Background and aim Low back pain and radiculopathy are the main annoying complaints in patients with degenerative disc diseases. Epidural steroid injection (ESI) has a role to reduce pain and improve disability by decreasing inflammatory process at the nerve root caused by herniated disc. This study was done to evaluate the efficacy of lumbar ESI regarding the improvement of pain and functional outcome. Patients and methods This study was a prospective randomized study on 30 patients, aged between 30 and 65 years with low back pain and lumbar radiculopathy secondary to lumbar disc prolapse with no absolute indication for surgery. The patients were treated by lumbar epidural injection of steroids. Patients were divided randomly into two groups: group 1 included 15 patients subjected to lumbar interlaminar ESI, and group 2 included 15 patients subjected to lumbar transforaminal ESI. Patients were evaluated using visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI) for functional capacity. They were followed up after 4 weeks, and clinical and functional outcomes were assessed using the same tools for evaluation. Results The mean VAS for the 30 patients improved by 58.33% (P<0.001), and the mean ODI for the 30 patients improved by 35.4% after 4 weeks following injection (P<0.001). In group 1, the mean VAS improved by 52% and the mean ODI improved by 31.13% after 4 weeks following injection (P<0.001). In group 2, the mean VAS improved by 64.66% and the mean ODI improved by 39.66% after 4 weeks following injection (P<0.001). We found that the mean improvement of VAS and ODI was more in group 2 than in group 1(P<0.026). Conclusion We found by the end of the study that the ESI is a safe and effective procedure in alleviating radicular pain and improvement of functional outcome, but the transforaminal approach gives better results than the interlaminar approach.

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Abstract Mallory–Weiss tear is a rare complication that could result following cardiopulmonary resuscitation, leading to vigorous upper gastrointestinal bleeding. We illustrate a case of an 84-year-old male patient, admitted to the hospital for investigation of lung nodules and bilateral pleural effusion. The patient developed cardiac arrest during pleural aspiration, and cardiopulmonary resuscitation was done, which was followed shortly by an attack of acute upper gastrointestinal bleeding. Urgent upper endoscopy revealed a mucosal tear with submucosal oozing of blood and two large vessels in its floor, which were successfully managed endoscopically with both injection and hemoclips. This case report emphasizes the importance of considering this potential complication, especially after performing a successful cardiac resuscitation.

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Background and aim Renal failure is usually treated by hemodialysis forever. Renal transplantation is the only curative intervention. However, regenerative therapies are expected to exert a beneficial role in such situations. The aim of this study was to study the role of mesenchymal stem cells (MSCs) in the treatment of acute renal failure (ARF) in an animal model. Materials and methods ARF was induced by cisplatin injection in 20 male rats weighing 200–225 g. Rats were allocated into one of two equal groups: group A included 10 rats with ARF and umbilical cord-derived stem cell treatment, and group B included 10 rats with saline treatment. In addition, 10 healthy rats were included as a healthy control group (group C). Both serum urea and creatinine were measured after induction of renal failure and on the 7th and 15th day after MSC treatment. Kidney sections were obtained, stained with hematoxylin and eosin, and examined histologically. Results Serum urea and creatinine showed marked elevation after cisplatin injection. These values progressively decreased with MSC treatment significantly. At the end of the second week, the values were near normal. In addition, histological examination of renal section confirms the results obtained by laboratory analysis. Conclusion Umbilical cord-derived MSCs could play a regenerative action in ARF.

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Background and aim The trapeziometacarpal arthritis is one of the most common joint problems affecting women after the age of 50 years. Surgery is indicated after failure of conservative treatment with continuation of pain and functional disabilities. One of the most reported and well-known surgical procedure for management of basal thumb arthritis is the ligament reconstruction and tendon interposition arthroplasty. The aim of the study was to evaluate patients who underwent modified Zancolli arthroplasty for basal thumb arthritis. Patients and methods The study included 15 patients with basal thumb arthritis (three males and 12 females). Full clinical examination and scoring of the hand was done using Quick DASH, visual analog scale, measuring range of motion, and grip strength. All patients underwent full radiological and laboratory investigations. Results Overall pain intensity was measured with a visual analog scale, which ranged from 5–10 preoperatively and ranged from 0 to 1 6 months postoperatively. Regarding the DASH score, there was improvement from a mean of 64.48±16.61 points preoperatively to a mean of 1.37±1.67 points postoperatively. The mean postoperative abduction was 75% to the normal side, opposition was 80% to the normal side, and power grip was 90% to the normal hand. Conclusion Modified Zancolli arthroplasty is an effective means of treating symptomatic patients with trapeziometacarpal arthritis who failed to improve with nonsurgical measures. This technique ensures a dynamic fixation of the apical ligament and provides better stability. The procedure is simple both technically and regarding postoperative care.

