Aim of this work To study the epidemiology of haemodialysis among patients in the Kafer El-Shakh Governorate. Background End-stage renal disease (ESRD) has become a worldwide health concern. In developed countries, there is electronic data registry, which allows easy statistical analysis and determination of the size of the problem for future plans. In developing countries, there is no data registry and only scarce data were available about the epidemiology of dialysed patients. Patients and methods A questionnaire was conducted in haemodialysis units in the Kafer El-Shakh Governorate during the year 2012, focusing on the demographic data, vascular access, the hepatitis C status and causes of ESRD. Results The mean age was 51.34 + 13.5 years, and 60.7% of the patients were male. The mean duration of dialysis was 34 + 1. The main known causes of ESRD were hypertension (34%) and diabetic nephropathy (14%), whereas unknown causes represented 25.3% of the cases. The prevalence of hepatitis C was 39.7%. Out of 735 patients, 654 (89%) had no history of vascular access failure. Conclusion In the Kafer El-Shakh Governorate, there was a low prevalence rate of haemodialysis compared with the whole of Egypt. Haemodialysis represents the only mode of treatment of ESRD patients. Hypertension and diabetes constituted the major known causes. A unified system of electronic data registry should be started in each governorate to constitute the National Egyptian Data Registry.

Objective To perform a systematic review on the recent advances in immunosuppression for kidney transplantation and how these recent strategies over the past decades have led to significant improvements in the field of renal transplantation. Data sources MEDLINE, EMBASE, and Cochrane databases were searched. The search was performed on 1 November 2013 and included articles published ahead of print, with no language restrictions. Study selection The initial search presented 500 articles, of which 20 fulfilled the inclusion criteria. The articles studied whether transplantation is the ideal treatment for kidney failure, presenting details on graft immunology and the mechanism of action of immunosuppressants, with a focus on novel mechanisms. Data synthesis Because of heterogeneity in the postoperative follow-up periods and outcome measures reported, it was not possible to pool the data and carry out a meta-analysis. Comparisons were performed by a structured review. Conclusion Excellent outcomes have been achieved in the field of renal transplantation. A significant reduction in acute rejection has been achieved at many renal transplant centers using currently available immunosuppressives, consisting of an induction agent, a calcineurin inhibitor, and an antiproliferative agent with or without a corticosteroid. Despite improvements with these regimens, chronic allograft injury and adverse events still persist. The perfect immunosuppressive regimen would limit or eliminate calcineurin inhibitors and/or corticosteroid toxicity while resulting in enhanced allograft outcomes. The aim of this review is to consolidate the published evidence of the effectiveness and safety of investigational immunosuppressive agents in renal transplant recipients.

Objective The aim of the study was to evaluate the clinical aspects of the haemostasis and inflammation interface. Data sources Data sources were medical text books, medical journals and medical websites that have updated research with keywords (haemostasis and inflammation) in the title of the paper. Study selection Systematic reviews that addressed haemostasis and inflammation and the role of haemostasis and inflammation in clinical studies were included. Data extraction A special search was performed in MEDLINE with keywords (haemostasis and inflammation) in the title of the papers; extraction was performed, including assessment of the quality and validity of the papers that met the prior criteria that describe haemostasis and inflammation and their role in clinical studies. Data synthesis It included the main result of the review. Each study was reviewed independently; the obtained data were rebuilt in a new language according to the need of the researcher and arranged in topics through the article. Conclusion Improved understanding of the molecular mechanisms that play a role in the bidirectional relationship between inflammation and haemostasis could help in the clinical management of patients by identifying new potential therapeutic targets that can modify excessive and inappropriate activation or deregulation of both systems. On the basis of experimental and clinical studies, it is likely that simultaneous modulation of both inflammatory and haemostatic activities, rather than specific therapy aimed at only one component, could be more successful in the treatment of clinical states and diseases in which a close link between inflammation and haemostasis considerably contributes to the pathogenesis or progression of the disease.

Objective The aim of this work was to study obsessive-compulsive disorder (OCD) from the Islamic viewpoint and programs of Islamic cognitive behavioral therapy (CBT) in OCD. Background OCD in Arab and Islamic populations is mostly viewed and managed from a religious perspective, and these individuals are often more religious and more likely to seek out religious counseling and less likely to receive medical treatment. Most early Islamic scholars associated most cases of OCD to the devil and related it to religion; they established Islamic legislations on the basis of this concept. Research from the Islamic viewpoint on issues linked to these disorders can prevent exploitation of patients by swindlers and imposters on the basis of religion. Methods The authors performed a systematic review and a narrative synthesis of studies; relevant publications were identified, reference lists were examined, and citation searches were performed. No restrictions on date or type of study were applied. Recent findings Religious patients receiving religious psychotherapy showed significantly more rapid improvement, and required lower dosage of medications and for periods less than others. The role of religion as CBT could be significant in the Islamic culture. Conclusion OCD is quite different from the whispers of Satan or self-talk by the Islamic understanding. Islamic legislation for patients with OCDs has to be revised in accordance with changes in the concept of obsessions in Islamic considerate. The religious component in CBT can be effective for religion-oriented OCD patients in Islamic culture. Education on OCD and specialized treatment trainings in religious settings could be beneficial to providing therapies. The correct teachings of Islam provide adequate support for individuals with scrupulous obsessions.

