Objective To summarize the methods of nutritional improvement used in cases of protein-energy wasting in patients on maintenance hemodialysis. Data analysis Search papers, systematic reviews, and randomized clinical trials from 2004 to 2021 were reviewed in the available MEDLINE databases, which included PubMed, Medscape, Springer, Elsevier, and Science Direct. Study selection English language publications that focused on critically ill populations on renal replacement therapy requiring nutritional support were searched. Data extraction: studies by Cano and colleagues, Liu and colleagues, Oğuz and colleagues, Marsen and colleagues, Chioléro and Berger, Fiaccadori and colleagues, Ramakrishnan and Shankar, Al-Dorzi and Arabi, Bost and colleagues, Anderson and colleagues, and Fiaccadori and colleagues were gathered by two authors, which were then reviewed by another author. They extracted data related to the year, total population, method and duration of nutritional supplementation, inclusion criteria, exclusion criteria, and main results for each study. They also collected data on age, sex, length of nutritional aid by month, mean and SD of BMI, weight gain, prealbumin, nutritional status, and any adverse effects. Data synthesis: a structured systematic review was performed. Findings Intradialytic parenteral nutrition enhanced patients' health and clinically relevant nutritional outcomes as compared with oral (enteral) supplementation, with a substantial reduction in mortality. It can enhance some nutritional markers while having well-tolerated adverse effects, making intradialytic parenteral nutrition a feasible therapy option, particularly in circumstances when enteral nutrition cannot be delivered. Conclusion Complete dosage of enteral protein is probably more suitable in the late stages of critical illness, when enteral nutrition is insufficient in the first week. In general, enteral nutrition is favored over parenteral nutrition, should be begun early (within 24–48 h), and should be progressively raised to target over at least a few days.

Objectives The aim was to evaluate the disorganized inner retinal layers, the thickness of the outer retinal layer, and central foveal thickness using spectral domain optical coherence tomography as predictors of visual acuity (VA) in patients with diabetic macular edema (DME). Data sources Medline databases (PubMed and Medscape) were searched, and all materials available in the Internet. The search was performed on January 2022. Study selection The initial search presented 120 articles. The number of studies that met the inclusion criteria was 15. The articles included both sexes, diabetic patients aged 18 years old or above and capable of giving consent and having DME as evidenced clinically with a slit-lamp biomicroscopy or on optical coherence tomography scans. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Data synthesis Significant data were collected. Then a structured review was performed. Finding In total, 15 potentially relevant publications were included; it was found that disorganization of the retinal inner layers seems to be the most valued predictor of function and VA. Conclusion Disorganization of the retinal inner layers seems to be the most valued predictor of function and VA followed by central retinal thickness, and then outer retinal thickness in patients with DME.

Objective To assess the utility of measuring right ventricular (RV) volumes and function by three-dimensional echocardiography (3DE) and speckle tracking in patients with nonischemic dilated cardiomyopathy (DCM). Background DCM represents a leading cause of heart failure and cardiac transplantation. The degree of left ventricular dilation and impairment in DCM patients is traditional determinants of adverse outcomes; moreover, many predictors have been established, for example, the presence of secondary functional mitral regurge, myocardial fibrosis, and enlargement of other chambers importantly the RV. The RV remodeling carries prognostic values to the progression and recovery of left ventricular remodeling in DCM patients. Recently, the 3DE gained an important role in the assessment of RV as it avoids geometric assumptions and offers superior reproducibility. Methods and results We prospectively enrolled 52 patients with nonischemic DCM. All patients underwent comprehensive clinical assessment, laboratory investigations, and transthoracic echocardiographic assessment by conventional echocardiography and 3DE assessment of RV volumes and ejection fraction. The mean age of patients was 45 ± 17 years. Of the patients, 61.5% were males and 38.5% were females. The median of brain natriuretic peptides was elevated to 1208 pg/dl with interquartile range (550–3227). The 3DE assessment of RV revealed increased mean RV volumes (end-diastolic volume 150 ± 59 ml, RVESV 95 ± 57 ml, and mean of RVEF of 42 ± 13%). In our study, 28 (54%) patients had impaired RV function by 3DE (RVEF <45%). In addition, the RV free wall strain was abnormal (<−20) in 27 patients. Conclusion The 3DE imaging has an evolved usefulness in RV volumetric function assessment and comes to be more comfortable, easier, and time saver than cardiac MRI. The RV3D assessment in patients with nonischemic DCM may carry a prognostic impact on cardiac outcomes in this critical group of patients.

Objectives To study the prognostic value of coronary computed tomography (CT) angiography in asymptomatic diabetic patients. Background Diabetic patients have a higher prevalence of coronary artery disease (CAD) and are more likely to have silent myocardial ischemia and myocardial infarction than nondiabetics and are characterized by multivessel disease and calcified, diffuse, and distal lesions. CT coronary angiography is a safe, accurate, and reliable technique of high ability to detect CAD and estimate the degree of obstruction, number of affected arteries, and the pattern of their affection and a reliable modality for exclusion of CAD. Patients and methods This study was conducted on 99 patients with type 2 diabetes mellitus without symptoms of CAD. Patients were referred for multislice CT angiography, for diagnosis of CAD and to detect patients with obstructive coronary lesions, and then patients were followed up for 1 year for cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina, or late coronary revascularization). Results Of the 99 patients, 58 (58.6%) had normal coronaries, 15 (15.2%) patients had nonobstructive, whereas the remaining 26 (26.3%) had obstructive coronary lesions, and of these 26 patients, three (3.03%) patients had moderate stenosis and the remaining 23 (23.3%) patients had severe stenosis. Those with severe stenosis were further classified into one-vessel disease (13 patients, 13.1%) and multivessel disease (10 patients, 10.1%). There were no cases of unstable angina, myocardial infarctions, cardiac deaths, and late coronary revascularization during the follow-up period. Conclusion Asymptomatic type 2 diabetic patients with normal coronary arteries and nonobstructive CAD on coronary CT angiography show excellent clinical outcomes over a 1-year follow-up.

Objective To investigate the diagnostic accuracy of some screening procedures as predictors of coronavirus disease 2019 (COVID-19) positivity in Egyptian community. Background COVID-19 has been recognized as a pandemic by the WHO. Multiple studies suggest that computed tomography (CT) should be a primary diagnostic tool for COVID-19 because they reported sensitivities with CT far superior to that of reverse-transcriptase (RT) PCR testing. Clinical features varied in different cases, and some patients showed asymptomatic infection. Patients and methods This study is a cross-sectional study, which was conducted on patients who were suspected of novel coronavirus infection attending Mehalla Chest Hospital. Results CT and laboratory were significant screening procedures with sensitivity of 72.8% and specificity of 100%; besides, negative predictive value was 24.2% and positive predictive value was 100% with accuracy of 75% for predicting COVID-19 positivity. Conclusion This is a cross-sectional randomized observational study that was conducted in Mehalla Chest Hospital. This study looks into CT chest imaging, D-dimer, C-reactive protein, and ferritin tests along with PCR, and suggests that if PCR is not an option, other testing methods for COVID-19 are not merely adequate, but could be very useful in rooting out positive cases and could even be used to measure outcome and mortality of COVID-positive patients.

Objectives To study serum T-cell immunoglobulin and mucin-domain 3 (Tim-3) levels in discriminating hepatocellular carcinoma (HCC) from chronic viral hepatitis. Background HCC is the most common primary liver tumor and considered the fourth leading cause of cancer-related deaths in the developed countries. As T cells respond to persistent tumor or viral antigens, they progressively lose their functional properties with cell-surface expression of multiple inhibitory immune-checkpoint receptors. By blocking immune-checkpoint proteins, the immune system can stimulate the body's own mechanism to remain effective in its defenses against cancer. Participants and methods The study was conducted on 100 participants divided into four groups as 25 chronic viral hepatitis patients' group, 25 newly diagnosed HCC group, and 25 HCC patients under conventional therapy. In addition, 25 healthy individuals were included as a control group. The level of serum Tim-3 was determined using enzyme-linked immunosorbent assay. Routine chemical tests were determined using chemistry autoanalyzer. Correlations were tested by Pearson's correlation analysis. Results HCC groups were significantly higher in hepatitis-C virus infection and cirrhosis than viral hepatitis group. The alpha-fetoprotein was significantly higher in patients' groups than controls and in HCC groups than viral hepatitis group. There was significant elevation in serum Tim-3 level in patients' groups than controls. The receiver-operating characteristic curve revealed that a cutoff value at or more than 315 ng/ml HCC was diagnosed from apparently healthy persons. Serum Tim-3 showed significant positive correlation with alpha-fetoprotein and significant negative correlation with albumin among patients. Conclusion Serum level of Tim-3 was significantly increased in HCC patients than controls. This designates that Tim-3 can participate in the pathogenesis of HCC.

Objective To investigate the in vitro quality of room temperature stored apheresis platelet concentrates (PCs) with and without adding a platelet additive solution (PAS) and to evaluate its therapeutic utility in oncology patients. Background Several studies have highlighted using PAS as a way to improve the storage conditions of PCs. PAS is a synthetic media used in the place of plasma for platelet (PLT) storage. It is used to support metabolism, provide buffering capacity, and to protect PLTs from the storage lesion. So, it can be used to extend shelf life of PCs. To date, its application in Egyptian blood banks has not been increased. Patients and methods Twenty apheresis PCs were collected and stored at room temperature and divided into two groups; A1 group suspended in 100% plasma and tested on days 0 and 5 and A2 group suspended in 65% SSP + PAS and tested on days 0, 5, 7, and 10 of storage for PLT count, mean platelet volume, pH, partial pressure of oxygen, partial pressure of carbon dioxide, bicarbonate level, swirling, bacterial examination, glucose, lactate, lactate dehydrogenase, annexin expression, and PLT aggregation. SSP + PCs were transfused to oncology patients against plasma PCs and the corrected count increment (CCI) was calculated. Results SSP + PCs were comparable to plasma PCs up to day 7 of storage regarding all studied parameters when compared with day 5 of group A1; 7 days SSP + PCs showed a CCI comparable to plasma PCs. Conclusion We reported a maintained PLT function and metabolism up to 7 days of storage of apheresis PCs in 65% SSP + with a CCI comparable to plasma PCs.

Background Individual predisposition to obesity and type 2 diabetes mellitus (T2DM) is determined by the interaction between genetic and environmental factors. The fat mass and obesity-associated gene (FTO) is an obesity-susceptibility gene identified to have a huge effect on obesity and DM in different populations. Objectives To investigate the association between FTO gene polymorphisms rs9939609 and rs17817449 and prediction of T2DM in Egyptian obese patients. Patients and methods In this case–control study, PCR–restriction fragment length polymorphism was used for investigating allele and genotype frequencies of FTO rs9939609 and rs17817449 in 90 participants divided into two groups: diabetic group and matched control group. Biochemical laboratory investigations including fasting blood glucose, glycated hemoglobin, lipid profile, serum insulin, and calculation of homeostasis model assessment of insulin resistance were done. Results Patients carrying T/A and A/A genotypes and A allele of rs9939609 had an increased risk of T2DM. However, no significant difference in genotypes and allele distribution between diabetic subgroups was detected. Meanwhile, T/G [odds ratio (OR)=8.1; 95% confidence interval (CI): 1.23–53.2; P = 0.02] and G/G (OR = 5.73; 95% CI: 1.02–32.1; P = 0.04) genotypes and G allele (OR = 2.42; 95% CI: 1.04–5.63; P = 0.04) of FTO rs17817449 had a higher frequency in diabetic obese than diabetic nonobese patients. Conclusion The FTO gene variant rs17817449 could play a role in the development of insulin resistance and hence the occurrence of T2DM among the Egyptian obese population.

Objective To demonst rate whether BCL-2 (-938C>A) polymorphism can act as a modifier in diffuse large B-cell lymphoma (DLBCL) development and to identify its prognostic significance. Background DLBCL is the most common type of B non-Hodgkin lymphoma. The functional BCL-2-938C>A promoter polymorphism is proved to influence the balance between apoptosis and survival of malignant lymphoid cells. We looked at its usefulness as a susceptibility factor and its prognostic impact in the disease course. Patients and methods The BCL-2 (-938C>A) was genotyped in blood samples of 66 non-Hodgkin lymphoma patients of DLBCL type and 40 age-matched and sex-matched controls using the restricted fragment length polymorphism technique. Results We found that homozygous AA and heterozygous AC genotypes were associated with an increased risk for DLBCL development against the CC genotype by 4.33-fold and 3.89-fold, respectively. A allele versus c allele and AA, AC genotypes versus CC genotype showed significantly higher distribution among DLBCL patients than the control. No significant association was observed between different genotypes and tumor characteristics. No significant association was found between any of the genotypes and disease-free survival or overall survival rates. Conclusions AA and AC genotypes of BCL-2 (-938C>A) is associated with susceptibility for DLBCL development; however, this single-nucleotide polymorphism did not influence neither the clinical parameters nor the patient survival.

Background Beta-thalassemia is a hereditary disease that is characterized by ineffective erythropoiesis and shortened red blood cell survival. In severe cases, blood transfusion is a mainstay therapy; however, regular blood transfusions result in iron overload with serious complications. Complement-mediated erythrocyte destruction is one of the pathological causes of hemolysis in beta-thalassemia. Membrane-bound complement regulatory proteins such as CD55 and CD35 ensure that the complement system does not become overactivated, thus causing harm to self-tissues. Objectives To assess the expression of CD55 and CD35 on erythrocytes of β-thalassemia patients and its correlation with hemoglobin (Hb) levels and other markers of hemolysis. Patients and methods Flow cytometry was used to evaluate the expression of CD55 and CD35 on erythrocytes of 50 patients with β-thalassemia and 50 age-matched and sex-matched controls. Results CD55 and CD35 expression on erythrocytes were significantly reduced in thalassemia patients as compared with controls (P < 0.001). Correlation analysis revealed a significant positive correlation between CD55% expression and Hb concentration (r = 0.347, P = 0.013). However, a significant negative correlation was demonstrated between CD55% and lactate dehydrogenase (r=−0.358, P = 0.011). A statistically significant positive correlation was observed between CD35% expression and Hb concentration (r = 0.302, P = 0.033). Moreover, a significant negative correlation was found between CD35% and reticulocyte % (r=−0.304, P = 0.032). Conclusions Low expression levels of CD55 and CD35 on erythrocytes of patients with β-thalassemia demonstrate the important role of these complement regulatory molecules in the pathogenesis of hemolysis and anemia in β-thalassemia.

Objective To evaluate autophagy-related gene 5 (ATG5) rs510432 T/C polymorphism in hepatocellular carcinoma (HCC) complicating chronic hepatitis C. Background HCC represents a universal health problem. Among Egyptians, it ranks the fourth common cancer. Autophagy is an evolutionarily conserved intracellular recycling system that obtains a fundamental role in maintaining metabolism and homeostasis. It was widely stated that dysregulated autophagy has been implicated in cancer development. ATG5 is a key regulator involved in autophagosome formation. Patients and methods A total of 100 participants (40 patients with HCC, 40 patients with liver cirrhosis, and 20 healthy controls) were selected, and ATG5 rs510432 genotyping was done by real-time PCR. Results No significant statistical difference was detected in the distribution of the genotypes and allele frequencies of ATG5 rs510432 polymorphism either between HCC and cirrhotic groups (P = 0.092 and 0.733, respectively) or between HCC and healthy control groups (P = 0.848 and 0.579, respectively). However, TC genotype in cirrhotic patients had statistically significantly higher ascites degree; higher bilirubin, aspartate aminotransferase, and international normalized ratio; and statistically significant lower albumin compared with CC genotype. Conclusions The current study revealed that the ATG5 rs510432 polymorphism was not associated with an increased risk of HCC in Egyptian population. However, it might have a probable role in pathogenesis of liver cell failure, cirrhosis development, and prognosis.

Objectives To compare the images obtained by dermoscopy and a simple jeweler's loupe device to evaluate the difference between these diagnostic tools in different skin diseases. Background The basic principle of dermoscopy is the transillumination of a lesion and studying it with high magnification. The main disadvantage of most dermoscopy devices is the relatively high cost. The aim of this study was to compare the images obtained by a dermoscopy and a simple jeweler's loupe to evaluate the difference between these diagnostic tools in different skin diseases. All participants were recruited from the outpatient clinic of the Dermatology Department at Menoufia University Hospital, Egypt. Patients and methods This study was done on 100 cases of different definitive skin diseases. Each case was subjected to dermoscopic evaluation by dermlite DL4, dermlite DL3, photo-documentation, jeweler's loupe (×10 magnification and a built-in light-emitting diode) examination, and photodocumentation. A comparison regarding the findings of each disease was done. Results Regarding the results of jewelry loupe, there was no significant difference between its results and dermoscopy results, except for a significant difference in honeycomb pigmentation in androgenic alopecia lesions and milia-like cyst of seborrheic keratosis not seen with the loupe. A highly significant difference in dotted blood vessels of psoriatic lesions was observed (100% with dermatoscopy and 20% with the loupe). Conclusion Jewelry loupe is a simple and cost-effective device that can be used in rural areas and also in teaching the basics of dermoscopy, although its image clarity is not as good as a proper dermoscope.