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Background and aim Bleeding is considered one of the most common problems in perimenopausal women. The menopausal transition is an imprecise period and can be established from the moment of appearance of menstrual disturbances and elevation of the serum follicle-stimulating hormone (FSH) level. The objective of this study was to evaluate the efficacy of tactile electrosurgical ablation of endometrium under rectal ultrasound guidance versus modified tactile versapoint hysteroscopic ablation in the management of perimenopausal abnormal uterine bleeding. Patients and methods This study was conducted in the Department of Obstetrics and Gynecology of Al-Azhar University Hospital (Assuit), Egypt on 50 perimenopausal patients with abnormal uterine bleeding. Patients were divided into two groups according to the method used. Group 1 included 25 participants, and ablation was done using tactile ablation guided by rectal ultrasound. Group 2 included 25 participants, who underwent hysteroscopic ablation using versapoint hysteroscope. Results Regarding sociodemographic study data, age in both groups ranged from 38 to 45 years, with P value of 0.903. Parity also showed no statistically significant difference between both groups. The incidence of complication was more in group 1 but less dangerous. Thermal injury of genital tract was seen in two cases in group 1 but no cases in group 2, with P value of 0.245. Cervical injury was seen in two cases in group 1 and one case in group 2, with P value of 0.500. Perforation occurred in two cases in group 1 and one case in group 2, with P value of 0.500. Regarding specific complication of endometrial ablation by versapoint hysteroscopic ablation, which occurred in group 2 only, by distension media, four cases had complications such as hyponatremia (decrease in serum sodium of 10 mmol/l). Postoperative complication such as hematometra occurred in one case only in group 1, with P value 0.500. The cost range in group 1 was from $14 to 20 and in group 2 it was from $40 to 50, with P value less than 0.001**. The time of surgery ranged from 10 to −15 min in group 1 and from 20 to 30 min in group 2, with P value less than 0.001**. After 6 months, two cases came back with recurrent Hge in group 1 and six cases in group 2, with P value 0.123. Conclusion Tactile ablation is easier, effective, and less costly.

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Background and aim Chronic total occlusion is a common condition in patients with coronary artery disease and represents one of the most challenging targets of lesion recanalization with successful percutaneous coronary intervention (PCI). Different echo-Doppler modalities can be used for the assessment of right ventricular (RV) performance in patients undergoing PCI with reported superiority of the newer modalities. The aim was to assess the effect of successful PCI for chronic totally occluded vessel on the RV performance by different echo-Doppler modalities. Patients and methods The present study enrolled 25 patients with chronic total occlusion for whom PCI was performed. Patients were subjected to history taking, clinical assessment, 12-lead surface ECG, and evaluation of RV functions before, within 48 h after successful PCI, and 1 month later, using conventional and new echo-Doppler modalities. Echo-Doppler parameters included RV dimensions, Doppler flow velocities (E, A, and E/A) across tricuspid valves, RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion, tissue Doppler systolic, and diastolic velocities (Sa, Ea, and Aa) at the lateral tricuspid annulus, in addition to evaluation of RV global longitudinal strain (RV-GLS). Results There was no significant improvement of parameters reflecting RV function comparing the pre-PCI and 48-h post-PCI values. On the contrary, significant improvement was detected comparing the echo-Doppler measures of either the pre- or 48-h PCI value with those of 1 month later. There was a significant increase of RV-FAC, tricuspid Sa and Ea, and RV-GLS (P<0.05). The E/A ratio of tricuspid flow and tricuspid annular plane systolic excursion showed no significant difference from pre- to 48 hr or 1-month PCI value. Conclusion RV performance improves after successful PCI of chronic totally occluded vessels. Newer echo-Doppler modalities appear to be better tools for assessment of RV performance.

