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Background Flexible bronchoscopy has become the most commonly used invasive procedure in pulmonary medicine used for diagnosis of multiple lesions of respiratory system presenting as endobronchial mass lesions, either benign or malignant in nature. Aim The aim was to detect the histopathological patterns of endobronchial lesions and the role of flexible bronchoscopy in their diagnosis. Patients and methods This is a retrospective study of bronchoscopy reports especially with endobronchial mass lesions diagnosed by fiberoptic bronchoscopy, which was performed at Chest Department, El-Hussein University Hospital, Al-Azhar University, over a period of 5 years from January 2012 to December 2016. Results The fiberoptic bronchoscopy was helpful in the diagnosis of endobronchial mass lesions in 65 (28.7%) patients of 350 patients who underwent bronchoscopy during this period. Their age ranged from 15 to 80 years. The patients comprised 35 males and 30 females. Overall, 42 (65%) lesions were malignant, 18 (28%) lesions were benign, whereas five (7%) lesions were inconclusive. Diagnostic yield was ∼92.3%. Repeat bronchoscopy for inconclusive results improved the diagnostic yield. Conclusion Fiberoptic bronchoscopy is the most important tool in pulmonary medicine used in the diagnosis of malignant as well as benign lesions that present as endobronchial mass lesions that mimic each other on visual impression, and thus adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

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Background One of the most common deformities that results from untreated obstetric brachial plexus palsy (OBPP) is internal rotation shoulder contracture. There are various surgical options for treating this deformity such as muscle release, tendon transfer, and humeral osteotomy. Objective This study expresses the outcome of isolated subscapularis release performed in children with internal rotation shoulder contracture as a consequence of unresolved OBPP. Patients and methods This prospective case series study was conducted in Al Azhar University Hospitals between April 2018 and January 2020. A total of 20 patients aged between 2 and 5 years (mean: 3.2 years) with internal rotation contracture of shoulder residual deformity from OBPP were included. Of the 20 patients, eight were males and 12 were females, and 12 patients were operated on right side and eight were operated on left side, and they were followed up for a period of at least 1 year. Results The mean abduction improved from 61.0±14.1° preoperatively to 103.0±15.25° postoperatively, the mean passive external rotation in adduction improved from −9.5±11.4° preoperatively to 30.5±11.91° postoperatively, the mean active external rotation in abduction improved from 0.5±8.26 preoperatively to 60.25±10.57 postoperatively, and the mean modified mallet score improved from 12.60±1.09 preoperatively to 17.70±1.17 postoperatively. Conclusion Open subscapularis muscle release is a proper starting surgical option in children who present with internal rotation adduction contracture of the shoulder owing to unresolved OBPP.

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Purpose The aim were to detect the prevalence of bla_OXA-48 carbapenem-resistant Klebsiella pneumoniae (CRKP) (K. pneumoniae) among the K. pneumoniae isolates isolated from the ICUs of Al-Azhar Assiut University Hospital by phenotypic and molecular methods and to investigate susceptibility of other alternative drugs for CRKP strains. Patients and methods This was a hospital-based cross-sectional study that was conducted on 63 isolates of K. pneumoniae isolated from clinical samples of patients .All isolates were subjected to phenotypic and genotypic susceptibility for carbapenem resistance. For identification of K. pneumoniae, it was done using conventional methods. The test for antibiotic susceptibility was done using disc diffusion method. Strains were resistant for carbapenems, with antibiotic sensitivity testing being investigated for confirmation of carbapenem resistance. Phenotypic confirmation was done using modified Hodge test, whereas the molecular confirmation was done using PCR. Results K. pneumoniae isolates were most frequently seen in sputum (38%) followed by blood (20%) and sputum (16%). Of 63 K. pneumoniae isolates, 24 (38%) isolates were carbapenem resistant by disc diffusion method. By using modified Hodge test, 22 (91.7%) isolates were positive by modified-Hodge test and two (8.3%) isolates were negative, which was confirmed by PCR for bla_OXA-48, giving results that 22 (91.7%) isolates were positive and two (8.3%) were negative. Conclusion OXA-48 gene is a common source of carbapenem resistance in CRKP in the hospital environment in our country. Antibiotic susceptibility testing by disc diffusion method and modified Hodge test are cost-effective and suitable methods for the initial detection of CRKP, especially when molecular detection methods are not available.