Objectives To evaluate the serum level of interleukin-15 (IL-15) in patients with alopecia areata (AA) in an attempt to verify its role in the pathogenesis of the disease. Background AA is a chronic, inflammatory, and autoimmune disease, presenting with nonscarring hair loss. It is a disorder with different clinical presentations. It most commonly affects the scalp, but any hair-bearing area of the skin can be affected. Patients and methods A total number of 80 individuals were included in this case–control study; 40 patients with AA and 40 age-matched and sex-matched healthy controls. All cases were randomly selected from the Outpatient Clinic of Kafr El-Sheik Dermatology and Leprosy Hospital. Full history taking (Dermatology and Leprosy Hospital, history), clinical and dermatological examinations were done. IL-15 level was measured using enzyme-linked immunosorbent assay. Results IL-15 level was significantly elevated in AA patients (mean level of 62.72 ± 35.66 pg/ml) than in controls (mean level of 35.49 ± 19.72 pg/ml). All the studied parameters such as sex, family history, recurrence, site of the lesion, pattern, and shape had no statistically significant relation with IL-15. Conclusion The results obtained may suggest the involvement of IL-15 in the pathogenesis of AA.

Objective The aim of the present study was to evaluate serum irisin, in addition to fasting insulin and fasting blood glucose levels in patients with acne vulgaris (AV), and assessment of its clinical significance and relation to insulin resistance (IR). Background AV is recognized as an almost universal cutaneous disease, the third most prevalent skin disease worldwide, with the highest prevalence among adolescents, ranging between 40 and 70%. Patients and methods This study was conducted on 40 patients suffering from AV (group A) and 40 healthy individuals of matched age and sex as a control group (group B). Serum irisin level was detected by a double-antibody sandwich enzyme-linked immunosorbent assay kit for research use (Cat# 201–12–5328). While serum fasting insulin was measured by a double-antibody sandwich enzyme-linked immunosorbent assay kit for diagnostic use (Cat# E29-072) and a standard colorimetric method was used to estimate serum fasting blood glucose level. IR was calculated according to the Homeostasis Model Assessment of Insulin Resistance index: [Fasting glucose mmol/l) × Fasting serum insulin (mIU/ml)] ÷ 22.5] Results Serum irisin level was significantly lower in AV patients than in the control group (P < 0.001). It showed a significant negative correlation with IR among patients (P = 0.012). Moreover, it was decreasing significantly with the increase in disease severity (P = 0.004). Conclusion From the results of the present work, it was concluded that IR is more common among AV patients especially in patients with severe AV lesions and that could be explained by lower serum irisin levels in those patients. Since acne is a problem in adolescents, the early recognition of IR might help in better management of acne patients.

Background Heat shock proteins (HSPs) are proteins that are expressed under a variety of stresses. How stresses and HSPs affect alopecia areata (AA) is not fully understood. Objectives To evaluate the possible role of serum level of HSP70 in the pathogenesis of AA. Patients and methods The current work examined 43 individuals with AA and 40 analogous age-matched and sex-matched healthy controls. Patients underwent full history taking, clinical examination, and investigations (HSP70 serum levels using the enzyme-linked immunosorbent assay). The data were analyzed using the SPSS software. Results In the current study, among patients, serum HSP70 ranged between 3 and 135 ng/ml with a mean of 22.45 ± 25.916, while in controls, it ranged between 4 and 106 ng/ml with a mean of 21.47 ± 24.315, with no significant difference between AA patients and controls regarding their serum HSP70 level (P = 0.616). Conclusion There was no significant difference between AA patients and controls regarding their serum HSP70 level. So future research and large-scale studies on different population and ethnicities are needed for a firmer conclusion.

Objectives To evaluate the effect of follicular unit extraction (FUE) in patients with androgenic alopecia (AGA) and evaluate the satisfaction factors after surgery. Background AGA greatly influences individual's quality of life and psychological state. So, effective and available treatments are sought for patients with AGA. Among the different hair restoration methods, hair transplantation, especially FUE, is the most popular and acceptable option known for patients with hair loss. Patients and methods A prospective cohort study was conducted at the Departments of Dermatology and Plastic Surgery, Menoufia University Hospital, from June 2019 till October 2021. The study was approved by the ethical committee, Faculty of Medicine, Menoufia University. This study included 20 patients with AGA who underwent FUE and were followed up for 1 year. FACE-Q scale was used to assess the degree of satisfaction after FUE, and the factors that may affect patient satisfaction after surgery were investigated. Results This study shows that hair transplantation, especially FUE, has a significant positive effect on postoperative satisfaction with appearance among nearly 90% of participants. They appeared younger than their real age from their point of view. Conclusion Hair transplantation has evolved from follicular unit transplantation to FUE in patients with AGA, resulting in less surgical trauma and faster recovery. The FACE-Q scale is used to evaluate satisfaction in patients undergoing FUE. Larger studies included large sample sizes are needed to confirm our results.

Objectives To assess interferon-induced helicase 1 (IFIH1) gene rs1990760 single-nucleotide polymorphism (SNP) in vitiligo susceptibility and protection. Background Vitiligo is a common progressive autoimmune depigmenting disorder. Its pathogenesis remains elusive; however, it is linked to both genetic and nongenetic causes. The IFIH1 is a gene locus that is related to some autoimmune disorders. Patients and methods A case–control research study was done on 50 patients with vitiligo and 50 healthy controls who were age and sex matched. The IFIH1 rs1990760 genotypes of the patients were determined by real-time PCR (Taqman allelic discrimination). For the examined SNP, different genetic models were evaluated and were adjusted for age and sex. Results The patients and their controls were agreed with the Hardy–Weinberg equilibrium for the studied SNP (2q24.2, rs1990760, IFIH1, C/T). The P value was 0.777 and 0.786 for patients and controls, respectively. In terms of IFIH1 rs1990760 genotypes, alleles, or the studied genetic models, there was no statistically significant difference between cases and controls. Conclusion IFIH1 rs1990760 has no statistically significant relation with vitiligo susceptibility and protection in the current studied sample.

Objective To evaluate the role of superoxide dismutase (SOD) enzyme in melasma. Background Melasma is one of the most common acquired disorders of hyperpigmentation. SOD enzyme is upregulated in the presence of oxidative stress and can be utilized to detect it. Even though many potential etiological factors have been proposed, there is still much to learn about the pathophysiology of melasma. Patients and methods A cross-sectional study was conducted on 50 patients presenting with melasma and 50 apparently normal individuals as a control group selected from the Outpatient Clinic, Dermatology, Andrology and Sexually Transmitted Diseases Department, Faculty of Medicine, Menoufia University during the period from April 2019 to August 2021. SOD expression was studied by the immunohistochemical staining procedure. Results The modified melasma area and severity index (MASI) score was higher in melasma cases with positive SOD expression compared with negative SOD expression cases, and this difference was highly significant (P < 0.001). Melasma cases with moderate or strong intensity of SOD were significantly associated with high mean and median modified MASI score in comparison to melasma cases with a mild intensity of SOD (P = 0.013). Conclusion Oxidative stress could play a role in the pathogenesis of melasma manifested by overexpression of SOD in melasma compared with normal skin. SOD expression could deteriorate the severity of melasma manifested by worsening of the MASI score.

Objectives The current study aimed to investigate the immunohistochemical expression of nuclear factor-erythroid-2-related factor 2 (NRF2) in nonmelanoma skin cancer (NMSC) [squamous cell carcinoma (SCC) and basal cell carcinoma (BCC)] and correlate its expression with the clinical and histopathological data. Background NMSC shows different behavior, growth, and metastasis; however, both BCC and SCC have a good prognosis if detected at their initial stages. BCC has lower mortality rate than SCC, which accounts for about 75% of deaths owing to NMSC. Patients and methods This study was conducted on 30 patients with NMSC and 30 age-matched and sex-matched healthy volunteers as a control group. Cases were selected from the dermatology outpatient clinic at Menoufia University Hospital. The histopathology and the immunohistochemical study were done at the Pathology Department of Menoufia University Hospital. Result NRF2 protein was definitely expressed in normal skin tissues. NRF2 expression in tumor islands was higher in BCC cases compared with SCC. NRF2 was detected in tumor islands in 50% of SCC cases and detected in 100% of BCC cases. NRF2 was expressed in 80% of normal skin biopsies. Conclusion NRF2 is expressed in NMSC cases. Antioxidant defense by NRF2 that can cope with excessive reactive oxygen species formation in human body may be useful to prevent reactive oxygen species-mediated neoplastic transformation of various tissues including the skin.

Background The most common cause of erectile dysfunction (ED) is vascular insufficiency. Fragmented QRS (fQRS) is an ECG marker of myocardial ischemia in patients with coronary artery disease. Objectives To evaluate if the fQRS by ECG can be detected earlier and if it is possible to track simpler markers of cardiovascular involvement in patients with arteriogenic ED than pharmaco-penile duplex ultrasonography. Patients and methods A total of 100 patients with ED were included. They were classified according to International Index of Erectile Function-5 and subjected to detailed history taking, thorough clinical examination, and imaging studies, including pharmaco-penile duplex ultrasonography and ECG, to detect fQRS. Results The presence of fQRS was significantly different among the studied groups (P = 0.005), as 66.7% of patients with severe ED and 60% of patients with moderate ED had fQRS, whereas 28.6% of patients with mild–moderate ED and 24% of patients with mild ED had fQRS. fQRS was more specific (83%) than sensitive (56%), with an accuracy of 72% in arteriogenic ED prediction. Conclusion fQRS is an efficient specific and simple marker of arteriogenic ED. Absent fQRS can exclude the arteriogenic ED, and the patient could be considered normal or venogenic.

Background Iron is an essential nutrient for mammals. Accelerated loss of nutrients through hyperproliferation and desquamation from the skin in psoriasis is known. Hepcidin is a recently discovered regulator of iron homeostasis and consequently in the pathogenesis of psoriasis. This study aimed to evaluate its level in psoriasis. Objective To evaluate serum level of hepcidin in patients with psoriasis vulgaris and its relation with severity of the disease. Patients and methods A total of 20 patients (12 males and eight females) who presented to the Dermatology Clinic of Menoufia University between October 2020 and January 2021 and diagnosed clinically as having psoriasis vulgaris and 20 healthy individuals as a control group (13 males and seven females) were included in this study. The serum levels of hepcidin and ferritin were measured by the ELISA method. The serum level of iron and total iron-binding capacity were measured by the colorimetric method. Results There was a statistically significant difference between psoriasis group and control group regarding the levels of hepcidin, ferritin, iron, and total iron-binding capacity. Conclusions Measuring the level of hepcidin in psoriatic plaques will contribute to our understanding the role of iron and hepcidin in the pathogenesis of psoriasis.

Objective This study aimed to investigate the relation between endoglin as an endothelial marker in smoker and nonsmoker patients with erectile dysfunction (ED). Background ED is a benign disorder, but it can have a significant effect on the quality of life of the patients, partners, and families. Patients and methods A prospective randomized study was conducted on 90 men having ED and attending the Andrology Clinic in Menoufia University Hospital during the period from October 2020 to March 2021. Results Regarding clinical data (P < 0.05), 33.3% of nonsmokers with ED had diabetes, whereas 36.7% of smokers with ED had diabetes and hypertension and 83.3% of control group had no commodities (P = 0.001). All smokers with ED and nonsmokers with ED had metabolic syndrome. BMI and waist circumference were significantly higher in nonsmokers with ED group than nonsmokers with ED and control groups. There was a statistically significant difference between smokers with ED and nonsmokers with ED regarding mean serum endoglin level, as it was higher in smokers than nonsmokers (17.6 ± 0.97 vs. 14.0 ± 0.17) (P < 0.001). Moreover, serum endoglin was higher in smokers with ED and in nonsmokers with ED than in the control group (9.23 ± 0.69) (P < 0.001). Conclusions Endoglin can be considered as the endothelial dysfunction marker in male smokers with ED.

Objective To evaluate the role of dermoscopy in the confirmation of vitiligo diagnosis and evaluate its role in disease prognosis and its clinical stability. Background Vitiligo is an acquired disorder characterized by circumscribed depigmented macules and patches with or without leukotrichia. Dermoscopy by magnifying the clinical image many folds allows the appreciation of subtle features invisible to the naked eye. Dermoscopy has been reported to be beneficial in certain circumstances in vitiligo, including diagnosis of early vitiligo, assessment of the stage of the disease, assessment of treatment response by detecting clinically in apparent leukotrichia, especially in the segmental variant, and differentiation of guttate vitiligo from idiopathic guttate hypomelanosis. Patients and methods The study was conducted in Dermatology Outpatient Clinic of Menoufia University Hospital on 30 clinically diagnosed patients with vitiligo, including clinically stable and unstable vitiligo cases. The patients were subjected to full history taking with special consideration to family history of vitiligo disease, general, dermatological, and dermoscopic examinations using Derma lite 4 device. Results There is a statistically significant relation between clinical stability and absent pigment network, perifollicular depigmentation, and presence of marginal hyperpigmentation. Conclusion Dermoscopy can be used to monitor the disease activity and can be regarded as a reliable noninvasive simple tool to evaluate clinical stability of vitiligo.

Background Chronic kidney disease (CKD) is known to induce a wide spectrum of cutaneous manifestations, which has been widely reported in the literature. Lipocalin-2 (LCN2), also known as neutrophil gelatinase-associated lipocalin, is a protein secreted mainly by activated neutrophils. Objectives To evaluate the relation between LCN2 expression in normal skin samples with clinical parameters of CKD. Patients and methods This cross-sectional study was conducted on 20 CKD patients. All patients were subjected to history taking and complete medical examination. Punch biopsy of normal skin was taken from each patient for the detection of immunohistochemical expression of LCN2 protein. Results LCN2 was positively expressed in the skin of all CKD patients, but with no significant association with the clinical data of the patients. Conclusion Despite positive expression of LCN2 in all normal skin samples of the studied CKD cases, it seems that this expression was not related to the clinical parameters of those patients.

Objective This study was designed to evaluate the clinical efficacy and safety of plasma gel as a dermal-filler injection for facial rejuvenation. Background The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet-poor plasma (PPP). Plasma gel had gained popularity in plastic surgery, orthopedic surgery, oral surgery, and various other fields. Patients and methods A cross-sectional study was carried out on 200 females more than 40 years presented with facial aging. They were divided into two main groups: group A included satisfied females with different types and grades of facial wrinkles (150 patients), and group B included unsatisfied females with different types and grades of facial wrinkles (50 patients) selected from the Outpatient Clinic of Dermatology and Venereology Department, Menoufia General and Menoufia University Hospitals, after taking a written informed consent. They were assessed clinically before treatment sessions and at the end of the follow-up period. Results All patients showed immediate significant clinical improvement after plasma-gel injection that maintained till the end of the follow-up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) and Tear Trough Rating Scale (TTRS). Patient's satisfaction was significantly correlated with WSRS, TTRS, and absence of complication (r: 0.57, 0.63, and –0.283, respectively). The cutoff points of TTRS score and WSRS for best satisfaction were 1.2 and 0.98, respectively, with high area under the curve (0.91, 0.89, respectively). Conclusion PPP-gel injection technique is a safe treatment method for all skin types. Autologous PPP-gel injection seems to be cost-effective, safe, well-tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear-trough deformity.

Objectives To evaluate serum adropin level and neutrophil-platelet ratio (NeuPla ratio) as predictors of ulcerative colitis (UC) activity compared with fecal calprotectin (FC). Background UC is a chronic disease characterized by periods of activity and remission. Several markers are used in detecting UC activity like FC, serum adropin, and NeuPla ratio. Patients and methods This case–control study involved 49 patients with UC and 40 healthy individuals. The NeuPla ratio was calculated from complete blood count, and serum adropin was measured using an enzyme-linked immunosorbent assay. Correlations with UC activity scores and clinical and laboratory markers were evaluated. Results According to the Mayo's score, there were 15 patients in remission, 13 mild disease, 12 moderate disease, and nine severe diseases. The NeuPla ratio was significantly higher in UC compared with controls (17.053 ± 5.537 vs. 10.732 ± 2.578). Serum adropin levels were significantly lower for UC than controls (0.162 ± 0.089 vs. 1.164 ± 0.505 ng/ml). The NeuPla ratio cutoff point for predicting UC activity was more than 18.71 and was less than or equal to 0.1302 for serum adropin. There was no marked difference between NeuPla ratio and serum adropin combination and FC in UC activity detection. Conclusion NeuPla ratio and serum adropin level are promising predictors of UC activity and a combination of both is better than the use of either of them alone without the use of invasive studies like colonoscopy.

Objective This study aimed to the frequency, presentation, and outcome of meningitis after spinal anesthesia for various surgical procedures. Background Postoperative bacterial meningitis may result in prolonged hospitalization, an extended course of antibiotics, and possibly mortality. Patients and methods This cross-sectional study included 141 patients referred to El Mahala El Kobra Fever Hospital complaining of symptoms and signs of meningeal irritation after spinal anesthesia for different surgical procedures. The patients were classified according to the clinical, laboratory, and cerebrospinal fluid (CSF) analysis and culture into two groups: group I: positive for meningitis that included 79 patients, and group II: negative for meningitis that included 62 patients. Results Bad sterilization was statistically more common in meningitis group (P = 0.04), positive Kernig's sign, Brudzinski neck sign, and Brudzinski leg sign were significantly more frequent in group I (P = 0.026, 0.008, and 0.048, respectively). Mean Glasgow Coma Scale (GCS) was statistically significantly lower in meningitis group (P = 0.002). Total leukocyte count and C-reactive protein were significantly higher in GI. Complications during anesthesia, such as improper sterilization, worsening conscious level, GCS, serum creatinine level, and platelets were significant predictors of meningitis. About 44% of patients had no growth in CSF culture, 21.3% had Staphylococcus aureus, 14.2% had group-B Streptococci, 12% had Neisseria meningitidis, and 8.5% had Pseudomonas spp. Further analysis showed that history of chronic disease, neurological deficit, and low GCS, high total leukocyte count and C-reactive protein, positive blood culture, lower glucose, higher protein levels in CSF, and positive CSF culture were associated with poor outcome. Conclusion Postoperative meningitis, especially by S. aureus, is considered a serious complication following spinal anesthesia. A high level of suspicion and early management guard against lethal complications. Fever, headache, neck stiffness, and signs of meningeal irritation may be conflicting presentations, albeit should be considered and investigated for possibility of meningitis.

