Background and aim Noninvasive radiological techniques such as dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) can help distinguish between malignant and benign lesions of the breast. The current study was conducted to evaluate the diagnostic values of DCE-MRI and DWI in differentiation between benign and malignant breast lesions. Patients and methods This study was conducted on 30 patients with 32 lesions during the period from June 2019 to May 2020 at the Radiology Department and approved by the Ethics Committee. DCE-MRI and DWI were acquired for each patient using a 1.5 T machine with breast coils. Histopathological results were collected as a gold standard of the study. Results Of 32 lesions, histopathology revealed that 22 (68.75%) lesions were malignant and 10 (31.25%) lesions were benign. Mean apparent diffusion coefficient (ADC) of benign lesions was 1.25±0.56×10⁻³ mm²/s, which was significantly higher than those of malignant lesions (0.93±0.42×10⁻³ mm²/s). DWI-MRI had high sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in distinguishing benign from malignant lesions (90.9, 70, 86.96, 77.78, and 84.38%, respectively). However, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DCE-MRI were 95.5, 80, 91.3, 88.9, and 90.6%, respectively. Conclusion Compared with DWI, DCE-MRI has a higher sensitivity and specificity for distinguishing between benign and malignant lesions of the breast. Diffusion-weighted MRI provides quantitative assessment of benign and malignant lesions of the breast by measuring the ADC values.

Background and aim Online and blended learning (BL) are widely adopted by colleges during coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze BL tools that were applied in integrated ophthalmology curriculum for medical students during the COVID-19 pandemic. Patients and methods Subjective analysis was done using the Google platform survey. In all, 230 third-level medical students at Al-Azhar Faculty of Medicine responded to 19 Likert scale questionnaires at the end of the ophthalmology course. Statistical Package for the Social Sciences program, version 24 was used to measure statistical differences of students’ responses from neutrality. Results Students’ responses suggested that lecturers used effective instructional tools and explained course topics clearly, but 6 weeks for ophthalmology curriculum in association with other medical courses were exhausting for students. Virtual case-based learning can substitute practical real patients’ dependent learning for undergraduates during the COVID-19 pandemic, and using of more animations, simulations, and videos can improve clinical learning. Interaction between instructors and students was essential for better understanding and solving any educational problems. Microsoft teams was easy for studying and for conducting the examination. Most students reported that BL is more useful than only face-to-face traditional learning as BL helped them to improve thinking and selves’ confidence, and they can study at any time at home comfortably but they met some technical problems related to internet connection and electronic applications. Conclusion BL has valuable advantages over traditional only face-to-face methods and is effective in the absence of practical real patients’ dependent learning for undergraduates during the COVID-19 pandemic.

Background Using infliximab (IFX), an antitumor necrosis factors antibody, has dramatically increased therapeutic choices for ulcerative colitis (UC). This study assessed IFX therapy’s efficacy, safety, and action predictor variables for UC. Patients and methods This prospective interventional study was done on 50 patients with UC. Patients underwent colonoscopy, biopsy, complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) before start of IFX and after 8 weeks. Patients started 5 mg/kg IFX infusion at 0, 2, and 6 weeks and then every eight weeks. After 6 months, cases were subjected to colonoscopy, biopsy, CRP, complete blood count, and ESR to assess IFX therapy. Results After therapy, hemoglobin and inactive UC cases (90%) increased significantly and white blood cell, ESR, and CRP decreased significantly than before treatment, without significant difference in platelet count. IFX treatment was associated with improvement in 90% of cases. There was a significant relation between improvement and colonoscopy, histopathology finding, and CRP after treatment (P<0.001) as the majority of cases had inactive UC, UC chronic phase with mild inflammation, and negative CRP after therapy. There was a nonsignificant relation between improvement and disease extension and severity (mayo clinic score) after the period. Conclusions Active UC cases treated by IFX had a better mucosal healing and clinical responses, corrected of anemia and thrombocytopenia and normalized acute-phase reaction.