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Background and aims Tailored (culture and sensitivity) therapy has gained attention over recent years as an effective option for eradication of Helicobacter pylori infection. The authors aimed to assess the efficacy of antibiotics sensitivity-guided therapy versus clarithromycin or levofloxacin triple therapies as the first-line therapy for H. pylori. Patients and methods Dyspeptic patients who underwent esophagogastroduodenoscopy were prospectively enrolled. Patients with positive H. pylori results by the rapid urease test were randomized to receive either antibiotics sensitivity-guided therapy or empirical clarithromycin or levofloxacin-based triple therapy for 14 days. Antimicrobial sensitivity tests for seven antibiotics (clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline, nitrofurantoin, and rifampicin) were performed using the disk-diffusion method. Group A received antibiotics sensitivity-guided therapies that included esomeprazole plus two antibiotics for which the isolates were sensitive and group B received conventional therapies that included esomeprazole, amoxicillin plus clarithromycin or levofloxacin for 2 weeks. Eradication of H. pylori was checked using stool antigen 4 weeks after therapy. Results A total of 25 patients completed the study in each group. Both studied groups were matched for baseline characteristics. The most commonly used regimen in the antimicrobial sensitivity-based therapy was clarithromycin-based triple therapy (46.5%), followed by levofloxacin-based triple therapy and levofloxacin and nitrofurantoin plus esomeprazole. The association analysis demonstrated that, in the intention-to-treat populations, the H. pylori eradication rate was significantly higher in the antibiotic sensitivity-guided therapy group [85.7% (24/28) vs. 53.3% (16/30) in the conventional therapy group (P=0.035). In the per-protocol populations, the eradication rate was 96% for the sensitivity-guided therapy group and 64% for the conventional therapy group (P=0.005). The rates of adverse events were similar in both sensitivity-guided and conventional therapies, with no significant differences (P=0.527). Conclusions Culture-based eradication therapy demonstrated superior eradication rates than empirical therapy as a first-line therapy for H. pylori in a region with high rates of antimicrobial resistance.

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Background and aim Nystagmus is an ocular motility disorder in which the eyes make uncontrollable, repeated movements. These movements can cause vision and depth perception problems, as well as affect balance and coordination. The aim was to study electrophysiological changes that occur in patients with nystagmus and pattern of changes in each disease. Patients and methods A prospective, institutional, clinical trial was conducted on 60 eyes with nystagmus. The age of the patients ranged between 5 and 50 years, and the patients were chosen from Al-Hassan Eye Center, Giza and Al-Azhar University Hospital outpatient clinic. Results The study revealed the relation between photopic electroretinogram (ERG), scotopic ERG, and flash visual-evoked potential (VEP) and each of fundus examination and final diagnosis of the studied group, and it shows highly statistically significant differences between groups according to fundus examination and final diagnosis. Conclusions Electrophysiological examination is an essential step in the assessment of patients with early-onset nystagmus especially when the eyes are apparently normal on routine examination and should be enrolled within their medical records. This study clarified the need to investigate cases with nystagmus by ERG and suggested that the ERG was useful where the diagnosis was uncertain. Visual-evoked potential is complementary to ERG and can be tested simultaneously.

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Background and aim Diabetes mellitus (DM) is a major risk factor for atherosclerosis that increases platelet activation and aggregation. Aim This study aimed to investigate the different types of platelet activation markers in diabetic patients with peripheral arterial disease (PAD). Patients and methods Using flow cytometry on forty noninsulin-dependent diabetic type II patients with PAD receiving antiplatelet therapy, participants were divided into two groups: those with controlled, uncontrolled DM and 20 control samples. Results There was a highly significant increase in mean platelet volume, CD62P%, CD62 mean fluorescence intensity, and CD63% in the uncontrolled DM group compared with the control group, in addition to a highly significant correlation between CD62P% and glycated hemoglobin in all cases, with a P value of 0.015. Conclusion The CD62P% is a more selective platelet marker that is activated in uncontrolled DM, causing atherosclerosis and leading to PAD. Glycemic control is the most important factor in the prevention of atherothrombotic progress than antiplatelet treatment.

