Background Transversus abdominus plane (TAP) block is one of the multimodal techniques that are used to relieve postoperative pain in cesarean delivery. Addition of adjuvants to local anesthetic agents reduces postoperative opioid consumption and helps in prolonging their analgesic effect. Aim This study compared the influences of addition of dexmedetomidine versus fentanyl to bupivacaine in ultrasound-guided TAP block for postoperative analgesia after spinal anesthesia in cesarean delivery and evaluating the time to the first dose of analgesia postoperatively as the primary outcome. Patients and methods A total of 120 female patients scheduled for elective cesarean delivery were conducted in this study. Patients were divided into four equal groups. All patients received spinal anesthesia. Group TAP received ultrasound-guided TAP block using bupivacaine, group TAP-F received TAP block with addition of fentanyl to bupivacaine, group TAP-D received TAP block with addition of dexmedetomidine to bupivacaine, whereas control group received spinal anesthesia only, and morphine was used for pain relief. Postoperative, time to first dose of rescue analgesia, number of patients who requested rescue analgesia, patient satisfaction, and visual analog pain scale were recorded. Results The time to give rescue analgesic in TAP-D group was the longest in comparison with the other studied groups. Regarding the number of patients who requested rescue analgesia, at the end of 24 h, significant differences were observed between control group and the other groups, and least number of patients who requested rescue analgesia was in TAP-D group during 24 h postoperatively, and differences between this group and the other groups were highly significant. Conclusion Dexmedetomidine as an adjuvant to bupivacaine in TAP block delayed the time to first rescue analgesia when added to bupivacaine using ultrasound-guided technique and improved patients’ satisfaction with decrease in total morphine consumption, whereas addition of fentanyl to bupivacaine has no added advantage.

Background Many cerebrospinal fluid (CSF) biomarkers were reported to be associated with demyelinating diseases in adults. Some of these biomarkers are chitinase 3-like 1 (CHI3L1), oligoclonal bands, and neurofilament light chain (NFL). We aimed to investigate the association of CSF CHI3L1 and NFL with demyelination disorders in pediatric patients. Patients and methods All children with age less than 18 years who came to our department with possible demyelinating of neuroinflammatory disorder from the duration between 2009 to 2019 were included in the study. Enzyme-linked immunosorbent assays were used for the analysis of the needed values. Results The data of 97 children were retrieved, and they were categorized as follows: patients with a demyelinating disease (n=17), patients with inflammatory neurological disorders (n=25), patients with systemic inflammatory disorders (n=9), patients with other neurological disorders (n=28), and normal pediatric population (n=18). There was a significant difference between these groups regarding the CSF level of CHI3L1 and NFL, as they were significantly higher in demyelinating disorders rather than other groups. Conclusion The levels of CHI3L1 and NFL in the CSF showed the diagnostic value in demyelinating disorders of pediatric populations and would be effective in distinguishing between different demyelinating disorders.

Background Comorbidities are commonly associated with multiple sclerosis (MS). Not only do they delay the diagnosis of MS but also deteriorate the quality of life, progress the disease, and perhaps increase health care costs. This study was performed to assess the prevalence of comorbidities in Egyptian patients with MS and to evaluate its effect on the cognitive function, disability, and disease relapse. Patients and methods All patients were subjected to clinical assessment and cognitive evaluation using the mini-mental state examination and the symbol digit modalities test. The relapse was assessed using the Assessing Relapse in Multiple Sclerosis questionnaire. Results The current study included 420 participants. Of them, 310 patients had MS, whereas 110 did not have MS (control group). The most common comorbidities among patients with MS were depression, in 71 (22.9%); anxiety, in 68 (21.9%); and hypertension, in 59 (19.0%). Patients with MS with comorbidities experienced a statistically significant (P<0.001) lower mean of mini-mental state examination (26.61±1.88) and symbol digit modalities test (37.44±9.65), in contrast with those without comorbidity. There was no statistically significant difference between both groups regarding comorbidity count (P=0.507) and individual comorbidities (P>0.05). Conclusion Egyptian patients with MS and comorbidities were more vulnerable to develop cognitive dysfunction and disability, relative to those without. However, the negative effect of comorbidities on disease relapse was not established. Employment of such knowledge in MS treatment protocols might reflect considerably on the quality of life and disease outcomes.

Background The primary brain tumors including astrocytic tumors, ranging from circumscribed into diffuse and glioblastoma (GBM), which is considered as a highly malignant neoplasm of the central nervous system. They share common molecular and biological abnormalities. This study was aiming to illustrate the role of c-erbB-2 protein [human epidermal growth factor receptor 2 (HER2 neu)] and E-cadherin expression in varied groups of astrocytic tumors. Patients and methods The material of this work consisted of 50 cases with histopathological diagnosis of astrocytoma and GBM. The patients were classified histopathologically into four grades based on the WHO 2007 criteria: pilocytic astrocytoma (G1), diffuse astrocytoma (G2), anaplastic astrocytoma (G3), and GBMs (G4). C-erbB-2 protein and E-cadherin expressions were estimated semiquantitatively on immunohistochemically tissue sections stained with antibodies against c-erbB-2 protein and E-cadherin. Results Checking HER2 scores, 29 (58%) cases were HER2 neu positive. Comparing the percentage of all cases of astrocytic tumors, it was found that the most obvious positive staining was observed predominantly in anaplastic astrocytoma and GBM cases. Regarding E-cadherin, 19/50 (38%) cases were E-cadherin positive with variable expressions moderate to strong immunostaining, but was typically higher in low-grade astrocytoma than in higher grades. Conclusions Taken together from our and other data, HER2 overexpression may be considered a poor prognostic marker in patients with astrocytic tumors of the brain especially GBM and cadherin cell–cell contacts in astrocytoma cells may decrease its invasion, and they could become a new potential therapeutic strategy for astrocytoma’s treatment.