Background At present, there is really no unique biomarker for detecting diabetes-related vascular complications. As a result, it is critical to investigate specific biomarkers for diagnosing, detecting, and catching the early stages of disease progression. Objectives To analyze the relationship of long noncoding RNA in patients with asymptomatic atherosclerotic diabetic. Patients and methods This case–control study included 312 participants recruited from Menoufia University Hospitals' Internal Medicine Outpatient Clinics and Inpatient Departments and divided into two groups: group I was the diabetic with subclinical atherosclerosis group, which included 176 patients with type 2 diabetes mellitus, with the carotid intima-media thickness assessed according to carotid intima-media thickness reference intervals, and group II included 176 apparently healthy individuals. All participants in the study underwent the following procedures: history taking; clinical examination; and laboratory examinations, including fasting and 2-h postprandial blood glucose levels, glycated hemoglobin, total lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), and determination of gene expressions of long noncoding RNAs (SENCR) by real-time PCR. Carotid intima-media thickness was measured using duplex ultrasound (carotid intima-media thickness). Results In comparison with controls, there was a significant statistical increase in the expression levels of SENCR in the patient group's peripheral blood (P = 0.001). When the area under the curve (receiver operating characteristic) for the long noncoding SENCR gene was calculated, the area under the curve was 0.89, indicating an association between SENCR and atherosclerosis. At a cutoff point 1.68, the sensitivity was 92.5%, specificity was 92.8%, and accuracy was 92.7%. Conclusion Our results show an association between SENCR and atherosclerosis. Long noncoding SENCR expression levels could be used as a predictor for the detection of complications of diabetes mellitus (atherosclerosis).

Objectives To evaluate the flapless thyroidectomy technique in reducing postoperative seroma. Background The incidence of seroma after thyroidectomy has been reported to be between 1.3 and 7%. The history of thyroid surgery reflects evolution of surgery itself, but shifting the focus toward less invasive techniques has resulted in the emergence of minimally invasive approaches for the thyroid compartment. Flapless technique for thyroid surgery may reduce the incidence of postoperative seroma. Patients and methods This study was conducted at the General Surgery Department, Menoufia University and El Sheikh Zayed Specialized Hospital, and it had included 30 patients with goiter. This study is a prospective observational study focused on detecting if this technique has an advantage in reducing postthyroidectomy seroma. Flapless thyroidectomy techniques for the treatment of goiter made up the study population. Results There was significant difference between cases with seroma and without seroma regarding gland weight (g) and gland volume (cm³). There was no significant difference between cases with seroma and without seroma regarding age (years). Only one patient developed seroma with the use of a minimally invasive flapless technique. Conclusion Operative duration is the only independent factor significantly related to clinically detected postoperative seroma with its subsequent postoperative pain. Especially in elderly patients, a flapless technique would be recommended as these patients developed larger volumes of SC collections with subsequent higher pain scores, even if seroma was not clinically detected. Minimally invasive flapless technique is a safe and feasible alternative to conventional thyroidectomy in the management of benign thyroid disease, with shorter incision, less bleeding, reduced operative time, and better cosmetic results.

Background Early diagnosis of meningitis and differentiation of bacterial from nonbacterial plays an important role in the effective treatment of patients. Objectives To evaluate the role of serum and cerebrospinal fluid (CSF) heparin-binding protein (HBP) in early diagnosis of acute bacterial meningitis (ABM) and its efficacy in differentiating acute bacterial from non-BM. Patients and methods This was a case–control study performed between January 2020 and April 2021. It included 65 patients with ABM, 48 patients with acute non-BM, and 20 healthy persons. Diagnosis of meningitis was based on history, clinical criteria, and CSF examination and culture. HBP was measured using enzyme-linked immunosorbent technique in both serum and CSF. Results CSF HBP mean levels were 73.11 ± 58.11 ng/ml in bacterial and 2.08 ± 4.36 ng/ml in non-BM. Both serum and CSF HBP levels were significantly higher in patients with acute bacterial than non-BM. Serum HBP was 55.42 ± 43.27 ng/ml in ABM and 1.85 ± 4.25 ng/ml in acute non-BM. At a cutoff point of 32.8 and 37.65 ng/ml in serum and CSF, respectively, HBP can predict ABM with accuracy of 81.2 and 80.2%, sensitivity of 67.7 and 67.6%, positive predictive value of 100 and 99.9%, negative predictive value of 69.6 and 70.5%, and area under curve of 0.812 and 0.802 in serum and CSF, respectively, with specificity of 100% in both serum and CSF. Conclusion HBP in either serum or CSF is a promising biomarker in differentiating acute bacterial from non-BM.

Objective This study aimed to assess the prevalence and risk factors of overweight and obesity among adolescents. Background Obesity is a significant public health concern affecting more than half-a-billion people worldwide, with increasing its prevalence among adolescents. Its consequences include hypertension, diabetes mellitus, hyperlipidemia, coronary-artery diseases, and some cancers. Patients and methods This cross-sectional study included 200 adolescents aged 10–19 years old from two preparatory schools and two secondary schools in Shebin El-kom district (one city and one village selected randomly). Data were collected through a predesigned questionnaire. Participants were evaluated for sociodemographic characteristics, nutritional, family history, and physical activity. The studied participants were categorized (normal, overweight, and obese) according to BMI. Results Out of 200 adolescents recruited in this study 31.5% were overweight and obese. There was a statistically significant relation between adolescents' BMI, sex, residence, practicing sports, eating fast food and dessert, and family history of obesity. The most significant factor predicting overweight and obesity among adolescents was family history of obesity [odds ratio (OR): 5.2, confidence interval (CI): 1.9–15.6] followed by eating sugary/creamy dessert [OR: 4.8 (CI: 2.3–10.2)] followed by female sex [OR: 3.1 (CI: 1.6–6.1)]. The most protective factor was practicing any kind of sport [OR: 0.4 (CI: 0.2–0.9)]. Conclusions Overweight and obesity are prevalent problems among adolescents, parents' obesity, female sex, urban residence, dietary habits, and physical activity are the most predicting factors.

Background Diabetic foot ulcer (DFU) results in major medical, financial, and social burden for the patients, their families, and society. Objective To assess the severity of DFU and identify the predictors of ulcer severity among the studied patients. Patients and methods A cross-sectional study of 70 DFU patients was undertaken. They were evaluated through a structured self-administrated questionnaire composed of four parts (sociodemographic data, diabetes-related data, knowledge, and practice about foot care) followed by physical examination to assess DFU severity. Results According to Wagner's classification, grade 2 DFU was the most prevalent among the studied group (42.9%), Followed by Grade 3 (28.6%). A logistic regression analysis revealed that the following factors were significantly associated with high ulcer severity: elevated glycated hemoglobin [odds ratio (OR)=3.02, P = 0.002], treatment with insulin (OR = 4.94, P = 0.008), heavy smoking (OR = 49.00, P = 0.01), long duration of diabetes (OR = 3.02, P = 0.026), and unsatisfactory foot care practice (OR = 3.6, P = 0.02). Conclusion Heavy smoking, elevated glycated hemoglobin, and unsatisfactory foot care practice are preventable predictors of high ulcer severity. Therefore, multidisciplinary management programs that focus on smoking cessation and education about proper foot care and glycemic control is recommended to prevent exacerbation of DFU and decrease the incidence of lower-extremity amputations.

Objectives To assess the effect of coronavirus disease 2019 (COVID-19) on sleep quality and its relation to disease severity. Background Many medical complications associated with COVID-19 have received significant attention, increasingly, studies are reporting sleep complications as well. Patients and methods A prospective cohort study was conducted in Menoufia University Hospitals during the period from January 2021 to March 2022. A total of 110 patients who were tested positive to coronavirus, were evaluated clinically and by using Pittsburgh Sleep Quality Index after 2 months and 1 year after COVID-19 infection. Results After 2 months of COVID-19, the sleep quality was poor in 85% and good in 15% of the studied group. The more severe the dyspnea attack and the longer the mean duration of the COVID-19 attack (P = 0.02), the poorer sleep quality was. Having severe symptoms of COVID-19 [odds ratio (OR) 4.9, P < 0.001], then being in the fourth stage of dyspnea (OR 5.1, P = 0.005), then suffering from moderate symptoms (OR 3.6, P = 0.01), and then suffering from third stage of dyspnea (OR 2.4, P = 0.02) were the most influencing factors arranged ordinally. Conclusion COVID-19 infection affects sleep quality significantly in early period of infection and that effect mostly wanes by time.

Objectives To assess the effect of a diet and exercise program on clinical and metabolic features among women with polycystic ovary syndrome (PCOS). Background PCOS affects 5–10% of reproductive-aged women and is associated with reproductive and metabolic dysfunctions. Obesity worsens the presentation of PCOS, and weight management (weight loss or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes including diet and exercise interventions. Patients and methods This study was conducted in two stages: the first stage was a cross-sectional study, and the second stage was an interventional prospective study. A total of 300 medical students were recruited in this study. All of the studied participants were evaluated through a predesigned questionnaire to assess ovulatory function; features of hyperandrogenism; examination to assess blood pressure; BMI waist circumference; and degree of hirsutism, acne, and androgenic alopecia. All women who fulfilled the diagnostic criteria for PCOS underwent fasting plasma glucose and lipid profile tests and were subjected to a diet and exercise program to reduce body weight, and then they were evaluated for the same features 6 months after the program. Results The present study revealed that the prevalence of PCOS among the studied group was 10.7%. After 6 months of the diet and exercise program, there were improvements in menstrual cycle irregularities, BMI, waist circumference, total cholesterol, and low-density lipoprotein cholesterol levels. However, there was no significant effect on the degree of hirsutism or acne. Conclusion Lifestyle modifications in the form of diet and exercise should be emphasized on during management of women with PCOS, as lifestyle changes and reducing body weight could improve some of the clinical features of PCOS.

Objectives To estimate the prevalence of chronic kidney disease (CKD) among obese patients. Background Obesity is a risk factor for cardiovascular diseases and type-II diabetes, which together predispose the development of CKD among people. Patients and methods This cross-sectional study was conducted on 200 obese patients, with BMI more than 30 kg/m², aged 18–65 years. All patients were recruited from six governmental hospitals. Patients included in this study were subjected to a questionnaire containing medical history, CKD-related questions, and familial history of kidney disease. Clinical examination, including general examination, anthropometric measurements, and local abdominal examination, was done. Serum urea; serum creatinine; urine albumin-to-creatinine ratio; urinalysis; serum albumin; serum calcium, sodium, potassium, and phosphorus; uric acid; and abdominal ultrasound were done. Results Most non-CKD and CKD cases were obese (86.9 and 65.1%, respectively), whereas being overweight was the lowest presented in non-CKD and CKD cases, with 5.8 and 9.5%, respectively. However, 10.9 and 22.2% of non-CKD and CKD cases, respectively, had diabetic nephropathy. Moreover, a significant negative correlation was found between estimated glomerular filtration ratio (eGFR) and age, systolic blood pressure, diastolic blood pressure, hemoglobin, glycated hemoglobin, cholesterol, triglyceride, low-density lipoprotein, calcium, phosphorus, sodium, potassium, urea, creatinine, albumin, albumin-to-creatinine ratio, and uric acid (P < 0.001). Binary logistic regression showed that age, BMI, systolic blood pressure, diabetic nephropathy, and glycated hemoglobin were the most significant risk factors for CKDs (P < 0.05), with odds ratio of 1.007 (P = 0.034), 1.007 (P = 0.016), 0.975 (P = 0.023), 0.213 (P = 0.020), and 2.267 (P = 0.012), respectively. Moreover, linear regression for predictors of eGFR indicated that the regression model statistically significantly predicted the eGFR, with odds ratio of 0.580, 95% confidence interval, −0.229 to 0.089, t = 5.028, P value less than 0.001. Conclusion Obesity is a potent risk factor for the development of CKD. Diabetes in association with obesity accelerates the occurrence of CKD. All overweight and obese individuals should be periodically screened for renal function abnormalities. Preventing and managing obesity should start early enough to halt, if not prevent, the development and progression of CKD.

Background Hemodialysis (HD) is one of renal replacement therapies for patients who need dialysis acutely and for many patients as maintenance therapy. Objectives To assess safety measures in HD units in Sharkia Governorate. Patients and methods This was a cross-sectional study done over 3 years on 22 HD units in Sharkia Governorate. A questionnaire was designed for the assessment of infection control measures in HD units. Results Regarding hand washing facilities, all units mostly fulfilled the majority of criteria. On assessing personal protection, all units mostly fulfilled the majority of criteria, with no significant difference between central and peripheral units. Regarding dealing with furniture and sheets, there was no significant difference between central and peripheral units, and mostly all units fulfilled the criteria. Regarding environmental cleansing, machine cleansing and bed cleansing were adequate in most of the units. Separation between storage areas and treatment areas was associated more with peripheral units, but not significantly. All units were perfect in dealing with blood stains. On assessing vaccination of the staff to hepatitis B virus, there was no significant difference between central and peripheral units. One central and two peripheral units reported isolation of hepatitis B virus-infected patients. Conclusion All studied units showed satisfactory percentage regarding methods for preventing pollution. They were very good regarding environmental cleansing and were ideal in dealing with furniture and sheets.

Objective To study the validity of triglyceride–glucose (TyG) index and triglyceride/high-density lipoprotein (TG/HDL) ratio as insulin resistance (IR) markers and correlating them with atherosclerotic cardiovascular disease (ASCVD). Background IR is a metabolic disorder that leads to metabolic syndrome, which is an important risk factor for ASCVD; early detection by noninvasive, easy and cheap markers is important. Patients and methods A cross-sectional study carried out on 81 participants attending to the outpatient clinic and inpatient ward in the Internal Medicine Department. Full history, physical examination, and biochemical profiles were obtained. Participants were classified according to the Framingham Wilson score into two groups: group 1 with a score of less than 5% in 10 years and group 2 with a score of more than 5% in 10 years. Framingham Wilson score is a simplified tool used to estimate the risk level of coronary artery disease over 10 years. TyG and TG/HDL as markers for IR were evaluated in comparison to Homeostasis Model Assessment for insulin resistance (HOMA-IR) and their predictive capacity of ASCVD were studied. Results Of the studied participants, 50.6% were males and 44.4% had Framingham score more than or equal to 5 (P < 0.001). Regarding TG/HDL and TyG they had the highest area under the curve (0.94 and 0.90, respectively) compared with HOMA; there was high significant positive correlation between Framingham score and both indices (P < 0.001). Conclusion The superiority of TyG and TG/HDL over HOMA in predicting ASCVD in both diabetic and nondiabetic patients, representing useful, noninvasive, and non-expensive tools for determining IR.

Objectives To investigate the severity, risk factors, and outcomes of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19). Background COVID-19 has been associated with elevated incidence of AKI. More search is required to confirm the role of COVID-19 as an independent risk factor for AKI. Patients and methods This retrospective cohort study included data collected from medical records, patients' follow-up, and charts of 100 patients who were diagnosed with COVID-19 infection by a positive RT-PCR assay of a specimen collected via nasopharyngeal swab between the first of December 2020 and 31 May 2021 in COVID-19 isolation wards and ICU in Benha Teaching Hospital. Results Age and BMI were significantly higher in the AKI group, but oxygen saturation was significantly lower than in the non-AKI group (P < 0.0001). AKI was significantly associated with respiratory diseases (P = 0.003), administrating immune-suppressive drugs (P = 0.042), high sequential organ failure assessment score, critical severity, and invasive respiratory support (P < 0001). D-dimer, creatinine kinase, and creatinine were significantly higher among cases with AKI, but glomerular filtration rate was significantly lower (P < 0.001). AKI was significantly associated with high mortality (P < 0.001). The severity of disease, sequential organ failure assessment score, creatinine, glomerular filtration rate, and D-dimer were significant independent predictors for AKI. Conclusion AKI is a frequent serious complication in hospitalized patients with COVID-19 and is associated with a high risk of mortality, and the severity of COVID is an independent predictor for AKI.

Background Carbapenemase-producing carbapenem-resistant Enterobacteriaceae are a significant problem worldwide that causes life-threatening infections. Objectives To evaluate the performance of the phenotypic method [modified carbapenem-inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM)] tests to detect carbapenemase production compared with the genotypic method (real-time PCR) in Escherichia coli and Klebsiella species strains that were isolated from patients in the Menoufia University Hospitals. Methods E. coli and Klebsiella species strains were isolated from patients in different departments of the Menoufia University Hospitals. The isolated strains were tested by the phenotypic method (mCIM and eCIM) tests to detect carbapenemase production, and screened by the real-time PCR for the presence of the carbapenemase gene (blaOXA-48). Results This study showed that the percent of carbapenem-resistant strains that were positive for mCIM was 72.3%, while 27.7% were negative for the test. Regarding eCIM, 46.2% of the carbapenem-resistant E. coli and Klebsiella species-strain isolates were positive, while 53.8% were negative for the test. The use of mCIM test combined with eCIM (mCIM/eCIM) showed a positivity of 46.2%. The percent of the carbapenem-resistant E. coli and Klebsiella species strains that harbored the blaOXA-48 gene was 60%, while 40% were negative for the gene. About 84.6% of the carbapenem-resistant strains that harbored the blaOXA-48 gene were positive for the mCIM test. Conclusion There was a reasonable agreement between the phenotypic method and molecular method for detection of carbapenemases; however, further study on a large number of samples is recommended.

