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.

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Background Diagnosis of the cause of fever of unknown origin (FUO) is a great challenge. Serum ferritin may be a useful index for differentiating between infectious and noninfectious causes of FUO (malignant disease or collagen disease). In this respect, serum ferritin has the advantage of decreasing the number of unnecessary tests and helping to exclude infectious disease. Objective This study aimed to evaluate serum ferritin levels among patients suffering from FUO. Methods A comparison was made between infectious, noninfectious, and undiagnosed cases of FUO as regards serum ferritin level using an in-vitro enzyme-linked immunosorbent assay. Results The most common causes of FUO were infectious diseases (120/300, 40%), followed by noninfectious diseases such as malignant (61/300, 20.4%) and autoimmune causes (49/300, 16.3%). Undiagnosed cases constituted 70/300 (23.3%). The mean serum ferritin level in the infectious group, noninfectious group, and undiagnosed group was 99.25±49.58, 1098.94±284.54, and 112.40±183.23, respectively, with highly significant difference between infectious and noninfectious causes of FUO (P<0.001). However, there were no significant differences between infectious and undiagnosed causes of FUO. The optimal cutoff point was 559.0; the area under the curve was 0.79, with highly significant difference (P<0.001) at 95% confidence interval of 0.71–0.88. Conclusion High serum ferritin level (>559 ng/ml) helps in differentiation between infectious and noninfectious causes of FUO. In undiagnosed cases of FUO we must direct our thinking to infectious diseases.

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Introduction Bronchial asthma is a chronic, inflammatory lung disease with exacerbations. Patients with asthma have higher risks of coronary heart disease, diabetes mellitus, and hypertension, although the impact of asthma on other vital organs is not yet verified. Chronic kidney disease (CKD) is a major global problem. In addition to well-known risk factors of CKD, there might be other previously underestimated or unrecognized risk factors that are not yet discovered. Aim The aim of this study was to determine the frequency and factors associated with CKD among asthmatic patients. Patients and methods An analytical, cross-sectional study was conducted on 118 patients known to have bronchial asthma and 118 healthy individuals; all of them were subjected to spirometry. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study group equation. Results Development of CKD was significantly higher among asthmatic patients than in healthy individuals (17.4 vs. 0.8%, respectively). GFR was higher in the well-controlled asthmatic group than in the uncontrolled group (96.3±18.1 vs. 90.1±20.3), but this difference was statistically insignificant. Occurrence of CKD was significantly higher among those with asthma for 20 years or longer than those with asthma for less than 20 years (45.5 vs. 2.4%, respectively). GFR was negatively correlated to age, BMI, and disease duration with high statistical significance, and was positively correlated with all parameters of pulmonary function test (FVC%, FEV₁%, FEV₁/FVC, and PEFR%) and partial O₂ pressure with high statistical significance. Significant predictors for the development of CKD among asthmatic patients were longer disease duration and higher BMI. However, high partial O₂ pressure was protective for the development of CKD. Conclusion Bronchial asthma can be associated with CKD. Prolonged disease duration and higher BMI were the most common predictors for the development of CKD.

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Background Appendicitis is by far the commonest major emergency general surgical operation. Pathological evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The objective of this study was to analyze the clinical benefit of histopathological analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. Patients and methods The clinicopathological data of 460 patients who underwent appendectomies for presumed acute appendicitis were reviewed prospectively. Results There were 265 men and 195 women [sex ratio (male/female): 1.4] aged between 16 and 62 years (mean: 27.6 years). All patients underwent open appendectomy. Histological examination of the surgical specimen showed normal appendix in 28/460 (6%) cases, gross inflammation in 365 (79.3%) cases, gangrenous appendix in 32 (7%) cases, perforation and localized peritonitis in 30 (6.6%) cases, and generalized peritonitis in five (1.1%) cases. Incidental unexpected pathological diagnoses were noted in 39 (8.5%) appendectomy specimens. They included Enterobius vermicularis (n=19), mucinous neoplasms (n=3), neuroendocrine tumors (n=1), granulomatous inflammation (n=12), tuberculosis (n=1), bilharziasis (n=1), and endometriosis (n=2). Other associated pathological findings were ruptured ovarian cyst (n=9), perforated duodenal ulcer (n=3), Meckel’s diverticulum (n=1), disturbed ectopic pregnancy (n=3), and cecal adenocarcinoma (n=2). Conclusion The diagnosis of acute appendicitis has been improved, with a significant reduction in negative appendectomy rates. Routine pathological examination of appendectomy specimens is of value for identifying unsuspected pathologies requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic examination. It is highly recommended that in order to avoid misdiagnoses, all appendix specimens should be examined histopathologically.