Background and aim Vitamin D deficiency is a challenging health problem in premenopausal females that negatively affects bone mineral density (BMD). Low BMD in premenopausal women is related to lifestyle, vitamin D insufficiency, and secondary hyperparathyroidism. So, we aimed to evaluate BMD in young and premenopausal females and its relation with vitamin D, parathormone (PTH), BMI, and lifestyle factors. Patients and methods A total of 86 young and premenopausal females were included, and BMD, serum calcium, vitamin D, PTH, BMI, and lifestyle were determined. Results Z score of the spine showed that 26.7% of the patients were below expected. According to T score, 30% were osteopenic, and 9% were osteoporotic. Overall, 59.3% had vitamin D deficiency, and 20.9% had insufficiency. Patients with below expected BMD, osteopenic, and osteoporotic had significantly low vitamin D and BMI and high PTH. Spine and hip-BMD and spine T and Z scores were positively correlated with BMI and vitamin D and negatively correlated with PTH. Hip T and Z scores were positively correlated with BMI and vitamin D. PTH was negatively correlated with vitamin D and BMI. Spine and hip BMDs were positively correlated with sunlight exposure and physical activity but negatively correlated with carbonated and caffeinated beverage consumption and family history of osteoporosis. Conclusion Low BMD is a challenging health problem in young and premenopausal females, which may be related to low BMI, vitamin D deficiency, and lifestyle factors in the form of inadequate sunlight exposure, excessive consumption of caffeinated and carbonated beverages, and decreased physical activity, in addition to hyperparathyroidism and positive family history of osteoporosis.

Background and aim Accelerated atherosclerosis is a leading cause of increased cardiovascular morbidity and mortality in patients with systemic lupus erythematosus (SLE). Atherosclerosis is mediated by multifactorial processes including inflammation, endothelial dysfunction, autoantibodies, dyslipidemia, and traditional risk factors. So, we aimed to evaluate carotid intima-media thickness (CIMT) for early detection of subclinical atherosclerosis in patients with SLE and to determine its correlation with disease activity. Patients and methods A total of 50 patients with SLE and 50 healthy controls were included in this study. Full detailed history, clinical examination, and laboratory findings for all the participants were recorded. ECG was done for the patients and controls for the detection of QT dispersion. CIMT was measured bilaterally at the distal common carotid artery. Results On measuring CIMT, we found thickened CIMT (>0.8 mm) in 28% and plaques in 18% of the patients. There was a highly significant increase in the right CIMT, left CIMT, and mean CIMT of both sides in the patients in comparison with the controls (P<0.0001, P=0.004, and P<0.0001, respectively). The ECG findings showed that 40% of our patients had normal ECG, 10% had abnormal ST segment, 34% had sinus tachycardia, and 16% had QT dispersion. Moreover, CIMT was positively correlated with SLE disease activity index (SLEDAI) and associated with other nontraditional risk factors including age, disease duration, anti-dsDNA, C3, and nephritis. Conclusion Premature atherosclerosis is a devastating health problem in patients with SLE, which may be accelerated by multiple risk factors related to the disease process and medications; hence, early detection of subclinical atherosclerosis through the measurement of CIMT using carotid ultrasonography is a reliable noninvasive technique to allow early therapeutic intervention and to reduce the mortality.

Background There are laboratory and clinical associations between liver and thyroid diseases. Hepatitis C virus is known to be responsible for both hepatic and extrahepatic diseases. Direct-acting antivirals (DAAs) provide high sustained viral response rates and much reduced adverse effects and impaired health-related quality of life during treatment. Aim To assess thyroid function in patients with chronic hepatitis C (CHC) receiving DAAs before start treatment and after achieving of SVR. Patients and methods A prospective study was conducted on 300 patients with CHC infection who were recruited for the study after obtaining written informed consent. Full history was taken, as well as routine examination and special investigations were done for all patients before the start of the remedy and by the end of treatment with DAAs. Results PCR results revealed a statistically significant difference, as SVR was evident in 98% of patients. Analysis of thyroid function assessments in the present study showed that 277 (92.3%) patients were euthyroid and 23 (7.7%) patients had thyroid disorders, comprising seven (2.3%) patients with subclinical hypothyroidism, 14 (4.66%) patients with overt hypothyroidism, and two (0.7%) patients with subclinical hyperthyroidism. Conclusion Thyroid function in patients with CHC infections was not damaged with treatment with DAAs for hepatitis C virus treatment. Hypothyroidism is prevalent in patients with CHC, and after treatment with DAAs, thyroid dysfunction slightly improved, especially subclinical, after achievement of SVR.