Introduction Subclinical endocrine disorders are entities of mild degrees of endocrine dysfunction with no recognizable clinical findings. Objectives To shed light on up-to-date information on subclinical endocrine disorders and provide a brief overview of the risks, diagnosis, and workup of these disorders. Materials and methods We searched reference electronic databases, especially ScienceDirect, The Lancet, and Medscape, in the title of the article with the key words mentioned; extraction was carried out, including assessment of the quality and the validity of papers. Studies on subclinical disorders of each gland were collected; each study was reviewed independently. The data obtained were rebuilt in new language and divided into topics throughout the article. Recent findings There is strong evidence supporting the evolution of subclinical entities of various endocrine disorders. Some of these entities may behave as clinical ones, with possible adverse effects on body systems; thus, some symptoms may manifest soon, whereas others may be discovered accidently during routine laboratory and radiological investigations and they require careful periodic follow-up. Conclusion Subclinical hypothyroidism and subclinical Cushing's syndrome are well-known disorders. There have been advancements in early detection using screening programs and cases of these disorders. There is also evidence supporting their negative impact on cardiovascular morbidity and quality of life. Large-scale randomized-controlled trials are needed to inform how to best care for these and to gain more knowledge of these disorders.

Objectives To discuss the pathophysiology of morbid obesity in pregnant ladies and the anesthetic management of morbidly obese parturients. Background The association between obesity and pregnancy can result in further limitation of parturient physiological reserve. Indeed, maternal obesity is associated with an increased risk of delivery and postpartum complications. Conclusion Complete understanding of the physiology, pathophysiology, comorbidies and their implications for anesthesia and analgesia in morbidly obese parturients should lead to improvement of safety and anesthetic care. 2- Reviews and Meta-Analyses. Objective To determine the anesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery. Data analysis was preformed through a search on the pub med, Google and ovid medline data base. Recent Findings early epidural analgesia during labor is valuable and that regional anesthesia is usually preferable, but a number of challenges arise. Conclusions Morbidly obese women experienced increased complications during pregnancy and childbirth. Due to the high rate of caesarean sections and the potential difficulties of emergency anesthesia among these women, epidural anesthesia during labor should be planned and administered as often as possible.

Objectives The aim of the study was to perform systematic review to summarize the investigation and management of lactose intolerance among children. Data sources Medline, articles in Medscape, AAFP, and PubMed were searched. The search was performed on 1 April 2014 and included all articles with no language restrictions. Study selection The initial search presented 320 articles. The number of studies that met the inclusion criteria was 15. The articles included lactose intolerance and health common clinical presentation, investigation to confirm the diagnosis, dietary modification and its impact on bone health, supplementation using different formula, and manifestation of lactose intolerance. Data extraction 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 There was heterogeneity in the collected data. It was not possible to perform meta-analysis. Significant data were collected. Thus, a structured review was performed. Conclusion Five articles were review articles and one systematic review summarized the clinical presentation, investigation, and management. Two studies showed the effect of lactose intolerance on bone and serum calcium and zinc as lactose intolerance prevents the achievement of an adequate peak bone mass; calcium absorption was significantly greater from the lactose-containing formula than from the lactose-free formula, whereas zinc absorption showed no difference. Six studies showed the relationship between ingested formula and clinical manifestation and relationship with methane production, which recommended the supplementation using small frequent doses or gradual increasing dose to produce adaptation. One study showed that the LCT(T/C-13910) polymorphism was associated with subjective milk intolerance and reduced bone mineral density (BMD) that may predispose to bone fractures.

Objective The aim of the study was to assess the effect of Helicobacter pylori treatment on disease activity in patients with rheumatoid arthritis. Background A triggering infectious agent has long been postulated in rheumatoid arthritis. Data on the possible role of H. pylori infection are lacking. Patients and methods Forty adult patients with established rheumatoid arthritis and dyspeptic symptoms were recruited. In all, 17 patients were H. pylori positive and 23 patients were H. pylori negative on the basis of H. pylori fecal antigen test. All infected patients were treated successfully. We evaluated the disease activity using clinical [duration of morning stiffness, tender and swollen joints counts, Disease Activity Score 28 (DAS28), visual analog scale (VAS), and Health Assessment Questionnaire (HAQ)] and laboratory parameters such as complete blood count, erythrocyte sedimentation rate, C-reactive protein (CRP), and rheumatoid factor titer at baseline and after 2 months and compared the variations in the two subgroups. Results At the initiation of the study, H. pylori-positive patients had significantly longer duration of morning stiffness, more tender and swollen joint counts, and higher value of CRP than the negative group. In addition, the DAS28 and pain scores such as VAS and HAQ were significantly higher in the positive group. After 2 months, H. pylori-eradicated rheumatoid arthritis patients differed significantly (P = 0.009-0.001) from patients without H. pylori infection in terms of improvement of tender and swollen joints count, DAS28, VAS, and HAQ. At the same time point, several laboratory indices (CRP and rheumatoid factor titer) showed significantly lower values (P = 0.003-0.001) in the H. pylori-eradicated subgroup compared with the H. pylori-negative subgroup. Conclusion Our data suggest that H. pylori infection is implicated in the pathogenesis of rheumatoid arthritis; its treatment may induce a significant improvement of disease activity over 2 months. H. pylori treatment seems to be advantageous in infected rheumatoid arthritis patients, but controlled studies are needed.