Background and aim Bullying is one of the most serious problems that children face in the education system. Several other studies have found that bullying represents a standard problem in schools worldwide. This study aims to assess the incidence of school bullying as well as its suspected risk factors among primary school students. Patients and methods The study included 280 primary school students (146 males and 134 females) aged from 10 to 12 years old in the first stage of the study for screening for bullying behavior. A self-administered questionnaire was used to collect data about the bullying behavior among the selected students. The questionnaire was adopted from the validated Arabic version of Bullying Behavior Scale for children and adolescents. Results The incidence of significant bullying among the included students was found to be 12.5%, with males showing higher degrees of bullying. There was a significant association between involvement of the student in the bullying behavior and the risk factors such as student exposure to frequent punishment and negative attitude by the teacher, lack of acceptance from colleagues, and exposure to previous bullying. Conclusion Male students in primary schools showing higher degrees of bullying with significant association were found between bullying behavior and its risk factors.

Background and aim Meibomian-gland dysfunction (MGD) is a very common disease we face every day in the clinic. It is the essential cause of evaporative dry eye. It is a chronic, diffuse disorder of the meibomian glands, distinguished by terminal-duct obstruction and/or qualitative/quantitative variations in glandular secretion. It may result in alteration of the tear film, manifestations of eye irritation, clinically evident inflammation, and also ocular-surface disease (OSD). The aim of the study was to relate Demodex colonization to MGD. Patients and methods This study included 76 eyes divided into two groups, group A (patients’ group) included 38 eyes with MGD, group B (control group) included 38 eyes with normal lid margin. Both groups were subjected to history taking, MGD evaluation by MGD grading, fluorescein breakup time, OSD index, Schirmer-1 test, and lash sampling. The lashes sampled were examined for Demodex colonization by light microscopy. Results There was a statistically significant difference in Demodex colonization between the patients’ group 16 (42.1%) eyes and the control group four (10.5%)eyes. We noticed predominance of female sex in the MGD patients’ group (84.2%). There was a statistically significant difference between the two groups regarding fluorescein breakup time, OSD index, and Schirmer-1 test with P value less than 0.001. Conclusion Demodex colonization is incriminated as an important cause of MGD and OSD. Our study suggests that treating Demodex is crucial in MGD patients.

Background and aim Meconium-aspiration syndrome (MAS) is a common cause of respiratory distress. MAS is a serious disease that affects neonates born through meconium-stained amniotic fluid. The pathophysiology of MAS is multifactorial, inflammation has an important role in MAS, so anti-inflammatory drugs like corticosteroids may be effective in the treatment of MAS. Budesonide is a nonhalogenated glucocorticoid that can reduce vascular permeability, inhibit secretion of mucus, relieve edema and spasm, and help pulmonary ventilation. In this study we aimed to find out the effect of early nebulized budesonide in the treatment of MAS. Patients and methods This was a prospective study conducted during the period from October 2017 to July 2018 at El-Minia General Hospital and Al-Azhar University Hospital, Assiut. Intervention: budesonide inhalation in a dose of 50 mg every 12 h till clinical recovery, whichever was earlier. Results The present study revealed that nebulized budesonide improves the clinical outcome of newborns with MAS in terms of lowering the duration of O₂ dependency, duration of respiratory distress, duration of hospital stay, duration of radiograph clearance, time for full feeding (P<0.001), and thus early discharge from the NICU. Conclusion Early nebulized budesonide is effective in treating MAS and has high safety with almost no short-term complications.

Background and aim Cytomegalovirus (CMV) transmission to seronegative patients with inadequate immunity might result in significant consequences. The goal of the study was to determine the prevalence of CMV antibodies in healthy blood donors at the Kafr El Sheikh General Hospital. Patients and methods This research enrolled 100patients with the same inclusion and exclusion criteria, in age ranging between 18 and 60 years, with confirmed seronegativity for hepatitis C virus, hepatitis B virus, and HIV. All patients were asked to complete history taking, full clinical examination, laboratory assessment, and peripheral blood samples. The blood samples were taken from each individual to test for CMV immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. Another sample was taken from IgM-positive cases in order to do PCR testing for CMV DNA. Results All cases among the study group were showing a positive CMV IgG with a high rate up to (100%). Consequently, in the general hospital in Kafr El Sheikh, healthy blood donors had a significant prevalence of CMV IgG. While, there were three (3%) patients of them had positive CMV IgM and 97 (97%) patients of them had Negative CMV IgM, this indicates a rarity of CMV IgM in healthy blood donors at Kafr El Sheikh General Hospital. Conclusion The high seroprevelance of CMV is a barrier to developing blood products of seronegative CMV in blood banks; nonetheless, we found that concentrated screening of a specific group of blood donors would be the best way to achieve this goal.