Purpose To evaluate and compare the visual outcome after femtosecond laser-assisted keratoplasty (FLAK) versus conventional penetrating technique. Settings and design This is a nonrandomized prospective comparative study that included a total of 30 eyes of 30 patients (16 females and 14 males) who underwent keratoplasty at three private eye centers in Assiut city, Egypt. These patients were divided into two groups: group I included 15 patients who were subjected to femtosecond laser-assisted penetrating keratoplasty and group II included 15 patients who were subjected to conventional penetrating keratoplasty (PKP). Patients and methods Visual outcome and intraoperative and postoperative complications were evaluated over a 18-month follow-up period. Statistical analysis Statistical analysis was performed using SPSS program. Student t test, paired sample t test, and χ² test were used for the comparisons. Results Both uncorrected and best-corrected visual acuity showed marked improvement in both groups at 1, 3, 6, 12, and 18 months postoperatively. However, FLAK group showed statistically better uncorrected and best-corrected visual acuity at 3, 6, 12, and 18 months compared with conventional PKP group (all P<0.01). The mean sphere improved significantly in both groups at all follow-up periods. Flattest K (K1), steepest K (K2), and K mean showed a significant reduction in both groups at all follow-up periods with no significant differences between groups. Lower occurrence of postoperative complications was noticed in FLAK group compared with PKP group, with a nonsignificant difference (P=0.255). Conclusion Both techniques are effective, but FLAK has been shown to result in faster and better visual recovery, with significantly less astigmatism and lower complications compared with conventional PKP.

Background Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airway disease (e.g. obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person. Aim The aim of the study was to measure diffusing capacity for carbon monoxide using single-breath technique in different stages of COPD. Patients and methods A total of 100 patients with COPD with mild to very severe obstruction were included in the study. Results There was a statistically significant negative (inverse) correlation between both transfer capacity of the lung (TLCO%) and KCO and PCO₂ and HCO_3, and there was a statistically significant positive (direct) correlation between both TLCO% and KCO and PO₂, and arterial oxygen saturation. There was a statistically significant positive (direct) correlation between forced vital capacity %, forced expiratory volume in 1 s%, forced expiratory flow (FEF)25%, FEF50%, and FEF75% and each of TLCO% and KCO. Conclusion Decline in forced expiratory volume in 1 s/forced vital capacity is associated with decline in diffusing capacity of the lung for carbon monoxide, and it is affected more in patients with severe and very severe degrees of chronic obstructive pulmonary disease (COPD).

Objective To compare the safety and efficacy of single end-point coagulator versus T-shaped sliding coagulator used for tactile electrosurgical endometrial ablation (TEEA) in stopping or decreasing active resistant perimenopausal intrauterine ball (IUB). Patients and methods In this study, 50 cases with perimenopausal IUB not responding to medical or hormonal treatment were included, comprising 25 treated by using single end-point coagulator, whereas the other 25 treated by T-shaped sliding coagulator. Outcomes depended on which technique is better regarding immediate stopping of bleeding, need for another TEEA, or need for hysterectomy. Results Duration of operation in T-shaped sliding coagulator was ∼5 min, and bleeding immediately stopped in 22 of 25 cases. Follow-up of those cases for 12 months revealed that 11 of them had developed amenorrhea, seven developed minimal bleeding, five developed regular menses, one required another TEEA, whereas one required hysterectomy. Duration of operation in single end-point coagulator was ∼10 min, and bleeding immediately stopped in 15 of 25 cases. Follow-up of those cases for 12 months revealed that three of them had developed amenorrhea, nine developed minimal bleeding, nine developed regular menses, three required another TEEA, whereas one required hysterectomy. Conclusion TEEA is an easy, almost costless, rapid, and effective procedure in treating active perimenopausal IUB. Overall results showed that the T-shaped sliding coagulator (first procedure) is better than single end-point coagulator (second procedure). However, more studies with large number of cases are recommended to confirm its safety and effectiveness.

Background Cold stress is one of the potentially life-threatening challenges that could exert dramatic effects on adult health. Cold stress could affect the synthesis of some important neuroproteins and increase the susceptibility for infection. Besides, it is one of the famous predisposing causes that can affect mood and result in actual mood effect. Hawthorn plant possesses various bioactive natural compounds. However, there has been little attempt toward exploring the potential health effects of hawthorn. Objective The aim of the research is to validate if hawthorn extract could be used as a strategy against the multiple health adverse effects that might result from cold stress. Materials and methods A total of 50 adult male albino rats were equally divided into five groups: control; hawthorn administered; cold stress exposed; cold stress exposed and pretreated by hawthorn; and cold stress-exposed and concomitantly treated by hawthorn. Blood samples were collected to investigate the proinflammatory markers, such as serum interleukin-6 (IL-6), oxidative stress markers, superoxide dismutase (SOD), and malondialdehyde (MDA), as well as the brain-derived neurotrophic factor (BDNF). Results Rats exposed to cold stress showed significant increase in serum IL-6 and MDA, whereas serum SOD and BDNF were significantly decreased. Fortunately, hawthorn-administered rats revealed alleviation of these disturbances, as serum IL-6 and MDA were significantly decreased, with an associated significant increases in serum SOD as well as BDNF. Conclusion Hawthorn extract can be used as a neuromodulator, an antioxidant, and an anti-inflammatory agent for reversing the adverse effects of cold stress.