Objective The aim of the study was to evaluate the toxicity, feasibility, and efficacy of concurrent capecitabine (Xeloda) with adjuvant radiotherapy in the treatment of high-risk breast cancer patients. Background Breast cancer ranks as the first malignancy affecting women. Patients with breast cancer have high risk of locoregional and/or distant failure: the locoregional failure rate is variable depending mainly on the disease stage and the adjuvant treatment. Different radiotherapy schedules are used in the adjuvant treatment of breast cancer. Concurrent chemoradiotherapy is the standard for many solid tumors; it is promising to be investigated in breast cancer. Patients and methods This study was conducted at the Clinical Oncology Department, Menoufia University Hospital, and included patients with a high risk of breast cancer after mastectomy and adjuvant chemotherapy. They were randomized to receive radiotherapy 40 Gy in 15 fractions through 3 weeks with or without concurrent capecitabine 825 mg/m ² every 12 h on radiotherapy days. Patients were assessed for treatment regularity, toxicity, and recurrence. Results In this study, 100 patients were enrolled from April 2011 to October 2011 and followed up for 2 years; patients were randomized into 50 patients in each treatment group. Generally, the incidence of acute and late toxicities were comparable in both treatment groups with no incidence of grade III/IV early toxicity; only a mild increase in gastrointestinal side effects was noticed with capecitabine; however, 96% of the patients were able to finish their concurrent capecitabine therapy and all patients finished radiotherapy; no radiotherapy interruption occurred due to toxicity. Most of the late radiation adverse effects were grade I/II. Regarding efficacy, the concurrent capecitabine arm had better disease control locally and systemically and better disease-free survival, but the difference was statistically insignificant. Conclusion Concurrent capecitabine with postmastectomy hypofractionated radiotherapy is highly feasible, safe, and effective, but a longer follow-up is recommended.

Objective The aim of the study was to evaluate the effect of clinicopathological features and treatment modalities on clinical outcome and survival of breast cancer patients. Background Breast cancer is the most common malignancy among women in developed as well as in some developing countries. In Egypt, breast cancer constitutes 33% of all female cancer cases. Axillary nodal metastases, HER-2 status, stage of disease, and appropriate treatment are the most important factors affecting survival. Patients and methods This study included 972 patients with breast cancer who presented at the Clinical Oncology Department, Menoufia University, from January 2000 until December 2004. Data on patient and disease characteristics and treatment modalities were collected from files, and clinical outcome and survival data were reported. Results It was found that the mean age of the patients was 48.55 years (range 23-86 years). Female patients represented 99% and male patients represented 1% of cases. Among the female patients, 52.3% were premenopausal and 46.7% were postmenopausal. Invasive ductal carcinoma (IDC) was the most common (94.2%) type of cancer. Stage III was the most frequently seen stage (46.7%), followed by stage II (39.5%). Modified radical mastectomy (MRM) was the most common type of surgery performed (91.4%). In early-stage breast cancer (stages I and II), the median overall survival was 65 months and the median Disease free survival (DFS) was 55 months. There was a statistically significant correlation between overall survival and nodal status, HER-2 status, type of surgery, hormonal treatment, and site of relapse on univariate and multivariate analyses. In stage III, the median overall survival was 42 months and the median DFS was 26 months. In stage IV, the median overall survival was 17 months and the median progression-free survival was 10 months. Conclusion Axillary nodal metastases, HER-2 status, stage of disease, and appropriate treatment options are strong factors affecting the survival of breast cancer patients.

Objective The aim of this study was to assess the impact of primary tumor resection on the survival and quality of life in women with stage IV breast cancer. Background About 3-10% of patients with breast cancer have distant metastases (stage IV) at initial presentation. Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined strictly to palliation. However, retrospective studies have shown improved survival in patients who have undergone surgery for their primary tumor. Thus, new clinical questions have emerged in terms of surgery of the primary site in those women with metastatic disease and a resectable intact primary tumor. Patients and methods This study included patients with stage IV breast cancer who presented to the Clinical Oncology Department, Menoufia University, from September 2009 till August 2011. Patients were divided on the basis of treatment into two groups: those who underwent surgery and those who did not undergo surgery. All patients then received anthracyclin-based chemotherapy, followed by hormonal treatment according to hormonal status. Patient characteristics and survival were evaluated using univariate and multivariable analyses. Results In total, 151 patients were included in this analysis; 61 patients underwent surgery and 90 patients did not. The median survival of the patients who underwent surgery for their primary tumor was significantly longer than that for the patients who did not undergo surgery (39 vs. 24 months). The median time to progression in the surgery group was 26 months versus 13 months in the no-surgery group. The 2-year survival was 73.8% in the surgery group compared with 38.9% in the no-surgery group. A multivariate proportional hazards model identified the grade of tumor as a significant independent prognostic factor. Conclusion Primary tumor resection increased survival in patients with metastatic breast cancer. Thus, the role of surgery in women with stage IV breast cancer needs to be re-evaluated.

Objectives The aim of this work is to study oxidative stress and the profile of antioxidant mechanisms in common neonatal disorders. These disorders are prematurity, neonatal hyperbilirubinemia, and perinatal asphyxia. This study also aimed to evaluate the effect of treatment of these disorders on oxidative stress. Background In a broad sense, oxidative stress may be considered an imbalance between prooxidant and antioxidant forces or between the amount of reactive oxygen species and antioxidant defenses. The term oxygen radical disease of neonatology has been suggested to designate diseases whose pathogenesis includes tissue aggression from free radicals and reactive oxygen species. However, the mechanisms involved are more complex and involve more than oxidative stress; inflammation, infection, and other factors are important in preterm and neonatal diseases such as neonatal hyperbilirubinemia and exposure to perinatal asphyxia. Materials and methods Fifty neonates were studied. Clinical assessment, lab detection of antioxidant enzymes (catalase, glutathione perioxidase, and superoxide dismutase) in plasma, and oxidation reaction initiated by free radical products (F8-isoprostane and melanodialdehyde) in plasma at admission to NICU and before discharge were performed. After discharge, 15 neonates were studied as controls (healthy neonates being followed up at the outpatient clinic and matched for sex and postneonatal age). The remaining 35 neonates were divided into three groups: preterm group, hyperbilirubinemia group, and perinatal asphyxia group. Results At admission, the plasma level of antioxidant enzymes was insignificantly suppressed in the preterm group, except superoxide dismutase, which was significantly suppressed. The level of antioxidant enzymes was insignificantly higher in neonates with hyperbilirubinemia and significantly suppressed in neonates exposed to perinatal asphyxia; there was no significant difference in the level of oxidation reaction products in preterm and neonatal hyperbilirubinemia groups compared with the controls, but their level was significantly increased in neonates exposed to perinatal asphyxia. Before discharge, preterm patients received a higher concentration of oxygen (in the form of mechanical ventilation), and oxidation reaction products were significantly elevated as in neonates exposed to perinatal asphyxia. Conclusion Oxidative stress plays a definite role in the pathogenesis of complications caused by immaturity and neonatal exposure to oxidative stress favoring factors such as oxygen and many life-saving procedures used in the NICU.