Background and aim Atrial fibrillation (AF)-related stroke represented more than 79% of all strokes of cardiogenic origin. AF is the crucial factor of cardiogenic stroke. AF-related stroke is manifested with severe clinical manifestation, significant disability, high mortality, and easier relapse. The incidence of mortality is twice as high as non-AF-related stroke. The AF type is usually of nonvalvular origin. The current work is aiming to determine the incidence of cerebral microembolization in nonvalvular AF patients. Patients and methods The current study was a prospective study of two groups of individuals: control and nonvalvular asymptomatic AF cardiac condition, hypertension, age, diabetes, sex, and stroke (CHADS) score 2 or more. Patients were collected from the cardiology clinic and department (Al-Azhar University Hospital, New Damietta, Egypt). Patients were submitted to history taking, clinical assessment, echocardiography, and transcranial Doppler ultrasonography, and microembolic signal detection and count. Also, the transcranial Doppler was used to monitor both middle cerebral arteries. Results There was a statistically significant difference between the control and study groups in relation to the number of microembolic signals. Signals of microembolizations were detected in eight cases (all were in the study group). There was a positive correlation between embolic signals and patient age (r=0.424, P=0.020) and there was a significant association with female sex. In addition, there was a positive correlation between embolic signals and left-atrium dimension (r=0.502). Regarding correlation, there was a negative interaction between embolic signals and anticoagulation use (r=−0.413, P=0.023). Conclusion Asymptomatic embolic signals occur in patients with nonvalvular AF who are not being treated with anticoagulants at a significantly greater frequency than in age-matched controls.

Background and aim Milk from a mother’s breast is the most suitable nutrient source for healthy growth and development of infants. Cesarean section (CS) is one of the factors that affect breastfeeding. This study aimed to show the effect of CS on breastfeeding at the age of 6 months. Patients and methods This was a retrospective cohort study conducted in primary health care centers of Sherbin District during a period of 1 year from December 2018 to December 2019. Each mother underwent full history taking and assessment of breastfeeding state regarding the following parameters: time of initiation of breastfeeding, no prelacteal feeding practice, exclusive breastfeeding (EBF), and breastfeeding performance index (BFPI). Results Time of initiation of breastfeeding, no prelacteal feeding practice, EBF, and BFPI are significantly higher in normal vaginal delivery than CS, with P values of 0.043, 0.028, 0.001, and less than or equal to 0.001, respectively. CS group is more likely to be younger and primiparous than the vaginal group. EBF was more evident among housewives, previously breastfed mothers, and mothers delivered vaginally than the CS group. Suckling before 1 h is more common among older mothers (>30 years of age), multiparous mothers, and previously breastfed mothers. Labor in a nonprivate place and CS were found to have a 30% more incidence of suckling after 1 h. No prelacteal feeding practice is more commonly seen among older mothers, multiparous, previously breastfed mothers, and mothers delivered vaginally than the CS group. Previously breastfed mothers and mothers delivered vaginally are more likely to have high BFPI. Conclusions CS is a negatively associated with EBF, early breastfeeding start, no prelacteal feeding practice, and BFPI.

Background and aim Laparoscopic sleeve gastrectomy (LSG) has become a popular procedure in the bariatric field in Egypt. However, little is known regarding the prevalence and risk factors of inadequate weight loss (IWL) following this procedure. Thus, we conducted this study to estimate the prevalence of IWL and its predictors after LSG. Patients and methods The data of consecutive 118 obese adults who underwent LSG were reviewed. The collected data included preoperative and intraoperative variables. Our primary outcome was to estimate the prevalence of IWL or failure after LSG (percent of excess weight loss <50), while the secondary outcomes included identifying risk factors or predictors for this unsatisfactory outcome. Results Failure was encountered in 34 patients out of the included 118 cases. Therefore, the prevalence of failure was 28.81%. Older age and higher basal BMI were associated with failure. Sex distribution was comparable between success and failure groups. Obesity-related comorbidities showed no significant difference between the same groups, apart from obstructive sleep apnea, which showed a significant rise in the failure group. Additionally, operative time, bougie size, and distance from pylorus did not show any significant differences between the two groups. Conclusion Older age, higher basal BMI, obstructive sleep apnea, increased number of obesity-related comorbidities, and previous gastric balloon are significant risk factors for IWL following LSG. Another bariatric procedure (mainly malabsorptive) should be offered for these high-risk groups.