Objective The aim of this study was to study the psychiatric comorbidities, signs, symptoms, and general functioning in HIV-infected/AIDS patients. Background Co-occurring psychiatric disease has direct clinical impact on patients infected with HIV, such as worsening quality of life and rapid progression of HIV/AIDS symptoms. Patients and methods This study was carried out in Shebin Elkom tropical hospital 'outpatient clinics' on 30 patients with positive HIV infection/AIDS patients. The tools used are mental-state examination, Hamilton Anxiety Scale, Hamilton Depression Scale, drug-of-abuse urine-screen test, and Karnofsky Performance Scale Test. Results There was a statistically significant association between the presence of depression and overall Hamilton Anxiety Scale scores (P < 0.001); depressed patients exhibited higher scores than nondepressed patients. On the other hand, there was no statistically significant association between the presence of depression and Karnofsky scale (P = 0.119). Conclusion HIV-positive individuals experience higher rates of all categories of mental illness compared with the general population. A wide range of factors may help explain this finding.

Objectives To identify barriers against thrombolytic therapy of acute ischemic stroke (AIS) and to evaluate its efficacy and complications in Egypt. Background Tissue plasminogen activator is the only FDA-approved thrombolytic therapy for AIS. However, its use in Egypt is below best practice benchmarks. Patients and methods In a cohort observational study, 120 patients with AIS were recruited from the stroke unit of Menoufia University Hospitals and were divided into three groups: group A included 40 patients who received intravenous thrombolysis (IVT), group B included 40 patients who were eligible but did not receive IVT, and group C included 40 patients who came after 4.5 h but within 24 h of stroke onset. Causes of prehospital and in-hospital delay were recorded. Complications and outcomes using NIHSS and mRS were assessed. Results The most prevalent cause of prehospital delay (mean value 2.12 ± 1.09 h) was lack of awareness of the therapeutic window of IVT (85.8%), whereas in hospital delay (mean value 1.92 ± 0.87 h), it was the time wasted in hospital owing to lack of a well-constructed stroke service (52.5%). Regarding functional outcome, there was a statistically significant improvement in mRS after 3 months in the thrombolysed group (P = 0.00), whereas hemorrhagic transformation was noted in 11 (27.5%) of 40 patients. Conclusion Among the studied barriers against thrombolysis in AIS, lack of awareness of therapeutic window and defective well-structured hospital stroke service were the most common barriers. The clinical outcome was better in patients who received-tissue plasminogen activator, but the hemorrhagic transformation occurred in more than one-fourth of them.

Background Obstructive sleep apnea (OSA) can negatively affect patients' physical and psychological functioning, as well as their quality of life. A major consequence of OSA is impaired cognitive functioning. Indeed, several studies have shown that OSA mainly leads to deficits in executive functions, attention, and memory. Objectives To assess cognitive function in patients with sleep apnea syndrome. Patients and methods This prospective study was done on 70 patients with sleep apnea syndrome who were referred to Chest and Neurology Departments, Menoufia University Hospital, in the period from January 2021 to April 2022. The study was done after written consents from 70 patients with sleep apnea syndrome based on clinical criteria and confirmed with overnight polysomnography. They were assessed by the Montreal Cognitive Assessment questionnaire for their cognitive function, which was classified according to severity. Results Of 70 patients with sleep apnea syndrome, 56 (80%) patients had cognitive dysfunction. The most prevalent type of cognitive dysfunction was memory and attention (30 patients) followed by visuospatial orientation, memory, attention, and language. Cognitive dysfunction was significantly higher among diabetic patients and related to severity of apnea–hypopnea index. Cognitive dysfunction had a significant negative correlation with BMI, apnea–hypopnea index, and oxygen desaturation. Conclusion Cognitive dysfunction has a high incidence in patients with sleep apnea syndrome, especially obstructive type, and in obese diabetic ones. Other studies should be done on the effect of treatment of sleep apnea on reversal of the cognitive dysfunction.

Objectives The aim was to investigate whether psoriasis is affected by the use of selective serotonin reuptake inhibitors (SSRIs). Background Psoriasis is an immune-mediated dermatological disorder with psychological and social morbidity. Stress plays an important role in psoriasis, including the negative somato–psychiatric rebound occurring in the disease. Patients and methods This prospective, analytic, cohort study was conducted at the Neuropsychiatry Department, Faculty of Medicine, Menoufia University, and included 64 patients with psoriasis attending Outpatient Clinic of Dermatology Department, Faculty of Medicine, Menoufia University Hospitals, between November 2020 and October 2021, after approval from the Research and Ethics Committee. Patients were randomized into two equal groups: studied patient group, which was additionally treated with the SSRI escitalopram, and studied control group, which was not treated. All participants underwent history taking, general medical examination, and psychiatric and dermatological assessments by Psoriasis Area and Severity Index, Beck Depression Inventory II, Beck Anxiety Inventory, and the WHO quality of life questionnaire-shortened form (WHOQOL–BREF) at baseline and after 3 months. Results Patients treated with the SSRI escitalopram had a significant reduction in mean scores of depression (P < 0.001), anxiety (P < 0.001), and psoriasis severity (P = 0.014) and improvement in overall QOL score (P = 0.024) as well as other QOL domains, but there was a nonsignificant difference in switching from systemic to nonsystemic psoriasis treatment (P = 0.590). Conclusion Our study suggests that psychiatric intervention with antidepressant medications may improve perceived symptom severity, mood symptoms, QOL, and compliance to treatment without necessarily affecting psoriasis treatment.

Objectives To assess the immunohistochemical expression of programmed death-ligand 1 (PDL1) in tumor cells and tumor-infiltrating immune cells of the urothelial bladder carcinoma (UBC) and correlate it with the available clinicopathological data. Background UBC is the tenth most frequent cancer worldwide and ranks 13^th in terms of death ranks. In Egypt, UBC is classified as the third malignancy after breast and colorectal cancers. PDL1 is one of the most important checkpoint molecules that have been studied and become clinically important targets of drug therapy. Patients and methods This retrospective study included 83 UBC cases retrieved from the archives of Pathology Department, Faculty of Medicine, Menoufia University, during the period between September 2017 and September 2020. The slides were subjected to PDL1 immunohistochemical staining using a streptavidin–biotin–peroxidase technique. The relationships between PD-L1 expression and clinicopathological parameters were statistically analyzed. Results PD-L1 immunohistochemical reactivity in tumor cells was significantly associated with muscle invasion, high tumor grade, advanced pathological stage and desmoplastic stroma (P < 0.001 for all), presence of nodal metastasis (P = 0.028), and presence of lymphvascular invasion (P = 0.019). PDL1 H score expression in tumor-infiltrating immune cells showed statistical difference in favor of muscle invasion, high tumor grade, and advanced pathological stage (P < 0.001 for all). Conclusion From the previous results, PDL1 expression is associated with parameters of poor prognosis and tumor progression. Thus, PD-L1 inhibitors might have clinical implications as a target of therapy for the management of patients with PDL1-positive UBC.

Background Epileptic seizures are due to excessive, abnormal, or synchronous signaling, or depolarization, in the brain cells. Homocysteine (Hcy) and interleukin-6 (IL-6) are a thiol metabolite derived from the demethylation of methionine. It is widely known that folate deficiency takes place in a few epileptic patients taking antiepileptic drugs (AEDs), causing decreased remethylating or transculturation of Hcy. The effect of systemic inflammatory responses on generalized motor seizures in pediatric patients with epilepsy needs to be evaluated. Objectives To measure serum levels of Hcy and IL-6 in children with idiopathic epilepsy in relation to their clinical findings. Patients and methods A case–control study was conducted on 80 children recruited from outpatient Pediatric Neurology Clinics and inpatients admitted to Pediatric Department, Menoufia University Hospitals, during January 2020–March 2021. The participants include 40 epileptic children with idiopathic epilepsy, in which 15 children were recently diagnosed (≤ 1 month of presentation) before the start of AED and 25 children with idiopathic epilepsy on anti-epibiotic drugs for more than or equal to 1 year. In total, 40 children matched for age and sex serving as controls. Full history taking, through clinical examination, and laboratory investigation emphasized that serum Hcy and IL-6 levels were investigated. Results Serum Hcy and IL-6 were significantly higher among those with idiopathic epilepsy controls (P = 0.004, 0.001, respectively). There was a significant positive correlation between serum Hcy level and alanine transaminases, aspartate transaminase, urea, mean platelet volume, and platelet-count test. The best cutoff point of interleukin-6 for prediction of epilepsy was more than 50 ng/ml, with sensitivity 87.5%, specificity 87.5%, and accuracy 85.21%, while the best cutoff point of serum Hcy was more than 12 ng/ml, with sensitivity 86%, specificity 91.9%, and accuracy 90.35% for diagnosis of epilepsy. Conclusion Hcy and interleukin-6 are significantly increased in patients with idiopathic epilepsy on AEDs weather monotherapy or polytherapy. It is suggested that all the patients who are on AEDs, whether monotherapy or polytherapy, should be screened for Hcy levels to avoid the adverse effects of hyper-Hcy and be treated accordingly if the levels are found to be high.

Objective To evaluate the prevalence of metabolic syndrome (MS) in a group of school-aged obese children of both sexes. Background Data about MS in children are limited in Egypt as the prevalence and magnitude of obesity among school-aged children has been increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the MS. Patients and methods This cross-sectional study was conducted on obese children (BMI ≥ 95^th percentile), aged 6–16 years. Detailed history taking with family pedigree; complete systemic examination; anthropometric measurements, including weight (kg) on Z score, height (m) on Z score, waist circumference (cm), hip circumference (cm), waist-to-height ratio, waist-to-hip ratio, and BMI on Z score; and laboratory investigations such as kidney function tests (urea and creatinine), fasting blood glucose, estimation of glycosylated hemoglobin, liver function tests (alanine transaminase and aspartate aminotransferase), lipid profile (low-density lipoprotein, high-density lipoprotein, and triglyceride), and serum fasting insulin were done. Results The prevalence of the MS was 7% among the studied obese children. The mean triglyceride and cholesterol (mg/dl) levels were 132.4 ± 47.2 and 176 ± 37.4, respectively. The mean insulin (mmol/l) and alanine transaminase (IU/l) were 17.5 ± 10.4 and 27.5 ± 18.3, respectively. The mean aspartate aminotransferase (IU/l) and low-density lipoprotein (mg/dl) were 46.2 ± 53.1 and 94.1 ± 35.9, respectively. Conclusion MS is prevalent even in young children, so we suggest screening programs for children aged 6–16 years to control obesity and MS in the developing world.

Objective To assess anthropometry of the lower zone of the face (philtrum length, philtrum width, intercommissural distance, and lower lip to chin length) in preschool-aged children in Menoufia Governorate. Background All health personnel having a responsibility toward the care of children should be sufficiently familiar with normal patterns of growth and milestones so that they can recognize overt deviations from the normal range as early as possible, for underlying disorders to be identified and given appropriate attention. Patients and methods This was a cross-sectional study conducted on 516 Egyptian apparently healthy preschool children of both sexes (between 3 and 6 years old) who attended outpatient clinics or admitted in the pediatric department of Menoufia University Hospital and preschool nurseries in the period from September 2019 to July 2020. Results Regarding the studied parameters of the lower zone of the face in this age group, we observed that the mean value of the philtrum length of children was 1.29 ± 0.12 cm. The mean value of the philtrum width of children was 0.944 ± 0.55 cm. The mean value of the intercommissural distance of children was 3.79 ± 0.21 cm. The mean value of lower lip to chin length was 3.53 ± 0.16 cm. There was a statistically significant increase in the intercommissural distance and lower lip to chin length in males compared with females in the studied children (P = 0.000 and 0.000, respectively), whereas there was no statistical difference between philtrum length and philtrum width with respect to sex (P = 0.948 and 0.06, respectively). Conclusion We drew many centiles for these measures for Egyptian children which can be a reference for every researcher who can plot his/her results on our centiles to detect any deviation from the normal.

Objectives The aim of this study is to investigate the possible role of neuroglobin as a novel biomarker in children with febrile seizures and epileptic children. Background Neuroglobin is a new globin member that is highly expressed in the central and peripheral nervous system. Patients and methods This case–control study has been conducted on 75 children, divided into three groups: group I included children with simple febrile convulsions, group II included children with newly diagnosed idiopathic epilepsy, and group III included healthy children selected as controls. Serum neuroglobin assay, complete blood count, C-reactive protein level, random blood sugar, serum electrolytes, liver-function and kidney-function tests, and electroencephalogram were performed for all children. Results The overall results showed that serum neuroglobin levels were significantly increased in patients' groups than in controls and more in epileptic children than children with febrile seizures (P<0.05 for all). Neuroglobin levels were negatively correlated with the hemoglobin levels and positively correlated with the total leukocytic count in the patients' groups. Conclusion Higher serum neuroglobin levels among children with seizures, especially epileptic ones, reflecting its involvement in seizure process. This study may give the initial clue to newer anticonvulsant or antiepileptic therapy through acting on neuroglobin levels.

Objective To assess the role of pancreatic stone protein (PSP) in evaluation of critically ill children admitted to a pediatric intensive care unit (PICU). Background PSP was suggested to be a promising biomarker for determining critical illness severity among pediatric children. Patients and methods This prospective observational study was conducted on 75 critically ill children and 15 healthy controls. Serum PSP was measured in patients within 24 h of PICU admission and on healthy controls with commercially available enzyme-linked immunosorbent assay kits. Results Serum level of PSP was significantly elevated among patients than controls (P < 0.001). The most common cause of PICU admission was respiratory illness (44%). Besides, C-reactive protein, white blood cell count, and absolute neutrophil count were significantly elevated among patients compared with controls (P = 0.001, 0.005, and 0.012, respectively). There was no significant difference in PSP between survivors and nonsurvivors (P = 0.796). Furthermore, there was a positive correlation between serum PSP and total serum bilirubin (r = 0.388, P = 0.001) and a negative correlation between serum PSP and serum total calcium (r = −0.280, P = 0.015). Conclusion PSP is an acute-phase reactant, which is suggested to be a promising biomarker for diagnosis of pediatric sepsis, but it is not useful for predicting mortality. However, its correlation with bilirubin and calcium levels suggests an indirect role in prediction of mortality among critically ill children.

Background Secondary hyperparathyroidism and bone fractures are common complications of chronic kidney diseases (CKD). Klotho (KL) protein is a coreceptor for fibroblast growth factor 23 and hence is involved in maintaining endocrine-system homeostasis and reduces cell death. Furthermore, KL is a valuable regulating factor in calcium/phosphate (Ca/P) metabolism. Objective To identify the KL polymorphism rs9536314 and its relationship with Ca/P metabolism and parathyroid-hormone (PTH) concentrations in children on regular hemodialysis (HD). Patients and methods A cross-sectional study was conducted for 6 months, from December 2020 to June 2021, on 50 pediatric patients with CKD on regular HD and an exact number (50) of apparently healthy children served as a control group after informed consent. The serum Ca, P, PTH, hemoglobin (Hb), and iron concentrations were measured. The KL polymorphism rs9536314 was identified by PCR–restriction-fragment length polymorphism. Results The results showed that the levels of serum Hb and Ca were significantly lower in the pediatric patients with CKD on regular HD group than in controls (P < 0.001). While P and PTH levels were higher in the patients' group (P < 0.001) than in the control group. Genotyping analysis of KL rs9536314 polymorphism (TT, TG, and GG) in the patient and control groups showed no significant difference between the two groups with regard to sex (P = 0.904), consanguinity (P = 0.239), Hb (P = 0.424), Ca (P = 0.783), P (P = 0.490), and PTH (P = 0.716). Conclusions There is no association between the KL polymorphism and Ca/P metabolism in pediatric patients with CKD on regular HD.

Objectives The aim of the current study was to study serum albumin level in critically ill children admitted to the pediatric ICU in Menoufia University hospital and its relation to the outcome. Background Hypoalbuminemia is a common feature in critically ill children in pediatric ICUs and is associated with a poor outcome. Patients and methods A cross-sectional study was conducted on 118 critically ill children from January 2021 to December 2021. All patients in the present study were subjected to detailed history, physical examination, and laboratory investigations. Pediatric Sequential Organ Failure Assessment (PSOFA), Pediatric Risk of Mortality III (PRISM III), and neutrophil percentage-to-albumin ratio (NPAR) scores were measured in the first 24 h of admission. Results Within the first 24 h of admission, 72 (61%) cases had hypoalbuminemia while during pediatric ICU admission, 84 (71.2%) cases had hypoalbuminemia. Hypoalbuminemia at admission was associated with significant higher PSOFA and NPAR scores, lower Glasgow coma scale, lower platelets count, lower Na level, and higher C-reactive protein levels while during pediatric ICU admission it was associated with significant worse final outcome, lower platelets count, lower Na level, higher PSOFA, NPAR, and PRISM III scores in comparison to the non-hypoalbuminemia group. According to the receiver operating characteristic curve study of scoring systems to predict mortality, PSOFA and NPAR scores were significantly high in the studied groups at admission while PSOFA, PRISM III, and NPAR scores were significantly high in the studied groups during pediatric ICU admission. Conclusion Hypoalbuminemia is an independent predictor of pediatric ICU mortality.

Objective To evaluate the prevalence of Helicobacter pylori infection among children diagnosed as having nephrotic syndrome (NS). Background NS is primarily a pediatric disorder and is 15 times more common in children than adults. H. pylori colonizes more than 50% of people worldwide. Patients and methods This prospective study was conducted on 50 children with NS admitted and followed up in the Pediatric Nephrology Unit at Menoufia University Hospital. They were screened for H. pylori by urea breath test, stool analysis (Rapid HpSA test), and serum H. pylori antibodies. The included patients were divided into two groups regarding clinical manifestations of H. pylori. Results The mean age was 8.80 ± 3.19 years, and 68% (34 cases) were males. Abdominal manifestations were more prevalent among patients with NS with H. pylori infection. The intake of NSAIDs increases the risk for H. pylori. There was a significant relation between H. pylori infection and platelet count and white blood cells among the studied patients. The diagnostic value of H. pylori stool antigen test was 100%, serum H. pylori antibodies was 90.9%, and urea breath test was 81.8%. Conclusion In the presence of unspecified abdominal pain and other gastrointestinal tract symptoms, H. pylori should be taken into consideration. Noninvasive diagnostic tests could be useful in diagnosis of H. pylori in children with NS.