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Background and aim All platelet indices may be useful biomarkers for follow-up in inflammatory bowel disease patients as they show a strong correlation with disease activity. In this work, we aimed to investigate the relation between mean platelet volume (MPV) and ulcerative colitis (UC) activity by comparing the MPV values between cases with active UC, mild cases and normal individuals. Patients and methods This observational study was carried out on 90 individuals aged >18 years. They were divided equally into the following groups: group A: active UC, group B: remitting UC and group C: healthy controls free of any systemic diseases as a reference. UC was confirmed based on colonoscopy and biopsy. Results Patients with active UC have significantly smaller MPV in comparison with patients with disease remission or healthy controls (P value <0.001), without a difference between patients in remission and healthy controls. MPV was directly proportional to the Hemoglobin level among study populations (r=0.64, P<0.001). MPV was negatively correlated with erythrocyte sedimentation rate (r=−0.74, P<0.001), total leukocytic count (r=−0.49, P<0.001) and platelet count (r=−0.24, P=0.023) in all the study populations. Conclusion MPV decreases in the active phase of UC compared with the remission phase or healthy individuals. There is a relationship between the degree of disease activity and MPV in UC. Hence, MPV can be a useful biomarker for assessing disease activity for UC.

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Background and aim Systemic hypertension (SH) causes a gradual increase in the mass of the left ventricle, resulting in left ventricular hypertrophy (LVH). Derangement of LV function is caused by morphologic changes in the left ventricular (LV) walls, which result in hypertrophy. According to a recent meta-analysis, LVH raises the risk of cardiovascular morbidity and mortality. The aim was to compare between hypertensive patients with LVH and hypertensive patients without LVH regarding LV function (by Simpson’s method) and myocardial performance index (by Tissue Doppler echocardiography). Patients and methods The study included 40 selected hypertensive patients and 20 healthy participants undergoing echocardiographic assessment at the echocardiography unit. The patients were classified into two groups: group I included 20 normotensive healthy control, and group II included 40 hypertensive patients. Group II was further divided into two subgroups according to the absence or presence of echocardiographic signs of LVH: group IIa included 20 hypertensive patients without echocardiographic signs of LVH, and group IIb included 20 hypertensive patients with echocardiographic signs of LVH. Results Regarding systolic and diastolic blood pressures, there was an extremely statistically significant difference between the two groups. Regarding LV mass index, there was a highly statistically significant difference. However, LVMI in subgroup IIa was normal in comparison with subgroup IIb, with an extremely statistically significant difference. Regarding ejection fraction (EF%), there was an extremely statistically significant difference between the two groups. Regarding EF%, there was an extremely statistically significant difference between group I and group IIa. Regarding EF%, there was an extremely statistically significant difference between subgroup IIa and subgroup IIb. Regarding myocardial performance index, there was an extremely statistically significant difference between the two groups (0.36±3.2 in group I vs. 0.51±4.8 in group II). Conclusion First, SH causes a cascade of LV hemodynamic changes that can range from maladaptive hypertrophy to heart failure. Second, Tissue Doppler echocardiography appears to be able to differentiate between the many types and degrees of LV dysfunction in SH, as well as the various stages of the hypertensive disease process. Third, Myocyte apoptosis and collagen deposition in the interstitial space appear to be factors that favor the transition from LVH to heart failure.

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Background and Aim Pilonidal sinus disease (PD) affects youngsters and is more recorded in males. Although a wide variety of treatment modalities to manage this disorder are still in use in everyday surgical practice, nevertheless, there was no consensus to which of those procedures is closer to perfect in providing definitive management. With recent advances in surgery, application of the laser was found to be an effective approach in the treatment of PD. The aim was to compare the outcome of management of PD by excision andprimary closure, excision and reconstruction by flap, and a 1470-nm diode laser, and to analyze its effectiveness, postoperative complications, recurrence rate, and satisfaction of the patient. Patients and methods This prospective comparative study between three methods of treatment of pilonidal sinus was made. This study includes 45 cases presented with PD disease: they are divided randomly into three groups. Group A (15 patients) was subjected to pilonidal excision and primary direct closure, while group B (15 patients) was subjected to pilonidal excision and local flap reconstruction, and group C (15 patients) was subjected to a 1470-nm diode laser. Results A significant difference was found to be between three groups regarding the duration of surgical procedures (in minutes). As regards to diode laser, all 15 cases had been managed efficiently on an outpatient procedure. Only one recurrent case was recorded. Conclusion Laser pilonidotomy is effective in the treatment of PD with a high rate of success, less complications, and high satisfaction of the patient.