Objective The aim of this study was to assess mast cell tryptase (MCT) expression in skin tags (STs) in comparison with normal skin. Background STs or acrochordons are common benign connective tissue of the dermis that are composed of loose fibrous tissue, in middle-aged and elderly individuals, located predominantly in intertriginous skin and neck, which consists of a bit of skin projecting from the surrounding skin. Patients and methods This study was carried out on 30 patients and 10 control participants. One biopsy was obtained from each patient. Mast cell count and mast cell density were assessed by immunohistochemical staining for MCT and expressed as mean, median, and range (the average mast cell count/high-power field). Results The results of the present study showed a statistically significant increase in the mast cells count in STs in comparison with normal skin. Conclusion Higher expression of MCT in ST compared with normal skin and this enzyme mediator may be responsible for induction of fibrosis in ST.

Objectives The main aim of this study was to improve the referral system. The specific aims were to determine the referral rate, to study its current status as well as to identify the obstacles at family health facilities in Shebein El-Koum District, Menoufia Governorate, Egypt. Background The referral system is a process that ensures accessibility to higher levels of medical care for patients attending the primary healthcare facility. Referral is usually sought to obtain expert professional advice, undergo a diagnostic technique, seek a therapeutic intervention, or receive inpatient care when these are not available at the referring site. The referral system aims to provide efficient, effective, affordable, and equitable community-based healthcare services. For a successful referral, there must be first and foremost geographical access to referral care facilities, referral staff must be trained to provide high-quality care, services must be affordable, and essential drugs, supplies, and equipment must be available. Participants and methods A cross-sectional study was carried out from 1st of March 2011 to the end of April 2013 in all rural and urban family health units/centers (No. 23 and 4, respectively) of Shebein El-Koum District, which was selected randomly to represent Menoufia Governorate, Egypt. All the managers (No. 25), family physicians (No. 125), and nurses (No. 186) at the site of the study were subjected to a predesigned questionnaire for complete assessment of the current status of the referral system. Results The referral rate was significantly higher in urban versus rural areas (16.2 and 11.2%, respectively). The usage of referral letter is the main means of referral; the highest referral rate was among adults and the lowest was among adolescents. There was no significant difference in the referral rate in terms of sex in either urban or rural facilities. Training of the physicians is considered an important factor for quality assurance of the referral system. Conclusion We found that the highest referral rate was found among adults; however, the lowest referral rate was found among adolescents. The rate was high for ENT and Ophthalmology Clinics. Lack of training and availability of means of transportation and absence of feedback were the most common obstacles for the referral process.

Objective The aim of the study was to determine the clinical profile of genital warts (GWs) among Egyptians and evaluate the therapeutic effect of podophyllotoxin. Background External GWs are caused by proliferation of squamous epithelial cells secondary to human papillomavirus infection. It is sexually transmitted and affects sexually active adults and adolescents. The reason for its occurrence in children without evidence of sexual abuse is still unclear. There are several treatment options, but none has been proven to be the most efficacious. Patients and methods All patients complaining of GWs were recruited from the Dermatology Outpatient Clinic of Menoufia University Hospital during the period from March to September 2011. The patients were investigated for HIV and syphilis. Cervical Pap smear, colposcopy, and anoscopy were performed. Biopsies were taken from every patient to confirm the diagnosis. Podophyllotoxin 0.5% solution was used for treatment. Results A total of 140 cases of GWs were found among patients attending the Dermatology Outpatient Clinic, and included 100 female and 40 male patients (132 adults and eight children). A total of 120 patients received podophyllotoxin treatment and 20 were excluded as they were pregnant. Response to podophyllotoxin was variable and ranged from complete cure to absolute resistance. Conclusion Podophyllotoxin was well tolerated and had a good cure rate.

Objective The aim of this study was to examine the evidence for impact of bacterial sepsis and multiple organ failure in patients with liver cirrhosis. Data sources A review of contemporary (1995 to present) English medical literature using the terms bacterial infection, hepatic encephalopathy, multiple organ dysfunction, and spontaneous bacterial peritonitis was conducted. Study selection Abstracts were reviewed independently by two authors, and relevant articles were then evaluated. Exclusion criteria included editorials, non-English language, comments, and letters. Data extraction Level of evidence was assigned in accordance with the Oxford Center for Evidence-based Medicine guidance (levels I-V). Results Thirty-seven articles met the inclusion criteria; of which, 11 were of level III, 22 of level IV, and four of level V evidence. Bacterial sepsis and multiple organ failure are common in patients with liver cirrhosis. There was level III evidence that third-generation cephalosporins are the treatment of choice for infections in patients with liver cirrhosis. Conclusion This review indicates that bacterial sepsis and multiple organ failure are common in patients with liver cirrhosis, supported principally by level III/IV evidence.

