Objectives To discuss the link age between nonalcoholic fatty hepatic disease and malignant tumors. Data sources MEDLINE databases (PubMed, Medscape, Science Direct) and every one material obtainable on the net from 1998 to 2019 were searched. Study selection The initial search included 88 articles, of that 34 met the inclusion criteria. The articles studied the linkage between nonalcoholic fatty hepatic disease and malignant tumors. Data extraction If the studies failed to fulfill the inclusion criteria, they were excluded. Study quality assessment enclosed whether or not moral approval was gained, eligibility criteria nominative, applicable controls and adequate data, and outlined assessment measures. Data synthesis Comparisons were created by structured review with the results tabulated. Findings In total 23 probably relevant publications were enclosed. The studies indicated that nonalcoholic fatty hepatic disease plays an important role in development of different types of malignant tumors, including hepatocellular carcinoma, colorectal carcinoma, and prostate cancer. Conclusion Nonalcoholic fatty liver disease (NAFLD) is a complicated multifactorial disease closely interrelated with obesity and type 2 diabetes, and shares with them a significant enhanced risk of several types of malignant tumors. Further studies are necessary to better define patients with high-risk NAFLD and effective screening strategies, but we encourage health care providers taking care of patients with NAFLD to be vigilant for any signs and symptoms of cancer, particularly hepatocellular and colorectal cancers, and refer the patients for further assessment and management.

Objective The aim was to discuss the neuroprotectors in hypoxic ischemic encephalopathy (HIE) in neonates. Materials and methods A systematic review of MEDLINE (PubMed, Medscape, Science Direct, and EMF-Portal) and internet was conducted on all articles published from 2002 to 2018. English-language reports of the neuroprotectors in HIE in neonates were searched. The initial search presented 117 articles, where 29 had inclusion criteria. Articles not reporting on the neuroprotectors in HIE in the title or abstract were not included. A total of five independent investigators extracted data on methods. Comparisons were made by a structured review, with the results tabulated. A total of seven studies were about hypoxic ischemic encephalopathy in neonates, nine about experimental translational studies, and 13 about current clinical trial studies for neuroprotectors in HIE. Results HIE is still a serious condition that is unresolved and causes significant mortality and long-term morbidity. Approximately 20–25% of term newborn infants die during the neonatal period and ∼25% of those who survive develop permanent neurological disabilities. Several studies showed that there were neuroprotective molecules that bring hope to future treatments such as melatonin, topiramate, xenon, interferon-β, and stem cell transplantation. Owing to the lack of imaging diagnostic difficulties to detect HIE in premature newborns and insufficient data, present stem cell therapy trials are restricted to full-term infants. Besides stem cell transplantation, there is research ongoing in the field of stem cell factors. Conclusion Some gaps in the knowledge concerning the pathophysiology and the timing of important endogenous neuroprotective and neuroregenerative mechanisms still exist. To make basic science results more clinically relevant and translational, combinational therapies with hypothermia should be considered and studied. There is also a need for more biomarker studies that can be used along with the brain imaging, and long-term neuroassessments.

Objectives To develop an Arabic version of the hospital anxiety and depression scale (HADS) to detect and measure anxiety and depression prevalence in dizzy patients. Background Dizziness is a common complaint that has many causes and may be related to psychiatric disorders like anxiety and depression. Early detection of anxiety and depression in dizzy patients helps in proper management and a better outcome. The HADS is a valid screening tool, and having an Arabic version will be of great help. Patients and methods The original English HADS was translated following the cross-cultural adaptation guidelines into Arabic. The final Arabic version of HADS was administered to samples of 100 healthy control persons, 30 anxious patients, and 30 depressed patients. Reliability and validity of the translated Arabic HADS were examined. The prevalence of anxiety and depression in dizzy patients were assessed through 100 dizzy patients who were asked to complete the validated Arabic HADS. Results The translated Arabic HADS was found to be reliable with strong internal consistency (Cronbach's alpha was 0.811 for the anxiety group and 0.758 for the depression group). The test–retest reliability was high (Spearman's correlation was 0.980 for the anxiety group and 0.928 for the depression group). There was a good correlation between psychiatric assessment and HADS for anxiety and depression using the Mann–Whitney test, indicating its validity. We performed the receiver operating characteristics curve, and the most sensitive cutoff point for HADS anxiety subscale was 8.5 and for HADS depression subscale was 9.5. In the dizzy group, 32% gave positive HADS scores for anxiety subscale and 22% gave positive HADS scores for depression subscale. Conclusions This version of the Arabic HADS is a reliable and valid psychological screening tool for anxiety and depression. The anxiety and depression prevalence in the dizzy patients was 32% and 22%, respectively.

Objectives To assess the vestibulo-ocular function in epileptic patients in the interictal period. Background Vertigo or dizziness are common symptoms with epileptic seizures. Patients and methods This is a cross-sectional study. The participants included in this study were divided into two groups. The control group consisted of 40 normal participants not complaining of any dizzy symptoms, with an age range of 20–40 years, and the study group (epileptic cases group) consisted of 40 epileptic patients, with age range of 20–40 years. All participants were subjected to vestibular assessment in the form of videonystagmography and video head impulse test (vHIT). Results There was no significant statistical difference between both groups regarding age (P = 0.17, Student t test) and sex distribution (P = 0.65, χ² test). A total of 25 (62.5%) epileptic patients had vestibular symptoms. On videonystagmography, saccadic intrusions in pursuit test were reported in four (10%) epileptic patients, and seven (17.5%) epileptic patients had abnormal velocity in the saccade test; there was a significant statistical difference between both groups regarding the velocity of the saccade test (P = 0.02, Student t test). On vHIT, there was a significant statistical difference between both groups regarding lateral canal gain (P = 0.001, Student t test). A total of 29 (72.5%) patients in the study group had an abnormal gain in at least one canal of the six semicircular canals. Eight (20%) patients in the study group had low gain, and 21/40 (52.5%) patients had high gain. There was a significant statistical relationship between vestibular abnormalities and type of epilepsy, as well as EEG findings. Conclusion Vestibular system may be affected with epilepsy; high gain was the most frequently encountered abnormality in the vHIT.

Objectives The objective is speckle tracking echocardiography evaluation of left ventricular (LV) function in hemodialysis patients versus uremic nondialysis patients. Background Hemodialysis patients have a high cardiovascular risk and mortality even with normal LV function by conventional echocardiography. Settings and design A total of 75 patients with LV ejection fraction more than 50% were enrolled prospectively and assigned into two groups. Patients and methods Group 1 included 45 patients with chronic renal failure on regular hemodialysis three times/week for more than 2 years, and group 2 included 30 nondialysis patients with chronic kidney disease in the early stages. Statistical analysis used This was a comparative case-control study. Results Global peak systolic longitudinal strain was significantly lower in hemodialysis patients than nondialysis (−15.09 ΁ 3.36 vs. −17.96 ΁ 2.24, P = 0.0001). Moreover, average regional peak systolic longitudinal strain of 4CH, 2CH, 3CH, basal, mid, and apical regions was significantly lower in hemodialysis group than nondialysis (−14.77 ΁ 3.48 vs. −17.52 ΁ 2.42, respectively, P = 0.0003; −15.02 ΁ 3.99 vs. −18.08 ΁ 3.60, respectively, P = 0.001; −15.46 ΁ 4.28 vs. −18.28 ΁ 3.06, respectively, P = 0.003; −11.83 ΁ 3.2 vs. −15.23 ΁ 2.94, respectively, P < 0.0001; −14.62 ΁ 3.31 vs. −17.72 ΁ 2.36, respectively, P < 0.0001; and −18.79 ΁ 5.08 vs. −20.3 ΁ 3.64, respectively, P = 0.049). Global systolic strain rate and early diastolic strain rate (1/s) in dialysis patients were significantly delayed than nondialysis (−0.92 ΁ 0.20 vs. −1.07 ΁ 0.13, respectively, P = 0.001, and 0.90 ΁ 0.26 vs. 1.0 ΁ 0.18, respectively, P = 0.003), and global systolic strain rates less than −1 in hemodialysis patients was 62.22 versus 26.67% in group 2, P = 0.003. Conclusion Hemodialysis patients have more affection and reduction of LV functions including global, regional longitudinal strain, systolic strain rate, and early diastolic strain rate. Impaired LV systolic and diastolic functions could be detected and accurately assessed by two-dimensional speckle tracking echocardiography despite being normal by conventional echocardiography.

Objective The objective of this study was to evaluate serum visceral adipose tissue-derived serpin (vaspin) level with the severity of coronary artery disease (CAD). Background There is controversy between the researchers on the subject of serum vaspin concentration in CAD. Patients and methods Twenty control and 68 CAD patients were enrolled in this study. Vaspin was detected by enzyme-linked immunosorbent assay method. Results Serum levels of vaspin were significantly low in patients with CAD compared with healthy controls and low vaspin concentrations were correlated with CAD severity. Conclusions Decreased serum vaspin levels were observed in the existence and severity of CAD in patients assessed by coronary angiography.

Objective The aim was to outline the relationship between female pattern hair loss (FPHL) and metabolic syndrome (MetS). Background Several studies have examined the association of MetS with hair loss in men, whereas there were scanty studies focusing on female sex association, especially in Egypt. Participants and methods This prospective study was carried out on 30 women with different stages of FPHL and 30 age-matched and sex-matched healthy women as controls. Results Among the cases group, the majority of them (70%) had not been diagnosed with MetS. There was a significant difference in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure (BP), diastolic BP, and waist circumference between both groups (P = 0.002, <0.001, <0.001, <0.001, <0.001, and 0.002, respectively). There was a significant relation between MetS and Ludwig's classification, fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, systolic BP, diastolic BP, and waist circumference (P < 0.001, 0.029, 0.021, <0.001, <0.001, <0.001, <0.001, and 0.029, respectively). Conclusion There was a significant correlation between MetS components, especially waist circumference and hypertension, and FPHL.

