Background and Aim Meniscal tears are one of the most frequent disorders affecting the knee joint in athletes and normal people. MRI the first choice of imaging of knee joint but in recent days, ultrasound (US) has made strides in imaging of musculoskeletal disorders due to improvement of imaging qualities. This study aimed to investigate the role of US in diagnosis of meniscus tears as compared to MRI. Patients and Methods A total of 100 patients examined by high definition US and under go to MRI examination of the knee joint. Results Regarding the diagnostic performance of US compared to MRI, the sensitivity reached (89.1%), specificity (∼72.2%), positive predictive value (∼90.1%), negative predictive value (70.1%), and accuracy (84.7%). Conclusion Ultrasonography may be used as a screening tool before arthroscopy in selected cases where MRI was a contraindication or is not available or if the patient was not affording. Ultrasonography showed a dynamic image of the meniscus and thus may prove useful if studied in conjunction with correct clinical examination.

Background and Aim This study aimed to evaluate the role of diffusion-weighted imaging (DWI) and apparent diffusion coefficient in diagnosis of the breast lesions. Patients and methods This study included 100 patients referred to the Radiology Department of Al-Azhar Assiut University Hospital from February 2018 to May 2020 for DWI MRI examination with a provisional diagnosis of breast lesions. All patients were recruited after meeting the inclusion criteria. They underwent clinical examination, mammography, ultrasonography, and contrast-enhanced MRI with DWI. Results Our study included 100 cases. The combined MRI protocol of dynamic contrast-enhanced (DCE)-MRI and DWI was true positive in 60 and true negative in 30 patients. The combined MRI protocol of DCE-MRI and DWI provided a sensitivity of 92%, a specificity of 90%, a positive predictive value of 95.8%, a negative predictive value of 81.8% and accuracy of 91.43%. In this study, the addition of DWI to standard DCE-MRI provided a 10% increase in the specificity of breast MRI, with a 4% decrease in the sensitivity. Conclusion DWI is a short unenhanced scan and had the highest specificity compared with other imaging modalities, as it reduced the false-positive results. It should be added to conventional breast MRI to increase the sensitivity and specificity of MRI.

Background and Aim Carbohydrate antigen 15.3 (CA 15.3) is the most frequently used tumor marker in breast cancer (BC). MicroRNAs (miRs) can be used to screen, diagnose, evaluate, and follow-up on some cancers. Our research aimed to explore the value of circulating miR-155 and miR-21 for diagnosis and monitoring therapy of BC compared with CA 15.3. Patients and Methods Our study included four groups: 25 women who were completely healthy, 20 women suffering from benign breast diseases, 20 patients suffering from BC after complete therapy, and 25 patients with BC before undergoing any therapy. CA 15.3, MiR-155, and miR-21 were measured for all participants. Results MiR-155, miR-21, and CA 15.3 levels in the four groups showed significant differences. MiR-21 is the most sensitive, followed by miR-155 and CA 15.3. Conclusion Serum miR-155 and Serum miR-21 could be useful tests like CA 15.3 for differentiation between women suffering from BC, women suffering from benign breast diseases, and completely healthy women.

Background and Aim The definition of chronic rhinosinusitis is inflammation of the nose and paranasal sinuses characterized by two or more symptoms like nasal obstruction, congestion of nasal mucosa, reduction or loss of smell, facial pain, and either endoscopic signs of polyps edema or mucosal obstruction primarily in middle meatus, maybe computed tomography changes showing mucosal changes within the ostiomeatal complex and sinuses. The aim of this study was to assess the outcome of medical treatment in comparison with functional endoscopic sinus surgery as a treatment of allergic nasal polyposis. Patients and methods A prospective study was carried out at Al-Zahraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, which included 40 patients (30 males and10 females) divided into two groups, mean age of group A (36.9±10.2) and mean age of group B (39.8±9). Results There is no statistically significant difference between both groups as regards runny nose, nasal obstruction, postnasal drip, smell sensation, taste sensation, sneezing, fascial pain, or headache before intervention. There is a statistically significant difference between both groups after intervention (by medication or surgery) as regards runny nose (P=0.034), nasal obstruction was highly significant (P=0.001), and smell sensation was highly significant (P=0.005), while there was no significant difference between both groups as regards other symptoms like postnasal drip, fascial pain, headache, sneezing, and taste sensation (P>0.05). Conclusion We conclude from our data that medical treatment was cost-effective and time-saving. Many patients who received medical treatment responded well to the point of refusing any surgical procedure, functional endoscopic sinus surgery is essential when medical treatment was not sufficient in improving manifestations.