Background Reelin (RELN) is a large secreted extracellular matrix glycoprotein that regulates processes of neuronal migration and positioning in the developing brain by controlling cell–cell interactions. RELN has been suggested to be implicated in pathogenesis of several brain diseases. Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills. Aim The purpose of this case–controlled study was to explore the linkage between RELN gene polymorphism (rs2229864) with autism. Patients and methods In total, 180 Egyptian children were enrolled in this study, including 120 children with autism and 60 age-matched and sex-matched controls. Genotyping was performed for RELN (rs2229864) gene using Taqman allelic-discrimination (real-time PCR) technique. Results The patients were randomly selected from those attending at the Pediatric Neurology outpatient clinic, Department of Pediatrics, Menoufia University Hospitals, in the period from October 2019 to July 2020. This table shows a nonsignificant difference between the studied groups regarding sociodemographic characteristics (P > 0.05). rs2229864 CC genotype or C allele were significantly more prevalent among cases of autism than controls, while rs2229864 TT genotype or T allele were significantly less prevalent among autism cases than controls (P < 0.001). Conclusions SNP rs2229864 may be considered a potential risk factor for genetic predisposition and severity of autism in a sample of Egyptian population. Further gene-expression research with larger samples representative of various populations creates new opportunities for clarifying autism's etiology, potentially leading to advances in prevention and management of the condition.

Objective Clinical assessment and follow-up in school-aged diabetic children. Background Diabetes mellitus requires continuous medical care, patient self-management, education, and support to prevent acute complications and to reduce long-term complications. Patients and methods This descriptive study was conducted on 110 diabetic Egyptian children. All patients were subjected to detailed history taking, complete general examination including anthropometric measurements and laboratory investigations including estimation of fasting blood glucose level (mg/dl), postprandial blood glucose level (mg/dl), glycosylated hemoglobin (HbA1c%), lipid profile (cholesterol, low-density lipoprotein, and triglyceride), microalbumin in urine, and thyroid function (thyroid-stimulating hormone and FT4). Results The mean age of the studied children with type 1 diabetes mellitus (T1DM) was 12.35 ± 3.19, with female predominance (55.5%), positive consanguinity (25%), variable complications of diabetes among the studied children with 25.4% suffering from nephropathy, 18.1% with dyslipidemia, and obesity, with recurrent diabetic ketoacidosis and poor control in 17.2%, short stature in 16.3%, and finally hypothyroidism in 4.5% in patients under study. Cases with complications are with high HbA1c. Conclusion The mean age of studied children was 12.35 + 3.19 with female predominance (55.5%) and with positive family history of T1DM (5.5%) only. The main presentation was diabetic ketoacidosis (74%). Chronic complications of T1DM encountered in our study were nephropathy (25.4%), dyslipidemia (18.1%), hypothyroidism (4.5%), short stature (16.3%), and obesity (18.1%). The risk of these complications increased with poor metabolic control (high HbA1c) regardless of the duration of illness.

Background Patients on hemodialysis often have gastrointestinal complications; however, it is unclear whether Helicobacter pylori infection is more prevalent in these patients. Objective To determine the incidence of H. pylori infection in pediatric patients with chronic kidney disease on regular hemodialysis and to investigate the diagnostic value of noninvasive tests [urea-breath test (UBT), stool-antigen test (SAT), and serology] in diagnosing H. pylori infection in hemodialysis patients. Patients and methods An analytical cross-sectional study was carried out on 62 children with the end-stage renal disease treated by regular-maintenance hemodialysis in the Nephrology Unit in Pediatric Department, Menoufia University Hospital, to determine the incidence of H. pylori infection in pediatric patients with chronic kidney disease on regular hemodialysis and the diagnostic value of noninvasive tests (UBT, SAT, and serology) in diagnosing H. pylori infection in hemodialysis patients. Results As regards the diagnostic value of UBT and serology in diagnosing of H. pylori, our results reported that the H. pylori antibody test and SAT detect all positive cases and 97% of negative cases and only one false-positive case, while UBT detects 65.5% of positive cases (true-positive cases) and 66.7% (22 cases) (true-negative cases). Conclusion The SAT and serological test performed better than the UBT for H. pylori diagnosis where H. pylori SAT was more sensitive and accurate than UBT.

Background The TMPRSS6 (Transmembrane Serine Protease 6) gene is found on chromosome 22. TMPRSS6 is a protein-coding gene. Iron absorption and metabolism in the body is controlled by matripase-2 enzyme, which is encoded by TMPRSS6 gene. Objectives TMPRSS6 rs855791 polymorphism was investigated for its effect on serum iron levels of patients with iron-deficiency anemia. Patients and methods A tertiary referral hospital served as the study setting. The complete blood count was analyzed using an automated five-part hemtoanalyzer. Enzyme-linked immunosorbent assay (ELISA) was used to analyze ferritin in serum. Restriction fragment length polymorphism PCR-RFLP was used to genotype TMPRSS6rs855791 C>T iron assimilator gene using StuI restriction enzyme. Results There were 21 heterozygous patients and four homozygous patients. TMPRSS6 (rs855791C>T) mutants were found to present 14 heterozygotes, whereas no homozygotes were present in controls. Serum ferritin and hemoglobin levels were also elevated in mutants with this mutation. C-reactive protein (CRP) levels and Erythrocyte sedimentation rate (ESR) levels were decreased in mutant genotypes. These parameters were statistically significant. The total iron-binding capacity level and % transferrin saturation levels were significantly higher in TMPRSS6 (rs855791C>T) genotypes, and the P values were statistically significant. TMPRSS6 (rs855791C>T) mutation is associated with less severe iron-deficiency anemia symptoms. Conclusion As the results of our study indicate, mutations protect against iron-deficiency anemia and confer selection advantage to heterozygous carriers.

Objectives To evaluate thyroid dysfunction prevalence and antithyroid antibody production including antithyroglobulin and thyroid peroxidase in systemic lupus erythematosus (SLE) patients with lupus nephritis and their relationship to SLE disease activity and progression. Background SLE is an autoimmune disorder in which the production of a variety of antibodies like anti-double-stranded DNA, antinuclear antibodies, anti-Ro antibodies, and others is associated with the organ-specific autoimmune thyroiditis. Patients and methods This cross-sectional study included 120 SLE patients divided into two groups: 60 SLE patients with nephritis and 60 SLE patients without nephritis. Clinical assessment includes assessment of disease activity by SLE disease activity (Systemic Lupus Erythematosus Disease Activity Index). Laboratory assessment of thyroid hormones and antithyroid antibody was done by enzyme-linked immunosorbent assay. Results SLE patients with nephritis had significantly higher thyroid autoantibodies (antithyroglobulin and thyroid peroxidase) than SLE patients without nephritis (90 vs. 55%, 60 vs. 30%, and 65 vs. 30%, respectively). However the means of complement 3 and complement 4 were lower in SLE patients with nephritis than SLE patients without nephritis (51.8 ± 17.6 vs. 103.9 ± 24.8 and 8.8 ± 3.6 vs. 35.4 ± 23.5, respectively). Conclusions SLE patients with lupus nephritis had significantly higher thyroid autoantibodies than SLE patients without nephritis with significant positive correlations between these autoantibodies and SLE disease activity. Thyroid autoantibodies are important new and potential prognostic factors predicting poor outcomes in SLE patients with lupus nephritis. Further large-scale, multicenter, and prospective studies are needed to confirm these findings.

Objective To assess the role of transcranial ultrasound in children with sickle-cell disease to predict stroke and prevent its occurrence. Background Transcranial Doppler (TCD) ultrasound is a noninvasive and inexpensive imaging modality to measure mean blood-flow velocities through large intracerebral arteries in children with sickle-cell disease. Patients and methods The study was conducted on 20 patients presenting sickle-cell disease diagnosed by clinical examination and laboratory investigations. Patients included in this study were subjected to detailed history with special emphasis on the history of present illness suggestive of sickle-cell disease, clinical examination, and TCD ultrasonography for all patients. Results The best cutoff of the anterior cerebral artery in TCD in the prediction of transient ischemic attack (TIA) among the studied patients is more than or equal to 127.5, with the area under the curve (AUC) 0.933, sensitivity 80%, specificity 80%, positive predictive value (PPV) 57.1%, negative predictive value (NPV) 92.3%, and accuracy 80%, the best cutoff of the middle cerebral artery in the prediction of TIA among the studied patients is more than or equal to 155.5, with AUC 0.926, sensitivity 80%, specificity 66.7%, PPV 44.4%, NPV 90.9%, and accuracy 70%, and the best cutoff of posterior cerebral arteries (in the prediction of TIA among the studied patients is ≥105, with AUC 0.68, sensitivity 80%, specificity 53.3%, PPV 36.4%, NPV 88.9%, and accuracy 60%). Conclusion The use of TCD is a useful screening test for sickle-cell disease in children.

Background General: metabolic-associated fatty liver disease, which was previously known as nonalcoholic fatty liver disease, is a chronic liver disease that can progress to cirrhosis and hepatocellular carcinoma. Specific: this study evaluates the correlation of fatty liver and abdominal subcutaneous fat using unenhanced multidetector computed tomography (CT). It also investigated the prevalence of hepatic steatosis in study cases. Objectives To determine the prevalence of hepatic steatosis in Menoufia Governorate and to determine an association between steatosis and quantitative measures of abdominal subcutaneous tissue. Patients and methods This study had been conducted on 143 patients and patients had to be undergoing imaging for a primary complaint felt to be independent of liver pathology, as to provide a representative sample of the general population. They referred for imaging by multidetector CT scan of the abdomen and pelvis performed in the Radiology Department of Menoufia University between April 16, 2018 and November 6, 2020. The study population was divided into two groups, depending on the CT criteria of steatosis on nonintravenous contrast scans that included liver attenuation 10 HU less than the spleen attenuation, absolute liver attenuation of less than 40 HU. Results Our study found that 38 patients meeting inclusion criteria were identified by radiology as having steatosis, and the normal group was 105 patients. Our study shows that there was no significant difference between hepatic-steatosis group and normal-liver group regarding their age or sex. Conclusion Regarding the prevalence of hepatic steatosis in our study group in Menoufia Governorate, there was positive association between steatosis and quantitative measure of abdominal subcutaneous tissue.

Background Bladder cancer is one of the most common cancers in Egypt. Currently, diffusion-weighted imaging (DWI) is the only imaging technique that is able to assess molecular diffusion in vivo and provide information about the biophysical properties of tissue such as cell organization, density, and microstructure. Objectives This study is designed to detect the value of diffusion-weighted MRI in the diagnosis and staging of urinary bladder cancer. Patients and methods This study is a prospective study of descriptive and analytical design. The study included 30 adult patients with suspected bladder mass, who attended Menoufia University Hospitals. Results This study included 30 adult patients. Regarding histopathological type results, urothelial tumors were found in 25 (83.3%) patients, squamous cell carcinoma was found in four (13.3%) patients, and adenocarcinoma was found in one (3.3%) patient. According to the staging of urinary bladder lesions in diffusion-weighted MRI among the studied patients, DWI showed restricted diffusion in all cases with a low apparent diffusion coefficient value. T staging by DWI showed 56.7% of the patients were of T3 and 6.7% were of T1. Conclusion Adding DWI and the apparent diffusion coefficient value to T2WI improves the accuracy of MRI in bladder cancer detection and staging. This noninvasive method could be efficiently used for the evaluation of patients with hematuria of lower urinary tract origin.

Objectives The primary outcome was to compare metoprolol versus pregabalin as oral premedication to control intraoperative hemodynamics, while the secondary outcome was to assess surgical field visibility score. Background Elective lumbar spine surgeries are commonly performed under controlled hypotensive general anesthesia to ameliorate intraoperative blood loss and improve surgical field visibility. Patients and methods A total of 40 adult patients of both sexes, American Society of Anesthesiology I physical status, aged between 18 and 50 years, scheduled for elective spinal surgery during the period from August 2019 till July 2020, were randomly divided into two equal groups of 20 patients each. Group M was premedicated with 50 mg metoprolol. Group P was premedicated with 150 mg pregabalin. Oral premedication was given 90 min before the induction of anesthesia. Heart rate and mean arterial blood pressure were recorded throughout the surgery. Surgical field visibility score, surgeon satisfaction, and incidence of complications were also recorded. Data were analyzed by the variance test. Results Blood pressure and heart rate were more controlled to lower acceptable degree in metoprolol than pregabalin (P < 0.001). The surgical field visibility score was more clear with metoprolol than pregabalin (P < 0.001). Conclusion Metoprolol was found to be more effective than pregabalin in blunting hemodynamic stress response by controlling heart rate and blood pressure to lower acceptable ranges. In addition, metoprolol provided a more clear surgical field with less blood loss than pregabalin in patients undergoing spine surgery.

Objective The aim was to compare low-dose combined spinal-epidural and conventional epidural anesthesia for elective cesarean section in patients with severe preeclampsia. Background Severe preeclampsia endangers the life of the mother and/or the fetus through decreasing the blood flow to the placenta, leading to growth retardation, low birth weight, preterm birth, breathing difficulties to the newborn, placental abruption, heavy bleeding, HELLP syndrome, eclampsia, cerebrovascular stroke or hemorrhage, pulmonary edema, renal failure, liver failure, and disseminated intravascular coagulopathy, and also it may end up in death. Patients and methods This study included 60 patients with severe preeclampsia undergoing elective cesarean section. They were divided into two groups: group I received low-dose combined spinal-epidural anesthesia, with 7 mg of 0.5% heavy bupivacaine with 25 μg of fentanyl intrathecally and incremental doses of 3–5 ml of plain bupivacaine in the epidural catheter 10–15 min after the intrathecal injection, and group II patients received conventional epidural anesthesia, with 16 ml of 0.5% plain bupivacaine (after 4 ml of lidocaine 2% as a test dose). Results There was no statistically significant difference between the two studied groups regarding the mean arterial pressure, the heart rate, and the oxygen saturation of the mother; the umbilical cord measurements; and APGAR score of the fetus at different time points. Conclusion The use of low-dose combined spinal-epidural anesthesia for elective cesarean section in patients with severe preeclampsia seems to be as safe and efficient with the same better outcome for the mother and the fetus as conventional epidural anesthesia.

Objectives To assess the efficacy and safety of ultrasound-guided erector spinae-plane block (ESPB) in neonates undergoing tracheoesophageal fistula repair regarding postoperative pain management with measurement of narcotic and anesthetic consumption, hemodynamic changes, and incidence of complications. Background Neonates' pain causes significant stress, which has adverse circulatory and ventilator effects. Thoracotomy produces damaging surgical insults due to damage to ribs and peripheral nerves. Patients and methods A prospective control study on 40 neonates scheduled for a trachea–esophageal fistula repair via thoracotomy was randomized to group E (20 patients). Ultrasound-guided ESPB group: 2.5 mg/kg bupivacaine 0.25% with epinephrine 1: 200 000 (maximum total volume 5 ml). Group-C (20 patients) control group will receive general anesthesia and systemic analgesia without any regional block. Results Group E had significantly lower Face, Legs, Activity, Cry, Consolability (FLACC) score than group C (P = 0.0186). The analgesic consumption 24-h postoperative was significantly lower in group E than group C (P = 0.0282). Group E had more hemodynamic stability as regards heart rate up to 12-h postoperative compared with group C (P = 0.0476). Conclusion ESPB provides effective pain relief in neonates undergoing tracheoesophageal fistula repair.

Background Ultrasound subcostal transversus abdominis plane block is an efficacious field block in abdominal surgeries. Various adjuvants have been used to prolong the local anesthetic effect. Objectives To evaluate the effect of adding dexamethasone to bupivacaine on pethidine consumption in the first 24 h postoperatively as a primary objective. Patients and methods Our randomized controlled double-blinded trial was conducted on 44 patients with American Society of Anesthesiologists physical status I and II, aged more than or equal to 18 and less than or equal to 60 years, scheduled for upper abdominal surgery under general anesthesia. The study was conducted at the National Liver Institute and Menoufia University Hospitals. Patients were randomly divided into two groups, with 22 patients each. Patients in group LD received 20 ml of 0.25% bupivacaine and 2 ml of dexamethasone (8 mg). Group L received 20 ml of 0.25% bupivacaine. Results Pethidine consumption in 24 h was higher among the L group than the LD group. Its mean in the LD group was 119.44 ± 62.16 and was 160 ± 55.25 in the L group; this difference was statistically significant. The first time of analgesia was significantly longer among the LD than the L group (3.62 ± 1.63 in group LD and 2.43 ± 1.25 in group L); the difference was statistically significant. Visual analog scale score was significantly higher in the L group at 1 h than in the LD group. Median (interquartile range) was 2 (2–3) in the LD group and was 3 (2–3) in the L group; this difference was statistically significant. Conclusion The results showed that dexamethasone is a good additive to subcostal transversus abdominis plane block as it prolongs the duration of analgesia and reduces postoperative pain scores after upper abdominal surgeries.