Objective To estimate the prevalence of leprosy during the period from 2013 to 2017. Background Leprosy is a chronic infection with highly visible debilities and psychological effects. Unfortunately, Egypt is still reporting high number of new cases per year especially among children. Patients and methods Data were collected from the medical records of patients in leprosy clinics of the randomly selected governorates, Menoufia, Gharbiya, Kalyobeya, Dakahlia, and Damietta for the previous 5 years from January 2013 till December 2017. The collected data included personal data, age, sex, and residence. Results Prevalence of leprosy in the studied governorates within the studied years showed variation, with higher rates in Menoufia and Gharbiya, whereas Dakahlia and Kalyobeya showed lower rates. Age of the patients ranged from 4 to 91 years, and there were 31 (9.4%) children. Male affection was more than female, and rural record was predominant over urban. Conclusion Despite the success achieved in Egypt in leprosy control, Egypt remains one of the 22 countries of leprosy global priority. Leprosy still is a health problem especially in rural areas and among males, with high grade of disability especially in children, which are still far away from the global target, and also, there was a high relapse rate.

Objectives To assess cluster of differentiation 93 (CD93) protein serum level in psoriasis cases and its role in the disease pathogenesis. Background Psoriasis is a common, chronic inflammatory skin disease. It is a complex multifactorial condition related to a combination of genetic, environmental, and immunological factors; hence, this study was established to study the role of CD93 in the psoriasis pathogenesis. Patients and methods This prospective study was carried out during the period from June 2018 to December 2018. This case–control study was conducted on 30 patients with psoriasis vulgaris and 20 age-matched and sex-matched healthy volunteers as a control group. Cases were selected from the Dermatology Outpatient Clinic at Menoufia University Hospital during the period from June 2018 to December 2018. Control were selected from the healthy staff of Menoufia University Hospital. The laboratory part of the study was done at the Biochemistry Department of Menoufia Faculty of Medicine. Results There were no significant differences in CD93 protein levels in serum between patients with psoriasis and controls. Conclusion There were no differences in CD93 protein expression in serum among psoriasis cases and control group.

Objective The aim was to evaluate the role of signal transducer and activator of transcription 3 (STAT3) in lichen planus (LP). Background LP is a chronic mucocutaneous T-cell-mediated inflammatory disease. STAT3 is responsible for signal transmission to the nucleus from many receptors and nonreceptor-associated kinases. Materials and methods A prospective case–control study was conducted on 20 cases with LP and 20 age-matched, sex-matched, and localization-matched apparently healthy participants. All sections were immunohistochemically stained for STAT3. Results There were significant differences between the studied groups regarding STAT3 positivity in both dermis and epidermis (P = 0.043 for both), as well as STAT3 intensity of expression in epidermis and dermis (P = 0.008 and 0.001, respectively). There were significant associations between moderate and strong STAT3 expression and generalized lesions, presence of precipitating factors, presence of dermal melanophages, and presence of moderate spongiosis (P = 0.01, 0.005, 0.05, and 0.04, respectively). Conclusion Overexpression of STAT3 in LP could play a role in pathogenesis and severity of LP. Anti-STAT3 target therapy might be suggested to ameliorate LP.

Objective The aim of this study was to evaluate the possible role of mast cell tryptase (MCT) enzyme in the pathogenesis of uremic pruritus by measuring its level in the serum of patients with chronic kidney disease (CKD) with pruritus and to correlate its level with the severity of pruritus. Background The pathogenesis of pruritus in renal disease is not yet understood. Evidence suggests that mast cells play a role, as the number of dermal mast cells is increased in patients on hemodialysis. Patients and methods The present study was conducted as a prospective case–control study that included 60 patients with CKD and 20 healthy participants who had neither CKD nor pruritus and served as controls. All cases were selected from the Outpatient Clinic and Dialysis Unit of Nephrology Department, Menoufia University Hospitals, and Aga General Hospital, spanning the period from February 2017 to July 2017. Patients with CKD were subdivided into three groups according to the stage of kidney disease as follows: group 1 included 20 patients with stage 3 (CKD), group 2 included 20 patients with stage 4 (CKD), group 3 included 20 patients with stage 5 (CKD), known as end-stage renal disease, who were on hemodialysis. Each participant underwent full general and dermatologic examination followed by measurement of serum MCT enzyme by enzyme-linked immunosorbent assay. Degree of pruritus was measured by 5D score. Results Serum MCT levels were above 11.4 ng/ml (95^th percentile) in patients with CKD. The intensity of pruritus correlated significantly (P = 0.001) with the tryptase levels. Conclusion Mast cells or even tryptase itself may be involved in the pathogenesis of pruritus in patients with CKD.

Objective To study the serum substance P (SP) and its role in renal pruritus patients. Background Uremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including SP, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of SP in uremic pruritus in patients. Patients and methods This study was conducted according to sample size calculation on 44 renal pruritus patients and 30 sex-matched and age-matched healthy individuals as a control group and were selected by random sample. This was a case–control study. Results SP has an important role in renal pruritus as there was a statistically significant difference between the two studied case and control groups (P = 0.001). Also, there was positive correlation between the duration of renal disease and the frequency of pruritus. Conclusion SP may have an important role in renal pruritus patients.

Background Women with hirsutism have social phobia, insecurity about interpersonal relationships, shattered confidence, and profound psychological sequelae. Patients and methods This cross-sectional study was conducted on a sample of 200 female patients aged greater than or equal to 18 years, having hirsutism, with a Ferriman and Gallwey scores (F-G scores) greater than 6, (moderate: F-G score 8–15 and severe: F-G score 16–36), with normal or irregular menstruation, with or without polycystic ovarian disease, and normal/abnormal hormone profiles. Demographic characteristics like name, age, marital status, and address; severity of hirsutism; and F-G scores of hirsutism were recorded. Results The study showed that 78.0% of cases had a large effect on QoL (DLQI score was 11–20), 21.5% had a very large effect (DLQI score was 21–30), and only 0.5% had a moderate effect (DLQI score was 6–10). There was no significant difference in DLQI between different F-G scale of hirsutism (P = 0.741). There was a nonsignificant negative correlation between DLQI and F-G scale (P = 0.872) and between BMI and F-G scale (P = 0.747). Conclusion Hirsutism had potent effect on the QoL of Egyptian women with marked negative effect on personality, daily activities, and interpersonal relationships.

Objective The aim was to evaluate echocardiographic changes and cardiovascular (CV) risk in psoriatic patients in comparison with controls. Background Psoriasis is a chronic autoimmune inflammatory skin disorder. Its incidence rate is 2.8%. Psoriasis is associated with numerous comorbid diseases, including cardiometabolic, gastrointestinal, and kidney diseases as well as malignancies, infections, and mood disorders. CV diseases are of particular importance, as they often directly affect the patients' mortality. Psoriasis is associated with CV risk factors such as hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Patients and methods This case–control study was carried out on 45 cases with psoriasis and 39 age-matched and sex-matched healthy participants as a control group. All participants were subjected to full history taking, general examination, local examination with determination of site of lesions and assessment of Psoriasis Area and Severity Index score, and echocardiography. Results Our results showed that there was a significant difference between cases and controls regarding ECHO cardiographic results, with 60% of cases having abnormal ECHO finding (pulmonary hypertension was present in 10% of cases, ischemic heart disease was present in 10% of cases, whereas valvular heart disease was present in 40% of cases), and no abnormal finding among control group. Conclusion Echocardiographic abnormalities could be found in psoriasis compared with normal population. Psoriasis, may be an independent CV risk factor. Psoriasis is more commonly associated with valvular heart disease but less commonly with pulmonary hypertension or ischemic heart disease.

Objective To evaluate the role of serum S100B in vitiligo. This may provide a closer understanding of the pathogenesis of this disease entity. Hopefully, this insight can set the route for newer therapeutic approaches. Background Vitiligo is an acquired dyschromia of the skin, in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is ~ 0.1–2% worldwide. The exact pathogenesis of vitiligo remains elusive and is likely multifactorial. S100 proteins are localized in the cytoplasm and nucleus of a wide range of cells and involved in the regulation of a number of cellular processes such as cell cycle progression and differentiation. Patients and methods This case–control study was carried out on 40 patients with vitiligo and 40 age-matched and sex-matched healthy volunteers as a control group. All participants were subjected to a full history taking, general examination, local examination with determination of site of the lesions, assessment of vitiligo activity and severity, and laboratory investigation for quantitative measurement of S100B protein in vitiligo serum. Results There was a highly significant difference between cases and controls regarding the mean S100B level. There was a significant difference between cases with elevated S100B and normal level of S100B regarding vitiligo area scoring index score. There was a significant positive correlation between S100B and vitiligo disease activity score. Conclusion S100 protein is elevated in patients with vitiligo more than healthy population. This may be owing to that S100 protein is involved in vitiligo pathogenesis through affecting Ca homeostasis and activation of proinflammatory cascade with release of interleukin-1B and interleukin-6.

Objectives To assess the role of high-mobility group box 1 (HMGB1) in the pathogenesis of vitiligo patients and its relation to severity of vitiligo. Background Vitiligo is a chronic inflammatory disease characterized by skin depigmentation caused by the loss of epidermal melanocytes. Its prevalence ranges between 0.5 and 2%. The pathogenesis of vitiligo is poorly understood. Patients and methods This is a case–control study that was conducted on 80 participants, who were divided into two main groups. The first group A included 40 patients with vitiligo. The second group B included 40 age-matched and sex-matched healthy participants as a control group. Blood sample was taken from each participant for measurement of plasma HMGB1 level by the enzyme-linked immunosorbent assay technique. Results The result showed significant increase in the level of plasma HMGB1 in vitiligo patients (79.48 ± 110.5) compared with controls (51.70 ± 69.16) (P = 0.040). The result also showed that HMGB1 concentration was not correlated with clinical parameters such as age, sex, disease onset, duration of recent aggravation, or percentage of vitiligo involvement. Conclusion Our data provide insights into the possible role of HMGB1 for the pathogenesis of vitiligo.