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Background The assessment of adrenal insufficiency (AI) in cirrhotic patients varies according to the stage of the liver disease. The authors aimed to study the diagnostic role of salivary cortisol (SC) level in the assessment of AI in chronic hepatitis C cirrhotic patients. Patients and methods A case–controlled study of 50 patients with liver cirrhosis owing to chronic hepatitis C infection and 34 apparently healthy persons was conducted. Fasting serum total cortisol (STC), SC, and corticosteroid-binding globulin (CBG) level assessments, as well as calculation of free cortisol level (CFC) were done. Results SC (P<0.000), STC (P<0.000), CBG (P<0.000), and CFC (P<0.000) were reduced significantly in patients compared with controls. A total of 11 (22%) patients were diagnosed with AI by reduced STC level, but only five (10%) were diagnosed by reduced SC. In cirrhotic patients, SC (P<0.000), CFC (P<0.000), and CBG (P<0.000) were significantly decreased with the severity of liver cirrhosis according to Child–Pugh classification. High-density lipoprotein level was positively correlated with SC (P<0.000), CFC (P<0.000), and STC (P<0.000) levels. SC was better correlated with CFC than STC, with a significant difference between the two correlations (z score=−2.716 and P<0.003). On receiver operating characteristic curve analysis, SC (at a cutoff value 5.65 ng/dl) had a sensitivity of 76% and specificity of 87.5% compared with 38 and 97.3%, respectively, for STC (at a cutoff value of 12.6 μg/dl). Conclusion SC correlated well with CFC and is more sensitive than serum total cortisol in the diagnosis of AI in cirrhotic patients.

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Background Placental adhesive disorder (PAD) is a fatal condition the rate of which has been rising progressively over the previous 50 years. PAD is the main reason for maternal morbidity and mortality and is now the most common cause of emergent postnatal hysterectomy. When transabdominal ultrasound (US) cannot conclusively exclude PAD as a diagnosis, the following imaging technique used is color Doppler ultrasonography. The gold standard investigation in high-risk patients is MRI in antenatal diagnosis. Aim The purpose of the study was to judge the accuracy of US and color Doppler vs MRI in the prenatal diagnosis of PAD. Patients and methods A prospective study included 50 patients aged from 20 to 40 years for high risk of developing or suspected to have PAD. The patients were evaluated by US and MRI and diagnosis was matched to postnatal outcomes. Results A total of 50 gravid women, the age of whom ranged from 20 to 40 years were included in the study. At gestational age that ranged from 20 to 39 weeks all gravid women were examined using MRI and US. The sensitivity of the US in the evaluation of PAD was 100%, the specificity 78.95%, positive predictive value 60%, negative predictive value 100%, and the overall accuracy was about 84%. The sensitivity of MRI in the evaluation of PAD was 100%, the specificity 89.47%, positive predictive value 75%, negative predictive value 100%, and the overall accuracy was about 92%. The P value for both US and MRI diagnoses of PAD was less than 0.001. Conclusion The US remains the primary imaging modality for assessment of the placenta. MRI has several exclusive features that make it superior in the evaluation of the placenta. Corresponding to the study, the most accurate US signs are the presence of lacunae and an unusual color Doppler imaging pattern. Corresponding to the study, the most reliable MRI signs are placental bands, heterogeneous placenta, and uterine bulging.