Objectives The primary aim of the study was to show the effect of pregabalin premedication on anesthetic requirements in knee arthroscopy. The secondary aim was to study its effect on postoperative sedation, analgesia, and recovery time. Background Outpatient arthroscopic knee surgery can be performed with general or regional anesthesia. Recent data suggest that spinal and epidural anesthesia require longer discharge times than the newer shorter-acting general anesthetic drugs. Patients and methods The study was a prospective randomized controlled trial that was carried out on 112 patients admitted to Orthopaedic Surgery Department for elective knee arthroscopy. Patients were randomly classified into two groups: group I received 150 mg of oral pregabalin 1 h before surgery and group II received a placebo tablet. All patients received total intravenous anesthesia using propofol and dexmedetomidine. Propofol infusion was titrated by 20 μg/kg/min increments whenever the entropy value was above 60 for more than 10 s. Measurements included demographic data, vital signs, entropy readings, total propofol consumption, postoperative visual analog scale, Ramsay sedation scores, and recovery time. Results Total consumption of propofol was significantly lower in group I (P = 0.0001). State entropy at 20, 25, 30, 35, and 40 min intraoperative was significantly lower in group I (P = 0.0013, 0.002, 0.001, 0.0018, and 0.011, respectively). Visual analog scale was lower in group I throughout the postoperative follow-up period (P = 0.001). Postoperative Ramsay sedation scale was significantly lower in group I 15 and 30 min postoperative (P = 0.013 and 0.042, respectively). Recovery time was significantly shorter in group I (P = 0.0012). Conclusion Pregabalin as premedication can enhance the recovery by decreasing anesthetic dose and postoperative pain.

Objective To study the effect of adding dexmedetomidine to bupivacaine for transversus abdominis plane (TAP) block on the postoperative analgesia following cesarean section performed under spinal anesthesia. Background Cesarean section is frequently associated with a considerable postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals that stem from the abdominal wall. Postoperative pain after cesarean section increases analgesic consumption, disturbs bowel function, and prolongs the duration of hospital stay. Patients and methods The present study was conducted on 60 consenting pregnant women scheduled for elective cesarean delivery under spinal anesthesia who were randomly allocated into two groups of 30 females. Group 1 received ultrasound-guided bilateral TAP block with 20 ml of 0.25% bupivacaine with adding 2 ml of normal saline (total 22 ml on each side). Group 2 received ultrasound-guided bilateral TAP block with 20 ml of 0.25% bupivacaine with the addition of dexmedetomidine 1 μg/kg diluted with normal saline to 2 ml. Results The visual analog scale was significantly lower in group 2 than group 1 starting from 10 to 24 h postoperatively (P < 0.05). The time of the first analgesic request was significantly longer in group 2 (P < 0.05). The patient-satisfaction score was significantly higher in group 2 (P < 0.05). Side effects were comparable between groups (P > 0.05). Conclusion The addition of dexmedetomidine to bupivacaine for TAP block is more effective on the postoperative analgesia following cesarean section.

Background Various types of intubation stylets are used to facilitate tracheal intubation because orotracheal intubation (OTI) delay or failure can adversely affect patient outcomes. Objectives To compare the efficacy and safety of Parker Flex-It directional stylet (PFS) versus conventional malleable stylet (CMS) in OTI with the fiberoptic Macintosh laryngoscope. Patients and methods This was a randomized clinical trial that was carried out on 80 patients requiring general anesthesia with OTI for elective noncardiac surgery at Damanhour Teaching Hospital, El-Beheira, Egypt, between May 2021 and March 2022. Patients were randomly allocated into two equal groups: group P, intubated using PFS, and group M, intubated using CMS. Results Time required for OTI and total OTI duration were significantly shorter in group M (13.00 ± 2.801 and 22.25 ± 2.677 s, respectively) than in group P (15.60 ± 2.836 and 25.23 ± 3.034 s, respectively), P value less than 0.001. Endotracheal tube insertion was significantly easier in group M (72.5%) than in group P (45%), with P value of 0.028. Modified Cormack-Lehane grade, external laryngeal manipulations, intubation attempts, and first-attempt success rate were comparable between both groups. Heart rate and noninvasive blood pressure were significantly increased in group P than in group M, and the incidence of tachycardia was significantly higher in group P (22.5%) than in group M (5%), with P value of 0.023. Hypertension and oropharyngeal trauma occurred in both groups, with no statistically significant differences. Conclusion CMS is more effective and safer than PFS in the direct laryngoscopic OTI. It was associated with faster OTI, easier endotracheal tube insertion, and fewer complications rates.

Objectives We evaluated different doses of dexmedetomidine to achieve the optimal balance between efficacy and safety. Background Great auricular nerve block can be used for surgical procedures to enhance patient comfort and decrease pain. Dexmedetomidine has been found to significantly prolong the duration of peripheral nerve blocks. Patients and methods A total of 120 adult patients undergoing tympanomastoid surgery were randomized into three equal groups after fulfilling the criteria of the study population. After induction of general anesthesia, great auricular nerve block was done using either 4 ml of 0.25% bupivacaine and 1 ml of normal saline in group I, 4 ml of 0.25% bupivacaine added to 50 μg dexmedetomidine in 1 ml of volume in group II, or 4 ml of bupivacaine 0.25% added to it 1 ml of dexmedetomidine (100 μg) in group III. The visual analog scale in the first 24 postoperative hours was the primary end point. The cumulative consumption of analgesics within the first 24 postoperative hours, the time for the first analgesic request, operative field quality, and postoperative sedation were the secondary outcomes. Results The visual analog scale values were significantly lower in group III compared with groups II and I (P < 0.001). There was a significant reduction in postoperative analgesic requirements in group III compared with groups II and I (P < 0.001). Conclusion A dose of 100 μg perineural dexmedetomidine may represent the optimal balance between efficacy and safety as it improve the analgesic quality of the peripheral nerve block without an obvious adverse effects.

Objectives This study aimed to assess the results of video-assisted thoracoscopic surgery (VATS) in patients with chronic pleural empyema. Background Empyema thoracis (ET) is an abnormal accumulation of excess fluid in the pleural space because of infective and/or inflammatory process. Chest tube drainage or thoracocentesis is the first-line management choice for early-stage ET. Surgical intervention is the favored first-line treatment option for advanced stages of ET. Controversy still exists about the effectiveness of VATS drainage and decortication in the advanced stages of ET. Patients and methods This is a prospective study that included 30 patients with third-stage empyema. All patients were operated with open posterolateral thoracotomy in Menoufia University Hospital. Patients were followed up 1 month post-discharge from hospital. Results Conversion rate in the VATS group to open thoracotomy was 6.7%, those who converted were excluded from the study. Sixteen (57.1%) patients had positive pleural fluid culture and 10 (35.7%) patients had comorbidities. The mean operation time was 291.07 ± 56.66 min and three (10.7%) patients needed blood transfusion. Intraoperative blood loss was 209.29 ± 80.32 ml. No patients needed postoperative ICU stay or mechanical ventilation. The Wong–Baker FACES pain scale median was 4.0 (2.0–4.0). Of the patients 32.1% had postoperative complications. Conclusion VATS showed hopeful results concerning pain, operative time, blood loss, and early return to daily activities. So, VATS is recommended for the management of third- stage empyema with more accurate selection of cases and upgrading of instruments to decrease the rate of conversion to open thoracotomy.

Objectives This study aims to evaluate the clinical outcome of combined coronary artery bypass grafting (CABG) and valve replacement within 6 months regarding safety, efficacy, and feasibility. Patients and methods From 2016 to 2020, 41 patients were operated on with combined CABG with aortic valve (AV) and/or mitral valve (MV) replacement. Patients were classified according to valve type into three groups: AV (n = 20), MV (n = 10), and double valve (DV) (n = 11) groups. Comparative analysis of demographic, preoperative, operative, and postoperative data with follow-up clinical outcome for 6 months was done. Results Preoperatively hypertension and rheumatic valves were significantly frequent in AV and MV groups, respectively, with P value of 0.011. ICU and hospital stays were significantly longer in the DV group. Permanent pacemaker insertion was done in three (27%) patients in the DV group, with a statistically significant difference (P = 0.027). Within the first month, pleural, pericardial effusion, and atrial fibrillation were the most frequent complications (36.6, 29.2, and 29.2%, respectively), followed by sternal wound infection (12.2%), acute kidney injury (7.3%), myocardial infarction (7.3%), postoperative bleeding (4.8%), tamponade (7.3%), agitation and confusion (7.3%), and subdural hemorrhage (7.3%). Mortality rate was two (4.9%) patients. At the sixth month, 12.8% of patients remained atrial fibrillation, readmission was seen in 4.9% for noncardiac causes, and no mortality was reported. Echocardiography data for all 39 survivors revealed increase in mean postoperative left ventricular ejection fraction to 48.3 and 50.4% at 1 and 6 months, respectively, with significant difference at the 6 month (P = 0.004). Overall, New York Heart Association grading showed significant improvement (P < 0.001) at 1 and 6 months. Conclusion Concomitant CABG with valves replacement is relatively safe with acceptable short-term outcomes and complications.

Objectives To outline the care of oncological emergencies in the emergency room (ER) and its effect on the patient outcomes. Background Care of emergency oncology patients shows many challenges due to symptoms of underlying cancer and toxicities of its treatments. Early recognition of acutely unwell cancer patients is important not only to initiate treatment but also to improve the quality of outcome. Patients and methods This prospective study included 300 adult patients with previous diagnosis of malignant tumors presented to the Emergency Department of Menoufia University Hospital. All patients were classified according to ER triage, primary survey with the airway-breathing-circulation-disability approach, resuscitation, diagnosis, and outcome. Then these data were reported and further assessed. Results Among the 300 adult patients enrolled, the median age was 58 years (range, 20–87). There were 51 patients with repeated visits and with the same symptoms, diagnosis, and ER outcome. There were high significant relations between: triage priority with complaints, critical interventions, and diagnosis. Regarding ER outcome there were high significant relations with complaints, triage priority, and diagnosis, while hospital outcome had significant relations with triage priority, diagnosis, ER outcome, and Multinational Association for Supportive Care in Cancer score. Conclusion Factors that affect ER outcome among cancer patients are cancer type, active cancer treatments, triage complaint, triage priority, and diagnosis. Factors that affect hospital outcome are increased age, active cancer treatment, triage complaint, triage category, diagnosis, and Multinational Association for Supportive Care in Cancer score in neutropenic fever. Older age, palliative treatment, secondary metastasis, neurologic complaints, priority 1 triage category, and disease progression may be predictors for poor ER outcome.

Objective To define and determine acute kidney injury (AKI) based on the Kidney Disease Improving Global Outcome criteria in severe trauma patients, and to evaluate injury severity score (ISS) in the prediction of AKI and outcomes. Background Because of the great risk of AKI in severe trauma that may be life threatening especially if uncontrolled, early assessment of it reduces mortality of polytraumatized patients. Patients and methods This is a prospective study on 116 trauma patients, who were presented to the Emergency Department of Menoufia University Hospital from April 2019 to April 2020. ISS and the Acute Physiology and Chronic Health Evaluation scores were applied to all trauma patients. Results The overall incidence of AKI following trauma was 33.6%. There was no difference in patients' age, sex, and body weight between groups, whereas there was a significant difference in ISS, Glasgow coma scale, and presence of shock. In multivariate analysis, the independent risk factors associated with AKI after trauma included the ISS (odds ratio = 1.063, P < 0.05) and presence of shock (odds ratio = 0.958, P = 0.003). Renal replacement therapy was required for 11 (28.2%) patients in the AKI group. Hospital mortality rate was higher in the AKI group (23/39, 59%) than the non-AKI group (20/77, 26%; P = 0.001). Conclusion The development of AKI was associated with the severity of trauma, and AKI increased mortality rates.

Objective To determine any association between positive findings in ultrasonography examination and initial base deficit (BD) value in the diagnosis of intraabdominal bleeding following blunt abdominal trauma. Background Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. It is one of the most prevalent trauma injuries, bringing thousands of patients into the Emergency Department annually. Patients and methods This is a prospective study conducted on 40 patients with blunt abdominal trauma, who presented to the Emergency Department of Menoufia University Hospital during the period from March 2019 to April 2020. Arterial BD was evaluated with respect to the presence of any association with intraabdominal bleeding with FAST. Results A total of 40 patients were included in this study. By FAST, there were 50% of them who had intraperitoneal free collection after trauma and 50% of the patients had negative FAST of free collection. The mean SD for age was 45.58 ± 16.35 years, where males were more than females (85 and 15%, respectively) and 32.5% of them were hypertensive and smokers. According to multivariable analysis, a statistically significant association was observed between negative admission BD and both intraabdominal bleeding. There was a significant effect of BD in the prediction of positive FAST as the P value of 0.031, so it shows a high sensitivity for high BD in predicting abdominal collection by FAST (90%). Conclusion This study revealed that arterial BD is an early accessible important marker to identify intraabdominal bleeding.

Objectives To use the BIG score to predict the mortality in the pediatric blunt trauma. Background There are many scores to predict mortality in pediatric blunt trauma and BIG score is one of them. Patients and methods This study is prospective and cross-sectional and included 50 pediatric patients with blunt trauma treated at the Emergency Department of Menoufia University Hospital. They were selected according to certain inclusion and exclusion criteria, and then, we calculated BIG score for those patients, which is calculated by a combination of results from three categories: [Glasgow Coma Scale (GCS), international normalized ratio, and base deficit]: (calculated according to the following formula: [base deficit+(2.5 × international normalized ratio)+(15 – GCS)]. Results This study included 50 cases with injuries due to blunt trauma. There were 26 (52%) boys and 24 (48%) girls with mean age of 5.16 ± 2.64 years. The median BIG score in the survivor group was 9.87, which was statistically significantly lower as compared with the nonsurvivors 36.5. The best cutoff point of BIG score to differentiate between the survivors and nonsurvivors was more than 25.37 with 75% sensitivity and 97.6% specificity. With univariate regression analysis, low GCS and high BIG score were shown as risk factors for mortality, but with multivariate regression analysis, only high BIG score was shown as independent predictors for Morris study that involved 50 patients. Conclusion This study found that pediatric BIG score could be applied in children with polytrauma for prediction of mortality with a good sensitivity and excellent specificity.

Objective To assess whether MRI textural analysis could predict survival in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (NACT). Background The current gold-standard treatment of LARC is surgery after NACT. MRI is a gold-standard tool for restaging of rectal cancer before and after NACT. Texture analysis (TA) represents a promising radiomic biomarker that can predict oncological outcomes according to tumor's MRI heterogeneity. This study hypothesizes that TA has the ability-predicting survival. Patients and methods This is a retrospective analysis of LARC patients' MRIs who received NACT. Six parameters were systematically extracted from textural histograms of post-treatment scans. The correlation between TA and overall survival was tested using Mann–Whitney U test. These parameters were then examined to determine their ability in predicting overall survival by means of Kaplan–Meier survival curves and log-rank tests. Results Two out of the six parameters extracted were significantly able to predict survival, entropy (P = 0.001), and mean of positive pixels (P < 0.001), with cutoff values of 50.265 and 5.745, respectively. Conclusions MRI textural features are potentially significant imaging biomarkers in predicting survival in LARC treated with NACT.

Objective This study was conducted to assess the chemerin level and detect its role as a predictor for gestational diabetes mellitus (GDM) by studying the relation between the serum chemerin level in the first trimester and the development of GDM. Background Chemerin is an adipokine that regulates adipocyte development and metabolic function as well as glucose metabolism in liver and skeletal muscle tissue. GDM is defined as glucose intolerance first recognition during pregnancy. The incidence of GDM is increasing year by year all over the world, especially in developing countries. Patients and methods This case–control study has been conducted on a total number of 162 pregnant women during the first trimester of pregnancy, divided into two groups according to their body mass index (BMI): Group 1: normal weight and Group 2: overweight, marked or morbidly obese. Participants were selected from those attending Obstetrics and Gynecology Outpatient Clinic, Birket Al Sabaa Hospital. Based on the past review of literature that assumed the prevalence of gestational diabetes to be 13.2%, sample size has been calculated and it was 162 patients. Results Based on the current results, gestational diabetes was diagnosed among 12.3% (20 patients), 142 free gestational diabetes ones. In the present study, we found that weight and BMI were significantly higher among GDM group than non-GDM one. Elevated levels of chemerin were found among women with GDM. Conclusions Serum chemerin level measured from a single blood sample may be used as a marker for prediction of GDM specially in overweight or obese women. Weight and BMI were significantly higher among GDM group than non-GDM one.

Objective To evaluate the accuracy of transcerebellar diameter (TCD) in estimating gestational age (GA) of pregnant women in the third trimester. Background On-target estimation of GA is crucial for favorable outcome of pregnancy. Miscalculation of GA may lead to preterm delivery, low birth weight, and hence perinatal morbidity and mortality. TCD is one of the parameters recently proposed for this aim. Patients and methods This cross-sectional study was conducted on 160 pregnant women in the third trimester of pregnancy who attended the Obstetrics and Gynecology Department of Menoufia University Hospitals during the period from October 2020 to June 2021. Results Of 160 patients of the study, TCD gave accurate assessment in 151 (94%) patients. Femur length gave accurate assessment in 100 (62.5%) patients. However, the biparietal diameter gave accurate assessment in 80 (50%) patients, and abdominal circumference gave accurate assessment in 52 (32.5%) patients. Conclusion TCD is an accurate parameter for assessment of GA in the third trimester exceeding the accuracy of femur length in late gestation. Incorporating measurements of TCD with other routine parameters would minimize the margin of error from the actual GA.

Background Recurrent pregnancy loss (RPL) is defined as the spontaneous loss of two or more clinical pregnancies as documented by ultrasonography or histopathologic examination, which occurs in up to 5% of women in the reproductive age. Objectives To evaluate the relationship between changes in blood indices and RPL. Patients and methods Our case–control study was conducted on 150 women attending Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University. They were divided into group A (100 women), who had a history of RPL, and group B (50 women), who had given birth at term (>37 weeks of gestation) to healthy infants. Results There were highly significant differences between the two groups regarding platelet distribution width. Receiver operating characteristic curve analysis showed that platelet distribution width could significantly predict repeated pregnancy loss (P < 0.05). Moreover, there were highly significant differences in red blood cell distribution width-standard deviation and red blood cell distribution width-coefficient of variation. Receiver operating characteristic curve analysis showed that red blood cell distribution width-standard deviation and red blood cell distribution width-coefficient of variation could significantly predict repeated pregnancy loss (P < 0.05). Conclusion Platelet indices and red blood cell indices can be used as predictors of RPL as they are of low cost and easily available tests.