Objective To evaluate troponin I level in patients with alopecia areata and those with female pattern hair loss in comparison with controls. Background Alopecia areata is an autoimmune disease with a variable, typically relapsing or remitting course. Its incidence rate is 2%. Alopecia areata is associated with numerous comorbid diseases including hypothyroidism, celiac disease, type 1 diabetes, hyperlipidemia, and atherosclerosis. All these comorbidities are risk factors for cardiovascular disease. Female pattern hair loss is a nonscarring progressive thinning of hair. Its incidence rate is 12%. It is often associated with dyslipidemia, obesity, insulin resistance, and hypertension as comorbidities. Cardiovascular diseases are of particular importance as they often directly affect the patients' mortality. Patients and methods This case–control study was carried out on 29 female patients with alopecia areata, 30 cases with female pattern hair loss, and 23 age-matched and sex-matched healthy controls. All participants were subjected to a full history taking, general examination, and local examination with assessment of alopecia areata by Severity of Alopecia Tool score and assessment of female pattern hair loss by Ludwig classification. Troponin I level was done for all cases and controls. Results Our results showed that patients with alopecia areata had significantly higher mean levels of cardiac troponin I than female pattern hair loss group and control group. Conclusion High troponin I levels in patients with alopecia areata reinforces the association between alopecia areata and cardiovascular diseases compared with female pattern hair loss and normal population.

Objective This is to evaluate the prevalence of female sexual dysfunction during pregnancy in the Delta Region of Egypt using the female sexual function index questionnaire. Background Pregnancy is a physiological process that causes various anatomical and physiological changes in a pregnant woman; such changes may play a part in affecting her sexual behavior and activity. Despite the increasing number of epidemiologic studies, there are no sufficient data in the medical literature regarding the prevalence of sexual dysfunction during pregnancy in Egypt. Patients and methods A cohort study was conducted with 300 healthy pregnant women receiving routine antenatal care at obstetric's clinic at Menoufia University Hospital in the duration from March 2019 till November 2019. Results The female sexual dysfunction significantly increased in the first and third trimesters, as the percentage of the female having sexual dysfunction was 68 and 72% in the first and third trimesters, respectively. Better indicators were in the second trimester, as the percentage of women having sexual dysfunction was 51% of the studied sample. Conclusion Specific changes that occur in each pregnancy trimester have significant influences on sexual behavior. A reduction in sexual intercourse frequency, desire, and satisfaction occurs in many women as pregnancy progresses, particularly during the third trimester, compared with before pregnancy.

Objective To study the prevalence of vaginismus in Delta, Egypt, and its effect on human sexual life. Background Sexual dysfunction in women is an important public health problem worldwide. Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles. The prevalence of vaginismus is poorly understood and relatively unknown. Patients and methods This cross-sectional study included 200 women of different ages. This study was performed on women in Delta, Egypt, in the period from April 2019 till October 2019. Result The findings of the study indicate that vaginismus is a common sexual problem, as its prevalence in Delta, Egypt, according to the present study is 20%. This result depends on that vaginal penetration and vaginal examination is impossible and has not occurred in 20% of cases. Vaginismus causes distress to both partners, where 72.5% of the cases' partners showed no response, 12.5% got angry, and only 15% supported. Regarding affection of pain to life, 77.5% of cases had no effect, 7.5% decrease sexual desire, 5% had depression, 7.5% had low physical and emotional satisfaction, and 2.5% had phobic anxiety. Regarding the female sexual function index, mean desire score was 3.36, arousal score was 3.97, lubrication score was 3.36, orgasm score 3.75, satisfaction score was 3.95, pain score was 3.98, and mean female sexual function index was 22.86. Conclusion Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners.

Background Health care-associated infections (HAIs) are a health challenge. Objectives To assess the incidence and patterns of HAIs and their relation to the length of hospital stay and underlying patient clinical status in tertiary care hospitals based on the surveillance system of Center for Disease Control and Prevention. Patients and methods During the period from the November 2016 to December 2018, the active surveillance system of HAIs in Menoufia university hospitals' ICUs was assessed based on Center for Disease Control and Prevention rules. Results A total of 13 ICUs in four tertiary care university hospitals contributed to 93 280 patient days and revealed 36.7% of the patients with HAIs, where 33.1% were central line-associated bloodstream infections (CLABSI), 34.4% were ventilator-associated pneumonia (VAP), surgical site infections represented 19.1, and 13% were urinary tract infections. CLABSI had the highest rate of both the incidence of device-associated infection (58.5%) and incidence per 1000 device day (4.08). The total length of hospital stay in patients with HAIs (14.3 ± 23.8) was significantly higher than community-acquired infections (6.1 ± 2.5), and was observed in CLABSI (29.6 ± 18.3). The most frequent underlying medical conditions in CLABSI and VAP were diabetes mellitus (23.1 and 33.3%, respectively) and cirrhotic patients (17.3 and 10.4%, respectively). VAP had the highest in-hospital mortality rate (42.6%). Regarding antimicrobial resistance pattern, 86% of staphylococcal isolates and 94.6% of gram-negative isolates were multidrug resistant. Conclusion HAIs are a major burden in Egypt. In the studied hospitals, there is a high incidence of Staphylococcus aureus-associated BSI. Besides, a co-presence of gram-negative organisms with high rate of multidrug-resistance mandates the commitment to antimicrobial stewardship.

Objective To study the role of esophagogastroduodenoscopy (EGD) in assessment of patients undergoing bariatric surgery. Background The role of EGD in obese patients before bariatric surgery is controversial. In this study, we aimed to evaluate the extent to which endoscopic findings affect the plan of surgical approach in bariatric patients. Patients and methods A single-center cross-sectional study was done on 70 patients planned for bariatric surgery in the period from January 2019 to January 2020. Patients were classified into four groups according to the endoscopic findings: GI: patients with normal endoscopic findings, GII: patients with abnormal endoscopic findings that did not alter the surgical approach or postpone bariatric surgery, GIIIa: patients with endoscopic findings that changed the surgical approach, GIIIb: patients with endoscopic findings that postponed bariatric surgery for medical treatment, and GIV: patients with endoscopic findings that contraindicated the bariatric surgery. Results There were 56 (80%) females and 14 (20%) males, and the mean ± SD BMI was 52.3 ± 11.89 kg/m2. According to the endoscopic findings, surgical approach has been modified in seven (10%) patients, postponed for medical treatment in 23 (32.9%) patients, and contraindicated in only two (2.9%) patients. However, 13 (18.6%) patients with normal endoscopic findings and 25 (35.7%) patients with abnormal endoscopic findings have not shown a change in their planned surgical approach or postponed bariatric surgery. Conclusion A total of 32 (45.7%) of the examined patients had abnormal endoscopic findings that affected bariatric surgery. So, we suggest routine EGD before bariatric surgery for its high diagnostic value and decrease in postoperative complications.

Objectives The study was designed to detect the rate of cesarean sections (CS) and assess maternal knowledge and attitudes towards the mode of delivery. Background Cesarean section (CS) was introduced in clinical practice as a life saving procedure both for the mother and the baby, but the increasing rate of births by CS has become an issue of concern in many countries. Maternal beliefs may influence the mode of delivery, and nowadays, CS is performed upon maternal request with no medical cause, so determining maternal knowledge and attitude is an important tool in examining the factors that have contributed to this increase. Methods A cross-sectional study was conducted on 400 mothers who were selected by using a simple random sampling technique from two family health units and one family health center in Benha district. Data were collected through a predesigned questionnaire to determine socioeconomic status, mode of previous delivery, knowledge, attitude, and source of their information about modes of delivery. Results Cesarean sections (CS) rate in Benha district was 55%. Near half of the studied women (46.3%) had intermediate (fair) level of knowledge regarding indications, advantages, and adverse effects of both modes of delivery (vaginal and CS) and 35.0% had negative attitude toward CS. Most of the studied women who were in the lower class socioeconomically (71.4%) had fair knowledge regarding both the modes of delivery. Conclusion The rate of CS in Benha district was 55%, which is much higher than the upper limit suggested by WHO (15%). Most of the studied women had fair knowledge about the modes of delivery. So prompt action is required to reduce the unaccepted high rate of cesarean section deliveries and improve maternal knowledge about its indications and complications.

Objective To assess knowledge of mothers regarding vitamin D before and after application of an educational program and assess factors associated with their knowledge regarding it. Background Mothers are the key person for nutrition of their children. Mothers' knowledge about proper nutritional behaviors has a direct effect on the nutritional quality of their children. Many mothers still do not get enough information about importance of vitamin D for their children health, so evaluation of maternal knowledge regarding vitamin D and identification of gaps in their knowledge is an important tool to design and implement an educational program to fill these gaps and improve their level of awareness regarding health importance of vitamin D. Patients and methods This prospective study was conducted on a sample of 294 mothers of preschool children. The mothers were selected randomly from two health care facilities, which were also randomly selected from Birket El Sabee district, and the sample was proportionally allocated according to total number of mothers' attendance rate in each health care facility. A predesigned questionnaire was used to assess mother's knowledge regarding vitamin D. An educational program was applied, and knowledge was reassessed with the same questionnaire after the program. Results The mean ± SD of mothers' knowledge about vitamin D was significantly increased after application of educational program from 14.7 ± 4.9 to 50.6 ± 1.8 (P < 0.001). Age and socioeconomic status showed a weak positive correlation with knowledge score (P = 0.009 and 0.002, respectively), whereas educational level showed a moderate positive correlation (P < 0.001), and all three correlations were statistically significant. Conclusion Knowledge of mothers regarding vitamin D significantly improved after application of the educational program, and maternal knowledge regarding vitamin D was significantly affected by their age, educational level, and socioeconomic status.