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Objective The aim was to evaluate the relationship between vitamin D deficiency and chronic idiopathic low-back pain (LBP), and to observe the effect of vitamin D correction and a proposed walking program exercise (WPE) on the severity of LBP. Patients and methods In this randomized, controlled study, 110 patients (100 with deficiency and 10 with insufficiency of vitamin D3), 95 women and 15 men with chronic idiopathic LBP were randomly assigned to receive either oral vitamin D3 or oral vitamin therapy and a proposed walking program exercise (WPE). Group A included 55 patients, 50 with deficiency and five with insufficiency Group B included 55 patients, 50 with deficiency and five with insufficiency over 3 months. Visual analog scale 0–10 was used to assess the degree of pain intensity. Results Findings have shown that 100% of the patients included in this study (n=110) (100 deficiencies and 10 insufficiencies) had an abnormally low level of vitamin D before treatment with vitamin D therapy and WPE. By the end of the study, all the 110 patients have normalized their vitamin D level after vitamin D oral therapy and WPE (100%). However, only 49 patients (group A) (44 deficiencies and five insufficiencies) reported disappearance of LBP after vitamin D oral therapy and only 51 patients (group B) (46 deficiencies and five insufficiencies) reported disappearance of LBP after vitamin D oral therapy and WPE so the total number of responders of both groups being 100 (90.9%) cases and the total number of nonresponders of both groups being10 (9.1%) Conclusion After correction of vitamin D3 over 3 months, the authors found that the chronic LBP has improved. A combination of both (correction of vitamin D3 and WPE) is more beneficial in improving chronic LBP.

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Background Vitamin D has a wide range of biological functions. The presence of vitamin D receptors (VDRs) in many tissues explains its diverse actions. The VDR gene is highly polymorphic, with many single nucleotide polymorphisms. The FokI polymorphism in the VDR gene is the only polymorphism that influences the size of the translated protein. Type 2 diabetes mellitus (T2DM) is a growing problem worldwide, it results from a complex of inheritance and environment interactions. Vitamin D deficiency and VDR gene polymorphism FokI have been linked to T2DM and diabetic microvascular and macrovascular complications. Aim The aim of this study is to determine the association of VDR gene polymorphism FokI with T2DM and diabetic microvascular and macrovascular complications in postmenopausal women. Participants and methods This study was carried out on 200 postmenopausal Egyptian women (50 healthy controls, 50 patients with T2DM without microvascular or macrovascular complications, 50 T2DM patients with microvascular complications, and 50 T2DM patients with macrovascular complications). VDR FokI genotypes were determined by PCR-restriction fragment length polymorphism analysis and hydroxy vitamin D (25OHD) levels were measured by enzyme linked immunosorbent assay. Results The prevalence of the polymorphic genotypes ff and the f allele was statistically significantly increased in diabetic patients than in controls (P<0.001), and the odds ratio was 7.84 (95% confidence interval: 1.75–35.09). There was a statistically significant increase in the polymorphic genotypes ff and the f allele in T2DM with microvascular or macrovascular complications compared with the control group (P=0.05). Plasma vitamin D (25OHD) levels were significantly lower in diabetic patients than in the control participants (P=0.032). On comparing the studied groups in terms of the plasma vitamin D (25OHD) levels, there was a statistically significant decrease in the levels in patients with microvascular and macrovascular complications in comparison with the control group (P<0.001). Conclusion The ff genotype and the f allele of VDR polymorphism FokI may represent a significant genetic molecular marker to predict the risk of diabetes and diabetic microvascular and macrovascular complications in postmenopausal women.

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Background and aim Fetal growth restriction (FGR) is a clinical and public health challenge that confers an increased risk of intrapartum and neonatal adverse outcomes. Doppler indices, particularly cerebroplacental ratio (CPR), may be useful in predicting adverse outcomes in pregnancies with FGR. We aimed to evaluate the potential value of CPR at 34–37 weeks’ gestation in predicting the perinatal outcome of pregnancies with FGR. Patients and methods A prospective observational study on singleton pregnancies with FGR, who underwent estimated fetal weight assessment and Doppler indices, including CPR, umbilical artery pulsatility index (PI), and middle cerebral artery pulsatility index (PI) at 34–37 weeks’ gestation. Patient characteristics, and intrapartum and neonatal outcomes were recorded. The main outcomes were a need for urgent cesarean section due to intrapartum fetal compromise, 5-min Apgar score below 7, neonatal death, and admission at neonatal ICU. Results Out of from 80 women participated in the current study, 16 women had an unfavorable outcome in their newborns. abnormal CPR (<1.08) was present in 27.5% of cases and was associated with a higher risk of adverse outcomes. The sensitivity and specificity of CPR in predicting adverse neonatal outcomes were 62.50 and 81.25%, respectively, and its diagnostic accuracy was superior to either umbilical artery pulsatility index or middle cerebral artery PI alone. Conclusion CPR measured at late gestation seems to be a useful method for predicting adverse intrapartum and neonatal outcomes in pregnancies with FGR. Routine measurement of CPR may decrease the incidence of these adverse outcomes.