Background and Aim Given the pandemic crisis of COVID-19 pneumonia, the computed tomography (CT) chest is widely used for initial management of patients with suspected COVID-19 because of its well-known high sensitivity for detection of COVID-19 pneumonia, but its cost, which decreases its availability for certain populations, risk of radiation, need for transportation of the patient, the burden of proper disinfection of the CT room and its unsuitability for some patients like pregnant and lactating women certainly lead to the necessity for a more advantageous tool like lung ultrasound that could solve many of the previous obstacles encountered while deciding to perform the CT chest. This study aims to determine the suitability of lung ultrasound as an alternative to CT chest to aid in the initial management of these patients. The aim was to determine the value of lung ultrasound in the diagnosis of lung parenchymal affection in patients with COVID-19. Patients and methods A prospective including 150 patients was carried out in the Chest, Interventional Radiology and Clinical Pathology Departments in Bab-El-Sha’aria and Al-Hussin Hospitals, Al-Azhar University, during the period from May 2020 to September 2020. Lung ultrasound was performed in 150 patients with COVID-19 pneumonia diagnosed based on the integrated clinical, laboratory, and CT chest radiological data. Results Among 150 patients, there were 86 males and 64 males, ranging in age from 30 to 75 years and a mean age of 55.8±12.1 years. Bilateral lung infiltrates in the CT scan were present in 146 patients (97.3%), CXR infiltrates were present in 63 patients (42%), sonographic evidence of pleuropulmonary involvement was present in 139 patients (92.7%), B lines and pleural line thickening were present in all patients with ultrasound findings (100%), subpleural consolidation associated with B lines was present only in 33 patients (23.7%) and pleural effusion was absent in all cases; crackles were only present in 53 (35.3%) patients. Conclusion Because of its simplicity in interpretation, bedside availability, lack of risk of radiation and good sensitivity in the detection of lung parenchymal affection, the chest ultrasound is a useful tool in the management of patients with symptoms suspicious of COVID-19 infection and seems to be a suitable substitute for the CT chest in such circumstances.

Background and aim Male pattern hair loss is a common noncicatricial alopecia that results from progressive miniaturization of the hair follicle. The aim of this study is to evaluate the role of trichoscopy in differentiating between severe and mild cases of male pattern hair loss. Patients and methods A hospital-based cross-sectional study was carried out on 300 males with pattern hair loss. Detailed history, clinical examination, and trichoscopy were performed. All participants were divided according to severity into two groups. Group 1 (n=207) included stages one, two, and three, while group 2 (n=93) included stages four, five, six, and seven on the basis of the Hamilton Norwood classification. Results The frequency of yellow dots, white dots, vellus hair, and hair shaft diversity (HSD) more than 20% was higher in group 2 than group 1 (P≤0.05). Conclusion Trichoscopy is a very valuable and useful method to differentiate between severe and mild cases of male pattern hair loss.

Background and aim Thalassemia is a chronic illness that has a range of serious clinical and psychological effects, it does not only affect the physical functioning of patients but also their emotional and social functioning and school functionings, leading to impairment of health-related quality of life of the patients due to the effects of the disease and its treatment. The aim of this study was to assess the effect of treatment with hydroxyurea on calcium homeostasis in β-thalassemia-major patients. Patients and methods This study is a prospective, case–control one, it was done on 50 patients with β-thalassemia major who received regular blood transfusion at Luxor International Hospital [25 patients received hydroxyurea (group II) and 25 patients did not receive hydroxyurea (group I)] and 25 apparently healthy children as controls. Results Group II (received hydroxyurea) had better results than group I (not received hydroxyurea) regarding the frequency of blood transfusion, manifestations of hypocalcemia (tetany, convulsions, and carpopedal spasm), and the occurrence of the boneache and bone fractures. Group II (received hydroxyurea) had better hemoglobin levels as well as other complete blood count parameters than group I (not received hydroxyurea). Group II (received hydroxyurea) had better results regarding serum-ionized calcium as well as serum ferritin, serum alkaline phosphatase, and serum phosphorus levels than group I (not received hydroxyurea). Conclusion Disturbed calcium homeostasis is one of these iron-overload hazards; it has different clinical and laboratory manifestations that can be improved by using the hydroxyurea therapy in the management of β-thalassemia patients.