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Background Atherosclerosis is a major disease of arteries, related to age and plasma cholesterol levels. Objective The objective of this study was to investigate the possible effects of ginger on experimentally induced atherosclerosis in the aorta of rabbits. Materials and methods Thirty, male rabbits aged 6 weeks were used in this study and were divided into three groups: group I included 10 male rabbits fed an ordinary diet for an experimental period of 8 weeks; group II included 10 male rabbits fed an ordinary diet mixed with 1% cholesterol powder at a dose of 200 mg/kg body weight for a period of 8 weeks; and group III included 10 rabbits fed an ordinary diet mixed with 1% cholesterol powder and were treated with ginger powder (4 g/kg of the dried rhizome) dissolved in saline solution daily for 8 weeks. The thoracic aorta was dissected and then processed for light microscopic studies. Results Our results showed an apparent decrease in the thickness of both tunica intima and tunica media in the ginger-treated group. There was no intimal invasion of smooth muscle cells. Regular wavy elastic fibers were noticed in the media with apparently normal smooth muscle cells distributed in between. In addition, there was no apparent difference in the CD34 reaction of endothelial cells in the ginger-treated group when compared with the control group. Conclusion Ginger has an attractive role in modulating atherosclerosis in the aorta of rabbits.

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Hepatitis B, C are commonly present together. They both share same routes of transmission. Dual infection carries a wide, variable range of virological, clinical profiles. Even in terms of management, large debates arose due to related issues such as priority for treatment, fate of the second virus if the primary one is eradicated.

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Objective The aim of this study was to identify the risk factors and common pathogens associated with catheter-associated urinary tract infection (CAUTI) in the ICUs of Assiut University Hospital, Egypt. Methods Urine samples were collected from patients suffering from CAUTI according to the case definition of Centers for Disease Control and Prevention. The samples were subjected to culture on different culture media, and all positive colonies were identified according to their biochemical profile and antibiograms. Klebsiella isolates were further tested for extended-spectrum β-lactamase production. Results The overall bacterial CAUTI incidence rate was 11% (15/136 patients). Female sex, old age (>60 years old), diabetes mellitus, and prolonged duration of catheterization (>6 days) were found to be risk factors for the development of bacterial CAUTI. Klebsiella was the commonly isolated microorganism (8/16, 50%). All Klebsiella isolates were found to be phenotypically Extended-spectrum β lactamase producers, and five of these isolates contained either blaTEM or blaSHV genes. Conclusion This study revealed the high incidence of bacterial CAUTI (11%) in ICUs of Assiut University Hospital. ESBL-producing Klebsiella spp. is responsible for about 50% of bacterial CAUTI cases. All isolated microorganisms were found to be multidrug resistant. Strict implementation of infection control procedures appears to be necessary to control the spread of multidrug resistant organisms.