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Background and aim As the ideal test to predict pregnancy-induced hypertension and preeclampsia should be inexpensive, reproducible, easy to do early in pregnancy, and noninvasive and have high sensitivity, the aim of this study was to evaluate clinical parameters, laboratory tests, and uterine artery doppler indices in prediction of preeclampsia and pregnancy outcome. Patients and methods This study was carried out in the antenatal care clinic of Obstetrics and Gynecology Department of Al Azhar University Hospital. The study included 177 pregnant women booked for antenatal care before 18 weeks of gestation, who were considered to be at increased risk of developing preeclampsia. Results Doppler flow velocimetry of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and in predicting preeclampsia, when used as a single test. Microalbuminuria between 24 and 34 weeks of gestation, in the first morning urine specimen, is a good predictor for the subsequent development of preeclampsia. Conclusion When three tests were combined to test their ability to predict preeclampsia, the best triple tests were microalbuminuria, uterine artery doppler flow velocimetry study at 24–26 weeks of gestation, and mean platelet volume, which gave the highest value when κ test of agreement was used.

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Background Studies have identified progranulin (PGRN) as a proinflammatory and anti-inflammatory protein. Data from other several inflammatory diseases suggest the role of this adipokine in psoriatic pathophysiology. Objective The aim was to investigate serum levels of PGRN in patients with psoriasis compared with healthy controls, and to consider their relation to disease duration, disease severity, and obesity markers. Patients and methods Serum PGRN concentrations were measured in 37 patients with active plaque-type psoriasis and 25 healthy controls by using specific enzyme-linked immunosorbent assays. Results Patients with psoriasis showed higher levels of serum PGRN compared with healthy controls (P<0.033). Concentrations of serum PGRN showed significant positive correlation with Psoriasis Area and Severity Index score, BMI, and waist circumference (P<0.001). Conclusion Serum PGRN could be a useful biomarker of psoriasis severity and could be a potential target for new therapies for psoriasis.

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Background and aim Anticoagulant use in pregnant women should be paid great attention in both the period of pregnancy and the postpartum period. Risks and benefits to the mother and fetus should be balanced in the choice of anticoagulant therapy. Clinical audit can be defined as the process of assessment through the use of evidence-based criteria and/or the outcome of care by comparison with others. In the current study, the aim was to audit the anticoagulant therapy usage in pregnancy and compared it with the chosen international standards (RCOG standards). Patients and methods The study was done at Gynecology and Obstetrics Department of Minia General Hospital, Egypt, on 300 pregnant women on anticoagulant therapy. Results Regarding the percent of patients following the international guidelines among the 300 studied cases on anticoagulant therapy, 174 (58%) cases agreed with RCOG guidelines and 126 (42%) did not agree with RCOG guidelines. Conclusion The use of anticoagulant in pregnancy must be balanced according to the benefit and the risks of use.

