Background and aim Many complications have been recorded after hypospadias repair surgeries. The most common one is the urethrocutaneous fistula (UCF). In this study, we aimed to compare the closure outcome of the small-sized and medium-sized UCF after hypospadias repair with and without autologs platelet-rich plasma (PRP) graft. Patients and methods This is a prospective comparative study for managing UCF in the pediatric age group of over 1 year. They were randomly divided into two groups: group A included 20 patients who underwent repair without PRP and group B included 20 patients who underwent repair with PRP. Complication rates were compared between the two groups. Results There was a significant difference in the occurrence of complications between the two groups. Recurrence of the fistula was observed in five cases, three (15%) in group A and two (10%) in group B. In group A, the three cases with fistula failed to be treated conservatively and needed another operation 6 months after the primary repair, while in group B, two cases were treated conservatively, and spontaneous closure of the fistula occurred while only one case required another operation for closure of the fistula. Postoperative infection was reported in two (10%) cases in group A and three (15%) cases in group B; they were treated using topical and systemic antibiotics. An extensive scar was reported in one case in group A. Conclusion Autologs PRP graft could be used in hypospadias surgeries and the repair of post-hypospadias repair UCF as it is safe, easily applicable, and proven its role in decreasing complications.

Background and aim Benign hepatic nodular lesions mimicking hepatocellular carcinoma (HCC) may be categorized into hyperplastic nodular lesions, neoplastic nodular lesions, and miscellaneous nodular lesions. This study aimed to assess the role of glypican 3 (GPC3), arginase 1 (ARG-1), and CD34 in differentiation between benign and malignant primary hepatic lesions. Materials and methods This study included 48 cases, where 25 (52.08%) cases were diagnosed as primary HCC in the liver and 23 (47.92%) cases were diagnosed as benign hepatic lesions. Of the 48 patients, five (10.42%) cases were diagnosed as focal nodular hyperplasia, four (8.33%) cases were diagnosed as hepatic adenoma, eight (16.67%) cases were diagnosed as dysplastic nodule, and six (12.50%) cases were diagnosed as regenerative nodule. Results The sensitivity of GPC3 for differentiation between benign and malignant primary hepatic lesions was 80% and its specificity was 82.5%. The sensitivity of ARG-1 was 90%, and its specificity was 0.0%. The sensitivity of CD34 for HCC in the study group was 84% and its specificity was 91.3%. Conclusion There was high sensitivity and specificity of both GPC3 and CD34 immunostaining for distinction of primary HCC from benign hepatic mimicker lesions, whereas there was high sensitivity of ARG-1 in both benign and malignant primary hepatic lesions but with no specificity for differentiating the benign from malignant primary hepatic lesions.

Background and aim 4Low-grade inflammation plays an important role in type-2 diabetes and coronary-artery disease pathogenesis. YKL-40 is expressed in cells of innate immunity and is associated with endothelial dysfunction. The research aims to see if YKL-40 levels in the blood could be used as a diagnostic biomarker in type-2 diabetic patients. Additionally, to evaluate if there is a link between YKL-40 and ischemic heart disease in diabetic patients. Patients and methods The study was carried out on 75 Egyptian individuals (25 healthy persons as control, 25 type-2 diabetic patients without ischemic heart disease, and 25 type-2 diabetic patients with ischemic heart disease). Enzyme-linked immunosorbent assay was used to assess YKL-40 levels. Results There was a significant elevation in the levels of YKL-40 when patients with type-2 diabetes mellitus (T2DM) uncomplicated by ischemic heart disease and patients with T2DM complicated by ischemic heart disease compared with the control group (P<0.05). The optimal YKL-40 cutoff threshold was greater than 65 ng/ml. Furthermore, the level of YKL-40 was significantly higher (P<0.05) in patients with T2DM complicated by ischemic heart disease compared with individuals with T2DM not complicated by ischemic heart disease. The best cutoff point for YKL-40 to differentiate between those two groups was greater than 110 ng/ml. Conclusion In type-2 diabetic patients, YKL-40 could be a valuable diagnostic marker for vascular complications.

Background and aim Collagen cross-linking (CXL) is the available treatment to arrest the progression of keratoconus (KC). It consists of photopolymerization of collagen induced by combined action of a photosensitizing substance, and ultraviolet-A light. The aim of the study is to assess higher-order aberrations (HOAs) of cornea in patients with early KC before and after cross-linking using the Bausch & Lomb Zywave II aberrometer. Patients and methods In total, 30 patients (nine males and 21 females), aged 19–35-years old with mild KC. HOAs examination was done using Zywave device before and after corneal CXL and followed up 1, 3, and 6 months postoperative. Results Preoperative and postoperative 1-month Root Mean Square (RMS) of the total HOA differences was statistically insignificant with P value of 0.102, however, preoperative and postoperative 3 and 6 months showed higher significance with P value of 0.007 and P value less than 0.001, respectively. Preoperative and postoperative 1-month RMS of total coma-order aberration differences was statistically insignificant (P=0.211), however preoperative and postoperative 3 and 6 months showed higher significance with P value of 0.024 and value less than 0.001, respectively. Preoperative and postoperative 1- and 3-month secondary astigmatism-aberration differences were statistically insignificant (P=0.070 and 0.216, respectively), however preoperative and postoperative 6 months showed higher significance with P value less than 0.001. Conclusion There is reduction in the parameters of HOAs after CXL in patients with KC, especially total HOA, coma, and secondary astigmatism aberrations.