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Background and Aim Acetabular bone defects are one of the most difficult problems in both primary and revision total hip replacements. Many techniques have been described to deal with acetabular bone defects in total hip replacement, including the use of cement with or without cages and rings, structural bone grafting, and impaction bone grafts with cementless or cemented cups. The aim of this study was to asses short-term to midterm clinical and radiological outcomes of acetabular reconstruction by impaction bone grafts and cemented cups in both primary and revision cases indicated for total hip arthroplasty (THA) with acetabular bone deficiency. Patients and methods This is a retrospective study that included 26 patients with total hip arthroplasty (THA) who underwent acetabular bone defect reconstructions with grafting and cemented cups between December 2014 and January 2019. The mean age at operation was 45.3 years. Among the procedures, 12 were primary THAs, whereas 14 procedures were revision THAs. The morselized grafts were used in eight cases only, along with combined strut graft and morselized grafts in five cases, acetabular rim mesh and morselized grafts in 12 cases, and Kerboul cross-ring with morselized grafts in one case. All cases were clinically evaluated by Harris hip score in addition to radiological evaluation. Results All the patients except one showed clinical improvement, where the mean postoperative Harris hip score became 84. Radiograph follow-up for all the cases showed graft incorporation without loosening or any significant cup migration, except one case, which was revised owing to loosening around the cup. Conclusion The use of impaction graft and cemented cups is safe and reproductive even in young patients. Moreover, this technique reconstitutes bone and gives a stable platform of bone stock for further revision, especially in young population.

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Background and aim The aim of this study was to investigate the advantages of the extended pterional approach and compare it with more invasive and less-invasive similar approaches. Patients and method s This study is an observational retrospective case-series study and descriptive statistics was used. Twelve patients with suprasellar and parasellar lesions were managed in the period between January 2016 and January 2019. Preoperative and postoperative clinical and radiological assessment were done for each patient. Results Twelve cases were done via this approach. There were nine females and three males. Age ranges from 2 to 55 years with a mean of 31.7 years. Regarding pathology, eight (67%) cases were meningiomas, three (25%) cases were craniopharyngiomas, while one (8.3%) case was pituitary adenoma. Most of the cases (91.7%) were presented with visual affection. The lesion was excised totally (gross total resection) in seven (58.3%) out of the 12 cases. Visual affection improved in seven (63.6%) out of 11 cases. Regarding complications, one case experienced permanent hemiparesis. One patient had deep-vein thrombosis that had been treated. One case had seizures. Approach-related complications: two cases had periorbital edema that disappeared within 1 week. One case had a rim of subdural hematoma. Frontalis nerve injury occurred in two cases, one of them improved within 6 months. We do not have a permanent cosmetic deformity with this approach. Conclusion The extended pterional approach has less functional and cosmetic complications and it can be done in lesser time than frontotemporal–orbitozygomatic approach. The exposure is much larger than conventional pterional approach.

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Background and Aim Diabetic peripheral neuropathy is one of the most challenging complications of diabetes mellitus. A large number of patients have subclinical neuropathy at the time of detection of diabetes. Proper detection of subclinical diabetic neuropathy is important to prevent more complications. When the symptoms start, there are not many effective therapeutic treatments. Nerve conduction studies (NCS) are known to be sensitive, reliable, noninvasive, and easy to perform to study diabetic neuropathy. Study of the medial plantar and sural nerves can test the most distal parts of the nerves and can be considered an alternative method for the diagnosis of polyneuropathy in the early stages. The aim of this work is to study the utility of both medial plantar and sural nerve conduction in the early diagnosis of diabetic polyneuropathy. Patients and methods Twenty diabetic asymptomatic patients and 20 healthy volunteers of both sexes were included. Their ages ranged between 26 and 44 years and 24 and 46 years, respectively. NCS of the medial plantar and sural nerves for all the patients and control groups is performed using the antidromic method of stimulation for sural nerve and orthodromic stimulation for the medial plantar nerve. Results There were significant changes in the sensory study of both medial plantar and sural nerves of neurologically asymptomatic diabetic patients compared with the control. Conclusion NCS of both medial plantar and sural nerves aids in the detection of subclinical diabetic polyneuropathy.

