical bipolar vessel sealer resulted in shorter operative time. The median procedure time in the electrosurgical bipolar vessel sealer group was 27.75 vs 43.5 min for the suture group (P=0.005). The median value of estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer [85.8 ml vs 105.4 ml for the suture arm (P=0.043)]. The incidence of complications did not differ statistically between the two groups (P>0.05). Conclusion Bipolar vessel sealer has shown a major decrease in intraoperative blood loss, procedure time, and hospital length of stay. Although complications and postoperative pain did not differ between the two groups, the sealer cases reported less visual analog scale scores compared with the other group.

Background MRI is an excellent imaging modality to evaluate the liver which is vulnerable to a spectrum of neoplastic and nonneoplastic conditions. Out-of-phase T1 weighted (T1W) gradient-echo imaging is a highly accurate technique to distinguish focal hepatic steatosis from neoplastic masses. Aim This study aimed to demonstrate the diagnostic value of gradient-echo in-phase and out-of-phase MRI sequence in the characterization of benign and malignant hepatic focal lesions. Patients and methods This study is carried out on 89 patients with 100 hepatic focal lesions; their ages ranged from 32 to 76 years (mean, ±52 years), who traveled for MRI liver for the diagnosis and characterization of hepatic focal lesions. MR examination was performed including T1WI, T2WI, postcontrast dynamic enhanced T1WI followed by gradient-echo in-/out-of-phase MRI sequences. Results The 100 hepatic focal lesions proved to be: 17 focal fatty infiltration, one lipoma and eight fatty-spared area (FSA), 11 hemangioma, 10 regenerative cirrhotic nodules (RN), eight siderotic liver nodules, 12 dysplastic liver nodules, 23 hepatocellular carcinomas, seven metastatic, and three lymphoma. At conventional MRI, most of the benign hepatic focal lesions exhibit iso/hyperintense signals at T1WI and iso/hypointensity at T2WI. However, nearly all malignant lesions exhibit mainly hypointense signals at T1WI and mild hyperintensity at T2WI. At DCE T1WI: focal fatty infiltration and FSA, RN, and siderotic liver nodules take no enhancement; hemangiomas showed marginal arterial enhancement with gradual filling and there is arterial contrast enhancement with venous washout in hepatocellular carcinomas and arterial enhancement with or without washout in metastatic lesions; however, lymphomatous lesions showed temporary perilesional arterial enhancement with delayed contrast enhancement. The gradient in-/out-of-phase sequence: accurately diagnoses the all fat-containing lesions that showed moderate hyperintensity in the in-phase images and signal loss in out-of-phase images, while FSA exhibit in-phase isointensity and hyperintensity in out-of-phase images while all other benign and malignant hepatic focal lesions revealed hypointense signals in both in-/out-of-phase images. Conclusion Gradient-echo in-/out-of-phase sequence is a simple and noninvasive method that can aid in the diagnosis and characterization of benign and malignant hepatic focal lesions with 100% accuracy in the diagnosis of fat-containing lesions. Also, it can differentiate RN from dysplastic liver nodules that is considered as premalignant lesions and improve the malignant hepatic focal lesion definition.

Background Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. SLE has different presentations that are not specific to the disease itself. Diagnosis and assessment of disease activity are considered a challenge to patients and physician, as both need experienced clinician to evaluate symptoms and laboratory findings. So, it is very important to search for an accurate diagnostic marker for SLE activity. In the past few years, increasing evidence has shown that progranulin (PGRN) may play a role in regulation of adaptive and innate immunity, so it might be a marker for disease activity. Aim To investigate the clinical significance of PGRN in patients with SLE regarding its role in pathogenesis and its correlation to clinical manifestations and disease activity. Patients and methods This is a case–control study conducted on 96 participants. Group I included 56 patients with SLE subdivided according to SLE Disease Activity Index (SLEDAI) score into patients with active and inactive SLE. Group II included 40 apparently healthy volunteers as a control group. All patients were subjected to a thorough history; complete clinical examination; assessment of disease activity by using SLEDAI; and laboratory investigations, including complete blood count, liver function, kidney function, complete urine analysis, anti-nuclear antibody, anti-double-stranded DNA antibody, complement 3, complement 4, and serum PGRN. Results There was a highly statistically significant increase in serum PGRN level in patients with SLE compared with healthy control group. Moreover, a positive correlation was found between PGRN levels and SLEDAI score. Conclusion Patients with SLE with higher SLEDAI score have higher serum PGRN level. So, serum PGRN level might play a role in SLE pathogenesis and as diagnostic marker for SLE activity.