Objective The aim of the study was to measure serum zinc level as a free radical scavenger in vitiligo patients to help us understand the pathogenesis of this disease entity. Background Vitiligo is a common and chronic skin disease. A deficiency of antioxidant substances is found in vitiliginous skin. Zinc is considered an antioxidant that also plays an important role in the process of melanogenesis. In addition, studies have shown a variation in zinc level in patients with vitiligo. Patients and methods This study was conducted on 60 patients with vitiligo who were selected from the Dermatology Outpatient Clinic, Faculty of Medicine, Menoufia University Hospital, during the period from April 2013 to October 2013, and on 60 healthy controls. Serum zinc level was measured in both groups using a Flame Atomic Absorption Spectrophotometer. Results Results showed that the mean zinc level of vitiligo patients was 104.0 ± 20.1 mg/100 ml and that of controls was 93.2 ± 19.5 mg/100 ml. The mean zinc level in both groups was found to be within the normal reference range and in vitiligo patients the mean zinc level was observed to be statistically significantly higher than that of controls (P < 0.05). There was a statistically significant association between serum zinc level in the studied cases and course of the disease as patients with progressive vitiligo showed significantly lower values. Conclusion In our study, serum zinc levels in patients with vitiligo were found to be within the normal range but higher than that of controls. Further studies may reveal a more significant relation between serum zinc and vitiligo.

Objectives The aims of this study were to correlate liver span measured clinically in healthy Egyptian children from 12 to 18 years of age in Dakahliah with ultrasound findings, and to obtain normal values of both liver and spleen spans in Egyptian children. Background A sound measurement of the liver size in children of different age groups is necessary to enable the pediatrician to exclude hepatomegaly. Participants and methods This study included 331 healthy Egyptian school children from Dakahliah, Aga district, from 12 to 18 years of age of both sexes (224 male and 107 female). The children underwent a complete physical examination and subsequent ultrasonographic scans were performed for the liver and spleen. The liver span in the midclavicular line was estimated clinically by palpation and percussion, both the liver and the spleen were measured by ultrasonography, and the values were tabulated and graphed. Results Normal values of liver and spleen measures were classified by age and sex; data were tabulated and graphed. There was a statistically significant correlation between clinical and ultrasound measures of liver span (midclavicular line, midsternal line) in healthy children. The liver span also correlated with body weight, height, and BMI and ultrasound spleen axis. Conclusion We could record a standard liver and spleen normogram on Egyptian children from 12 to 18 years of age. Also, clinical estimation of liver span showed a significant correlation with ultrasonographic findings in all our healthy children; thus, we can continue to use clinical methods for the evaluation of liver size in children.

Objectives To clarify the role of leptin in the pathogenesis of psoriasis. Background Psoriasis is considered a systemic disease with significant cardiovascular comorbidity. Studies suggested that hyperleptinemia might play an important role in obesity-associated cardiovascular diseases, including atherosclerosis. Methods The study included 40 consecutive patients with plaque-type psoriasis and 10 control individuals The patients were recruited from the Dermatology Outpatient Clinic, Faculty of Medicine, Menoufia University, and Shibin El Kom Educational Hospital. All the patients underwent were performed: Complete history taking, clinical examination, laboratory investigation to determine leptin concentration using solidphase ELISA and skin biopsies. Results The serum leptin level was significantly higher in psoriatic patients than in controls. There were statistically significant correlations between the serum leptin level and PASI score and duration of the disease, but insignificant correlations with respect to other clinical and histopathological parameters. Conclusion The study supports the view that leptin may be involved in the pathogenesis of psoriasis in overweight individuals.

Objective The aim of this study was to assess intermediate coronary lesions as detected by visual estimation in coronary angiography using two invasive modalities: fractional flow reserve (FFR) and intravascular ultrasound. Background The significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of more than 40% to less than 70%, continues to be a therapeutic dilemma for cardiologists. The two-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. Patients and methods Thirty patients with intermediate coronary stenosis on coronary angiography were subjected to a noninvasive stress test, either exercise myocardial perfusion imaging or stress echocardiography, and the results were compared with those of intravascular ultrasound and FFR. Results In this study, 30 patients were subjected to FFR measurement. Twelve of 14 patients had an FFR of less than 0.80; reversible ischemia was detected on the stress test. In contrast, only two of 16 patients with an FFR of more than 0.80 had a negative stress test for reversible myocardial ischemia. FFR value has a sensitivity and a specificity of 85.7 and 87.5%, respectively, in predicting the results of a noninvasive stress test, with a positive predictive value and negative predictive value of 85.7 and 87.5%, respectively, with an accuracy of 86.7%. It is also showed that the best cutoff value for the minimal luminal area that is concordant with FFR values is less than 4.5 mm ² , which has a sensitivity and a specificity of 57.1 and 56.3%, respectively, and positive predictive value of 53.3% and negative predictive value of 60%. Conclusion In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index for assessment of the functional severity of coronary artery stenosis in comparison with a noninvasive stress test and can be used as a guide before coronary revascularization.