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Introduction Methylene blue (MB) is a molecule that has been playing important roles in microbiology and pharmacology for some time. It has been widely used to stain living organisms and to treat methemoglobinemia, and lately it has been considered as a drug for photodynamic therapy. Nowadays, it is used in the treatments of basal cell carcinoma, Kaposi’s sarcoma, melanoma, and virus and fungal infections. MB has low toxicity and no adverse effects. Patients and methods This study was conducted in Aswan University on female and male patients. Our study was done on 70 patients, who had an average age of 29.8 years, with minimum of 25 years and maximum of 35 years. Patients were studied preoperatively with complete investigations, a multidisciplinary workup including specialist counseling (internal medicine, psychiatry, and anesthesiology), and complete performance status evaluation. Patients were well informed about the surgical procedure, with all potential advantages and possible complications and adverse effects. Then they were proceeded to laparoscopic sleeve gastrectomy and the uses of intraoperative MB to confirm any leaks from the stapler line. Postoperative data regarding fever, tachycardia, vomiting, abdominal pain and distention, abdominal ultrasound for any collection, and complete blood count were recorded. All the above data were collected and analyzed to obtain statistically relevant results. Results Apart from mild abdominal pain and tenderness, and low-grade fever, no collection appeared clinically or by ultrasound examination in all cases. All patients received oral fluids on the third postoperative day, and no vomiting developed. White blood cell count was done for all patients, and they were normal except five patients who developed chest infection with low-grade fever which improved with antibiotic. Before discharging the patients, abdominal ultrasound was done for all, and no collection of fluid appeared. Conclusion Intraoperative MB usage is a safe and effective technique in detecting gastric leak during laparoscopic sleeve gastrectomy.

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Breastfeeding is an unparalleled way of providing ideal food for healthy growth and development of the infant through its unique biological and emotional influences. WHO recommends exclusive breastfeeding for the first 6 months of an infant’s life, with continued breastfeeding and complementary feeding introduced after the first 6 months up to the age of 2 years. Many factors affect breastfeeding, and they can lead to cessation of breastfeeding. Myths about breastfeeding are considered one of main obstacles for continuation of breastfeeding. Physicians and nurses should be aware about common misconceptions and beliefs that make mothers think their milk is not enough or not suitable. They should be able to explain and advise properly. In this article, the most common myths are discussed, and how to deal with them on scientific bases is clarified.

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Background Dermoscopy is a simple and inexpensive diagnostic technique that permits the visualization of morphologic features that are not visible to the naked eye, forming a link between clinical dermatology and microscopic dermatopathology. For many years, skin biopsy was considered the only definite diagnostic tool that confirms or excludes the clinical diagnosis. Skin biopsies are invasive and have many adverse effects and precautions. Objective To evaluate the accuracy of dermoscope in diagnosis of skin tumors and its correlation with clinical and pathological diagnosis. Patients and methods Thirty-four patients who attended Dermatology Clinic at Qena University Hospital from January 2013 to December 2014 were recruited in a nonrandomized prospective study. The inclusion criteria were reported through the following: full history taking, such as (a) name, age, sex, duration of the lesion, onset, progress, and symptoms; (b) previous history of similar lesions or skin cancer; (c) family history of similar lesion or skin cancer; and (d) any recognized changes in the lesion in the past year such as change in size, consistency, hair growth, or bleeding; dermatologic examination, such as (I) type, site, size, shape, color, surface, and border of lesion have been also detected and reported by using of the three-point checklist as a method for differentiation between benign and suspicious lesions and (II) any specific manifestations as tenderness, bleeding, and recurrence have been detected; (III) digital photography has been performed using digital camera (Sony cyber-shot 16.1 mega pixels); dermoscopic findings by using dermoscope (HEINE BETA DELTA 20), and histopathological examination. Results There was an excellent diagnostic reliability of dermoscopy compared with skin biopsy with interrater κ value of 0.859 (confidence interval: 0.734–0.984, P<0.001). The overall agreement between dermoscopical and histopathological diagnosis was recorded in 27/33 (81.8%) cases. The ability of dermoscopy to differentiate lesion categories was investigated. Nine of the 10 neoplastic lesions and 22 of the 23 non-neoplastic lesions were identified by dermoscopy [χ²(1)=24.2, P<0.001] with sensitivity and specificity rates of 90 and 95.7%, respectively, and positive and negative predictive values of 90 and 95.7%, respectively. Regarding differentiation benign from malignant skin lesions, dermoscopy identified 25 of the 26 benign lesions and identified all malignant skin lesions [χ²(1)=27.8, P<0.001]. The specificity and sensitivity were 96.2 and 100%, respectively, and the positive and negative predictive values were 100 and 87.5%, respectively. Conclusion There was a good agreement between the dermoscopy and clinical diagnosis and also a good agreement between the dermoscopy and pathological diagnosis. So dermoscopy can be introduced as a routine diagnostic tool in dermatological examination and will be of a great aid in the accurate diagnosis of suspicious skin lesions before invasive skin biopsy. However, further studies with large sample size are needed later on.