Objective The aim was to sssess prevalence of substance use and the associated risky behaviors among adolescents. Background Adolescents often engage in risky behaviors such as smoking, drinking alcohol, using drugs, and early unprotected sex. When adolescents take one risk, they also tend to take other risks. Participants and methods A cross-sectional study was conducted in the context of time frame of 19 months. Sample size was 140 secondary schools adolescents, from two schools in a rural village academic year 2017–2018. Participants were randomly selected and assessed for substance use and risky behaviors using a predesigned questionnaire. Results Prevalence of substance use was 18.6%, and the most used substance was cannabis followed by bango and tramadol. Substance use was positively related to risk for use of unprescribed medications (P < 0.001), cigarette smoking (P < 0.001), drinking alcohol (P < 0.001), porn surfing (P < 0.001), sexual intercourse (P < 0.001), suicide attempting (P < 0.001), carrying weapons (P < 0.001), driving cars (P 0.032), and sharing cars with drunken drivers (P < 0.001). Religious commitment (P = 0.003) and having hobbies (P = 0.008) were protective from substance use. Conclusion Substance use was common among secondary school students in Egyptian villages. It was correlated to smoking, alcohol consumption, electronic devices' misuse, risky sexual acts, suicidal tendency, and risky driving. Moreover, substance use was inversely related to religious commitment and having hobbies.

Objectives To assess the level of awareness among primary health care physicians toward musculoskeletal complications among type 2 diabetic patients in Gharbia Governorate, Egypt. Background Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities owing to multiple factors, including musculoskeletal manifestations. Musculoskeletal complications related to diabetes are common and can lead to severe morbidity. Patients and methods A cross-sectional study was conducted on 175 primary health care physicians. All participants were interviewed using a predesigned questionnaire regarding personal data; socio-economic level; and knowledge, practices, and attitude toward musculoskeletal complications among type 2 diabetic patients. Results Approximately 61% of the physicians had satisfactory knowledge about musculoskeletal complications among type 2 diabetic patients. There is a significant relation between level of knowledge and number of patients attended per day (P = 0.005). Regarding the practices of physicians, 84% of physicians had nonsatisfactory practice level. Nearly two-thirds of the physicians had a positive attitude toward musculoskeletal complications of type 2 diabetes. Conclusion This study explored several aspects about musculoskeletal complications of type 2 diabetes related to knowledge, attitude, and practice among general practitioners and family physicians and revealed improved knowledge, positive attitude, but unsatisfactory practice.

Objective To assess the outcome of a diabetes self-management education (DSME) program in terms of the level of glycosylated hemoglobin (HbA1c) and diabetes self-care behaviors. Background Diabetes self-care behaviors related to food choices, physical activity, proper medication intake and regular blood glucose monitoring in type II diabetes mellitus have a potential impact on diabetic management. Patients and methods A quasi-experimental pretest and posttest interventional study was carried out on 74 uncontrolled type 2 diabetes patients attending the Manshet Sultan family health center, Menoufia Governorate, from May 2019 to December 2019. A matched control group was selected from the same center and was provided usual diabetes care. A DSME program was conducted for the intervention group as one session weekly for 6 weeks. Evaluation of the outcome of the program was performed after 3 months of follow-up by measuring the HbA1c level and by diabetes self-care assessment. Results and conclusion There were significant improvements in the HbA1c level before and after implementation of DSME sessions (9.8 ± 1.79, 8.8 ± 1.4) (P < 0.05). Significant improvements occurred in three domains of diabetes self-care assessment including dietary, blood glucose management, and health care use, but there was no improvement in the physical activity domain. There was no improvement in the HbA1c level in the control group at baseline and at the end of the study. This study revealed promising results of DSME sessions and their effect on better diabetes self-care behavior and HbA1c level (P < 0.05).

Objective The aim of the present work is to investigate the expression of Golgi protein 73 (GP73) in serum in patients with hepatocellular carcinoma (HCC) and determine its efficacy as a screening test in early detection of HCC. Background Serum GP73 is a promising biomarker for detection of HCC. Patients and methods This case–control study involved 30 patients with HCC, 30 patients with liver cirrhosis, and 15 healthy controls. Clinical examination, abdominal ultrasonography, and triphasic computed tomography for focal lesion were performed. Liver function tests were performed using clinical autoanalyzer, serum α-fetoprotein (AFP) was measured using enzyme-linked immune-sorbent assay method, and GP73 was determined by enzyme-linked immune-sorbent assay kit for GP73. Data were collected and statistically analyzed. Results GP73 was highly significantly higher in HCC group than cirrhotic and control groups. The sensitivity of GP73 in diagnosis of HCC was 83% and the specificity was 74%, at a cutoff point of 111 ng/ml, elicited from the receiver operator characteristic curve, with very good area under curve of 0.909, whereas that the sensitivity of AFP was 36.7% and the specificity was 100% at a cutoff point of 400 ng/ml, elicited from the receiver operator characteristic curve, with very good area under curve of 0.903. Conclusion GP73 is highly associated with HCC and is more sensitive than AFP for early detection of HCC.

Background Advanced age is a risk factor for the development of colorectal polyps and advanced adenomas (AA). However, few studies have investigated the features of colorectal polyps in the elderly. Objective To study different characteristics of colorectal polyps in Egyptian elderly patients in the Gastroenterology Endoscopy Center of Alexandria University Main Hospital. Patients and methods Between February 2018 and February 2020, 1852 patients underwent colonoscopy. Inclusion criteria were patients aged more than or equal to 65 years, a positive family history of colorectal polyps/cancer, chronic diarrhea, constipation, or chronic abdominal pain, unexplained weight loss, unexplained anemia, and rectal bleeding/hematochezia. Patients with no polyps or unresectable polyps on colonoscopy, and patients with a history of colectomy or proctectomy were excluded from the study. Results Patients were divided into three groups regarding age: 65–69 years (34%), 70–79 years (55.5%), and more than or equal to 80 years (10.5%). The mean age was 75.4 ± 4.2 years. A total of 253 (50.3%) of the patients were male and 250 (49.7%) were female. Patients from urban areas represented 62.8%, whereas 37.2% were from rural areas. Patients with positive family history represented 29.8%. Clinical presentations were constipation (21.2%), diarrhea (18.7%), abdominal pain/distension (15.7%), rectal bleeding or hematochezia (10.7%), loss of weight (9.3%), anemia (7.2%), positive fecal occult blood (6%), and regular health examination (11.3%). Histologically, 61.8% were nonadenomatous polyps, and 38.2% were adenomatous polyps, and of them, 47.9% were Non-advanced adenomatous polyps (NAAPs) and 52.1% were AAs. Concerning adverse affected, 39.1% were on right-sided colon and 60.8% on the left side. Regarding the size, 303 (60.2%) were minute less than or equal to 5 mm in their greatest dimension, 138 (27.4%) were 6–9 mm, 45 (8.9%) were 10–20 mm, and 17 (3.4%) were more than 20 mm. Larger polyps were more likely to be adenomatous, and advanced, even when the cutoff size was set at 5 mm. Conclusion The incidence of colorectal polyps increases with age. AAs were noticed more commonly in elderly females. Although AAs were commonly noticed in polyps with 0–III morphology and size more than or equal to 10 mm, a respectable percentage of AAs was noticed in minute and small polyps; therefore, these polyps should not be ignored and should be followed up.

Background Angiogenesis is an important process in hematological malignancies especially leukemia. Its role in acute leukemia has been discussed since the cloning of the vascular endothelial growth factor (VEGF) gene from acute myelogenous leukemia (AML). HL-60 is a human promyelocytic leukemia cell line. VEGF, a polymorphic gene, plays a key role in angiogenesis and tumor growth. Its different genotypes are associated with many human diseases. Increased angiogenesis, mediated by VEGF, was associated with poor prognosis in AML patients. AML that arises from neoplastic transformation of hematopoietic stem and progenitor cells remains one of the greater challenges in treating this AML. In adults, leukemia is included in the top 15 of the most common forms of cancer. Single-nucleotide polymorphism of the VEGF gene, 699947 is found in peripheral blood mononuclear cells of Iranian, Australian, Caucasian, and African patients with AML. The main target of this study is to investigate the relationship between VEGF gene polymorphism (rs699947) with AML. Patients and methods This a controlled study which included 100 and 76 individuals in each group, respectively. Group 1: a healthy control group and group 2: AML diagnosed patients. Blood samples were genotyped using the tetra-primer amplification-refractory mutation system-PCR and the results were confirmed by PCR-restriction fragment length polymorphism method. Results Our results suggest that there is a correlation between rs699947 single-nucleotide polymorphism and AML development and prognosis. However, patients with −2578 AA/CC genotypes were associated with significant better complete remission in comparison to patients with −2578 CA genotype (P = 0.0001). We found that certain polymorphisms are associated significantly with remissions while others with worse response to induction chemotherapy.

Objective To determine the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) among the patients admitted to a hospital on presenting the symptoms of acute viral hepatitis. Background HAV and HEV are enterically transmitted viruses responsible for causing acute viral hepatitis. They pose a heavy burden on the health care system of developing nations. Patients and methods A hospital-based study was conducted for a period of 18 months from September 2019 to February 2020. A total of 170 patients were considered for the study. Overall, 3–5 ml of venous blood samples was collected from patients presenting with the symptoms of acute viral hepatitis. Their serum was subjected to enzyme-linked immunosorbent assay test (DiaPro Diagnostic Bioprobes) for detection of anti-HAV and anti-HEV immunoglobulin M. Results Of the 170 serum samples tested, 35.8% samples were found to be positive for HAV and 51.7% samples were positive for HEV. Male preponderance was detected during both the infections. HAV was more common in pediatric population, whereas HEV was common among adult population. Coinfection was found to be 1.7%. Conclusion Our study mandates the screening of these enteric viruses so as to prevent the further complications associated with the disease. The data collected would essentially help in planning the vaccination strategies along with sanitation and hygiene in our geographical region.