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Background and aim This case–control study was conducted to evaluate serum ferritin, vitamin D, and thyroid functions in patients with telogen effluvium (TE) in comparison with controls and to find if they can be used as diagnostic biomarkers of TE. Patients and methods A retrospective matched case–control study was performed using data from Hera Hospital database, Makkah, Saudi Arabia. The case records of 100 women diagnosed with TE and treated in the dermatology outpatient clinic were analyzed retrospectively. To obtain appropriate controls, records were searched for age-matched and sex-matched women who came to the hospital for a condition other than TE during the same period. Results The mean levels of patients’ serum ferritin and vitamin D were significantly lower than those of the controls. With respect to thyroid function tests, the mean levels of thyroid-stimulating hormone, thyroxine, and triiodothyronine showed no statistically significant differences between patients and controls. Although nonsignificant, 7% of patients with TE had laboratory evidence of hypothyroidism compared with 2% of controls, and 16% had subclinical hypothyroidism compared with 10% of controls, suggesting a role of thyroid dysfunction in TE. Conclusions Low serum ferritin, vitamin D deficiency, and thyroid dysfunction could be the risk factors for TE and can be used as diagnostic biomarkers of TE; hence, treating such patients with iron, vitamin D, and correction of thyroid dysfunction would be valuable. Prospective clinical studies with a larger number of participants are required to further address the risk factors for TE.

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Background and Aim Sitagliptin is a selective dipeptidyl peptidase-4 inhibitor that is used worldwide to ameliorate hyperglycemia and insulin insensitivity-induced dysmetabolism. The current study assessed the effect of sitagliptin as well as silymarin (the standard hepatoprotective drug) against experimentally carbon tetrachloride (CCl4)-induced liver toxicity in male mice. Materials and methods Mice chronic liver fibrosis models were established and divided into olive oil-induced control group, CCl4-induced model group, silymarin-treated group, and sitagliptin-treated group. Hepatic fibrotic changes were evaluated by measuring hepatic enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase), histopathological score, activation of hepatic stellate cells (α-smooth muscle actin expression with special stain), and oxidative stress (malondialdehyde, glutathione, total nitrate/nitrite, and manganese superoxide dismutase levels). Results The injection of mice with CCl4 for 7 weeks resulted in a marked elevation of hepatic fibrotic changes and reduction of glutathione level; both silymarin and sitagliptin therapy showed a significant decrease in the fibrotic changes and a significant increase in endogenous antioxidants. Conclusion This study shows that sitagliptin ameliorates hepatic fibrosis in mice and announces a new strategy for treating hepatic fibrosis in humans.

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Background and aim and objectives T-tube choledochostomy is performed following open or laparoscopic common bile duct exploration. There is increased concern regarding safety and efficiency of choledochostomy. The present paper evaluates the short-lived effectiveness and safety of T-tube bile leak after its removal. Patients and methods A total of 86 cases of choledocholithiasis were admitted to Al-Azhar University Hospital, Assiut. They underwent cholecystectomy (open), choledochotomy, and T-tube choledochostomy. T-tube choledochography was performed 10 days after surgery, and removal of the tube was done after 12 days. Results Morbidities, mainly bile leak and peritonitis, were estimated. A total of 10 patients had evidence of radiological leak. Marked biliary reactions were noticed in six cases promptly following T-tube removal. Five of these cases had clinical peritonitis, treated conservatively. Only one patient had biliary peritonitis and required reoperation. Conclusion The operative use of T-tube choledochostomy has been in dramatical decline in the past 20 years (owing to the development and adoption of removal lesser invasive maneuvers of choledocholithiasis removal). Manipulation of T-tube (situation and extraction) is technically exigent. Intricacy and morbidity are critical; thus, it is recommended not to be performed as a routine maneuver. Easier options must be taken into account initially.

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