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Since the concept of surgical and nonsurgical facial rejuvenation has been introduced, scientists have developed a wide range of agents that can treat an aging face. With the high bill of surgical manoeuvres, most of the antiaging procedures are nonsurgical. A fair knowledge of nonsurgical facial rejuvenation is as important as the surgical tools to the practice of plastic surgeon or a dermatologist who offers cosmetic surgery. Nonsurgical facial rejuvenation has gained its popularity owing to the low-cost, quicker recovery and guaranteed results but with short-lasting effect. In this review article, the basics of different modalities of nonsurgical facial rejuvenation are reviewed regarding the concept behind them and their advantages and disadvantages. With the successful integration of each of these modalities, a complete facial regimen can be achieved, and patient satisfaction can be maximized.

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Background Inguinal hernia occurs in ∼1.5% of the general population and in 5% of male individuals. The bilateral type affects about 12% of patients, the direct and the combined ones being more frequent than the indirect. Simultaneous or sequential repair has been debated especially after tension-free repairs. Aim This study was carried out to compare Stoppa procedure with bilateral Lichtenstein hernioplasty for the treatment of primary bilateral inguinal hernia. Patients and methods This trial included 80 male patients with primary bilateral inguinal hernias. They were divided randomly into two equal groups. Group A underwent bilateral Lichtenstein hernioplasty and group B underwent Stoppa repair. Preoperative, operative, and postoperative characteristics were recorded for each patient in the study. Patients were followed up at 3, 6, and 12 months postoperatively. Results As regards preoperative data, there was no statistically significant difference between both groups. The Stoppa operation took a significantly shorter time than the bilateral Lichtenstein technique; the mean operative time for Stoppa and bilateral Lichtenstein was 84.0±8.6 and 96.4±6.2 min, respectively. Visual analogue scoring of pain 12 h postoperatively was significantly lower in the Stoppa group than in the bilateral Lichtenstein group. As regards operative and postoperative complications, there was no significant difference between both groups. Hospital stay, return to normal daily activities, and inguinodynia rates were similar in both groups. There was no recorded recurrence in both groups up to 1 year of follow-up. Conclusion Bilateral primary inguinal hernias can be operated upon in one setting without an increase in morbidity or recurrence rate. The Stoppa technique can be a good alternative to bilateral Lichtenstein procedure for the treatment of bilateral inguinal hernia, with comparable outcome.