Background and aim Pregnant women are more prone to psychological distress, which can have a deleterious effect on the mother and the fetus. coronavirus disease 2019 (COVID-19) pandemic is a new and dangerous event with limited data available that may adversely affect the mental health of pregnant women. So, the aim of this study was to assess the psychosocial effect of the COVID-19 pandemic on pregnant women, pregnant women’s perceptions toward COVID-19 epidemiology, and antenatal care service utilization during the pandemic. Patients and methods This cross-sectional study was carried out in the interval from February 2021 to September 2021 and included 340 Egyptian pregnant women with singleton pregnancy during the COVID-19 pandemic. A structured self-administered online questionnaire was completed by the participants. The validated 21-item Depression, Anxiety, and Stress Scale-21 was used. Results The study revealed a high prevalence of stress (61.5%), anxiety (73%), and depression (68.5%) among pregnant women. Chronic diseases, irregular antenatal care, and previous COVID-19 infection of family members were all significant predictors of anxiety and depression. In contrast, prior infection of the pregnant women with COVID-19 in the current pregnancy was a significant predictor for stress, anxiety, and depression. Conclusion There was a high prevalence of anxiety, depression, and stress among Egyptian pregnant women during the time of the COVID-19 pandemic. Psychosocial support is required, in addition to raising pregnant women’s awareness regarding COVID-19 infection.

Background and aim Chronic rhinosinusitis (CRS) is an upper respiratory-tract disease, which affects general health of patients. This study aims to detect Helicobacter pylori in paranasal sinus specimens of patients having CRS and to approve if there is a relation between H. pylori and CRS. Patients and methods This study included 60 patients complaining of nasal and gastroesophageal reflux disease (GERD) symptoms. According to computed tomography findings, patients were divided into group A: this included 30 patients, they had chronic sinusitis, or nasal polyp and GERD symptoms, and group B: this included 30 patients, they had inferior-turbinate hypertrophy without sinus affection and with GERD symptoms. All patients were submitted to endoscopic surgery, under general anesthesia, and the samples of diseased sinus mucosa or nasal polyp in group A and the samples of inferior turbinate in group B were sent for histopathological and microbiological examination. Results In group A, rapid urease test (RUT) was positive in 10 (33.3%) patients and negative in 20 (66.6%) patients, while immunohistochemistry (IHC) was positive in five (16.5%) patients and negative in 25 (83.5%) patients. In group B, RUT was positive in five (16.5%) patients and negative in 25 (83.5%) patients, while IHC was positive in 0 (0%) patients and negative in 30 (100%) patients. There was a significant difference between RUT and IHC results in both groups (P=0.032). Conclusion H. pylori infection has possible role in chronic sinusitis. More studies are required to confirm this correlation.

Background and Aim Matrix metalloproteinase (MMP) is a member of the MMP family, which is a zinc-dependent endopeptidase that degrades all extracellular matrix components and vascular basement membrane. Survivin plays a leading role in the process of apoptosis regulation. Survivin is unique for its expression in human malignancies but not in normal adult cells. This study aimed to assess immunoexpression of MMP-2 and survivin in pancreatic carcinoma. Patients and methods A total of 25 pancreatic carcinomas were evaluated for immunohistochemical expression of MMP-2 and survivin. The expression was evaluated by immunoreactive score that combines the intensity of immunoreactions with the percentage of positive cells. Results In this study, 24/25 of the cases were pancreatic ductal adenocarcinoma (PDAC) and 1/25 was acinar cell carcinoma. Regarding tumor differentiation, PDAC included five cases of adenocarcinoma that were well differentiated, 16 cases were moderately differentiated, and three cases were poorly differentiated. Pancreatic carcinoma specimens showed positive cytoplasmic MMP-2 staining with high expression in 22/25 (88%) studied specimens ranging from 6/9 to 9/9 with high extent and intensity. Survivin staining with high expression was seen in 23/25 (92%) studied specimens, ranging from 9/12 to 12/12 with high extent and intensity. Conclusion MMP-2 and survivin expressions were positive in pancreatic carcinoma with various grades but negative in non-neoplastic parenchymal, acinar, and pancreatic ductal epithelium. There were significant positive relationships between MMP-2 and survivin expression and poor histological grade in PDAC (P<0.024 and 0.021, respectively).