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Background Pancreatic and biliary malignancies are rarely operable. The role of intervention is to palliate jaundice. Biliary drainage can be done by surgical bypass or biliary stenting either percutaneously or by endoscopic retrograde cholangiopancreatography. Plastic and expandable metal stents (EMS) are available. Aim To compare metallic biliary stenting versus surgery for palliation of inoperable malignant obstructive jaundice due to unresectable pancreatobiliary cancer. Patients and methods This retrospective, cohort study included 43 patients, presented by malignant obstructive jaundice due to unresectable pancreatobiliary cancer. They were divided into two groups: group I (20 patients) underwent palliative biliary-enteric surgical bypass; group II (23 patients) underwent endoscopic retrograde cholangiopancreatography and metal stent drainage. Results This study showed that both surgical bypass and EMS insertion have similar short-term satisfactory results in the control of jaundice. Surgical bypass had low incidence rate as regards late complications, although gastric outlet obstruction may occur for patients without gastric bypass. Despite EMS resulted in a shorter hospital stay, the higher late complications rate raised the cost, especially stent occlusion. Conclusion Endoscopic EMS and surgical bypass had similar results according to the efficacy of biliary drainage and mean survival period. EMS had a shorter hospital stay and fewer early complications. But, in the long run, surgical bypass results in less recurrent jaundice than the EMS but higher morbidity and mortality.

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Objectives Many children in Egypt are being subjected to different forms of abuse. Numerous studies have documented that children exposed to child abuse are more likely to experience a set of adverse psychosocial and behavioral outcomes including low self-esteem and externalizing disorders. Patients and methods A total of 100 children and adolescents were included in the study; 50 of them were the case group with externalizing behavior [attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder] recruited from the outpatient clinic of psychiatry department, Al Zahraa University Hospital, whereas the other 50 were the control group from the outpatient clinic of Pediatric Department, Al Zahraa University Hospital. They were subjected to clinical assessment, the Wechsler Intelligence Scale, Child Trauma Questionnaire, and Coopersmith Self-Esteem Inventory. Results The most prevalent diagnoses of the externalizing disorder group were ADHD (46%), CD (26%), oppositional defiant disorder (16%), and ADHD with CD (12%). Comparison between the case group (externalizing disorders) and the control group regarding different types of abuse showed that there was statistically significant difference regarding emotional abuse, severe physical abuse, sexual abuse, and physical neglect. Comparison between different types of abuse in different diagnoses showed that both ADHD and CD are significantly associated with severe physical abuse and sexual abuse. The relation between self-esteem and different types of abuse showed that all types of abuse are significantly associated with low self-esteem. Conclusion The results highlight the need for strategies aiming at reducing child abuse and improving parenting style.

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Introduction Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD). Genetic susceptibility together with environmental factors disturbs intestinal homeostasis, resulting in repeated and chronic inflammation with remission and exacerbation cycles. Cathelicidin (LL-37) is an antimicrobial peptide known to be associated with various autoimmune diseases. The authors have attempted to determine if cathelicidin can accurately reflect IBD disease activity. The authors hypothesized that serum cathelicidin correlates with mucosal disease activity. Aims The aim was to correlate circulating cathelicidin level with mucosal disease activity in patient with IBD. Patients and methods This is a case-control study that was conducted on 90 adult participants, comprising 60 patients with IBD and 30 non-IBD cases studied as a control group, who attended the gastrointestinal endoscopy and liver unit at Al-Zahraa University and El-Haram Hospital. All participants were subjected to complete medical history, physical examination, laboratory investigations, and colonoscopic examination. LL-37 levels were determined by enzyme-linked immunosorbent assay. Data from patients were used for calculation of accuracies in indicating mucosal disease activity. Results There was a highly significant increase of serum LL-37 level in patients with IBD than control. Serum cathelicidin level was negatively correlated with partial Mayo scores for patients with UC and Harvey–Bradshaw indices for patients with CD. Among patients with IBD, low LL-37 level indicates moderate or severe disease activity, and high LL-37 level indicates remission. C-reactive protein (CRP) levels were directly correlated with partial Mayo score for patients with UC and Harvey–Bradshaw index for patients with CD. Co-evaluation of LL-37 and CRP levels was more accurate than CRP alone or LL-37 alone in the correlation with Mayo endoscopic score for patients with UC. Conclusion Patients with IBD have increased serum level of LL-37. Evaluation of both LL-37 and CRP can indicate mucosal disease activity in patients with UC, and both in combination are better indicators than LL-37 or CRP alone.