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Background Tracheal intubation results in an alteration of the laryngeal mucosa. Coughing during emergence from general anesthesia is a common clinical problem. Inflation of the endotracheal tube cuff with lidocaine would create a reservoir of local anesthetic, which might diffuse across the cuff membrane to anesthetize the mucosa and attenuate stimulation during tracheal extubation. Aim To evaluate the efficacy of intracuff lidocaine 2% for the prevention of postoperative cough and sore throat. Patients and methods This prospective, randomized, controlled, double-blind study included 80 healthy patients scheduled for elective surgery of less than 2 h under general anesthesia with orotracheal intubation. These 80 patients were randomized through a computer-generated and sealed opaque envelope method into four equal groups, with 20 patients each. After induction of general anesthesia and tracheal intubation, the tracheal tube cuff was filled with 2 ml of 2% lidocaine solution (40 mg) or 0.9% saline. Twenty minutes before extubation, the participants received 1.5 mg/kg intravenous lignocaine or saline. In this way, four groups were formed: lidocaine cuff–lidocaine group (lidocaine in cuff and lidocaine intravenous), lidocaine cuff–saline group (lidocaine in the cuff and saline intravenous); saline cuff–lidocaine group (saline in cuff and lidocaine intravenous), and saline cuff–saline group (saline in cuff and saline intravenous). The primary outcome was the incidence of coughing at extubation. The secondary outcomes were sore throat scores and hemodynamic change. The incidence and severity of sore throat was recorded at 15, 60 min, and 24 h after extubation. Hemodynamic change was assessed at before induction (baseline), 5-min interval after induction, at intubation, 10 min after intubation, 10 min before extubation, at extubation, and 10 min after extubation. Result There was a statistically significant reduction of postoperative cough and sore throat in lidocaine cuff groups in comparison to saline cuff groups. Intravenous lidocaine was not effective to reduce either cough or sore throat severity. However, there was no significant difference among all groups regarding hemodynamic change. Conclusion Intracuff lidocaine 2% reduces incidence of cough and the severity of postoperative sore throat in surgery of less than 120 min. Intravenous lidocaine was not effective to reduce either cough or sore throat severity. There was no significant difference among all groups regarding hemodynamic change.

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Background Hepatitis C virus (HCV) infection is associated with diabetes and may worsen glycemic control in patients with diabetes. The benefits of eradicating HCV infection with direct-acting antiviral (DAAs) may go well beyond avoiding the damage caused by chronic liver inflammation, to include declines in glycated hemoglobin percent and other metabolic parameters. The present study was designed to evaluate the effect of new DAAs drugs, used for treatment of HCV, on insulin resistance and glycemic control at the end of treatment and 3 months after end of treatment of HCV infection in patient with type 2 diabetic mellitus (T2DM) in Damietta Governorate. Patients and methods This study included 75 T2DM patients with chronic HCV infection. Patients were divided according to level of glycosylated hemoglobin percent into three groups. All patients received DAAs and were monitored by A1C%, homeostasis model assessment-insulin resistance, and fasting blood sugar before, at the end of treatment, and 12 week after the end of treatment. Patients were allocated into two groups: the first group included 57 (76%) patients with improved glycemic control (IGC) and the second group included 18 (24%) patients with nonimproved glycemic control (NIGC). Results In IGC group, 45 (78.9%) patients needed to decrease the dose of antidiabetic treatment. There were no significant differences between IGC and NIGC groups regarding sex and liver condition. The percentage of patients with old age, those with positive family history of T2DM, and those with long duration of T2DM were significantly higher in NIGC group compared with IGC. Conclusion Diabetic patients receiving DAAs should be closely monitored during reduction of antidiabetic drugs, especially regarding insulin and sulfonylurea, to avoid hypoglycemic events. Improvement of glycemic control with DAAs is seen more in younger patients without family history of T2DM and short duration of diabetes mellitus.

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Introduction The diagnosis, classifications, and treatment of injuries of the thoracolumbar spine continue to attract controversy. Objective The present study evaluated the efficacy of treatment of unstable thoracolumbar burst fractures by transpedicular screw fixation including the fractured vertebra. Patients and methods From January 2013 to March 2015, 40 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in Al-Azhar University Hospital, Damietta. Results Forty (25 male and 15 female) patients with age ranging between 16 and 66 years (mean 41.8%) were operated upon by posterior transpedicular screw fixation. According to the American Spinal Injury Association scoring system, all patients were grade E. The mean of kyphotic deformities measured preoperatively was 18.4±5.5° and after 12 months of follow-up it was 9.0±4.1°. Conclusion By applying the transpedicular screw fixation of the unstable fractures of the thoracolumbar spine, a stable fracture fixation can be achieved; this kind of fixation prevents secondary spine deformities.