Objectives To measure relation between brain-derived neurotrophic factor (BDNF) and executive function in cannabinoid addiction. Background In the United States, marijuana (Cannabis sativa) was the most commonly used illicit substance, the use of which usually started in the adolescence period. Patients and methods A case–controlled study was conducted on 40 addicts and 40 healthy individuals from 18 to 60 years who were recruited from both community (street) and hospital-based sampling in three Egyptian governorates from the October 1, 2017 to the end of March 2018. The control group comprised 40 healthy individuals who were selected after being age and sex matched with addicts. Patients were subjected to proper history taking, general medical and neurological examination to exclude medical and neurological complications, detection of severity of addiction according to addiction severity index, level of serum BDNF in both groups, and also executive function in both groups before and after treatment. Results There was no significant difference between cases and control regarding their age (P = 0.338). A total of 16 (40%) male addict patients were studied and 24 (60%) female addict patients. There was no significant difference between cases and controls regarding their sex (P = 0.644). The addict patients' BDNF 1 mean value was 231.12 ± 286.86 s, whereas BDNF 2 was 248.91 ± 55.01 s. There was a highly significant difference between cases and controls regarding their BDNF 1 and BDNF 2 (P < 0.001 and 0.007, respectively). There was a highly significant difference between cases and controls regarding their executive function 1 and executive function 2 (P < 0.001 for both). Conclusion Cannabinoid drugs are associated with impairment in executive function regardless of the level of BDNF.

Objectives To assess addiction severity index (ASI) problem rating before and after management and to assess the effect of opioid addiction on neural transmission within the primary visual tract of the brain by using visual-evoked potentials (VEP). Background An increasing phenomenon of opioid abuse has been demonstrated in Egypt in the last 4 years. Patients and methods A case–control study was conducted on 100 male patients. Fifty patients with opioid addiction disorder diagnosed according to Diagnostic and statistical manual of mental disorders, 5^th ed. and 50 volunteers with age and sex matched with the addict group formed the control group. Patients were subjected to history taking, general medical and neurological examination, detection of severity of addiction according to ASI before and after treatment, detection of VEP changes in both groups, addicts (before treatment) and controls, to assess the differences between addict and control groups. Result The mean of age addict patients was 34.52 ± 9.09 and the mean age of the control group was 33.50 ± 9.38. There was no significant difference between cases and control. Fifty addict male patients were studied in comparison with the other 50 healthy male controls. Regarding severity of problem areas of ASI before and after treatment, there were highly significant decline in problem ratings on drugs, legal, family/social, and psychological dimensions of the ASI. The only areas without significant decline were medical and employment/functioning. Regarding our VEP findings, there was highly significant difference in P100 latency and P100 amplitude between the studied cases and control groups. Conclusion Opioids became increasingly popular despite the potential harms associated with their use.

Objective The aim was to assess motor recovery and brain-derived neurotrophic factor level in patients with poststroke depression (PSD). Background PSD is a common problem of stroke that negatively interferes with the outcome of patients with stroke. Patients and methods This is a case–control study conducted in Neurology Department, Faculty of Medicine, Menoufia University. The authors included all 200 patients, and then patients with acute ischemic stroke were randomized into two groups: control group (100 patients) and depression group (100 patients). Each patient was subjected to complete history taking, detailed neurological examination, brain-derived neurotrophic factor level assessment, and neurological and psychological evaluation using the following scales: Fugl-Meyer stroke scale-motor assessment, National Institute of Health Stroke Scale, Modified Rankin scale, and Beck depression inventory scale at baseline and 3-month follow-up timing. Results There was a highly significant decrease in follow-up Fugl-Meyer assessment in the depressed group compared with the control group (P < 0.01). Moreover, the authors found a highly significant decrease in follow-up brain-derived neurotrophic factor level in the depressed group compared with the control group (P < 0.01). Spearman's correlation analysis shows that follow-up Beck depression inventory-II had a highly significant negative correlation with 90-day Fugl-Meyer assessment, with a highly significant statistical difference (P = 0.0012). Conclusion Correlation between PSD and functional outcome has been shown, and it has a negative effect on upper limb function and performance of self-care, with decrease in the levels of brain-derived neurotrophic factor.

Objective The objective of this study was to investigate the role of discoidin domain receptors (DDR1) in the pathogenesis of basal-cell carcinoma (BCC) through its immunohistochemical expression and to correlate its expression with clinicopathological parameters. Background BCC is the most common type of nonmelanoma skin cancer. The pathogenesis is usually combined with environmental factors, mainly ultraviolet irradiation through long-term sun exposure. Patients and methods This retrospective case–control study was carried out on 77 patients presented with BCC and 20 age-matched and gender-matched apparently healthy volunteers. Skin biopsies from controls and BCC cases were retrieved from the archives of Pathology Department, Faculty of Medicine, Menoufia University for histopathological and immunohistochemical DDR1 evaluation. Results Cytoplasmic localization of DDR1 could be incriminated in the development and progression of BCC. DDR1 offers potential targeted therapy in cancer, as none of the control groups showed cytoplasmic epithelial localization DDR1, whereas (90.9%) cytoplasmic epithelial localizations were demonstrated in BCC (P < 0.001). A significant difference between BCC and control group regarding DDR1 expression in stroma was noted (P < 0.002). There was also significant association between cytoplasmic localization of DDR1 and head and neck localization and ulcer clinical presentation (P > 0.001 and 0.005, respectively). Conclusion Cytoplasmic localization of DDR1 has a role in the pathogenesis of BCC which can be a new therapeutic target in BCC.

Objective To assess serum zinc and iron levels in children with febrile seizures (FS) and their relation to clinical findings. Background Zinc and iron deficiencies are assumed to be common in children with FS. Patients and methods This case–control study was conducted on 80 Egyptian children (from 6 months to 5 years old) attending the emergency room and pediatric departments. The children were divided into group I which included 20 patients with FS and group II which included 20 patients with afebrile seizures; group III included 20 febrile patients without seizures or history of previous seizures; and group IV included 20 clinically healthy children, age and sex matched. Detailed history, thorough physical examination, routine investigations, and serum iron and zinc levels were done. Results There were statistically significant differences between group I (children with FS, n = 20), group II (children with afebrile seizures, n = 20), group III (children with febrile illness, n = 20), group IV (healthy children, n = 20) regarding zinc and iron levels. The mean serum zinc levels were significantly low in group I than the other three groups (68.25 ± 11.2, 96.1 ± 6.05, 99.3 ± 6.38, 97.2 ± 6.58, respectively) (P = 0.001). Also, the mean serum iron levels were significantly low in group I than the other three groups (0.43 ± 0.20, 0.88 ± 0.12, 0.86 ± 0.13, 0.83 ± 0.15, respectively) (P = 0.001). Conclusion Children with FS had significantly low serum zinc and iron levels in comparison with afebrile seizures, febrile patients, and healthy children.

Background Patent ductus arteriosus (PDA) is a common complication in preterm neonates with the incidence of 30–67% in extremely preterm neonates, which results in increased pulmonary blood flow and increased incidence of further comorbidities such as chronic lung disease. Objective To evaluate the effect of oral acetaminophen versus ibuprofen in the management of PDA in premature infants by echocardiography. Patients and method The study was carried out on 50 preterm neonates diagnosed by echocardiography to have PDA in the neonatal intensive care unit in Menoufia University Hospital from March 2019 to September 2019. Patients were classified into two groups: group 1 included neonates who received oral acetaminophen at a dose of 15 mg/kg every 6 h for 3 days and group 2 included neonates who received oral ibuprofen at the initial dose of 20 mg/kg followed by 10 mg/kg for 3 days. Both acetaminophen and ibuprofen were administrated via an orogastric tube, which was flushed with 1–2 ml of sterile water to ensure delivery of the drug. Both groups were evaluated by echocardiography. All patients were subjected to complete history taking, thorough clinical examination, complete blood count, and kidney and liver function tests. Results After the first course of treatment, PDA closed in 21 (84%) patients who received oral acetaminophen versus 21 (84%) of those given oral ibuprofen (P = 0.766). After the second course of treatment, PDA closed in 12% of oral acetaminophen group and 8% of oral ibuprofen group. Conclusion There was no significant difference between the treatment of PDA with either oral acetaminophen or oral ibuprofen in preterm neonates, but acetaminophen has minimal adverse effects.

Objectives To study the epidemiology of nephrotic syndrome in pediatric patients. Background Nephrotic syndrome is a common renal problem in pediatrics, with great variation in patients' characteristics in different regions of the world. The aim of this study was to define these characteristics in Egyptian children with nephrotic syndrome. Patients and methods This study is an observational cross-sectional study in which records of 170 patients with nephrotic syndrome were reviewed. Demographic, clinical, and histopathological data and response to therapy were statistically analyzed. Results The mean age of onset was 4.66 ± 2.64 years. Overall, 23.5% of patients were steroid resistant, and 76.5% showed initial steroid response; 50 (29.4%) of the latter were steroid dependent. A total of 58 (34.1%) patients underwent a renal biopsy with minimal change nephrotic syndrome occurring in 69%, membranoproliferative glomerulonephritis in 13.8%, and focal segmental glomerulosclerosis in 17.2%. Overall, 1.8% of cases developed chronic renal insufficiency. Complete remission on cyclosporine occurred in 90% of steroid-resistant patients with nephrotic syndrome. Complete remission on mycophenolate mofetil occurred in 40% of steroid-dependent patients. Conclusion Minimal change nephrotic syndrome was the main pathology found in our patients. Response to immunosuppressive was different from other studies, probably owing to differences in the priority of selection for immunosuppressive therapy in our unit.

Objective To assess the ability of serum soluble urokinase plasminogen activator receptor (suPAR) to predict the severity of pediatric community-acquired pneumonia (CAP). Background CAP is an important cause of pediatric mortality and morbidity. Elevated level of suPAR has been associated with activation of the immune system, and it may be a novel biomarker for pneumonia severity. Patients and methods A prospective observational study was conducted on a patient group, consisting of 75 patients hospitalized for CAP, in addition to 15 healthy children as a control group. CAP severity was evaluated by Pediatric Respiratory Severity Score. The blood samples were collected within 24 h of hospital admission of patients and for all children in the control group for measurement of suPAR. Results The suPAR level in the patient group was significantly higher than controls [median and range, 3798 pg/ml (395–5694) vs. 395 pg/ml (173–729); P < 0.001]. suPAR level was significantly higher in children with severe pneumonia compared with those having nonsevere pneumonia [median and range, 4430 pg/ml (586.7–5540.3) vs. 3338.5 pg/ml (395–5694.9); P < 0.021]. suPAR was negatively correlated with age, weight, and saturation of peripheral oxygen (r_s = 0.31, 0.32, and -0.24, and P = 0.007, 0.004, and 0.041, respectively) but positively correlated with respiratory rate and pulse (r_s = 0.24 and 0.26, and P = 0.041 and 0.027, respectively). Conclusion suPAR is a marker of pediatric CAP and can be used for prediction of CAP severity.