Background The rationale for the recanalization of chronic total occlusion (CTO) is the possible improvement in left ventricular (LV) function through the recovery of hibernating myocardium. Tissue Doppler imaging (TDI) can be used for the assessment of global and regional LV function with high temporal and spatial resolution. Purpose This study aimed to assess LV function before and after CTO-percutanous coronary intervention (PCI) by pulsed wave (PW)-TDI. Patients and methods The present study enrolled 40 patients with CTO; 37 completed the final follow-up: 22 patients did not have infarction in the territories of recanalized CTO vessel (group I), and 15 patients had infarction in the CTO territories of recanalized CTO vessel (group II). All patients were subjected to conventional M-mode and two-dimensional echo-Doppler and TDI examination. PW-TDI was used to assess the velocity curves of basal and mid segments of the septal, lateral, anterior, inferior, posterior, and anteroseptal LV walls. The following indices were measured: Tp, Sv, E0΄, A΄, E΄/ A΄, acceleration of isovolumic contraction (IVC), isovolumic relaxation period, isovolumic contraction time (IVCT), contraction time, and TEI index. Results After recanalization of the CTO vessel by PCI, the patients in the noninfarction group showed a highly significant improvement in left ventricular ejection fraction% after 3 months of follow-up (P < 0.001), whereas the infarction group did not show any significant improvement (P = NS). In the LAD, left circumflex, and right coronary artery subgroup, noninfarction patients showed a reduction in left ventricular end-systolic volume, and increased fraction shorting% and ejection fraction% after 3 months of follow-up; also, there were improvements in TDI parameters in the form of increased E΄ and acceleration of IVC in all three subgroups and increased E΄/ A΄ in LAD and left circumflex, and an increase in the peak velocity of IVC and a reduction in A΄ and time to peak of IVC in both LAD and right coronary artery; only the S wave velocity increased in the LAD subgroup after 3 months of follow-up. Conclusion In patients with CTO, acceleration of IVC measured by PW-TDI can differentiate early improvement after successful recanalization of the CTO vessel by PCI. Noninfarction territories might show earlier recovery than that in patients with evident myocardial infarction.

Objectives This study was carried out to explore the changes and clinical significance of urea and creatinine in saliva in patients with chronic kidney disease (CKD) and provide a noninvasive, quick, accurate, and reliable test for diagnosing kidney disease. Background Monitoring of markers in saliva instead of serum is advantageous because saliva collection is a noninvasive, simple, and inexpensive approach. Measurement of biomarkers in saliva may be an effective alternative method for monitoring the effectiveness of hemodialysis. Patients and methods Urea and Cr in the saliva and serum were collected from both healthy individuals and CKD patients and measured with a biochemical analyzer. Fifty individuals participated in this study, divided into 40 patients with CKD and 10 apparent healthy controls. Results The concentrations of urea and Cr in both saliva and serum were positively correlated in healthy individuals and CKD patients. The levels of saliva urea and Cr in CKD patients were significantly higher than those of healthy individuals (P < 0.05). Saliva urea and Cr concentrations of middle-stage and late-stage CKD patients were higher than those of healthy people and early-stage CKD patients (P < 0.05). Areas under the curve of the receiver operating characteristic of saliva creatinine and urea and serum creatinine and urea were, respectively, 0.876, 0.796, 0.942, and 0.922 and specificity was 80, 80, 90, and 80, respectively. Conclusion The levels of urea and Cr in saliva and serum are closely related. The concentration of saliva urea and Cr can reflect renal damage, monitor the kidney function of CKD patients, and help in the diagnosis of middle-stage and late-stage CKD. It is a simple, noninvasive, and quick method.

Objectives The aim of this work was to study the complications of 6-mercaptopurine (6-MP) drug therapy developed during the course of chemotherapy in children with acute lymphoblastic leukemia (ALL). Background Mercaptopurine is an anticancer drug used in the routine treatment of pediatric patients with ALL, which is administered daily during maintenance phases of chemotherapy. The principal and potentially serious toxic effects of 6-MP are bone marrow toxicity and hepatotoxicity. Patients and methods Twenty-five children with ALL were included in the present study. Initially, complete blood count, liver function tests (alanine aminotransferase, aspartate aminotransferase), bone marrow examination, immunophenotyping, and cytochemical analysis were performed. Markers for hepatitis B and C using PCR were applied/determined. Data on toxicity were traced during the maintenance phase. Results During the maintenance phase, 16.0% of patients were seen to have febrile neutropenia grade 2 (ANC < 1.5 to >1.0 × 109/l), 56.0% to have febrile neutropenia grade 3 (ANC < 1.0 to >0.5 × 109/l), and 28.0% to have febrile neutropenia grade 4 (ANC < 0.5 × 109/l). Sixteen percent of patients had mildly elevated levels of liver enzymes up to 200 IU/l, 32.0% had elevated levels of liver enzymes more than 200 IU/l, and 52.0% of patients had normal levels of liver enzymes. Eight percent of patients did not need drug interruption, 24.0% needed interruption for up to 1 week, and 68.0% of patients had to discontinue 6-MP for more than 1 week. An overall 16.0% of patients required 6-MP dose modification by 25-50% reduction of total dose, 4.0% needed 6-MP dose modification by less than 50% reduction of total dose, and 80.0% did not need dose modification throughout the maintenance course. The total number of mortality cases was 10 (40.0%) of 25 patients. Conclusion 6-MP could induce hematological toxicity and several forms of hepatotoxicity. 6-MP dose reductions should be performed throughout the maintenance phase according to the protocol.