Background and aim In the developing and advanced countries across the world, young people have the tendency of consuming alcohol in combination with other abused substances. This study aimed to investigate the biochemical and histopathological effects of chronic toxic effects of two commonly abused substances, ethanol and/or tramadol, on testicular function in adult male Albino rats. Materials and methods Forty animals were equally divided into four groups: control group that received normal saline only, ethanol group that received ethanol [30% (v/v)] orally at a dose of 2 g/kg, tramadol group that received tramadol subcutaneously at a dose of 60 mg/kg, and ethanol+tramadol group that received ethanol+tramadol by the route and at the dose described above for 60 days. Twenty-four hours after the administration of the last dose, rats were sacrificed, blood samples were obtained, and serum testosterone was determined. Testes were harvested and weighed. Glutathione, superoxide dismutase, catalase, glutathione peroxidase, and malondialdehyde levels and histology (hematoxylin and eosin) were evaluated in the testis. Results Testosterone level, relative testicular weights, and testicular glutathione, catalase, superoxide dismutase, and glutathione peroxidase were significantly reduced in all experimental groups compared with controls. Conversely, malondialdehyde was significantly increased in all experimental groups compared with controls. Testicular histology in ethanol and/or tramadol showed structural aberrations that are consistent with antioxidant depletion and oxidative stress. Conclusion Abuse of ethanol and/or tramadol exerted similar, additive, and synergistic, adversely affected the male-reproductive functions, which may be due to the effects on the antioxidant-defense system and caused oxidative tissue injury as well as testicular structural aberrations.

Background and aim Proper nutrition in the neonate is essential for normal growth, resistance to infection, long-term health, and optimal neurologic and cognitive development. It is essential to start enteral nutrition early to infants by giving small amounts of milk to ensure that metabolic homeostasis is kept stable and to limit postnatal growth retardation. This study aimed to determine feeding problems in the newborns in the neonatal intensive care unit after starting enteral feeding in Minya General Hospital from May 2018 to August 2018. Patients and methods This study included 100 patients who had feeding problems, data of the patients were collected and analyzed according to standard guidelines, and values were expressed in terms of percentage. Results Abdominal distention was the most common feeding problem as it was in 42% of the studied cases. The most common morbidity associated with feeding problems was respiratory distress as it was in 68% of admitted cases, the common cause of distress was transient tachypnea of newborn followed by respiratory distress syndrome. The study showed a significant difference between full term and preterm regarding the method of feeding, type of milk formula, trophic feeding, and duration of parenteral nutrition. Conclusion The most morbidity associated with feeding problems was respiratory distress. Feeding problems increased in preterm. There was increasing incidence of feeding problems with infant formula than human milk. Also, necrotizing enterocolitis was in 11% of the studied cases and occurs mostly in preterm and the most common feeding problem was abdominal distention.

Background and aim Investigating the influence of intramyometrial carbetocin injections and rectal misoprostol on bleeding throughout myomectomy surgeries. Fibroids are firm benign tumors consisting of smooth muscle cells and fibrous connective tissues. Benign uterine leiomyomas (fibroids) are the commonest pelvic tumor in females, impacting 20–40% of all women, over the age of 35 and 50% of African–American women. This work aims to compare the effectiveness of intramyometrial carbetocin injections and rectal misoprostol on blood-loss amounts throughout myomectomy surgeries. Patients and methods A prospective randomized comparative study was performed on 120 females having myoma(s) recruited from the clinic. The 120 study participants were divided into three groups: group I involved 40 women who received intramyometrial injection of 100 µg of carbetocin, group II involved 40 women who received 400 µg of misoprostol, and group III involved 40 women who received nothing during the myomectomy operation. Results The mean blood loss was more in group III in comparison with misoprostol (group II) in comparison with carbetocin (group I) with a statistically significant difference among the three groups, it was 177.43±21.25 ml in group I, 238.00±43.87 ml in group II, and 288.00±29.72 ml in group III. Conclusion The usage of intramyometrial carbetocin injections throughout abdominal myomectomy surgery is more efficient in reducing the blood loss than the usage of rectal misoprostol than using nothing at all.