Background Primary hepatic malignant epithelial neoplasia includes several different types of tumors, among which includes cholangiocarcinoma (CC), the second most frequent cancer of the liver after hepatocellular carcinoma (HCC). However, the most common hepatic epithelial malignant neoplasms are metastatic adenocarcinomas (AC). Hepatocyte paraffin 1 antibody (Hep Par 1) is a monoclonal antibody that reacts with normal and neoplastic liver cell. Anti-epithelial cell adhesion molecule monoclonal antibody 31 (MOC-31) is an antibody directed against a cell surface glycoprotein. Cytokeratin 7 (CK7) is expressed in normal and neoplastic epithelia. Aim To study the usefulness of the immunohistochemistry of Hep Par 1, MOC-31, and CK7 in differentiating primary and secondary carcinomas in the liver. Materials and methods The present study included 45 specimens from cases of primary and metastatic liver tumors, including 15 primary HCCs in the liver, four intrahepatic CCs, and 26 metastatic ACs in the liver. They were studied to evaluate Hep Par 1, MOC-31, and CK7 expression. Results The sensitivity of Hep Par 1 for HCC in the study group was 73.3%, whereas its specificity was 100%. The sensitivity of MOC-31 for AC in the study group was 96.4%, whereas its specificity was 91%. The sensitivity of CK7 for CC in the study group was 100%, whereas its specificity was 54%. Conclusion Hep Par 1 has very sensitive and specific immunostaining for HCC, MOC-31 is a useful marker for AC with high sensitivity and specificity, and CK7 is highly sensitive for CC but its specificity is low. A combination of Hep Par 1 and MOC-31 is the most useful combination of two antibodies for the distinction between HCC and AC.

Background Osteoporosis affects women severely, especially in older ages after menopause. It may lead to bad drawbacks that may be prone to considerable pathological conditions, for example, fracture and sever pain. Objective This study aims to identify the effect of antioxidant and iron chelator on metabolic bone turnover in ovariectomized rats. Materials and methods The rats were divided into five groups: negative control, positive control, desferal-treated, vitamin E-treated, and desferal+vitamin E-treated groups. Determination of serum estrogen, ferritin, alkaline phosphatase (ALP), tumor necrosis factor-α (TNF-α), and osteocalcin was done at the end of experiment. Moreover, morphology of bone in female rats was evaluated at the end of experiment. Results Ovariectomy led to decrease in serum estrogen level and increase in serum levels of ferritin, ALP, TNF-α, and osteocalcin. On the contrary, usage of desferal and vitamin E led to decrease in serum levels of ferritin, ALP, TNF-α, and osteocalcin. Regarding histological picture of bone, our results showed abnormal structure of the bone of the untreated group vs improved histological picture of the treated groups. Conclusion The female rats that were subjected to ovariectomy and experienced osteoporosis showed improvement in their bone by using desferal and vitamin E alone or in combination.

Background Amlodipine as a calcium channel blocker has anti-inflammatory effect through overaugmentation of nitric oxide production and antioxidant effect by reduced superoxide radicals and increased level of superoxide dismutase. l-carnitine has anti-inflammatory action through reaction with acyl group that is accumulated in anoxic cells and antioxidant effect through decreasing the superoxide anion production. Aim The aim was to evaluate the possible ameliorating effect of amlodipine (AML) and L-Carnitine (L-C) combination on osteoporotic bony changes in ovariectomized (OVX) rats versus each drug separately. A total of 50 adult female albino rats (weighting 100–125 g) of local strain were chosen as an animal model for this study. The animals were randomly divided into five groups. Each group comprised ten rats: group 1, negative control; group 2, OVX rats, positive control; group 3, AML-treated OVX rats; group 4, L-C-treated OVX rats, and group 5, AML and L-C-treated OVX rats. Bony changes were examined through evaluating markers of bone turnover, such as alkaline phosphatase and osteocalcin; femoral metaphyseal histomorphology; and serum proinflammatory cytokines, such as tumor necrosis factor-α, expression. Results alkaline phosphatase, osteocalcin, and tumor necrosis factor-α were significantly elevated in positive control group, which was associated with marked deterioration of bone microarchitecture. Treatment with AML and L-C combination significantly mitigated inflammation and histopathological osteoporotic changes compared with each of AML and L-C drugs separately. Conclusion AML and L-C combination could have a synergistic role in management of radical osteoporosis in OVX rats over each drug separately.

Background and aim Numerous studies demonstrate natural killer (NK) cell dysfunction in hepatitis C virus (HCV) infection. Direct-acting antivirals (DAAs) can change NK cell activation when HCV replication is inhibited. Only few studies have reported the effect of DAAs on NK cells, especially in genotype 4. Therefore, our study aimed to examine the effect of elimination of HCV by DAA therapy on NK activity in chronic hepatitis C-infected patients. Patients and methods A prospective cohort study was conducted on 50 Egyptian naïve chronic hepatitis C-infected patients. The patients were treated with sofosbuvir/daclatasvir±ribavirin for 12 weeks, and NK cells were detected at baseline and at 12 weeks after the end of the treatment by multicolor flow cytometry. Results Overall, 98% of studied patients achieved sustained virological response (SVR) 12. One patient did not achieve SVR 12; this patient was given a second course of treatment with sofosbuvir (ombitasvir/paritaprevir/ritonavir) and ribavirin for 12 weeks and successfully achieved SVR. Therefore, SVR 24 of studied patients was 100%, and there was a significant increase in cluster of differentiation 16⁺ cluster of differentiation 56⁺ after treatment compared with pretreatment data (P=0.000). Conclusion Elimination of HCV infection by DAA therapy can restore the frequency of NK cells of chronic hepatitis C-infected patients.