Objective The main objective of the study is to evaluate the knowledge, attitudes, and practices (KAP) of adolescents regarding viral hepatitis B and C. Background Viral hepatitis is a silent epidemic, as it is a leading infectious cause of death, and affects the lives of 12 000-15 000 Americans each year. Adolescents are thought to be at risk because of their high-risk behaviors. They must improve their awareness about these infections to protect themselves. Participants and methods This is a cross-sectional study based on the multistage stratified random-sampling technique. Ashmoun district was selected randomly from nine districts of Menoufia governorate; one rural school (Shanshour school) and one urban school (Amin El Kholy school) were selected from Ashmoun district, and 640 students aged between 16 and 18 years were selected randomly from students attending both schools. Students were asked to fill a predesigned questionnaire regarding their KAP towards hepatitis A, B, C, and D infection including their KAP for prevention and control. Results The mean age of the participants was 17.25 ± 0.84 years (mean±SD). A total of 180 participants were male (30%) and 420 (70%) were female. The mean of the total score of students' KAP with regard to viral hepatitis were 58.11 ± 9.3, 13.07 ± 2.86, and 7.99 ± 2.84, respectively. Although 78 and 75% of the students had fair knowledge and attitude, respectively regarding viral hepatitis, only 31% had fair practice for self-protection. The sex, the socioeconomic status, and the source of knowledge constituted significant determinants of their knowledge. Conclusion There was no relation between students' knowledge and attitude regarding viral hepatitis and their practice for self-protection against it.

Objective The present work was designed to evaluate the role of multidetector computed tomography (CT) scanning in the diagnosis of sequelae of acute head trauma. Background Head trauma is a major cause of death and disability. CT of the head is commonly considered to be the imaging modality of choice for the diagnosis of sequelae of acute head trauma. CT imaging has vastly improved from single-section scanning to the present multidetector row CT (MDCT). MDCT has improved the diagnostic value through the availability of postprocessing techniques such as multiplanar reformation and three-dimensional reconstruction imaging. Methods We studied 63 patients, aged between 12 days and 70 years (mean age, 20 years), presenting to the Emergency Department of Kafr El-Dawar General Hospital with a history of acute head trauma from May 2013 to January 2014. All patients were examined using an MDCT scanner and showed positive findings on head MDCT. Results MDCT (Multiplanar reconstruction (MPR) and three-dimensional reconstruction images) added more information to the routine axial images alone in 32 (27%) of the 118 CT findings. It better demonstrated the type and extension of skull fractures in 18 patients (36% of patients with skull fractures and 28.6% of all patients), added more diagnostic value in 10 patients with extra-axial hemorrhages (22.7% of patients with extra-axial hemorrhages and 15.9% of all patients), and better demonstrated the contusions in four patients (21% of patients with hemorrhagic contusions and 6.3% of all patients). Conclusion MDCT was successful in the adequate characterization of the extent and type of hemorrhages and skull fractures in cases of acute head trauma.

Objectives The aim of the study was to determine the effect of phototherapy on serum calcium level in neonatal jaundice. Background Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. However, this treatment modality may result in the development of some complications such as induction of hypocalcemia. Patients and methods This study included 50 full-term neonates with jaundice (25 males and 25 females) who received phototherapy for treatment of neonatal indirect hyperbilirubinemia and 25 neonates (13 males and 12 females) complaining of exaggerated physiological hyperbilirubinemia taken as control not exposed to phototherapy. Serum calcium was checked before and 48 h after starting phototherapy. A comparative study was conducted between these groups to determine the effect of phototherapy on serum calcium level. Results In the neonates of the study group, the serum bilirubin level before phototherapy was 15.48 ± 1.94 mg/dl. However, the serum bilirubin level after phototherapy was 12.41 ± 2.10 mg/dl. There was highly statistically significant decrease of the serum bilirubin levels after phototherapy as compared with serum bilirubin levels before phototherapy in the study group (P < 0.001). With respect to the calcium level, the total serum calcium level before phototherapy was 9.36 ± 0.29 mg/dl, whereas the serum calcium level after phototherapy was 8.58 ± 0.76 mg/dl. There was highly statistically significant decrease of the serum calcium levels after phototherapy as compared with serum calcium levels before phototherapy in the study group. Conclusion Hypocalcemia is a common complication of phototherapy.

Objectives The objectives of this study were to compare immunoglobulin (Ig) levels in children with nephrotic syndrome and healthy children to understand changes in diseased state and predict response to treatment. Background Nephrotic syndrome is an immune-mediated disorder of the kidney associated with T-cell dysfunction and secondary disturbance of B-cell with changes in levels of Ig and the IgG : IgM ratio. These changes in Ig levels can be used as a proxy marker to determine the clinical variety and prognosis of nephrotic syndrome. Materials and methods Twenty-five children with nephrotic syndrome attended the Nephrology Unit of Pediatric Department of Menoufia University Hospital from October 2011 to January 2013. Their ages ranged from 1 to 15 years (mean = 6.3 years); 12 (60%) were boys and eight (40%) were girls. All patients were in the active stage of the disease. Twenty-five apparently healthy children were enrolled as a control group. Results In the 25 children with nephrotic syndrome, 10 (40%) had steroid-sensitive nephrotic syndrome, five (20%) had steroid-resistant nephrotic syndrome, five (20%) developed frequent relapses, and five (20%) had infrequent relapse nephrotic syndrome. Compared with the healthy children, the IgG level was low, the IgM level was high, and the IgG : IgM ratio was low ( P ≤ 0.05). The serum IgG level and the IgG : IgM ratio were significantly lower in children with steroid-resistant nephrotic syndrome and in children with steroid-dependent nephrotic syndrome than in those with infrequent relapse nephrotic syndrome and in children with steroid-sensitive nephrotic syndrome ( P ≤ 0.05). Conclusion Management of different nephrotic syndromes is based on the levels of Ig along with clinical and biochemical parameters. The decrease in the IgG level as a predictive marker for an unfavorable prognosis of nephrotic syndrome in children needs further evaluation in larger scale studies.