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Introduction Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening complication of cirrhosis. Several large studies have identified additional risk factors for the development of SBP. Zinc deficiency has been found to be frequent in cirrhotic patients. Aim of the work The aim of the present study was to evaluate the frequency, possible risk factors and the role of zinc in the development of first-time and recurrent SBP. Methodology A total of 176 cirrhotic ascetic patients admitted to the Hepatology Department in Sohag University Hospital were enroled in the study. SBP peritonitis was diagnosed through history-taking and through examination and laboratory investigations, including ascetic fluid study and the detection of serum zinc level. Results Of the 176 cirrhotic patients, SBP was diagnosed in 54 (31%); in total, 40 patients (23%) had single and 14 (8%) had recurrent episodes of SBP. Out of the 23 studied clinical and laboratory variables, we found that the prolonged use of proton pump inhibitor (PPI) (P = 0.001), lower prothrombin concentration (P = 0.03), ascetic protein level less than or equal to 1 g/dl (P < 0.0001) and zinc deficiency (P = 0.001) were independent risk factors for the development of SBP in cirrhotic patients; using multivariate analysis, only low protein in ascites less than or equal to 1 and low zinc status were predictors of SBP. Conclusion In our study, the frequency of SBP was 31%; overall, 23% of the patients had first-episode and 8% had recurrent SBP. The use of PPI, low platelet count, ascetic protein content and zinc deficiency were the predictors for the development of SBP; only low protein in ascites less than or equal to 1 and low zinc status were independent predictors of SBP.

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Background Obesity is a risk factor for obesity-related disorders such as type 2 diabetes mellitus, vascular disease, osteoarthritis, sleep apnea, and malignancy. Obesity cohinder the individual work capacity, and the cost for managing obesity complications is high. Objective The objective of this research was to study the role of pancreatic polypeptide family including neuropeptide Y and peptide tyrosine tyrosine (PYY) in obesity development and its metabolic changes. Materials and methods Twenty-seven adult female albino rats of a local strain were randomized into three equal groups for 5 weeks: sham-operated group, ovariectomized nontreated group, and ovariectomized treated group received PYY_3–36 at a dose of 50 μg/kg, by intraperitoneal injection twice daily during the fifth week. Results Peripheral PYY_3–36 administration reduces food intake, body weight gain, and serum glucose in ovariectomized obese female rats. Conclusion PYY system may offer a new therapeutic strategy for obesity management and its metabolic abnormalities.

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Background Some studies have described the relationship between autoimmune diabetes or type 1 diabetes mellitus (T1DM) and vitamin D deficiency. Few studies correlate between vitamin D deficiency and glycemic control. Purpose This study was conducted to appraise the status of vitamin D in adolescent and young adult T1DM patients and to correlate its deficiency to glycated hemoglobin (HbA1c). Patients and methods Around 63 Kuwaiti patients with T1DM were recruited in a descriptive cross-sectional study in April 2015. Serum level of vitamin D [25(OH)D] was measured using enzyme-linked immunosorbent assay, and glycemic control was measured by HbA1c using autoanalyzer. The relationship between vitamin D levels and HbA1c was analyzed by Spearman’s correlation. Among the participants, 21 (33.3%) were male and 42 (66.7%) were female. The mean age was 18.41±6.19, and the mean diabetes duration was 6.98±4.99. The mean vitamin D concentration was 47.29±2.91 nmol/l, with 38.1% of participants identified to have vitamin D deficiency and 19% identified to have vitamin D insufficiency. There were high levels of HbA1c (10.08±2.28), with a significant inverse correlation between HbA1c and vitamin D (r=−0.374 and P=0.003). Conclusion Low vitamin D in T1DM is extremely highly and closely correlated to HbA1c. We recommend that evaluation of the level of vitamin D in type 1 diabetic patients is very critical, and vitamin D supplementation may improve glycemic control.