Objectives To assess the upper limit of antistreptolysin O titer (ASOT) in healthy school-age children in Qalyubia Governorate. Background Acute rheumatic fever (ARF) and rheumatic heart disease are the most serious complication of group A streptococcal infection. Acute post-streptococcal glomerulonephritis occurs 2–3 weeks after skin or throat infection with group A streptococcus. Overdiagnosis of ARF based on a raised ASOT is common in endemic areas, although an isolated high ASOT is not sufficient to diagnose ARF. Patients and methods This cross-sectional study was carried out in Qalyubia Governorate, and the collected sample was tested in Clinical Pathology Laboratory at Menoufia University Hospitals. Our study was conducted on 4142 children during the period of September 2018 to May 2019. All children were subjected to full medical history, thorough clinical examination (general and systemic), and laboratory investigations, including ASOT and erythrocyte sedimentation rate assessment and throat culture. Results There was no significant difference between age and sex in the studied group. Our study showed significant correlations between age and ASOT among the studied groups. We found that the younger children aged up to 10 years had less basal levels of ASOT than older children. Rural children had significant higher ASOT than urban children. Males had significant lower ASOT compared with females. Conclusion We concluded that upper limit of normal values of ASOT in normal Egyptian children in Qalyubia Governorate is quite high and may reach up to 490 IU/ml.

Objectives To assess the upper limit of normal values of antistreptolysin O titer (ASOT) in healthy school-age children in Menoufia governorate. Background Acute rheumatic fever (ARF) and rheumatic heart disease are the most serious complication of group A streptococcal infection. Acute post-streptococcal glomerulonephritis occurs 2–3 weeks after skin or throat infection with group A streptococcus. Overdiagnosis of ARF based on a raised ASOT is common in endemic areas, although an isolated high ASOT is not sufficient to diagnose ARF. Patients and methods This cross-sectional study was carried out in Menoufia governorate, and the collected sample was tested in Clinical Pathology Laboratory at Menoufia University Hospitals. Our study was conducted on 4000 children during the period of September 2018 to April 2019. All children are subjected to full medical history, thorough clinical examination (general and systemic), and laboratory investigation, including ASOT and erythrocyte sedimentation rate assessment and throat culture. Results There was no significant difference between age and sex in the studied group. Our study showed also nonsignificant correlations between age and ASOT among the studied groups and among rural or urban participants. We found that the younger children aged up to 10 years had more basal levels of ASOT than older children. Conclusion We concluded that upper limit of normal values of ASOT in normal Egyptian children in Menoufia governorate is quite high and may reach up to 475 IU/ml.

Objective This study was designed to highlight clinicoepidemiological profile investigation findings of acute viral encephalitis in children. Background Owing to the high morbidity and mortality associated with viral encephalitis, it is important to establish a diagnosis and initiate therapy as soon as possible. Patients and methods This study was conducted on 50 cases that met the diagnostic criteria of encephalitis. Most of these patients were admitted at either General Department or Pediatric ICUs of Menoufia University Hospital and Shebin El-Kom Fever Hospital. All were subjected to complete history and examination, cerebrospinal fluid examination, electroencephalogram, computed tomography brain, and MRI brain. Results Of the 50 patients included in the study, there were 30 (60%) male 20 (40%) female patients, with mean ± SD age of 5.56 ± 4.90 (0.42–15.0) years. A total of 35 (70%) patients were from the rural area, 25 (50%) patients had low socioeconomic status, and 20% had positive consanguinity. Delayed development was observed only in 14% of patients. Pus cells ranged from 5 to 500 cell in 74% of patients, with mean lymphocyte percentage of 53.33 ± 35.98. Protein was elevated more than or equal to 50 in 82% of patients, and 20% of the patients showed background slowing and focal sharp wave in temporal lobe by electroencephalogram. Brain edema was detected in 15% patients. MRI abnormalities were detected in 24 patients. Conclusion Clinical data, laboratory results, and neuroimaging findings support the diagnosis of encephalitis.

Objective The aim was to compare between total bilirubin levels measured via blood vs skin in neonates. Background Neonatal jaundice is a common clinical problem. total serum bilirubin (TSB) with transcutaneous bilirubin (TCB) measurement can be used for evaluating bilirubin levels in neonates. Patients and methods This cross-sectional study was conducted on 200 jaundiced neonates with indirect hyperbilirubinemia, in the neonatal intensive care unit of Menoufia University Hospital, and they were randomly divided into three groups: group 1 (n = 100) included full-term neonates with gestational age ranged from 37 to 42 weeks; group 2 (n = 35) included late preterm neonates with gestational age ranged from 34 to 36 weeks; and group 3 (n = 65) included early preterm neonates with gestational age ranged from 30 to 33 weeks. Complete blood count with reticulocyte count was obtained along with TSB, Rhesus factor, and ABO blood groups for both mothers and neonates. Results There was a strong positive significant correlation between TSB and TCB, but the correlation decreased as both levels advanced [Pearson correlation (r)=0.983]. The correlation was better in full tem with TSB-TCB difference of 1.88 ± 0.39 in comparison with late and early preterm, which was 2.27 ± 1.99 and 2.55 ± 0.64, respectively. There was a strong positive correlation between TSB and TCB regarding weight, gestational age, and postnatal ages, with Pearson correlation of 0.08, 0.404, and 0.505, respectively, for TSB and 0.477, 0.489, and 0.558, respectively, for TCB. TSB always overestimates TCB. Conclusion TCB is a reliable method in screening of neonatal jaundice in full-term babies, reducing the need for TSB, which is expensive and invasive. Reliability is lesser for the preterm.

Objective The aim was to evaluate the role of urine reagent strips in the diagnosis of childhood meningitis and differentiating between septic and aseptic types. Background Previous research studies have declared that clinical manifestations of acute bacterial meningitis can be very subtle, nonspecific, or even absent, especially in neonates and infants. Urine reagent strips have been used to test urine, ascetic fluid, and pleural aspirate to evaluate infection in these biologic fluids. Patients and methods To reach the goal of this research, a prospective study was designed. The study sample included 50 participants divided into two groups. The first group was selected from clinically diagnosed patients with septic meningitis, whereas the second group was selected from clinically diagnosed patients with aseptic meningitis. All participants were subjected to detailed medical history taking, age, sex, vital signs, complete blood count with differential white blood cell count, blood culture, C-reactive protein, random blood sugar, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, and cerebrospinal fluid analysis. Results The authors found that there was a significant difference between septic and aseptic groups regarding presence of fever, which was more prevalent in septic group (P = 0.029). There were highly significant differences between both groups regarding cerebrospinal fluid reagent strip results with respect to cytology count, protein, and glucose (P < 0.001). Conclusion The study supports the association of urine reagent strips and early diagnosis of childhood meningitis and differentiating between septic and aseptic types.

Objective The aim was to assess the potential role of serum thrombomodulin level as a biochemical diagnostic marker in neonates with septic shock. Background Neonatal septic shock is a significant cause of morbidity and mortality. Thrombomodulin is expressed on vascular endothelial cells and is found in the body in a bound form and a soluble form. Patients and methods This prospective cohort study was done on 120 neonates who were divided into two groups: patients' group included 80 neonates with septic shock, and control group included 40 healthy neonates. Detailed history, thorough clinical examination, and laboratory investigations including level of serum soluble thrombomodulin were done. Results Neonates with septic shock had statistically significant higher level of serum soluble thrombomodulin than controls. Serum soluble thrombomodulin levels were significantly higher in patients with gram-positive bacteria in comparison with gram-negative ones. Nonsurviving septic neonates had statistically significant increase in serum soluble thrombomodulin levels than survived septic neonates. There was a statistically significant positive correlation between serum soluble thrombomodulin levels and quantitative C-reactive protein (CRP) values. The cutoff value of 20 of serum soluble thrombomodulin levels had a sensitivity of 91.5%, a specificity of 84.7%, positive predicted value of 91.9%, negative predicted value of 88.3% with accuracy 92.94% in the diagnosis of septic shock. Serum soluble thrombomodulin showed a higher accuracy in the diagnosis of septic shock than quantitative CRP values. Conclusion Serum soluble thrombomodulin level has a more sensitivity diagnostic role in septic shock than quantitative CRP value. Higher serum soluble thrombomodulin levels predict the prognosis of septic shock.

Objective The aim was to evaluate the efficacy of ultrasound-guided (USG) sacroiliac injection of platelet-rich plasma (PRP) for sacroiliitis in seronegative axial spondyloarthropathies (SPAs) vs triamcinolone acetonide injection. Background Sacroiliitis is considered a hallmark for the diagnosis of seronegative SPA. Sacroiliac joint steroid injection is a commonly used technique. A novel promising injective treatment is PRP. Patients and methods This interventional study included 70 patients with seronegative axial SPA, from 2017 to 2019. The patients were divided into two groups: group I received USG injection of triamcinolone acetonide, and group II received USG injection of PRP. Patients were evaluated for pain intensity by visual analog scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) 4 and 8 weeks after injection and with MRI 8 weeks after injection. Results Steroid and PRP were effective in the treatment of sacroiliitis by USG injection. The improvement was significant and lasted longer in group II (68.6% became with mild pain regarding VAS and 74.3% of minimal disability regarding MODQ) as compared with group I after 8 weeks of injection. Patients who received steroids improved dramatically at 4 weeks (60% of patients experience mild pain regarding VAS and 45.7% became with minimal disability regarding MODQ), with decreased efficacy after 8 weeks. With follow-up with MRI, active sacroiliitis can be fully improved by PRP injection (57.1% with normal MRI result after 8 weeks). Conclusions Steroid and PRP were effective in the treatment of sacroiliitis in seronegative SPA by USG injection, but PRP had a persistent and long-lasting effect.