Objective The aim of this study was to assess the ability of using beta-human chorionic gonadotropin (β-hCG) serum level as a predictive factor for medical abortion success within 24 h after using misoprostol. Background Serum β-hCG levels decline compared with gestational age when medical abortion is delayed owing to late diagnosis. This makes serum β-hCG more effective in predicting abortion success than gestational age. Kim and colleagues found that β-hCG lower than 40 000 mIU/ml may be a predictive factor of successful abortion within 24 h after misoprostol administration. Patients and methods This is an observational study where serum β-hCG level was measured in 135 women with miscarriage up to 11 weeks of gestational age before offering them medical abortion with misoprostol. Positive outcome of the study was achieving complete abortion without the need of surgical intervention within 24 h of misoprostol administration. Results Among 135 patients treated with misoprostol, 117 (86.7%) patients achieved complete abortion, whereas in 18 (13.3%) patients, the therapy failed. Receiver operating characteristic curve analysis showed that serum β-hCG level more than 32 043 mIU/ml is a good predictive factor for failure of medical abortion within 24 h. It had sensitivity of 76.7%, specificity of 56.5%, with positive predictive value of 73% and negative predictive value of 62% at area under curve of 0.593. Conclusion Women with serum β-hCG less than 32 043 mIU/ml are likely to achieve abortion within 24 h after intravaginal administration of misoprostol.

Objective To study the benefit of addition of oral fenofibrate to the standard management of diabetic macular edema (DME) regarding central macular thickness (CMT) and visual function. Background DME is the commonest cause of vision loss in diabetes. Systemic therapy for DME largely meant control of diabetes, hypertension, and lipid levels. A revival in the use of systemic medication for a local condition caused by a systemic disease has occurred recently with hypolipidemic drugs, namely, atorvastatin and fenofibrate. Patients and methods Our study was a randomized controlled trial. It included 100 eyes of patients with type-2 diabetes complicated with DME. Patients were randomized into two groups: treatment group (oral fenofibrate) and control group (receiving placebo). Both groups underwent treatment of DME as per the standard treatment protocol of our hospital, including intravitreal injections and grid laser. Patients were followed up after 3 and 6 months to note the CMT and visual acuity. Results There was a significant lower mean value of CMT with higher mean value of percent reduction (19.22 vs. 13.256%) and higher mean value of visual acuity in fenofibrate group than the control group after 6 months of treatment. Conclusions Adding of fenofibrate (dose of 160 mg/day for 6 months) to standard protocols of DME treatment has beneficial effect on percent reduction in CMT and visual acuity.

Objective The aim of the study was to evaluate the influence of rheumatoid arthritis (RA) treatment on the posterior segment of the eye using spectral-domain optical coherence tomography. Background RA is a common chronic autoimmune systemic inflammatory disease that primarily affects mainly small joints. It may affect many parts of the eye, such as conjunctiva, cornea, sclera, uvea, choroid, and retina. Patients and methods The study included 44 RA patients (22 on methotrexate and 22 on etanercept), and 21 healthy controls. Results A significant increase in choroidal thickness in the RA group compared with the control group. There were no significant differences between the groups in central macular thickness (CMT) and peripapillary retinal nerve-fiber-layer (RNFL) thickness, except for quadrants of temporal and inferior nasal, which were significantly thinner in the RA group. Moreover, a significant negative correlation was observed between the disease-activity index (DAS28) and both CMT (r=−0.463, P = 0.002) and subfoveal choroidal thickness (SFCT) (r=−0.524, P < 0.001) in RA patients. It means that there was an expected decrease in the CMT and SFCT of the eye when the DAS28 of the patient increased. On the other hand, a significant positive correlation was found between the DAS28 of the patients and inferior temporal quadrant of the peripapillary RNFL (r = 0.297, P = 0.05). Conclusion SFCT was markedly increased in RA patients compared with the control group. In addition, a significant positive correlation was found between the DAS28 of the patients and inferior temporal quadrant of the peripapillary RNFL.

Background Chronic dacryocystitis is an inflammatory disorder of the lacrimal sac that is accompanied by nasolacrimal-duct obstruction. Watering and discharge are the most common symptoms. Objectives To compare the effectiveness of endoscopic dacryocystorhinostomy (DCR) with ologen implant versus endoscopic DCR with silicone-tube implantation. Patients and methods A prospective comparative study was conducted to evaluate the effectiveness of endoscopic DCR with ologen implant versus endoscopic DCR with silicone-tube implantation. A total of 40 patients underwent primary endoscopic DCR surgery from March 2020 to March 2021. A total of 20 cases underwent endoscopic DCR using ologen implant (group A) and the other 20 cases underwent endoscopic DCR using silicone tube (group B). Results The success rate, which was evaluated by MUNK score and syringing test, was compared between both groups, also, rate the complications like epistaxis, implant complications, and postsurgery synechiae was compared. A success rate was 75% in ologen group and 85% in the other group. Epistaxis, infection, and postsurgery synechiae were statistically insignificant between the two groups, but implant complications were more in ologen group than the other group. Conclusion Endoscopic DCR with ologen implantation is not superior to endoscopic DCR with silicone stenting due to difficult fixation of ologen in lacrimal fossa, more complications, and the high cost relative to silicone stenting.

Objective To evaluate the use of manual keratoscope intraoperative to improve the outcome of intracorneal ring segment (ICRS) implantation in patients with keratoconus. Background Keratoconus is a bilateral, progressive, noninflammatory disease of the cornea that often leads to high myopia and astigmatism. It seems to be a multifactorial disease with an unknown exact etiology that impairs the quantity and quality of vision secondary to thinning in and protrusion of the cornea. This results in irregular astigmatism with or without myopia. Methods This was a randomized prospective cohort, interventional case series study conducted at Tiba Ophthalmic Center, Menoufia during the period from September 2018 to September 2020 on patients with keratoconus. The study included a sample of keratoconus patients planned for femto-laser-assisted ICRS implantation. The participants were randomly divided into two subgroups according to the use of manual keratoscope intraoperatively: Group A: blind implantation of ICRS without keratoscope. Group B: keratoscope-assisted ICRS implantation. Results According to K and Max elevation, there was a statistically significant difference between groups. Regarding Max elevation, Group B showed a higher Max elevation (front) than Group A. Within each group, there was a statistically significant difference postoperative. Conclusion The use of manual keratoscope improved best spectacle-corrected visual acuity with better maximum front elevation and anterior chamber depth of cornea in keratoconus patients' postoperative when compared with the blind implantation of ICRS.

Objectives To evaluate the macular, retinal nerve fiber layer (RNFL), and choroidal thickness alterations using spectral-domain optical coherence tomography (OCT) in postmenopausal, pregnant, and nonpregnant women. Background The choroid, also known as the choroidea or choroid coat, is a part of the uvea, the vascular layer of the eye. It contains connective tissues and lies between the retina and the sclera. Patients and methods A comparative study was conducted that included 75 eyes of 75 healthy women in the period from March 2021 to December 2021. They were divided into three groups: (a) nonpregnant women, (b) pregnant women, and (c) postmenopausal women. Each participant underwent a comprehensive ophthalmologic examination. Following this detailed ophthalmologic examination, the third-generation Spectralis OCT device (software version 5.6.3.0; Spectralis OCT) was used for the assessment of choroidal, macular, and RNFL thicknesses. Results The mean age of nonpregnant women was 29.64 ± 3.13 years, of pregnant women was 28.93 ± 3.89 years, and of postmenopausal women was 53.86 ± 1.75 years. There was no significant difference in all macular quadrants among the three study groups. Choroidal thickness was statistically significantly thicker in healthy pregnant women (333.36 ± 44.42) than in healthy nonpregnant women (326.93 ± 31.50) and significantly thinner in healthy postmenopausal women (282.64 ± 28.04) than in healthy nonpregnant women. There was no significant difference in RNFL thickness among the three study groups. Conclusion OCT has evolved over the past decade as one of the most important ancillary tests in ophthalmic practice. Pregnancy hormones may lead to an increase in fluid volume in many tissues of the body.

Objectives To compare endothelial cell density (CD) and morphology in the peripheral cornea before and after corneal cross-linking (CXL). Background Corneal CXL has been acknowledged as an effective method for halting the progression of keratoconus by photosensitization of riboflavin activated by ultraviolet A. For this surgical indication, it is usually recommended that the preoperative corneal thickness is at least 400 μm to prevent corneal endothelial cell damage caused by ultraviolet A irradiation. It has been reported that even 5 years after CXL, the endothelial CD did not change significantly at any postoperative interval. Patients and methods This study evaluated 40 eyes of 20 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial CD, the coefficient of variation in cell size, and the percentage of hexagonal cells, in the peripheral regions of the cornea, using a noncontact specular microscope. Results There was not any significant change in endothelial cell count particularly at 3 and 6 months post-CXL. In addition, the coefficient of variance was also statistically significantly higher at 3 and 6 months postoperatively than the pre-CXL value. There was a slight change in the percentage of hexagonal cells. Conclusion The use of accelerated CXL (10 mW/cm² for 9 min) has a transient negative impact on endothelial CD and/or endothelial morphology.

Objective To compare difluprednate 0.5 mg (0.05%) versus prednisolone acetate 10 mg MedCalc Software (1%) after cataract procedures in diabetic patients regarding their safety and efficacy in postoperative inflammation. Background Cataract is the world's most prevalent cause of vision loss, affecting mostly the elderly. Cataract surgery is now the sole therapy option. As a result, around eight million cataract operations are conducted each year. Furthermore, the higher life expectancy supports the likelihood of even more procedures in the coming years. Patients and methods This prospective interventional comparative research included 74 eyes of diabetic patients with cataract, attending Menoufia University Hospital outpatient clinic, undergoing uncomplicated phacoemulsification. They were divided into two equal groups, each one included 37 patients. The trial duration was from 6 to 12 months. Results Both difluprednate and prednisolone groups showed similar improvements in corneal edema (29.7 vs. 29.7%, respectively), with no substantial variations in the two treatment groups (P = 0.493). Conclusions According to the findings of this research, difluprednate seems to be equally safe and efficacious as prednisolone acetate in managing postoperative inflammation and pain in patients having phacoemulsification.

Objective To evaluate the macula and peripapillary retinal nerve fiber layer (RNFL) in patients with autoimmune thyroid compared with normal individuals using spectral domain optical coherence tomography. Background Thyroid eye disease is a complex orbital inflammatory disease that can be sight threatening. The acute progression of the disease is an ocular emergency, particularly optic nerve compression. Patients and methods A cross-sectional study was conducted on 32 eyes with autoimmune thyroid disease who were diagnosed by the Department of Endocrinology, Menoufia University Hospital, and examined by Ophthalmology Department, Menoufia University Hospital, Egypt, during the period study from March 2020 till October 2021. General and medical history, ophthalmologic examination, thyroid function tests, and optical coherence tomography were employed for all cases and controls to measure RNFL and macular thickness. Results The nasal RNFL thickness was significantly increased among the case group (73.50 ± 8.13) than the control group (61.87 ± 7.98) (P < 0.001). However, superior, inferior, and temporal did not show significant differences between the studied groups (P > 0.05). Moreover, macular thickness parameters such as central, inner, and outer rings were significantly increased among patients with autoimmune thyroid than the control group (P < 0.05). Conclusion Nasal RNFL thickness and macular thickness parameters such as central, inner, and outer rings were significantly increased among patients with autoimmune thyroid disease than the control group. Moreover, macular thickness did not show any significant correlation with T3 and free-T4 among the studied patients. However, macular thickness showed a significantly negative correlation with thyroid-stimulating hormone and a significantly positive correlation with TRAB among the studied patients with autoimmune thyroid disease.

Objective The aim was to evaluate early results of single-bundle augmentation of partial tears of the anterior cruciate ligament (ACL) with an autogenous hamstring graft. Background Intact fibers of the partially torn ACL preserve some of the proprioception of the knee joint. It adds some biomechanical strength and protection to the newly inserted augmentation graft in the early postoperative period and helps in early revascularization, ligamentization, and reinnervation of the newly inserted augmentation graft. Patients and methods A prospective study was performed for 20 patients with partial ACL tears treated with arthroscopic single-bundle augmentation with an autogenous hamstring graft. Patients were subjected to preoperative and postoperative evaluation according to Lysholm score, anterior drawer test, Lachman test, pain, and instability. Results There was a significant improvement after arthroscopic augmentation in Lysholm score, anterior drawer test, Lachman test, pain, and instability (P < 0.001). Conclusion The single-bundle augmentation technique, preserving intact fibers of the ACL, can be considered as a suitable method of treatment of symptomatic partial tears of the anterior cruciate ligament.

Objective To evaluate the clinical and radiological outcomes of microfracture alone versus with augmentation by bone marrow aspirate concentrate (BMAC) in the management of knee chondral lesions. Background Bone marrow aspirate is a cost-effective method in delivering mesenchymal stem cells to aid in the repair of cartilage defects. Patients and methods Patients were mutually allocated into two groups at a ratio of 1: 1: in group A 15 patients were managed by microfracture and in group B 15 patients were managed by BMAC augmented microfracture. All patients had grade III or IV chondral lesion at the weight-bearing surface of femoral condyles. The International Knee Documentation committee score was used for the clinical evaluation of patients. Also, radiograph and MRI were used for radiographic evaluation. Results The patients were followed up for 6 months. The International Knee Documentation Committee score was significantly improved in both groups (P = 0.023 in group A and 0.002 in group B). Group B showed better improvement than group A in patients younger than 45 years old. Also, MRI signal was significantly improved in both groups. The most common postoperative complication was mild effusion (66.7% of cases), which responded well to medical treatment. Conclusion Augmentation of microfracture with BMAC for the treatment of knee chondral lesions provides better clinical outcomes in patients younger than or equal to 45 years old.

Objective To evaluate early-term results of tantalum cones for reconstruction of major bone defects in revision total knee arthroplasty. Background Increased numbers of revision knee arthroplasties are reported with challenging bone defects. The best option for management of these bone defects is still unknown. Patients and methods Early results of tantalum cones for reconstruction of such defects were evaluated. Tantalum cones were implanted in 10 revision knee replacements including seven females and three males with an average age of 60 years. According to the Anderson Orthopaedic Research Institute bone defect classification, five knees had type IIA defects (one femoral and four tibial), whereas eight had type IIB bone defects (six femoral and five tibial). Three knees had no femoral defects and one had no tibial defects. All patients were followed clinically and radiologically. Results The average follow-up period of our patients was 2.85 years. The average knee society clinical score improved from 18.9 points preoperatively to 79.1 points at the final follow-up visit. Only one patient had poor result and one had good result. The all remaining eight were excellent. At the final follow-up, all porous metaphyseal cones showed evidence of osseointegration with the host bone. There was no evidence of loosening or migration of any of these constructs at the time of final follow-up. Conclusion With short-term follow-up, tantalum cones provided an effective option for bone loss management. Long-term follow-up and comparison with alternative reconstructive techniques will be required to evaluate the true effectiveness of this management approach.

Objective In this series, we will assess the expert tibial nails (ETN) in treating distal tibial metaphyseal fractures and their effectiveness as an implant in these fractures. Background Therapy of distal tibial fractures in adults without articular extension is difficult due to its anatomical features of their minimal soft-tissue covering, poor supply of blood, and closeness to the ankle joint. Internal fixation and open reduction result in revascularized fracture fragments with soft tissue and skin complications. Conventional nails have limited interlocking options. ETN offers an alternative for these fractures with multilocking options and higher stability. The aim of this research was to determine the effectiveness of the ETN in the management of distal tibial fissures. Materials and methods We established prospective research of distal tibial fractures treated with ETN. It included 26 individuals with AO type 4.3, subtypes A1, A2, and A3. The result was determined by fracture alignment, fracture union, rate of secondary surgery, and range of motion in the knee and ankle, and postoperative adverse outcomes within 1 year. Results The mean time required to repair a fracture was 16.89 weeks. About 7.69% of cases had a delayed union. Reoperations in the form of dynamization occurred at a rate of 7.69%. Primary malalignment was seen in 7.69% of instances. Most patients had normal-to-exceptional range of motion in their knees and ankles. One patient was infected superficially. Conclusion ETN offers strong internal fixation, early range of motion in the knee and ankle, angular stability, and hence a favorable clinical and radiographic result.

Objectives To compare the clinical and radiological outcomes between gamma nail and dynamic hip screw (DHS) in the treatment of intertrochanteric hip fractures in Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification subgroup 31-A1.3. Background In recent years, intertrochanteric fractures have become more prevalent, with a death rate of 30% within 5 years of the fracture. Trauma with high energy (rare; found in young male patients) or simple falls with low energy can cause intertrochanteric hip fractures (common; seen in elderly female patients). Patients and methods A prospective study was carried on 34 patients with intertrochanteric hip fractures, AO classification subgroup 31-A1.3, who were operated on using DHS or gamma nail, with 17 cases managed by DHS (group I) and 17 cases managed by gamma nail (group II). Inclusion criteria were skeletally mature (adult) and intertrochanteric fracture of the hip, AO subgroup 31-A1.3. Results In terms of functional grading, group I had 14 satisfactory outcomes and only three unsatisfactory results, whereas group II had 15 satisfactory results and only two unsatisfactory results; nevertheless, there were statistically insignificant differences in anatomical grading. For groups I and II, the percentage of patients who needed fewer than 12 weeks for union was 76.5 and 82.3%, respectively, and the mean time was 10 ± 2 and 9 ± 2 weeks, respectively. The union time discrepancies were not statistically significant. Conclusion Both gamma III nail and DHS techniques had satisfactory outcomes, namely, functional and anatomical. In addition, age, sex, medical history, and fracture classification had no influence on the outcome, may be because of the stable pattern of fracture enrolled in our study.