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'Modified PPIs' is the term given to proton pump inhibitors (PPIs) introduced after the four conventional PPIs – omeprazole, lansoprazole, pantoprazole, and rabeprazole – all of which have similar actions and limitations and are produced by similar technologies. Modified PPIs include isomeric PPIs, dual delayed release PPIs, immediate release PPIs, and long half-life PPIs, which are manufactured by different technologies to overcome certain limitations of conventional PPIs. This modified category includes esomeprazole (Nexium), dexlansoprazol (Dexilent), omeprazole-sodium bicarbonate mixture (Zegred), and S.tenatoprazole. Although some of these new products have better efficacy, longer duration of action, can be taken with disregard to meals, and have better nocturnal effect, we still lack the ideal PPI.

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Introduction Migraine is a common neurologic disorder. It is still controversial whether migraine is a primarily vascular disorder or caused by neuronal dysfunction, but it is likely that both have a significant role to play. Objective The objective of this study was to evaluate serum levels of interictal ceramide kinase in patients with migraine. Patients and methods A total of 35 patients with migraine, including 12 patients with migraine with aura and 23 patients with migraine without aura, and 16 apparently healthy, age-matched and sex-matched individuals were included in this study. Patients underwent full history taking, including type of headache, frequency of headache attacks per month, and assessment of migraine-related disability by the Migraine Disability Assessment Scale. Serum ceramide kinase level was evaluated for both patients (during pain-free period) and control participants using quantitative sandwich enzyme-linked immunosorbent assay. Results The patients with migraine had significantly higher serum levels of ceramide kinase than the control group, and these levels were significantly correlated with the frequency of the attacks and with scores of Migraine Disability Assessment Scale. Conclusion The results suggested that migraine is associated with alteration in sphingolipid metabolism and that might be because of increased levels of ceramide kinase.

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Background Gastrointestinal bleeding and anemia in patients with liver cirrhosis are common problems caused by various etiologies such as bleeding esophageal and gastric varices, bleeding peptic ulcer whether Helicobacter pylori or non-H. pylori related, portal hypertensive gastropathy (PHG), and other causes. Impairment of the gastric protective barriers and production of inflammatory cytokines such as tumor necrosis factor-α and interleukins, which occur because of colonization of gastric mucosa by H. pylori, may make the stomach more susceptible to the effects of portal hypertension. Aim of work The aim of this study was to investigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. Patients and methods Overall, 50 patients with liver cirrhosis and PHG (cases) and 50 patients with cirrhosis without PHG (controls) were enrolled in this study. H. pylori stool antigen rapid bedside test and upper endoscopy were done for patients in both groups to diagnose PHG and H. pylori infection. Results The prevalence of H. pylori infection among patients with PHG was higher than those without PHG (34 vs. 10%, respectively; P=0.031), and prevalence of H. pylori infection was 22% among the whole of the studied groups. There was no correlation between H. pylori infection and severity of PHG (P=0.381), Child score, Model for End-Stage Liver Disease score, or serum albumin level. However, our study showed a significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG (P=0.002). Conclusion There is significant association between H. pylori infection and PHG, but there is no significant correlation between H. pylori infection and the severity of PHG or the severity of liver cirrhosis. Also, there is significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG.