Objective The aim was to assess type and extent of clinically evident or suspected spinal abnormalities by MRI and to compare different sequences for identifying nervous and fatty tissue in different abnormalities. Background Spinal dysraphisms are congenital abnormalities of spine and spinal cord owing to faulty closure of midline structures. Imaging of spinal dysraphism should follow an organized approach and correlation between radiological, clinical, and developmental data should help in appropriate diagnosis. MRI is considered the best imaging modality for these abnormalities. Materials and Methods Pediatric patients aged 1 day till 2 years old, clinically evident or suspected to have spinal dysraphism, having back swelling, skin pigmentations, skin tags, hair tufts, hemangiomas of the back, criteria were included and underwent MR scan in Toshiba Excelart Vantage Titan (Japan) 1.5 Tesla MR Set with standard 16-channel head coil. Results Of 43 pediatric patients dated since birth till 2 years old with clinical evidence or suspicion of congenital spinal abnormalities for MRI scanning, spina bifida (41.9%), bony deformities (30.2%), tethered cord (27.9%), meningomyelocele (25.6%) were the commonest congenital spinal abnormalities. Neural tissues in the herniated thecal sac were detected in combination of three-dimentional half Fourier-acquired single-shot turbo spin echo (3D HASTE) sequence with turbo spin echo T1-weighted (TSE T1W) sequence in 15 patients, which was significantly high as compared with combinations of TSE T1W sequence with TSE T2 weighted (T2W), with short-time inversion recovery (STIR) and with single-shot myelographic sequence probability value of 0.03, 0.02, and 0.01, respectively. Fatty tissue was found in four cases, which were detected by a combination of STIR and TSE T1W sequences in all four patients. Conclusion Pediatric spinal dysraphism and different spinal anomalies can be diagnosed by MRI scanning with excellent accuracy. STIR and 3D-HASTE sequences should be part of the examination protocol of spinal dysraphism.

Aim and objectives To assess the effectiveness of sentinel lymph node biopsy in evaluation of the axillary status after neoadjuvant chemotherapy in breast cancer cases in comparison with standard axillary dissection. Background Breast carcinoma is the commonest malignant tumor in women. In Egypt, it accounts for ~25.5% of all women cases. In Egyptian women, the average age incidence is ~44.1 years, being more common in nullipara. The standard axillary lymph node dissection done in patients with breast cancer has many comorbidities that affect the patients' quality of life. Patients and methods The present cross-sectional study was conducted at Menoufia University Hospital on 50 patients with breast cancer who underwent sentinel lymph node biopsy after having neoadjuvant chemotherapy between January 2019 and February 2020. Results Sentinel lymph node biopsy after neoadjuvant chemotherapy has acceptable false-negative results, is less invasive than a complete or level one and two axillary dissection, and has lower both morbidity and cost. Conclusion Sentinel lymph node was successfully identified in 42 patients, with an identification rate of 84% (42/50). Of the eight cases in which sentinel lymph nodes was not identified, three had positive axillary lymph node deposits.

Background Laparoscopic cholecystectomy (LC) has become the standard procedure of choice for management of symptomatic gallstone disease recently. Sometimes, it is difficult and takes longer time or it may be converted to an open procedure. Aim This study was undertaken to determine the preoperative factors and their predictive value for the difficulty of LC. The study used some important factors preoperatively that have a significant effect in the literature that can predict difficult LC via a scoring method in Menoufia University hospitals. Patients and methods The present retrospective study was conducted by an experienced laparoscopic surgeon in the period of 1 year from October 2018 to October 2019 in the Department of General Surgery at Menoufia University hospitals. The study included 132 patients who underwent LC. A total score up to 15 score from history, clinical, and sonological findings was retrospectively analyzed to evaluate preoperative predictors included in our study. Score up to 5 predicted easy, 6–10 difficult, and more than 10 very difficult LC. All the data was recorded in a tabulated form and analyzed using SPSS software, version 2018. Results The factors included in the score of this study were divided as history factors, such as age, sex, BMI, previous abdominal surgery, and previous hospitalization for biliary causes; clinical factors, such as acute calcular cholecystitis, hydrops (mucocele) or empyema of gallbladder (GB), and acute pancreatitis; and sonological factors such as GB wall thickness, stone impacted at the neck of GB, common bile duct diameter, and pericholecystic fluid collection, and all were grouped to form a scoring method in Menoufia University hospitals that can strongly help the surgeon expect the difficulty of the procedure to be prepared preoperatively with the suitable plan for safety of both the surgeon and the patient. Conclusion The scoring system depending on preoperative factors included in this study was so reliable and useful that it could successfully predict difficult cases.

Background Intussusception is a common cause of intestinal obstruction in children, especially in infants. Intussusception is a pediatric abdominal surgical emergency, and hydrostatic reduction is an effective modality of treatment in selected group of patients. There are lack of data in Nigeria on the effect of symptom duration on hydrostatic reduction. Aim To evaluate the effect of duration of symptoms on the outcome of hydrostatic reduction of intussusception. Patients and methods This was a prospective study on the effect of symptom duration on the success of hydrostatic reduction of intussusception in children. This study was carried out at the pediatric surgery unit of a teaching hospital over a 3-year period. The patients were categorized into two groups: group A included patients who had successful reduction, and group B included patients who had unsuccessful (failed) reduction. Results A total of 96 cases of intussusception were managed during the study period, of which 32 (33.3%) patients underwent hydrostatic reduction. Mean age of the patients was 7 months, with a range of 4–12 months. Male to female ratio was 1.9: 1. All the patients had abdominal pain. There was more successful hydrostatic reduction in patients who presented within 48 h of onset of symptoms (group A), and this was statistically significant (P = 0.04). Conclusion Children with intussusception who present early (within 48 h of onset of symptoms) had more successful hydrostatic reduction when compared with patients who present after 48 h.

Objective The aim of our study is to evaluate the endovascular option for treatment of arteriovenous fistula (AVF) stenosis through assessment of success rates and primary patency rate after the angioplasty procedure. Background The quality of life of hemodialysis patients depends mainly on the patency and proper function of their vascular access. The main cause of AVF dysfunction is stenosis of the fistula. Vascular surgeons should have many surgical and endovascular plans to keep the hemodialysis access patent and functioning. Percutaneous transluminal angioplasty has become an established treatment of dysfunctional AVFs, with many advantages and benefits for the patients. Patients and methods A prospective study was conducted on 30 patients having end-stage renal disease scheduled for or already on regular hemodialysis with failing or recently failed native AVF during February 2018 till February 2020. Balloon dilation was done alone in 27 cases, whereas it was combined with thrombectomy procedure with a Fogarty catheter in three cases. Results A total of 30 patients (19 males and 11 females) were included. Overall, 56.67% of AVFs were brachiocephalic AVF. Radial access was mostly used as an access in 80% of cases, whether percutaneous or surgical. Venous juxta-anastomotic stenosis was the most common site of stenosis (40.91%). Technical success rates in this study reached 86.67%, and the overall primary patency rates were 84.62 and 76.92% at 3 and 6 months, respectively. Conclusion Balloon angioplasty of failing or recently failed native AVF is a safe and effective procedure. It is associated with high success rates, low complication rates, and maintained long-term patency of the hemodialysis access.

Background Spinal infection is an uncommon disease, which may result in serious complications with potentially high morbidity and mortality. Objective The aim was to evaluate the outcome of patients with postoperative spondylodiscitis after management in relation to age, sex, general condition, symptoms, signs, radiological findings, type, and time of intervention. Patients and methods A prospective study was conducted on 20 patients having postoperative spinal infection managed in the period between June 2017 to June 2019 in the Neurosurgery Department at Menoufia University Hospitals and Al Haram Hospital. Patients with postoperative spinal infection were evaluated neurologically by American Spinal Injury Association (ASIA) score, pain was evaluated by Denis score, and they were followed up radiologically by MRI and radiography for assessment of their neurological integrity, deficits, and outcome. Results There was a statistically significant difference between postmanagement Denis pain score, ASIA score, and C-reactive protein as compared with before management (P<0.001). Outcome of the 20 patients was categorized according to Odom's criteria as follows: 12 (60%) patients had excellent outcome, six (30%) patients had good outcome, one (5%) patient had fair outcome, and one (5%) patient had poor outcome. Conclusion Among the wide variety of organisms responsible for postoperative spinal infection, we found that Staphylococcus aureus accounted for most of it. The best modality of treatment is medical treatment with antibiotics and surgical management when failure of the medical one or presence of neurological deficits.

Aim To describe the epidemiological and clinical criteria of those patients with rare intracranial cysts. Background Central nervous system (CNS) hydatid cysts are a rare presentation of hydatid cyst, although may be the cause of intracranial space-occupying lesions in 4% in endemic countries. It affects mostly children. The diagnosis of CNS hydatid is still problematic despite the advancements in imaging techniques (computed tomography or MRI). Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery. Patients and methods A retrospective descriptive study was conducted on the CNS hydatid cases operated in our departments between 2011 and 2016. A total of 16 cases were included. For each case, we reviewed the presenting clinical manifestations and the imaging findings. The Glasgow Outcome Scale was followed for all cases throughout the follow-up period. Results Of 16 cases, 12 were children (<12 years). The most presenting findings were increased intracranial pressure. A single cyst was detected for 14 cases, whereas multiple cysts were identified in two cases. Extirpation of the cyst without rupture was achieved in 12 patients. Only two cases developed recurrent hydatid after 3 years. No intraoperative mortality was detected, whereas postoperative mortality occurred in one case owing to anaphylaxis following intraoperative rupture of the cyst. Conclusion Surgical excision of the whole hydatid cyst without rupture is the treatment of choice to avoid the life-threatening complications of CNS hydatid rupture.