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Background Intrauterine growth restriction (IUGR) occurs when there is deficiency of gas exchange and nutrient delivery to the fetus not allowing it to thrive in utero. This happens because of maternal diseases that decrease oxygen-carrying capacity (e.g. cyanotic heart disease, smoking, and hemoglobinopathy) or by maternal vascular diseases causing a dysfunctional oxygen delivery system or idiopathic causes. Sildenafil (phosphodiesterase-5) inhibitor consists of the citrate salt of sildenafil; it is a selective and specific inhibitor of cyclic guanosine monophosphate. It is primarily used for sexual dysfunction, antidepressant-associated sexual dysfunction, pulmonary hypertension, altitude thickness, and Raynaud’s phenomenon. Herein, the trial is used for improving uteroplacental perfusion by enhancing vasodilatation of myometrial small artery, decreasing peripheral resistance, and boosting flow within the uteroplacental bed. Aim The aim was to evaluate efficacy and role of sildenafil citrate on the blood flow of uteroplacental circulation and fetal growth in pregnancies accompanied by fetal growth restriction because of dysfunctional oxygen delivery system guided by umbilical Doppler ultrasound. Patients and methods Our study was a prospective double-blind, randomized, controlled trial. The patients were recruited from women with IUGR attending the emergency ward and outpatient clinic at Sohag teaching Hospital. The study comparing three groups of 150 women. Each group consisted of 50 women. One group received 20 mg of sildenafil citrate orally twice/day, the second received a dose of 40 mg every 12 h vaginally, whereas the last one received a placebo, as a control group. Results After treatment, improvement of Doppler in the form of S/D, resistance index, and pulsatility index showed highly significant difference between the two sildenafil groups compared with the control one. Conclusion Sildenafil therapy may offer a new breakthrough in treatment of IUGR-complicated pregnancies, with improvement of the perinatal outcomes.

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Objective Chronic leg ulcers (CLUs) present an economic burden to health care system and significant reductions in quality of life for those affected. Low-level laser therapies (LLLTs) can play a useful role in healing of CLUs. This study aimed to evaluate the efficacy of using LLLT in CLU healing, and we focused on the use of dermoscopy in healing progress follow-up of different types of CLUs regarding some features. Patients and methods This was a case–control study. It included 60 patients recruited from dermatological and vascular outpatient clinics and divided equally into two groups: study group and control group; in each group, there were 10 patients who had arterial ulcer, 10 patients who had diabetic ulcer, and 10 patients who had venous ulcer. The ulcers in the study group were treated by LLLT and the control group received conventional treatment. Pressure ulcer scale for healing and dermoscopic evaluation before and after treatment was done. Results There was a statistically significant difference before and after LLLT, which indicates the progress of healing. The pressure ulcer scale for healing score is decreased in patients who were treated with LLLT compared with patients treated with conventional treatment (P=0.002). Good improvement (≥75%) was seen regarding push healing ratio in the arterial group. Conclusion LLLT is safe, inexpensive, and effective and increases the healing progress of CLUs, which were detected with push score ratio and a novel use of dermoscope.

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Background Airflow limitation is associated with all-cause mortality and could worsen treatment outcomes in chronic diseases. In resource-limited countries, where availability of spirometry facilities poses a major challenge, the magnitude of airflow limitation among patients with chronic diseases is unknown. Such information may justify the need for routine lung function screening, early detection, and management of airflow impairment among this population. Objective This study aims to estimate the magnitude of airflow limitation among patients attending endocrinology and cardiology clinics in a tertiary healthcare facility in south-western Nigeria. Patients and methods A cross-sectional survey design study was performed, involving individual with diabetes and hypertension who were recruited from the outpatient unit of the hospital. A handheld digital spirometer was used to measure lung function indices. Data were analyzed using descriptive statistics of mean, SD, frequencies, and percentages. c² test was used to test for difference in proportions between sexes and patient groups. Results A total of 124 (90 females and 34 males) patients, comprising of 53 patients with diabetes, 67 with hypertension, and four with both diabetes and hypertension, participated in this study. Overall, 91 (73%) participants had airflow limitation: 52 (78%) of 67 hypertensive patients and 36 (68%) of the 53 patients with diabetes. Airflow limitation was significantly higher among men (94%) than women (66%). Severity of airflow limitation was as follows: 61 mild cases, 28 moderate, and two severe cases, which were undetected and untreated among the study population. Conclusion Airflow limitation is common among the study population. Strategies aimed at early detection through routine lung function screening may be beneficial.