Background Panniculectomy has frequently been asked by many women to be done in the same session as a cesarean section (CS), to remove excess skin and stretch marks that develop during pregnancy and gain the benefits from avoiding a future surgery and repeated anesthesia. Aim To evaluate the safety, the cosmetic results, and possible complications of combining panniculectomy with CS. Patients and methods This study included 50 pregnant women who underwent panniculectomy combined with CS. The study was conducted in Al-Hussain University Hospital, in Cairo, Egypt, during the period from April 2018 till February 2020, and had an average follow-up period of 6 months. Results This study showed that 24 (48%) patients were happy with the overall results. More than 50% of the cases had either postoperative complications or some unpleasant results. Persistent bulging of the abdomen and/or lack of waist definition (36%) were the most unesthetic result. Postoperative complications included infection (18%), wound dehiscence (9%), and distal skin necrosis (12%). Conclusion It may seem quite beneficial to combine the two surgical procedures in the same setting. However, owing to the higher risk of postoperative complications and unesthetic outcomes, it does not seem to be in the best interests of most patients.

Background Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vestibular disorder. Several studies have correlated between vitamin D deficiency and the development of BPPV. Objectives The aim of the study was to measure the serum levels of vitamin D and serum calcium in patients with BPPV and if vitamin D deficiencies have a role in the development of BPPV. Patients and methods The study included 50 patients with first attack of BPPV based on characteristic nystagmus on Dix-Hallpike’s and Supine-Roll’s tests, where serum levels of 25-hydroxyvitamin D and calcium, including both total and ionized forms, were measured and compared with control group of 25 apparently healthy individual. Results The mean vitamin D level in patients with BPPV and control groups was 22.80±11.26 and 29.30±10.62 ng/ml, respectively. There was a statistically significant difference regarding vitamin D levels in BPPV group in comparison with the control group (P=0.019). Moreover, there was a statistically significant difference regarding vitamin D deficiency in patients with BPPV in comparison with the control group (P=0.046). Conclusion Vitamin D deficiency contributes to the development of BPPV through abnormal calcium metabolism in the inner ear.

Background Psoriasis is a multisystem, immune disorder driven by inflammatory processes, characterized by skin and joint manifestations, and may be associated with hearing loss. Aim To assess the hearing function in patients with psoriasis and if psoriasis could cause sensorineural hearing loss (SNHL). Patients and methods A total of 50 patients with psoriasis and 50 apparently healthy controls matched for age and sex were included in a cross-sectional comparative study between May 2017 and April 2018. Medical history of patients was taken. Demographics, type of psoriasis, and disease severity evaluated by PASI score were assessed. All patients who were included in this study provided a complete history and audiological history. All patients underwent otoscopic examination, pure tone audiometry, speech audiometry, and immittancemetry including tympanometry and acoustic reflexes. Results There was no statistically significant difference in age or sex for patients with psoriasis and the control group. Eight patients with psoriasis showed impaired hearing function with significant longer duration with psoriasis and older age more than 20 years old in comparison with the rest of the patient. Conclusion Psoriasis is a chronic inflammatory immune-mediated skin disease with estimated prevalence in Upper Egypt at a rate of 0.19% of skin diseases. There were eight (16%) patients who had SNHL in psoriatic group in comparison with three (6%) cases in nonpsoriatic group. There was a statistically significant difference for the age and the duration of psoriasis in relation to hearing loss. SNHL increased with age in psoriatic patients much more than in healthy controls.

Objective Morbid obesity (defined as a BMI>40) is a severe condition in developing countries. Morbid obese patients are at high risk for psychiatric and psychological dysfunctional disorders. Moreover, many of bariatric surgery candidates experience mood disorders, anxiety, and eating disorders after bariatric surgery. Patients and methods Psychological assessment was done using the Arabic version of structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition axis I disorders for 70 morbid obese patients (22 males and 48 females), with mean age of 36.57 years, at Al-Zahraa University Hospital, before they underwent bariatric surgery. Psychiatric reassessment for the same patients was done 6 months later after the operation. Results The prevalence of psychiatric disorders among 70 morbid obesity participants who underwent obesity surgery was 48.6%, depression was 45.71%, anxiety was 12.86%, and eating disorders (binge eating) was 11.43% before surgery, whereas reassessment 6 months after surgery by reusing Arabic version of structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition axis I disorders showed decrease in psychiatric disorders by 20.6%, decrease in diagnosis of depression by 37.5%, and eating disorders, especially binge eating, by 62.5%, but no difference in anxiety. Conclusion The results highlight the importance of psychological assessment and counseling before and after bariatric surgery to help patients to achieve their goal of losing weight and improve their quality of life after surgery.

Background and aim Early detection of patients with gastroesophageal varices at high risk of bleeding is crucial. Nevertheless, sparing endoscopy to low-risk patients would be of value. Therefore, noninvasive methods have been proposed. Our study aimed to verify whether plasma GAS6 concentrations are related to the presence and/or degree of esophageal varices in patients with LC. Patients and methods This cross-sectional study included 100 patients with LC who underwent upper gastrointestinal endoscopy. Results Mean level of GAS6 was 77.70±21.31 among enrolled patients. Patients with varices had significantly higher level of GAS6 in comparison with those without varices (82.93±18.12 vs. 45.57±4.18 ng/ml; P<0.001). Level of serum GAS6 was also increased with advancement in the variceal grade. Conclusion Plasma level of GAS6 was higher among patients having varices in comparison with those without, and its level was increased with advancement in the grade of varices. GAS6 is reported to have a good predictive value for hepatic fibrosis in patients with chronic liver disease.