Background Vitiligo is a depigmenting disorder of the skin and mucous membranes. Latanoprost (LT) is a prostaglandin F2α analog used in the treatment of glaucoma and was found to induce skin pigmentation. Aim This comparative study aims to assess efficiency of topical 0.005% LT solution in combination with microneedling for treatment of segmental vitiligo. Patients and methods The authors addressed 50 patients with segmental vitiligo stable for at least one year divided into two groups in this study: group A included 25 patients treated with topical 0.005% LT solution in combination with microneedling sessions by using dermapen, and group B included 25 patients who were treated with topical 0.005% LT solution alone without microneedling. The response to treatment was evaluated by serial photographs, degree of pigmentation, and vitiligo area scoring index (VASI). All patients were evaluated before the start of the treatment and each month after the end of the treatment. Results The group A, which was treated by combination of topical 0.005% LT ophthalmic solution and microneedling, showed significant improvement in VASI score, whereas group B, which was treated by topical 0.005% LT ophthalmic solution alone without microneedling, showed minimal improvement in VASI score. Conclusion The use of microneedling in combination with using topical LT improves the results of treatment of segmental vitiligo.

Background The cochlea and the vestibule share the continuous membranous labyrinth of the inner ear. Moreover, there is great similarity between the cochlear and vestibular hair cell ultrastructures and the common arterial blood supply of the cochlea and vestibular end organs via the same end artery, so vestibular involvement in cochlear damage may occur. Aim The aim was to measure the effect of unilateral sensorineural hearing loss on both cervical vestibular-evoked myogenic potentials (cVEMP) and ocular vestibular-evoked myogenic potentials (oVEMP) and to compare between them in different degrees of hearing loss with or without vertigo. Patients and methods This is a cross-sectional study carried out on 40 adults with different degrees of unilateral sensorineural hearing loss. The other normal ear was used as a control for diseased ear with unilateral sensorineural hearing loss, cVEMP, and oVEMP recorded using air-conducted acoustic stimulus. Results cVEMP and oVEMP were abnormal and absent in 45 and 47.5% of ears, respectively. Moreover, there is no significant relation between the degree of SNHL, cVEMP, and oVEMP response in affected ears. There is a significant association and agreement between cVEMP and oVEMP in unilateral sensorineural hearing loss. There was a significant relation between vertigo and VEMP. Conclusion SNHL affects VEMPs response rate and other parameters, and the functions of vestibular organs are not associated with disease severity. cVEMP and oVEMP were affected equally in unilateral sensorineural hearing loss. Hearing loss may be associated with vestibular dysfunction even when there is no history of dizziness.

Background and aim Acetabular protrusion is medial displacement of the femoral head beyond the ilioischial line. Performing total hip replacement (THR) for cases with acetabular protrusion is a challenging procedure. Many techniques have been described to solve this problem (cement only, bone grafts with cementless cups, and bone grafts with cemented cups). The aim of the study was to asses clinical and radiological results of impaction bone grafts and cemented cups for cases with acetabular protrusion. Patients and methods In this series, 15 hips of 15 patients with acetabular protrusion were treated with impaction bone grafts and cemented cups; of those, nine were primary THRs, whereas six were revision THRs. Follow-up was from 12 up to 60 months. Results Clinical follow-up by Harris hip score showed marked improvements of all cases, and radiological follow-up showed incorporation of bone grafts in 100% of patients. No signs of failure were reported at a mean follow-up of ∼31months. Conclusion Impaction bone grafts and cemented cups are a reproducible technique for managing acetabular protrusion.