Background and Aim Helicobacter pylori (H. pylori) is a common etiology for infection-related cancers and represents 5.5% of global cancer burden that increases the need for more sensitive noninvasive diagnostic techniques. The aim was to evaluate the role of saliva and stool samples in the diagnosis of H. pylori infection to replace invasive techniques and to compare between three noninvasive diagnostic tests: salivary culture, PCR, and rapid stool antigen test (RSAT). Patients and methods The study was conducted on 45 patients with dyspepsia and 45 healthy participants as a control. Saliva and stool samples were taken from all groups and subjected to culture, PCR for detection of 16SrRNA gene of H. pylori, and RSAT to detect H. pylori. Gastric biopsy samples were taken for H. pylori culture, rapid urea test, and histopathology from 20 patients. Results A total of 15.6% specimens were positive by salivary culture in patients’ group and 2.2% specimens were positive in the control group. About 31% were positive by salivary PCR in patients’ group and 6.7% were positive by salivary PCR in the control group. About 71% were positive by RSAT in patients and 49% were positive by RSAT in controls. From 20 patients, gastric biopsy samples were taken, 11 patients were positive for H. pylori infection by gastric biopsy culture, 20 were positive by histopathological examination, and 13 were positive by rapid urea test. The salivary culture showed (100%) specificity, (38.5%) sensitivity, and (60%) accuracy. While PCR on saliva showed specificity (100%), (61.5%) sensitivity, and (75%) accuracy. RSAT showed (71.4%) specificity, 92.3% sensitivity, and 85% accuracy. Conclusion The oral cavity is an important extragastric reservoir of H. pylori; salivary PCR technique shows a much higher specificity and sensitivity than salivary culture. RSAT shows high sensitivity but with lower specificity.

Background and aim This is a prospective randomized single-center study aimed to assess the efficacy of carbetocin versus intramyometrial oxytocin in the prevention of atonic postpartum hemorrhage following Cesarean section in high-risk women. Patients and methods A total of 160 women with gestational age more than 38 weeks at high risk for primary atonic postpartum hemorrhage undergoing elective or urgent cesarean section under regional or general anesthesia were randomly divided into two equal groups: group A included 80 patients, and they received oxytocin 20 IU intramyometrially. Group B included 80 patients, and they received carbetocin, 100 μg intravenously. Results There was no significant difference in the mean values of hematocrit before and 24 h after delivery (P>0.05). Similarly, there was no significant difference in the estimated blood loss calculated by hematocrit values (P>0.05). Moreover, it was shown that 17.5% of women in the carbetocin group needed additional uterotonics versus 25% of women in the oxytocin group. Therefore, there was no significant difference between both groups regarding needing additional uterotonics. There were eight cases that needed more surgical intervention. Conclusion Both drugs are equally effective in prevention of atonic postpartum hemorrhage. There is no significant difference between single injection of carbetocin and intramyometrial 20 IU oxytocin in reducing the use of additional oxytocic agents.

Background and Aim Unconsummated marriage is a problem among couples who are not able to perform natural sexual intercourse. The aim of this work was to define the etiological factors of unconsummated marriage in newly married men. Patients and methods This is a case–control study that was carried out on 200 newly married men during the period between October 2019 and October 2020, comprising 100 men with sexual dysfunctions leading to unconsummated marriage as a case group and 100 men without any sexual dysfunctions having successful intercourse as a control group. They were evaluated through history taking, psychosexual questionnaires, general and local examinations, laboratory investigations (estimations of serum serum total and free testosterone, estradiol, prolactin, luteinizing hormone, follicle-stimulating hormone, fasting and postprandial blood glucose levels, and lipid profile), and penile duplex. Results Regarding sexual history, male c ause of unconsummated marriage was present in 82% of the patients in the form of erectile dysfunction (73% psychogenic and 9% organic, using penile dupplex), and the other 18% of the patients had history of female cause in the form of vaginismus. Psychosexual history showed that history of consulting scientific informative source concerning sexuality was present in only 3% of patients, history of refusing to look closely at the partner’s genitalia was present in 4%, and history of being afraid of feeling pain during penetration was present in 9%. Conclusion Psychogenic erectile dysfunction was the most common etiological factor for unconsummated marriage. Vaginismus was found to be a major concern regarding unconsummated marriage as well. Lack of scientific information about sexuality was found to be a major risk factor for unconsummated marriage in newly married men.