Objective Hypospadias is the most common anomaly of congenital urogenital defects. Tubularized incised plate (TIP) repair is an established technique. High rates of its complication advocate the idea of grafting of TIP incision. Grafts may be buccal mucosa or prepuce in this study. Patients and methods This prospective study included 64 patients complaining of mid and distal penile hypospadias. The patients were randomized into three groups according to the technique used in the repair of hypospadias. The first group included patients repaired by TIP urethroplasty, whereas group B and group C included patients repaired by inner perpetual skin and buccal mucosa, respectively. Follow-up was for 6 months. Results This study included 64 cases. TIP repair (group A) was done for 20 patients, whereas in 44 cases, TIP grafting was performed; groups B and C included 21 and 23 cases, respectively. The TIP urethroplasty was successful in 85%, whereas in groups B and C, the success rates were 91.5 and 87%, respectively. There were statistically insignificant differences in complications among all groups (P>0.005). Conclusion Outcomes of TIP grafts have no significant difference than outcomes of TIP technique.

Background Diabetic neuropathy is one of the most common neurological diseases. Dyslipidemia is very common in diabetic patients and thought to add to the effect of diabetes on peripheral nerves. Objectives To assess the effect of dyslipidemia on diabetic peripheral neuropathy among patients with type 2 diabetes mellitus. Patients and methods A total of 60 patients with peripheral diabetic polyneuropathy were included and divided into two groups: the first included 30 patients with diabetic neuropathy and dyslipidemia and the other 30 patients had diabetic neuropathy without dyslipidemia. Another 30 healthy volunteers were included as a control group. All were subjected to full history taking, clinical examination, laboratory investigations, and neurophysiological studies. Results Hypertension and smoking were significantly increased in cases when compared with controls. Regarding the severity of neuropathy, it was mild in seven (11.7%) patients, moderate in 34 (56.7%) patients, and severe in 19 (31.7%) patients. Neurophysiological studies of the studied populations revealed significant changes of both motor and sensory parameters in cases when compared with controls and in the group with dyslipidemia when compared with the group without dyslipidemia. In addition, there was a significant correlation between lipid profile and each of glycated hemoglobin, fasting and postprandial blood sugar, and different neurophysiological examinations. Conclusion Dyslipidemia added to the hazardous effect of diabetic neuropathy on neurophysiological studies. In addition, there was a significant correlation between lipid profile and changes in nerve conduction studies.

Background The prevalence of diabetes has increased exponentially over the past decade. Much has been published on its characteristics and its association with the obesity, but relatively little is known about the incidence of lean type 2 diabetes and its pathophysiology. Aim The aim was to determine the role of insulin resistance and β-cell dysfunction in disease pathophysiology in lean type 2 diabetic patients. Patients and methods The authors evaluated parameters including BMI, fasting blood glucose, fasting insulin, homeostatic model assessment for insulin resistance, and homeostatic model assessment for β-cell function percentage. This study was carried out on 300 adult patients who were classified into four groups: group I (lean type 2 diabetic patients with BMI ≤27 kg/m²), group II (obese type 2 diabetic patients with BMI >27), group III (lean controls), and group IV (obese controls). Results When comparing group I with group II, there was a statistically significant difference regarding the sex, where males (64%) were more in group I. Regarding homeostatic model assessment for insulin resistance, in group I, it was 2.00±0.79, whereas in group II, it was 4.97±1.22, with statistically significant difference (P=0.00), and regarding homeostatic model assessment for β-cell function percentage, in group I, it was 33.76±19.89, whereas in group II, it was 56.45±17.69, with statistically significant difference (P=0.00). Conclusion This study showed that lean type 2 diabetes was common in male sex and characterized by low level of insulin resistance and was associated with markedly reduced β-cell function in contrary to what occurred in obese type 2 diabetes with marked insulin resistance.

Background Sepsis is a common cause of morbidity and mortality among neonates. The clinical usefulness of assessment of presepsin concentration was studied and compared with other laboratory parameters in a prospective case–control study. Patients and methods A prospective case–control study was carried out in the neonatal intensive care unit of Al-Azhar University Hospital (Assiut, Egypt) from July 2016 to July 2018. The authors enrolled 80 newborns: 40 at high risk of neonatal sepsis (group A), 20 septic (group B) according to Tollner clinical sepsis score greater than 2 and/or positive blood culture, and 20 controls (group C). Full medical history, clinical examination, estimation of gestational age by new Ballard score, and laboratory investigations were done. Presepsin, C-reactive protein (CRP), complete blood count, and blood culture were done during first day (D1) of admission for all neonates. Additional measurements of presepsin and CRP were done at D3 for group A, and another measurement at D5 for neonates who have increased CRP and/or appearance of signs of sepsis (group A) at D3. Result Initial levels of serum presepsin in 80 neonates ranged from 293 to 1648 pg/ml. Presepsin had a significant difference between groups A and B (692.9±79.49 and 1327.3±208.41 pg/ml, respectively; P<0.001***). In group A, neonates who developed clinical signs of sepsis, presepsin levels had significant difference between D1, D3, and D5 (P<0.001***). Presepsin had a significant difference between full-term and preterm neonates (P<0.001***). There was a positive correlation of presepsin with CRP and white blood cells (r=0.580 and 0.546, respectively). Coagulase-negative staphylococci were the most isolated organism. The receiver operating characteristic curve of presepsin at enrollment shows an area under the curve of 0.99. The best calculated cutoff value was greater than or equal to 722 pg/ml, with 100% sensitivity and 97.5% specificity. Conclusion Presepsin level changes early in the disease course, so it can be used as a reliable biomarker for early diagnosis of neonatal sepsis, and it is a promising marker for detection of improvement.