Background Maternal administration of dexamethasone is essential to improve fetal lung surfactant production and hasten the fetal lung maturity in women at risk for preterm birth. Umbilical and fetal middle cerebral arteries' (MCAs) Doppler indices are important to evaluate the effects of dexamethason on fetal and uteroplacental circulation in pregnancies at risk for preterm birth. Objective The aim was to evaluate the effects of maternal dexamethasone administration on umbilical and fetal MCAs Doppler indices (Resistance index (RI), Pulsalitility index (PI), and S/D ratio) in singleton pregnancies considered at risk for preterm delivery. Patients and methods A total of 100 women were included in this study. They were at risk of preterm labor and were divided in two groups: 50 participants who took dexamethasone as a study group and 50 participants did not take dexamethasone as a control group. Doppler examination of umbilical and MCAs was performed, and comparisons between values of study group and control group were done after 0, 1, 4, and 7 weeks of dexamethasone administration. Results The authors found a significant change in the mean values of the pulsatility and resistive indices and systolic-diastolic ratios of study group in umbilical artery and fetal MCA after 1 week after dexamethasone administration. Conclusion Administration of dexamethasone improves Doppler indices and biophysical profile and decreases NICU admission. In healthy fetuses, a transient, significant, and unexplained decrease in fetal MCA impedance occurs on the fourth day following maternal dexamethasone administration.

Objective The aim of this study was to make a comparison between the effects of letrozole and a combination of clomiphene citrate and tamoxifen in ovulation induction in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). Background PCOS is the most common endocrine disorder affecting ~ 6–15% of women of reproductive age causing several medical problems mainly infertility. Ovulation induction can be achieved by administration of an oral drug or a combination of drugs such as clomiphene citrate, tamoxifen, and letrozole, which are considered the first-line treatment for anovulatory PCOS. Patients and methods This prospective comparative study has been performed at the outpatient clinic of Obstetrics and Gynecology of both Menoufia University Hospital and Quesna Central Hospital during the period from December 2018 to March 2020. A total of 100 patients with PCOS (resistant to clomiphene citrate) were selected according to 'Rotterdam criteria,' including biochemical hyperandrogenism. Results There were no statistically significant differences between group A (40 cases) and group B (39 cases) regarding age, BMI, and duration of infertility. The results of both groups regarding ovulation rate were comparable, with no significant difference between the two groups. Conclusion The results of the present study are comparable to previous reported studies, revealing that clomiphene citrate, tamoxifen, and letrozole are effective in the treatment of infertility in patients with PCOS. Addition of tamoxifen to clomiphene citrate enhances its effect and gives better results.

Objectives To assess the use of antenatal estimation of fetal-thigh soft-tissue thickness as a predictor for the actual neonatal birth weight (ABW) after delivery. Background Fetal weight estimation has become increasingly important, especially for evaluation of fetopelvic disproportion, decision for mode of delivery in complications of pregnancy, and in detection of intrauterine growth restriction. Patients and methods A prospective study was conducted on 72 pregnant women with different gravidity and parity attending the delivery room at Obstetrics and Gynecology Department, Menoufia University Hospital during April 2019 till June 2020. An antenatal ultrasound examination within 48 h of their delivery was done. The delivered neonates were weighted immediately after delivery to estimate the ABW. Results Of the 72 women included and who delivered within 48 h (ABW range, 2500–4200), their mean age was 26.34 ± 5.49 years, and gestational age was in the range from 37 to 41 years, with a mean of 38.7 ± 0.92 weeks. There were highly statistically significant differences between estimated fetal weight and ABW of the studied cases (P = 0.001). The prediction of fetal weight was similar between the formulas, although estimate of the new algorithm was more accurate, showing positive predictive value of 94% compared with 91% for Hadlock's. Conclusion The study concluded that the estimation of fetal antenatal estimated birth weight using new algorithm of estimated fetal-thigh soft-tissue thickness is more accurate and specific for estimation the expected ABW than using the standard Hadlock's formula.

Introduction Globally, neonates with lower birth weight (LBW) are at higher risk of death as compared with those with normal birth weight, yet in Ghana, little is known about the nationwide predictors of LBW in terms of maternal demographic and antenatal factors. Aim To identify maternal sociodemographic and antenatal factors as a predictors of LBW in Ghana. Patients and methods A descriptive cross-sectional design was adopted for this study using Ghana Maternal Health Survey data for 2017. The data analysis was done using SPSS. χ² and binary logistics regression model was used for associations at significance of P value less than 0.05. Results The average age of the women was 29.5 ± 9.8 years. The study recorded prevalence of LBW to be 7.4%. With significance at 95%, the following factors predicted absence of LBW: maternal age, 20–24 years [adjusted odds ratio (AOR)=1.8], 25–29 years (AOR = 2.4), and more than or equal to 30 years (AOR = 2.9), with 15–19 years as the reference category; unmarried mothers (AOR = 0.8); ethnicity, Ewe/Akan (AOR = 1.9) and Guan/Akan (AOR = 2.3); regional zone of the mother, Savanna/Coastal (AOR = 0.7); and antenatal medication, tetanus injection and iron table intake (AOR = 0.7 and AOR = 0.7, respectively). Conclusion The maternal factors identified as a predictor of LBW were maternal age, marital status, ethnicity, and regional belt or zone. Antenatal tetanus injection and iron table intake predicted LBW.

Objectives To evaluate the role of ologen implant with silicon tube implantation in dacryocystorhinostomy (DCR) surgery regarding the success rate. Background External DCR is the treatment option for most cases of lacrimal drainage obstruction, including distal canalicular obstruction, common canalicular obstruction, and nasolacrimal duct obstruction. Patients and methods This prospective comparative case–control study was carried out on 30 patients attending the Ophthalmology Department, Menoufia University Hospitals. Patients included were those with primary acquired nasolacrimal duct obstruction with a positive regurge test. Patients were randomly enrolled into two groups using the alternating choice technique. Group A included 15 patients who had DCR surgery to treat the obstruction with silicone tubes and ologen implants. Group B included 15 patients who had a DCR with silicone tubes only. Results Success rates regarding relief of symptomatic epiphora were 86.6% in group A and 93.3% in group B, and the time of dye disappearance test was 3.9 ± 1.033 min in group A and 3.87 ± 0.640 min in group B, with P values of 0.598 and 0.833, respectively. Apart from immediate mild postoperative hemorrhage that was encountered in two cases in group A and one case in group B, there were no significant complications in both groups. Conclusion This study shows that the application of ologen implants in external DCR surgeries may improve symptomatic epiphora without exposing the patients to more intraoperative or postoperative complications. However, the follow-up period was relatively short and the sample size is relatively small, and further work is required to verify the effect of ologen alone in external DCR surgeries.

Background Children with nasal foreign body (FB) often come to clinician for its removal. These children often present with foul-smelling nasal discharge, nasal obstruction, nasal mucosal irritation, and epistaxis. In most cases, unilateral nasal FB is easily removed but occasionally may lead to life-threatening situation. Objectives To study the details of the nasal FBs including treatment in children at a tertiary care teaching hospital of Eastern India. Patients and methods This retrospective study was done between June 2015 and July 2020 and included children attending the otorhinolaryngology clinic and emergency unit for nasal FB. Patient details such as age, sex, symptoms, type of FB, techniques of removal, and complications are analyzed. Results A total of 318 children with FB were included in this study. The mean age of the participants was 4.23 ± 1.8 years (range, 0–16 years); the male to female ratio was 1.6: 1 (male predominance). Most FB cases were owing to organic substances such as vegetables (30.81%), and nonorganic FB were paper piece, plastic piece, foam, metallic nuts, and button battery cell. The commonest clinical presentation among participating children was unilateral foul-smelling nasal discharge. Complications included epistaxis, rhinosinusitis, rhinolith, and perforation of the nasal septum. Conclusion FBs in the nasal cavities are a common accidental medical problem, especially in pediatric age. These nasal FBs are often harmless but may cause complications in some cases if neglected or overlooked without removing it in time. However, the best treatment remains the prevention.

Objective To evaluate the clinical efficacy and adverse effects of oral propranolol in comparison with topical timolol for the treatment of hemangioma. Background Previous research declares that hemangioma is the most common tumor of infancy and childhood, occurring in 4–10% of white infants. Patients and methods To reach the goal of this research, a prospective randomized study was performed by selecting 20 patients with hemangioma attending the Pediatric Surgery Clinic at Menoufia Main University Hospital and Damanhur National Medical Institute. All patients were subjected to detailed history taking, clinical examination, echocardiogram, complete blood picture, liver and kidney functions, and blood glucose level. Determination of the location and dimensions of hemangioma was based on direct measurement and photographic analysis. Doppler ultrasound was used for baseline data regarding site, size, depth, vascularity, and flow. Results There was a statistically significant difference regarding dimensions of the lesion (mm) when comparing propranolol patients before treatment and after treatment (P = 0.010) and also when comparing timolol patients before treatment and after treatment (P = 0.008). There was a statistically significant difference regarding to dimensions of the lesion (mm) by ultrasound when comparing propranolol patients before treatment and after treatment (P = 0.003) and also, when comparing timolol patients before treatment and after treatment (P = 0.008). Conclusion Our study reveals that both systemic and topical beta-blockers can be used effectively for treatment of hemangioma; however, much better improvements were obtained on using systemic propranolol than topical timolol. Topical timolol can be used as a first-line treatment for superficial infantile hemangiomas.

Objectives To evaluate the effect of preoperative finasteride on the surgical blood loss during monopolar transurethral resection of the prostate (TURP). Background Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in elder men. Prophylactic measures have been employed to reduce perioperative bleeding, including preoperative 5α-reductase inhibitors administration. Finasteride and dutasteride can block the conversion of testosterone to dihydrotestosterone and have been used to treat BPH and BPH-related hematuria. Patients and methods We conducted a randomized controlled study at the Urology Department of Menoufia University Hospital, comparing the preoperative use of finasteride 5 mg over the intraoperative bleeding during TURP. A total of 90 patients with BPH with prostate size varying between 40 and 90 g assigned for a monopolar TURP surgery were randomly allocated into three groups: the first group as control, the second group used finasteride 5 mg for 2 weeks before surgery, and the third group used finasteride 5 mg for 4 weeks before surgery. Results There was an insignificant difference between the three groups regarding age or associated comorbidities. Calculated blood loss was lower for the second and third groups in comparison with the control one (P = 0.046). Conclusion Results of our study elicit that treatment with finasteride for even 2 weeks before surgery significantly reduces surgical bleeding.