Background and Aim Previous studies have shown the relationship between children with type 1 diabetes and vitamin D. To evaluate the level of vitamin D in children with type 1 diabetes and the effect of low vitamin D level on the long-term blood glucose controls reflected by glycated hemoglobin. Patients and methods The study included 20 children who had already been diagnosed as having type 1 diabetes mellitus with vitamin D deficiency and 20 normal nondiabetic children as a control group. Full history taking, clinical examinations, and investigations for all children, including serum 25-hydroxy vitamin D level, were done. Results Vitamin D deficiency was present in ∼85% of children with type 1 diabetes compared with nondiabetic control, who showed good vitamin D level. Conclusion Type 1 diabetic children are associated with low vitamin D level. Perhaps infants supplemented with vitamin D level might be a safe and effective plan for decreasing the risk of type 1 diabetes and also may decrease and improve levels of glucose and glycated hemoglobin levels in type 1 diabetes mellitus.

Background and aim Otitis media with effusion (OME) is characterized by retention of fluid behind an intact tympanic membrane. The association of vitamin D deficiency, upper respiratory tract infections, and otitis media has been reported by several studies. Aim: The aim was to investigate the relationship between OME and vitamin D level in children. Patients and methods This study is a case–control study that was carried out at Otorhinolaryngology and Pediatric Clinics at Al-Azhar University for Girls and Al Mataria General Hospital. In this study, 40 children were included, 20 children were controls and 20 children were diagnosed with OME (cases). Patients were subjected to history, otoscopic examination, and audiological evaluation (pure-tone audiometry and tympanometry). Blood samples (5 cm) were taken from case and control groups in the laboratory to measure serum 25-hydroxy vitamin D level. Results In the case group, mean vitamin D level was 17.02 ng/ml, SD±8.49, and the median was 14.90 (8.7–35.0) ng/ml. In the control group, mean vitamin D level was 25.85 ng/ml, SD±8.94, and the median was 30.20 (9.8–36.1) ng/ml with P significance equal to 0.007. Sixteen children (80%) out of 20 children of the case group and eight children (40%) out of 20 children of the control group had an abnormal value of vitamin D. An abnormal value of vitamin D was statistically significant in children with OME than the control group with P significance equal to 0.03. Conclusion It was found that vitamin D plays an important role in OME in our children and can share in the regimen of treatment of OME when it was found abnormal. Measuring vitamin D level in the case group is necessary and must be treated if abnormal.

Background and aim Several previous studies on coronavirus disease 2019 (COVID-19) cases reported that impairment of organs, that is, the liver, heart, and the kidneys, other than the lung can occur. This study aimed to evaluate the impact of COVID-19 infection on the kidneys. Patients and methods The current study was conducted as a retrospective and prospective study, where two samples of adult inpatients (aged >18 years) were recruited. The study was carried out in the period from April to June 2020 (the first wave) and from December 2020 to February 2021 (the second wave). Results A total of 1065 COVID-19 confirmed patients were admitted to the two Asyut governorate quarantine hospitals by the end of the study period (first wave n=525 and second wave n=540 patients). According to renal function parameter results, kidney injury was reported in 57.5% (n=302) of the patients in the first wave and in 58.7% (n=317) of cases in the second wave. On follow-up, only a small proportion (<10%) of patients had improvement in the kidney function parameters. Conclusion About half of the confirmed COVID-19 patients admitted to the quarantine hospitals at Asyut Governorate had kidney injury, which persisted after treatment and less than 10% showed improvement on treatment with no significant effect on the mortality rate of the patients.