Background Asthma is a disease outlined by its clinical, physiological, and pathological features. Airways inflammation and hyperreactivity of bronchial tissues were the most important manifestations of bronchial asthma. Aim The aim was to evaluate serum sodium and potassium levels in pediatric asthmatic patients and match these levels during and in between the attack and with healthy control children. Participants and methods This was a case–control study that was done on pediatric patients with asthma. The cases were children with confirmed asthma of an age group of 5–12 years old, and the age-matched controls were children without respiratory signs or symptoms. Serum sample for measuring absolute eosinophilic count, sodium, and potassium value was obtained. Results The mean values of serum sodium during the attack and in between the attack were 136.78±2.66 and 140.51±2.62 mmol/l, respectively, with significant difference (P<0.05). Both the mean values of serum sodium were found to be significantly lower than the mean value of the control (141.58±2.34 mmol/l). The mean values of serum potassium during the attacks and in between the attacks were 3.28±0.44 and 3.94±0.32 mmol/l, respectively (P<0.05). Both the mean values of serum sodium, i.e., during and in between, were found to be significantly lower than the mean value of the control (4.12±0.32 mmol/l). Hyponatremia was detected in 8 and 6% of the asthmatic patients during the attacks and in between attacks, whereas hypokalemia was detected in 56 and 9% of the asthmatic patients during the attacks and in between the attacks. Conclusion The study showed that asthmatic patients presented with hyponatremia and hypokalemia, and there is a significant difference between serum sodium and potassium levels during attacks and in between attacks and when compared with the control group.

Background Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airway disease (e.g. obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person. Aim The aim of the study was to determine the effect of systemic corticosteroids in patients with severe acute exacerbations of COPD admitted to the ICU receiving ventilatory support. Patients and methods A total of 100 patients with acute exacerbations of COPD leading to hypoxemia and respiratory acidosis with pH less than 7.35 and PaCO₂ more than 45 mmHg admitted to the ICU who were receiving ventilator support (invasive or noninvasive mechanical ventilation) were included. Results It was noticed that steroid group had significantly lower duration of mechanical ventilation (4.67±2.76 vs. 2.76±1.11 days; P=0.01), ICU stay (5.33±2.87 vs. 7.89±3.36 days; P=0.04), and hospital stay (11.65±3.89 vs. 16.67±4.44 days; P=0.03). Conclusion Corticosteroid therapy was associated with significantly lower duration of mechanical ventilation, ICU stay, and hospital stay.

Background Gestational diabetes mellitus (GDM) may cause fetomaternal complications. GDM can be diagnosed conventionally by an oral glucose tolerance test (OGTT). Glycated hemoglobin (HbA1c) is a marker for the blood glucose level in the previous 2–3 months. Objective The aim was to assess the role of using HbA1c as a predictor for developing gestational diabetes in the second trimester. Patients and methods Fifty pregnant women were investigated by ultrasound, and HbA1c and OGTT were performed for all cases at 18–22 weeks of gestation and repeated at 32–36 weeks of gestation. Results There were statistically significant differences between women with HbA1c value less than 5.7% and those with 5.7–6.4% according to BMI, parity, and maternal weight. A positive correlation was detected between HbA1c level and development of GDM according to OGTT, which was done in the third trimester, as women with HbA1c values less than 5.7% have decreased risks of developing GDM than women with higher levels of HbA1c. Follow-up of all cases detected significant relation between level of HbA1c and neonatal birth weight, neonatal ICU admission, and APGAR score, where the pregnant women whose HbA1c less than 5.7% got infant with less birth weight and better APGAR score and the incidence of neonatal ICU admission was less in their infants. Conclusion HbA1c can be used to predict the development of GDM in second trimester. Receiver operating characteristic curve identified that the best cutoff value of HbA1c was 5.2%, with sensitivity of 75%, specificity of 80%, positive predictive value of 71.4%, negative predictive value of 82.8%, with accuracy of 87.2% for diagnosing GDM.

Background Rhinogenic contact point headache (RCPH) is intermittent pain localized in the periorbital and temporozygomatic or medial canthal regions. RCPH occurs owing to the presence of anatomical variations between adjacent mucosal surfaces in the nasal cavity. Concha bullosa (CB) is pneumatization of the middle turbinate, which is a common anatomic variation of lateral nasal wall. CB may increase in such a way that it fills the space between septum and lateral nasal walls, which creates areas of mucosal contact, predisposing to rhinogenic headache. Aim To evaluate the efficacy and outcomes of endoscopic turbinoplasty technique for CB ‘conchoplasty’ compared with lateral partial turbinectomy (LPT), in patients with RCPHs not responding to medical treatment. Patients and methods A prospective study was conducted that included 30 patients with RCPH and significant CB. The patients were randomly divided into two groups: group A included 15 patients who underwent LPT and group B included 15 patients who underwent conchoplasty. Results Complete cure or significant reduction in the severity of complaints reported in 13 patients who underwent LPT. In the conchoplasty group, 14 patients were completely cured at the end of the follow-up period. In the LPT group, a complication noted was synechiae formation in two cases. Conclusion Compared with LPT, conchoplasty is an equally effective surgical treatment of significant CB with lesser incidence of complication.