Background and Aim To evaluate the short-term effects and safety of prophylactic intravitreal injection of triamcinolone–moxifloxacin combination after cataract surgery. Patients and methods This study included 100 eyes of 84 patients who underwent cataract surgery associated with intravitreal injection of triamcinolone–moxifloxacin combination after surgery. The patients were re-assessed at the first day, first week, and then monthly up to 3 months after surgery. The outcome measures included unplanned use of topical anti-inflammatory or anti-infective drugs during the postoperative period, best-corrected visual acuity (BCVA), and intraocular pressure (IOP). The mean age of patients was 55.99±5.20 years. Results The mean BCVA showed a statistically significant difference between the preoperative and the postoperative values, where the mean BCVA improved from 1.21±0.27 logMAR before operation to 0. 83±0.25 logMAR at the first week, 0.46±0.21 logMAR at the first month, and 0.19±0.14 logMAR at the third month. The mean IOP revealed no statistically significant differences between preoperative and postoperative values at the end of the first month (P<0.084). The preoperative IOP ranged from 12 to 19 mmHg, with an average of 15.35±1.60 mmHg and became 14.52±1.11 mmHg at the end of the first month after surgery. There was no evidence of postoperative complications such as endophthalmitis or other complications such as retinal detachment and vitreous hemorrhage. Conclusion Intravitreal injection of triamcinolone–moxifloxacin combination after cataract surgery can be used as an alternative to medications applied topically for prophylaxis against postoperative complications associated with cataract surgery such as infection and inflammation.

Background and Aim Fetal hemoglobin (Hb) has been described as a new predictive biomarker for pre-eclampsia and has also been hypothesized to be a causative factor. Interestingly, the heme scavenger and antioxidant α-microglobulin increases in parallel with fetal Hb. The aim was to measure the level of fetal Hb in the serum of pregnant women with pre-eclampsia. Patients and methods This a prospective study that was conducted on 100 pregnant women selected from the Obstetrics and Gynecology Department of Al-Hussein University Hospital. Results There was a significant increase in fetal Hb in the patient group more than the control group. The fetal Hb shows a high sensitivity, specificity, and accuracy in prediction of pre-eclampsia and eclampsia. Conclusion Fetal Hb was significantly higher in patients with eclampisa and pre-eclampsia. Moreover, it can be used as a predictive marker for both eclampisa and pre-eclampsia.

Background and aim There were numerous previous studies comparing open appendectomy (OA) with laparoscopic appendectomy (LA). Although most of these have concluded that the LA is good as OA, there has been considerable controversy as to whether LA is superior to OA or not. The goal of this study was to compare the results of the previous two surgical methods and determine if LA is better than OA. Patients and methods A prospective research, including 40 patients with a suspected acute appendicitis, was conducted between January 2018 and May 2019. The LA group had 20 patients, while the OA group had 20 cases. LA was performed using three trocars/cannulas to create pneumoperitoneum with CO₂, whereas OA was done using the Mc Burney incision (Clinical trial registration number : PACTR202203884835048). Results Appendectomies were done on 14 males and 26 women for a total of 40 appendectomies. In LA, the mean operative time was 45.50±13.26 min, whereas in OA, it was 53.50±14.78 min (P=0.001). In the LA group, none of the patients experienced intraoperative problems, but four individuals in the OA group did. Postoperative problems were observed in four (20%) patients in the LA group and five (25%) patients in the OA group. Compared with those who had OA, those who had LA had a considerably shorter hospital stay (14.60±5.45 vs. 24.10±5.60 h, P=0.001). Conclusions LA is just as safe and successful as OA, with key advantages such as less discomfort, fewer wound infections, and shorter hospital stays.

The rate of multiple pregnancies in the past three decades has increased dramatically. Twin pregnancies have a higher risk of pregnancy loss owing to premature birth. Although the premature delivery of the first twin is usually followed by spontaneous birth of the second twin, there are ways to delay the delivery of the second twin to enhance survival and neonatal outcomes. However, there is insufficient evidence to support the role of any interventions such as cerclage, hospitalization, tocolytics, and/or antibiotics. As a result, the management of delayed interval for the delivery of the second twin varies depending on each case. The purpose of this study was to report the obstetric components of a successful delayed-interval delivery, with an emphasis on the current conflicts around the active management of the delayed interval delivery of the second twin. A case of a 40-year-old, G5P4, woman who had three cesarean sections is presented. She got pregnant with a dichorionic diamniotic twin. At 17 weeks of gestation, she developed sudden severe lower abdominal pain, vaginal bleeding, and spontaneous expulsion of the first fetus weighing 179 g. After delivery of the first twin, the vaginal bleeding became minimal, and the cervix was reconstituted soon, so cervical cerclage was not offered. The umbilical cord of the first fetus was cut at the level of the external cervical os, and the placenta was retained. She received intravenous fluids, anti-D prophylaxis, paracetamol, and antibiotics. The patient was keen to continue with the pregnancy and was informed about the risks and benefits. The management was mainly an outpatient basis after an initial short hospital stay of 6 days before being discharged (upon her request); during the follow-up, she did not develop any clinical manifestations of maternal infection. She was subjected to ANC at the outpatient clinic every 2 weeks, where vaginal culture, complete blood count, prothrombin time, and C-reactive protein levels and serial ultrasonography were checked consistently. The fetus showed adequate growth. After 136 days, she delivered by elective cesarean section a male baby weighing 2850 g at 37 weeks of gestation with good recovery. In certain situations, delayed delivery of the second twin of diamniotic dichorionic twin pregnancy may be a safe, simple with less interventions, and effective option to improve pregnancy outcome.