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Introduction With the advent of newer methods for inguinal hernia repair like laparoscopy and mesh, older techniques like darn repair have gone into the background. However, in developing countries like Egypt where cost-effectiveness is of prime concern, darn repair still enjoys a good reputation and popularity for the repair of inguinal hernia. This study was carried out to compare darn repair with Lichtenstein repair regarding early outcome. Patients and methods A total of 100 male patients aged from 20 to 60 years old who presented with primary inguinal hernia were operated upon with Lichtenstein or darn repair as elective procedure from January 2013 to October 2016. They were subjected to this prospective randomized-controlled trial. The primary endpoint was to compare the early outcome of these two procedures. Results The need for analgesia and hospital stay was higher in patients who had Lichtenstein repair. Hematoma occurred in one (1%) patient and seroma occurred in four (4%) patients in both groups. The prevalence of wound infections as superficial and deep infections in groups A and B was 4 and 4%, respectively, which were resolved through conservative management. Complications of recurrence in group A were 2% as compared with group B, which had a recurrence of 4%. This difference was not significant. Conclusion Both darn repair and Lichtenstein repair resulted in rapid recovery and low recurrence rates; however, the advantage of the darn repair lies in the fact that it does not require mesh, so it is much cost effective.

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Background Several noninvasive methods have been developed to predict esophageal varices (EVs) in patients with cirrhosis aiming to restrict endoscopic screening. Recently, two-dimensional shear wave elastography (2D-SWE) was evaluated for this purpose. The aim of this study was to evaluate the use of 2D-SWE for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) for prediction of EV presence and grading. Patients and methods This study included 100 patients with hepatitis C virus cirrhosis who were subjected to upper endoscopy for detection and grading of EV as well as LS and SS measurements using 2D-SWE. Results There was a significant difference between patients with and without EV regarding LS and SS (P<0.001). The measurement LS at cutoff of 16.2 kPa and SS at cutoff of 42.7 kPa by 2D-SWE predicted the presence of EV with sensitivity of 89.8 and 94.9%, respectively, and specificity of 57.6 and 87.9%, respectively. Moreover, at cutoffs of 19.6 and 51.5 kPa for LS and SS, respectively, the presence of high-risk EV was predicted with sensitivity of 77.5 and 85%, respectively, and specificity of 63.4 and 84.6%, respectively. Conclusion The measurement of LS and SS by 2D-SWE predicted the presence of EV and high-risk EV in patients with cirrhosis, with more sensitivity and specificity for SS than LS.

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Background Intussusception is the main reason of intestinal obstruction in pediatrics. Hydrostatic reduction (HR) is the cornerstone in its treatment. However, surgical treatment is indicated in case of failure of HR. Fixation of terminal ileum (ileopexy) has been used to reduce or even prevent recurrence of intussusception, but its outcome has not been well studied. Aim The aim was to investigate the effect of fixation of terminal ileum on recurrence rate after surgical reduction of intussusception in pediatric age group. Patients and methods A total of 80 children scheduled for surgical reduction of intussusception were included and randomly assigned to fixation of terminal ileum (group A; n=40) or no fixation (group B; n=40). All were assessed clinically, and laboratory investigations were done. Patient’s demographics and surgical outcome were documented and compared between both groups. Results Both groups were comparable regarding demographic data, clinical presentation, duration of symptoms before admission, surgical indication, and duration of hospital stay. In addition, the recurrence rate was nonsignificantly reduced in group A when compared with group B (5.0 vs. 15.0%, respectively). In addition, HR was successful in one and failed in the other recurrent case in group A (50.0% of success) compared with only one (16.7%) of six in group B. Conclusion Fixation of terminal ileum during surgical reduction of intussusception is safe, feasible, and simple technique. It results in reduction of the recurrence rate. However, the difference was statistically nonsignificant.

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Objective The aim of this study was to evaluate the epidemiological profile, surgical treatment, and outcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt. Patients and methods This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records. Results The most affected individuals were male patients younger than 49 years, most of them with low educational level and single. There was a predominance of trauma in the rural areas that mostly occurred at night-time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma. The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to 11 days. Most patients were discharged with permanent sequelae; there were six deaths. Conclusion Blunt trauma was the most common type of abdominal injury. Road traffic accidents were the most common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the site of trauma to the emergency department, and age of patient. Despite the magnitude of traumas, the outcome was satisfactory.

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