Background Three types of uterine factors have been implicated in infertility: leiomyomas, endometrial polyps, and intrauterine adhesions. Mechanisms of infertility have not clearly been elucidated; however, the end result is decreased endometrial receptivity and reduced likelihood of embryo implantation. Transvaginal sonography is a sensitive method for the evaluation of the uterine masses and abnormalities. Objective To evaluate the diagnostic accuracy of transvaginal ultrasonography in detection of intrauterine abnormalities compared with hysteroscopy in women with history of unexplained infertility. Patients and methods The study was conducted in infertility clinic of Al-Azhar Assiut University Hospital. A total of 30 cases were included in the study during the period between August 2018 and March 2019. The chief complaint of patients was unexplained infertility. All candidates underwent transvaginal ultrasound, and the uterus was examined in longitudinal and transverse planes (two-dimensional transvaginal ultrasound) and the three-dimensional transvaginal ultrasound), and hysteroscopic examination was done for all cases using general anesthesia. Results In our current study, using transvaginal ultrasound, we diagnosed 28 cases with abnormalities (nine intrauterine adhesions, seven fibroids, six polyps, four irregular endometrium, one case of endometritis, and one case of septum). By hysteroscopy, 27 cases were confirmed to have abnormalities (11 intrauterine adhesions, five fibroids, seven polyps, two endometritis, and two cases of septum). Conclusion Routine use of transvaginal sonography (two dimensional and three dimensional) in diagnosing uterine cavity abnormalities is satisfactory and consequently is becoming a basic tool in investigating infertile patients. Hysteroscopy which is the gold standard in investigating the uterine cavity should be used to confirm the findings of transvaginal sonography and also when transvaginal sonography gives doubtful results.

Background Thyroid eye disease (TED) is the most common autoimmune disease of the orbit. Management includes conservative measures, medical therapy, surgery, and targeted biologic therapy. Aim To compare the efficacy of repeated peribulbar triamcinolone injections with surgical orbital decompression in patients with moderate to severe TED. Patients and methods A prospective nonrandomized, noncontrolled comparative interventional study was conducted that included 30 eyes with moderate to severe inactive TED, which were divided into two groups: group A included 15 eyes that were enrolled for surgical orbital decompression and group B included 15 eyes that underwent repeated peribulbar triamcinolone injections. Patients were subjected to preoperative and postoperative ophthalmological examination, including visual acuity, intraocular pressure measurement, and degree of proptosis. Results Hertel’s exophthalmometer measurements showed mean±SD difference between preoperative and postoperative values in group A of 6.20±1.32, whereas group B had 2.53±0.92, revealing high statistically significant differences between preoperative and postoperative results in each group as well as between both groups. Differences in intraocular pressure values between preoperative and postoperative periods in group A were 1.73±1.39 and in group B were 1.13±0.92, showing a highly statistically significant difference. Concerning refraction, the mean difference between preoperative and postoperative periods in sphere, cylinder, and axis in group A showed a highly statistically significant difference in cylinder and axis, whereas only cylinder and not axis in group B. Conclusion Both repeated peribulbar injection of triamcinolone and surgical orbital decompression are effective modalities for management of moderate and severe inactive TED, with surgical orbital decompression having the upper hand in providing better results in reduction of proptosis.

Background Occupational noise can cause hearing loss and also may affect the vestibular system and result in vestibular dysfunction. Aim To study the effect of noise exposure on the cervical vestibular-evoked myogenic potential (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) and to correlate between duration of noise exposure and vestibular dysfunction if present. Patients and methods A total of 60 patients were included in this study, comprising a study group of 30 patients with noise-induced hearing loss and a control group of 30 healthy participants with normal hearing and vestibular function. Patients of both groups underwent cVEMP and oVEMP. Results cVEMPs showed a highly statistically significant difference between the study and control groups regarding P13 and N23 latencies and P13–N23 amplitude, and oVEMPs showed a statistically significant difference between the study and control groups regarding N1 and P1 in latencies and N1–P1 amplitude. A positive correlation was found between duration of noise exposure and VEMPs latencies, whereas a negative correlation between it and VEMPs amplitude. Conclusion Noise exposure is a hazard to inner ear structures that can enhance the damage of vestibular part, especially the sacculocolic pathway.

Background Behçet’s disease (BD) is considered a chronic multisystem disorder, where neurological manifestations are common. There is scarcity of investigations that have assessed the autonomic nervous system dysfunction in BD, with conflicting results. Objectives The current study aimed to identify presence of autonomic nervous system dysfunction using neurophysiological assessment in BD and to investigate the relationship between the indicators of autonomic function and the disease activity parameters. Patients and methods The study involved 30 patients with BD in accordance with the Universal Criteria for Behçet’s Diseases and 25 controls, who were subjected to clinical evaluation and Palmar sympathetic skin response (SSR). Results Patients with BD had a significant difference in SSR (P<0.001) compared with controls. Moreover, a significant positive association was found among neuropathic pain and disease activity parameters. Conclusion The study confirms the presence of sympathetic autonomic dysfunction in BD, which related to disease activity using a simple noninvasive test such as SSR.