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Background Total hip arthroplasty (THA) is one of the most successful surgeries in orthopedics. However, postoperative dislocation is one of the major complications. There are some patients with higher risk for dislocations. Dual mobility cup THA (DMC) may decrease the rate of dislocation and enhance functional outcome in those patients. Aim The aim was to retrospectively assess postoperative rate of dislocation and functional outcome in patients with preoperative risk factors for dislocation treated by DMC THA. Patients and methods A total of 26 DMC THAs were done for 25 patients with preoperative risk factors for dislocation. Functional outcome by Harris hip score and dislocation rates have been followed for a period of 12–48 months (mean: 31 months). Results There was 0% rate of dislocation till the last follow-up. There was marked improvement in Harris hip score, with good to excellent results in 74% of patients. Conclusion DMC THA is a good option for patients at risk for dislocations, with very low or no rate of dislocation, with good functional outcomes.

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Background There are inadequate studies validating the efficacy of several echocardiographic parameters of right ventricular (RV) function in assessing RV infarction and predicting stenosis of proximal right coronary artery (RCA). Most of them evaluated a single parameter and many lacked angiographic correlations. Aim To evaluate RV systolic function using systolic excursion of right ventricular outflow tract (RVOT-SE) by echocardiography with correlation to stenosis of proximal RCA in patients with first incident of acute inferior wall myocardial infarction. Patients and methods Parasternal short-axis view at the level of the aortic valve was obtained using M-mode echocardiography, and RVOT-SE was defined as the RVOT-SE anterior wall. It was measured in 50 patients who underwent CA after acute Inferior ST elevaion myocardial (STEMI). Results Patients with reduced RV function were identified with tricuspid annular plane systolic excursion (TAPSE) below 16 mm. RVOT-SE optimal cutoff values to predict RV systolic dysfunction was SE=5.4 mm with a sensitivity of 91.7% and specificity of 99.97% (area under the curve=0.935, P=0.00). RVOT-SE prediction of proximal RCA stenosis was with a sensitivity of 91.4% and specificity of 90.2%. The study showed significant positive correlations with RV-fractional area change and TAPSE (P=0.00) and significant negative correlations with tissue Doppler myocardial performance index and pulsed wave myocardial performance index (P=0.00). Conclusion RVOT-SE is a naive and precise method for assessing RV systolic function. This study suggested the use of RVOT-SE as a parameter of RV function paired with other indices such as TAPSE.

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Background and aim The aim of the study was to investigate the surgical techniques to remove meningioma en plaque and to compare our technique and results with other authors. Patients and methods This retrospective series case was done at our University Hospital. Eight patients were managed at Al-Zahraa University Hospital between March 2016 and March 2018. Preoperative and postoperative clinical and radiological assessments were done for each patient. Results There were eight patients in our study. All patients are women. The age range was from 34 to 60 years and the mean was 45.4 years. Proptosis was the main clinical manifestation and it was present in all eight patients. Three (37.5%) patients had visual impairment while two (25%) of them had headache and retro-orbital pain. We achieved total resection in six (75%) out of our eight patients. All tumors were WHO grade 1 meningiomas. Regarding surgical outcome, proptosis improved in six (75%) of the eight cases. Visual impairment improved in two (66.7%) cases out of three who had visual declination preoperatively. Conclusion Meningioma en plaque can be safely removed without any morbidity or mortality. Proptosis and hyperostosis in the sphenoid bone are highly suggestive and this requires more accurate radiological studies. MRI with contrast is essential for these cases. Extensive bony drilling is required for gross total resection. It also facilitates resection of the soft part of the tumor with its dura. Some cases may need orbital wall reconstruction. Proptosis mostly improves after surgery.

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