Objective The aim of this work was to evaluate triple arthrodesis in the treatment of adolescent rigid flatfoot regarding clinical outcomes, radiological findings, and complications. Background Rigid flatfoot is a common foot complaint in the adolescent age group. Moreover, some severe, rigid flatfoot deformities are associated with tarsal coalitions. The results of the triple arthrodesis procedure were evaluated in severe, symptomatic rigid flatfoot in adolescents. Patients and methods A prospective study was conducted on 16 adolescent patients who underwent triple arthrodesis procedure for symptomatic rigid flatfoot between July 2019 and October 2020 with a minimum follow-up period of 6 months. They were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score. Pain was evaluated by the visual analog scale (VAS). The radiological evaluation was made by the anteroposterior (AP) talar-first metatarsal angle (T1stMTA), AP talonavicular coverage, lateral T1stMTA, and lateral calcaneal pitch angle preoperatively and postoperatively. Result The mean age at the time of surgery was 16.5 years. Significant improvement was found in all radiographic measurements. Mean AOFAS and VAS were significantly improved at the time of last follow-up. The degree of satisfaction was evaluated using a scoring system by Coughlin, where 13 (81.2%) patients were excellent and three (18.8%) were good. Conclusions Triple arthrodesis is a good procedure for treatment of rigid flatfoot in adolescents regarding pain relief (VAS score), clinical outcomes (AOFAS), and radiological improvement in the following angles: AP T1stMTA, AP talonavicular coverage, lateral T1stMTA, and lateral calcaneal pitch angle.

Objective To evaluate the functional and oncological outcomes after extended curettage of giant cell tumor (GCT) around the knee joint. Background GCT is a relatively common benign bone tumor. The peak incidence is at the middle age. It usually involves the ends of long bones around the knee joint. Although many patients usually present with mild to moderate symptoms, the effect of the GCT on individual well-being can be significant. Patients and methods This is a prospective and retrospective nonrandomized study that included 20 patients with GCT around the knee joint. Patients were managed surgically with extended curettage with or without internal fixation. High-speed burr and bone cement were used in all cases. Plate and screws were used in eight patients (40% of cases), two (10%) patients were augmented with rush pins, and one (5%) patient was augmented with K-wires. Complications and oncological and functional outcomes were evaluated and analyzed. Results A total of 17 (85%) patients had no complications. One (5%) case had mild knee osteoarthritis. One (5%) case had a recurrence. One (5%) case had a soft tissue recurrence with osteoarthritis. No cases had lung metastasis. The mean total musculoskeletal tumor society score preoperatively was 20.4 ± 2.58 and postoperatively was 28.9 ± 1.17. The mean follow-up period was 25.75 ± 15.47 months. Conclusion Surgical treatment of GCT with extended curettage using high-speed burr and bone cement as adjuvant improves the patient's functional outcome and decreases GCT recurrence rate.

Background Syndesmotic injuries are common at ankle fractures and there are many modalities for the treatment of such injuries. Objectives To compare clinical and radiological results of closed reduction and fixation of syndesmotic injury by a single tricortical screw and two tricortical screws in the case of bimalleolar ankle fractures associated with syndesmotic injury. Patients and methods A prospective randomized study was carried out on 30 patients with bimalleolar ankle fracture associated with syndesmotic injury, who attended the Menoufia University Hospital. Results The ankle affected in group A shows that seven (46.7%) had the ankle affected in the left side and eight (53.3%) had the ankle affected in the right side while in group B six (40.0%) had the ankle affected in the left side and nine (60.0%) had the ankle affected in the right side. Conclusion There was no significant difference regarding the use of one screw or two screws in the fixation of syndesmotic injury in ankle fractures.

Background Total hip replacement is an established treatment for failed fixation of femoral neck fractures (FF.FNFs) as well as acute FNFs. Objectives To analyze and compare the results of primary total hip arthroplasty versus cases of FF.FNFs. Patients and methods In the period between June 2016 and June 2021, this prospective case series included 40 patients classified into two groups: group A included 20 patients with displaced FNFs, Group B included 20 patients with FF.FNFs. Preoperative, operative, and postoperative clinical and radiological data are collected and evaluated by Harris hip score. Results FNF had older average age of 62 years, while 49 years in FF.FNF. In total, 11 males, while seven males in FF.FNF more ambulant preoperatively, shorter operative time, and nine cementless prosthesis, while 11 cementless in FF.FNF, less hospital stay, and earlier postoperative ambulation. In FNF, early complications were two superficial infections, while in FF.FNF were one superficial and one deep infection. In FNF, late complications were two cases of thigh pain. In FF.FNF were three cases of thigh pain and one case of dislocation. Total Harris hip score result in FNF was 84.85, while 83.15 in FF.FNF. The average interval between initial surgery and total hip surgery was 15 months. Cannulated screws were the commonest hardware used for initial fixation of FNFs (85%); nonunion (55%) and avascular necrosis (45%) are the commonest causes of FF.FNFs. Conclusion Total hip replacement is a good salvage treatment for cases of FF.FNFs, although not giving full function comparable to total hip replacement in FNFs.

Background Tuberosity-avulsion fracture is the most common fracture of proximal fifth metatarsal accounting for 94% of fractures of the fifth metatarsal. Objective To compare between the results of conservative and minimally invasive surgical management of displaced avulsion fractures of the fifth metatarsal base (zone one) in adults. Patients and methods A prospective comparative study was conducted on 40 patients with avulsion fractures of the base fifth metatarsal bone at the Department of Orthopedics and Trauma Surgery in Menoufia University and Qabbary Hospital in Alexandria from September 2018 to 2021. Results A total of 40 patients with avulsion fractures of the base fifth metatarsal bone, their age ranged from 19 to 60 years with mean 36.65 ± 18.49 years. Among the cast group, the mean visual analog pain scale score declined from 7.27 ± 0.8 to 2.93 ± 1.1, then 0.53 ± 0.8, and finally 0. While, among the surgery group, the visual analog pain scale score declined from 7.4 ± 0.9 to 0.47 ± 0.7 and then finally 0, with a statistically significant difference between cast and surgery groups (P < 0.05). Time till fracture radiological union and till return to full activity was significantly decreased among surgery group (4.8 ± 1 and 6.87 ± 0.9 weeks) than cast group (6.67 ± 1.1 and 8.93 ± 1.2), respectively, with P value less than 0.001. Conclusion We concluded that interfragmentary screw fixation is a reliable, easy, and safe method of fixation for avulsion-base fifth metatarsal, which allows earlier union rate, earlier return to weight-bearing, and earlier return to normal activity in comparison with cast management that has longer union rate time.

Objective To evaluate functional outcomes of the shoulder according to University of California, Los Angeles (UCLA) score after ultrasound-guided subacromial injection of platelet-rich plasma (PRP) versus steroid for management of rotator-cuff tendinopathy. Background Subacromial corticosteroid injection is the treatment of choice for rotator-cuff tendinopathy. More recently, ultrasound-guided subacromial PRP injection for rotator-cuff tendinopathy has been considered as a viable alternative to steroid injection. Patients and methods This was a prospective comparative study. Consecutive patients were placed alternately into group A (PRP) and group B (steroid) in a ratio of 1: 1: group A: 25 patients had been managed by ultrasound-guided subacromial injection of PRP. Group B: 25 patients had been managed by ultrasound-guided subacromial injection with steroid. Results The mean age of group A was 44.88 ± 6.89, and 39.76 ± 10.96 in group B. There were no significant side effects reported in both groups. The mean follow-up duration of group A and group B was 6 months. The mean functional scoring system by UCLA score in group A was 28.36 and 33.00 in group B (P < 0.001). Regarding UCLA functional scoring scale, group A recorded as 30% was good, 70% were poor, while group B revealed as 60% was excellent, 30% were good, and 10% were poor. Conclusion Ultrasound-guided subacromial injection of steroid is favorable over PRP in functional outcome of rotator-cuff tendinopathy regarding UCLA score.

Background Fractures in children are common scenarios facing orthopedic surgeons. Forearm fractures in childhood account for 25% of all other injuries. Objectives This study aims to evaluate the outcome of management of diaphyseal forearm fracture in children under 12 years old during the coronavirus disease 2019 (COVID-19) crisis and how (COVID-19) affect our choice of management. Patients and methods This study was held on 50 patients; 25 of the children were managed at Menoufia University Hospitals and 25 children were managed at Al Iman General Hospital in Assiut from June 2020 to June 2021. All the patients were subjected to history, physical examination, plain radiograph anteroposterior and lateral views of the forearm from the elbow to the wrist. Method of treatment: of the 50 patients, 17 patients were treated by conservative management and 33 patients by surgical interventions. Results In our study, 17 (32%) cases were managed conservatively by closed reduction above-the-elbow plaster cast (CRAEPC) and 33 (68%) cases were managed operatively by different methods. Based on the Price and colleagues criteria, the functional outcome of our study was calculated, which showed excellent results in 34 (68%) patients, good in 13 (26%), fair in three (6%), and no poor results. All operated cases had general anesthesia on supine position. Conclusion Management of diaphyseal both-bone fracturess in children below 12 years, either conservative or operative, was not affected by COVID-19, that is the role of management is the same pre-COVID-19 and during COVID-19, but methods of follow-up depends on recent communication technology of social media.

Objectives To compare the results of threaded Kirschner wire (K-wires) and Herbert screw in the treatment of nonunion scaphoid using iliac graft. Background Scaphoid nonunion is challenging to manage because of its geometry, the direction and type of fracture, and the vascular supply to it. Patients and methods This prospective study included 30 patients with nonunion scaphoid fracture in the Orthopedic Department of Menoufia University and El-Qabary Hospital from 2019 to 2021. Patients were divided into two equal groups according to the fixation method (group A by threaded K-wires, and group B by Herbert screw) with open reduction and iliac bone graft using the volar approach. The mean age was 26.60 ± 5.58 years in group A and 27.33 ± 5.09 years in group B. These patients were assessed clinically using modified Mayo wrist score, Quick disabilities of arm, shoulder and hand-9, and radiologically. Result Union was achieved in 86.7% in group A and 100% in group B. The mean union time was 10.92 ± 1.55 weeks in group A and 12.13 ± 1.77 weeks in group B. The mean 6-month score postoperatively was 81.67 ± 9.39 in group A and 82.67 ± 6.23 in group B according to the modified Mayo score and 25.67 ± 14.97 in group A and 23.93 ± 11.25 in group B according to Quick disabilities of arm, shoulder and hand-9. Radiologically, 26.7% were grade 1, 60% were grade 2, and 13.3% were grade 4 after 6 months postoperatively in group A and 40% were grade 1 and 60% were grade 2 in group B. Conclusions Combination of iliac bone graft and threaded K-wires or Herbert screw provides a good option for the treatment of scaphoid nonunion without superiority regarding outcomes.

Objectives To assess the vestibulo-ocular and oculomotor functions in vestibular-migraine (VM) patients in-between and during the attacks using video head-impulse test (vHIT) and oculomotor-function tests. Background Dizziness and migraine are very common complaints. Patients and methods This case–control study included two groups: 1 – control group consisted of 60 normal participants not complaining of any vestibular symptoms. 2 – study group consisted of 30 VM patients, which were subdivided into two subgroups: subgroup 1 was examined in-between attacks (nine patients) and subgroup 2 was examined during the attack (21 patients). The vHIT and oculomotor tests were used to assess both groups. Results Oculomotor abnormalities were reported in 20/30 of VM patients (67%): four (44%) patients in subgroup 1 and 16 (76%) patients in subgroup 2. vHIT abnormalities were reported in 20/30 of patients (67%): three (33%) patients in subgroup 1 and 17 (81%) patients in subgroup 2. In total, 18 patients from subgroup 2 were reevaluated after treatment, 3-month interval, and showed improvement in duration of headache, frequency of attacks, and duration of vertigo. The number of abnormalities in vHIT results decreased after treatment. Conclusion Abnormalities either in oculomotor-function tests or vHIT are common in VM, which were more pronounced during the attacks than in-between the attacks. The high gain was the most frequent vHIT abnormality during the attack, which shows improvement after treatment in more than half of the patients in the current study. vHIT can be used as a monitoring tool during the management of VM patients.

Objectives To assess platelet count in predicting outcomes in major burn patients. Background Burns are one of the most common devastating forms of trauma. Burn patients are ideal hosts for opportunistic infections. A burn wound has a much higher incidence of sepsis as compared with other forms of trauma because of extensive skin barrier disruption and an alteration in cellular and humoral immune responses. Patients and methods This study included 30 cases of burn patients. This study was done at Menoufia University and Shebin Elkom Teaching Hospitals between October 2018 and October 2019. Routine platelet count was done on first, third, fifth, and seventh day by withdrawing 5 ml of venous blood by a 22 G needle into a plain tube mixed with 1.25 ml sodium citrate and then sent to a laboratory for platelet count. Results This study included 30 patients. All patients were admitted to the burn-ICU at Menoufia University Hospital with major burns. We had 14 female patients and 16 male patients in the period of this study. Also, of our patients, 21 recovered while nine patients died in our unit during this study with a mortality rate of 30%. Conclusion Platelet count can predict the outcome in major burn patients.

Objectives The aim of the study was to assess the effect of Hounsfield unit (HU) of renal stones and skin-to-stone distance (SSD) detected by noncontrast computed tomography on the outcome of extracorporeal shock wave lithotripsy (ESWL). Background Urolithiasis is a worldwide health problem with renal stones being the most prevalent entity. ESWL proved to be an efficient modality to treat renal stones. Optimizing stone and patient factors is mandatory to maximize the success rate. Patients and methods In all, 60 patients with renal stones were prospectively enrolled between December 2017 and December 2019. All patients were treated by ESWL using an electromagnetic Dornier lithotripter. Patients were divided into four groups: group 1 with HU less than 1000 HU and SSD less than 10 cm, group 2 with HU less than 1000 HU and SSD more than 10 cm, group 3 with HU more than 1000 HU and SSD less than 10 cm, and group 4 with HU more than 1000 HU and SSD more than 10 cm. All patients were evaluated 2 weeks after each ESWL session with plain kidney-ureter-bladder (KUB) and noncontrast computed tomography. Results Groups 1 and 3 showed 100% stone-free rate, which were nonsignificant to each other or to group 2 (86%). In group 4, the stone-free rate was 80% which was significantly lower than that in groups 1 and 3 but not group 2. HU and SSD were found to be significantly correlated to the number of ESWL sessions. Conclusion HU and SSD are essential predictive factors of ESWL success. Renal stones with HU more than 1000 and/or SSD more than 10 cm should be addressed by treatment other than ESWL.

Background The miniaturization of endourological instruments and improvements in laser lithotripsy have revolutionized the approach to renal stones. Flexible ureteroscopy (FURS) is an integral part of minimally invasive contemporary treatment of urinary stone disease. Objective To assess the effectiveness of FURS in the treatment of renal stones. Patients and methods Symptomatic patients with renal stones less than 2 cm were prospectively enrolled and treated using FURS (Boston Scientific LithoVue). Patients were considered stone free if no residual stones were seen endoscopically and radiographically after the procedure. The efficiency and the safety of the procedures were analyzed. Results Between June 2020 and June 2021, 50 ureteroscopic procedures were performed in our department. Holmium: yttrium-aluminum-garnet laser lithotripsy was necessary in 41 (82%) patients. The mean ± SD stone size (mm) was 14 ± 4. The overall stone-free rate after a single procedure of FURS was 76%. The remaining 12 patients had residual stones. Complications have been recorded in eight (16%) patients, including fever in six cases and gross hematuria in two cases. No major complications occurred. All patients were treated conservatively. Conclusions FURS is an effective treatment option in patients with renal stones. Single-procedure stone-free rates are high with a low rate of only minor complications.

Background Urinary retention is often the result of bladder outlet obstruction secondary to benign prostatic hyperplasia. Benign prostate enlargement with aging causes partial bladder outlet obstruction, a situation known as benign prostatic obstruction. For such patients, prostate surgery, such as transurethral resection of the prostate (TURP), has a good chance of improving lower urinary tract symptoms. Objective To evaluate the recoverability of detrusor muscle function in patients with benign prostate enlargement after treatment with TURP. Patients and methods The study was carried out on 34 patients at the Urology Department of Faculty of Medicine, Menoufia University, from July 2019 to October 2021. These patients had postvoiding residual urine more than 150 ml, had weak detrusor contractility [low bladder contractility index (BCI)<100)], and were scheduled for TURP. Results A total of 34 patients underwent evaluation using ultrasound and urodynamics studies preoperatively and postoperatively, but six patients missed evaluation by urodynamics postoperatively. The preoperative median postvoid residual urine was 175 (range, 153–600 ml), which reduced postoperatively to a median of 37.5 ml, with a range of 18–230 ml. BCI ranged between 35 and 98.5, with a median of 74. A total of 28 (100%) patients showed weak detrusor contractility (low BCI <100). Postoperative BCI ranged between 76 and 167, with a median of 136. A total of eight (28.6%) patients still showed weak detrusor contractility (low BCI <100), 15 (53.6%) patients showed normal detrusor contractility (normal BCI 100–150), and five (17.9%) patients showed strong detrusor contractility (high BCI >150). Conclusion Detrusor function can be recovered after TURP in patients with benign prostatic hyperplasia with detrusor underactivity.