Objective Evaluation of the safety and the efficacy of different anticoagulants in thromboembolic prophylaxis after major abdominal surgeries. Background Thromboembolic events are serious complications after major abdominal surgeries, and there are different modalities to prevent them. Materials and methods Sixty patients who underwent major abdominal surgery were assigned in a randomized, double-blinded manner and classified into three groups: group A (n = 20) was started on enoxaparin at a daily dose of 40 mg. Group B (n = 20) was given recombinant hirudin 15 mg twice daily. Group C (n = 20) was given fondaparinux 2.5 mg subcutaneously daily. The duration of treatment was 5-12 days. The efficacy of the three drugs was compared by the occurrence of DVT (assessed by Doppler ultrasound) or fatal and nonfatal pulmonary embolism (by computed tomography). The safety was assessed by postoperative bleeding in terms of the number of transfused whole blood units, plasma expanders, or packed red blood cells and fatal bleeding. Results Results showed that enoxparin, fondaparinux, and recombinant hirudin were equally effective in the prevention of thromboembolism. The least risk of postoperative bleeding was noticed in patients receiving enoxparin in comparison with patients receiving fondaparinux or recombinant hirudin. Conclusion Enoxaparin, hirudin, and fondaparinux are equally effective in protection against thromboembolic events in patients undergoing major abdominal surgeries; however, enoxaparin is superior to the others regarding safety.

Objective The aim of the study was to evaluate the quality of life (QoL) of asthmatic children and their parents and assess the effect of the disease on the QoL of their parents. Background Asthma is a public health problem that adversely affects different aspects of an individual's QoL. Childhood asthma is common in Egypt and is associated with repeated school absenteeism and hospital admission. The family and particularly the primary caregiver may face considerable burden. Participants and methods This is a case-control study carried out on 100 children with bronchial asthma, aged between 7 and 15 years, attending the Outpatient Clinic of the Pediatric Department of Menoufia University Hospital, and their primary caregivers. These children were compared with 100 control children whose diagnosis was free of bronchial asthma or any chronic diseases, as well as their primary caregivers. The following questionnaires were administered: the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire. In addition, the parents' socioeconomic level was determined. Results The scores of all parents and children in the study group were lower than the scores of controls. Parents' activity score and child's activity score were the most affected domains. There was significant relationship between the parents' score and child's score. The caregiver's and child's health-related QoL was significantly associated with each other. Age, sex, and socioeconomic status revealed no significant difference. Conclusion Childhood asthma significantly adversely affects the QoL of the affected children and their primary caregivers.

Objective The aim of this study was to determine the effectiveness and safety of transcatheter arterial chemoembolization (TACE) using iodized oil with and without gel foam for the management of hepatocellular carcinoma (HCC). Background HCC is one of the most common malignant diseases worldwide, with an increasing incidence in the industrialized countries. The extensive application of surveillance programs for the early detection of HCC in high-risk patients has increased the number of tumors detected at a subclinical stage as well as those that are responsive to effective treatments. Patients and methods This study was carried out on 40 patients with HCC; of these, 20 patients were treated with TACE by lipiodol and adriamycin, group I, and 20 patients were treated with TACE by lipiodol and adriamycin, followed by gel foam, group II. Results A unique criterion of this study is that all the entire study population of the cirrhotic groups had posthepatitic cirrhosis (hepatitis C virus). After TACE, there was a decrease in tumor size, safe in liver function, and a decrease in α-fetoprotein. Conclusion TACE was safe and effective in the treatment of HCC. We found a trend toward greater survival when gel foam was used as the embolic agent for TACE for HCC, although this was not significant compared with lipiodol.

Objectives This work aimed to study the incidence of false-positive brucellosis among tuberculosis (TB) patients and to study the difference between the standard tubal agglutination method and enzyme-linked immunosorbent assay (ELISA) in the presence of false-positive results when used in the diagnosis of brucellosis. Background The diagnosis of brucellosis is usually made by the standard tubal agglutination method and ELISA, but false-positive results are observed by the two methods in TB patients as well as normal individuals. Comparison between the TB patients and normal individuals for the presence of false-positive brucellosis is very important. Patients and methods A comparison between TB patients and normal individuals was performed for the presence of false-positive brucellosis using both tubal agglutination methods and ELISA; tubal agglutination methods and ELISA were compared for false-positive results when used in diagnosing brucellosis. Results Ten percent of TB patients had false seropositive brucellosis by both ELISA and tubal agglutination methods, whereas 2.5% of normal individuals had false seropositive brucellosis by both ELISA and tubal agglutination methods; these results were statistically insignificant. There were no statistically significant differences between the results obtained by Brucella ELISA and tubal agglutination methods when used in the diagnosis of brucellosis. Conclusion Four out of 40 TB patients showed false positive seroreactivity for brucellosis, whereas one out of 40 individuals included as controls showed false positive seroreactivity for brucellosis; these results were statistically insignificant. That is, there was no statistically significant difference between TB patients and normal individuals in false positive seroreactivity for brucellosis. There was no statistically significant difference between the results obtained from ELISA and the tubal agglutination test in false positive seroreactivity for brucellosis.

Objectives The aim of the study was to evaluate the prevalence of hyponatremia in liver cirrhosis and the correlation between serum sodium and the Model for End-Stage Liver Disease (MELD) score in patients with liver cirrhosis. Background Hyponatremia (Na<135 mEq/l) is a common finding in advanced liver cirrhosis. Cirrhotic patients with hyponatremia have poor survival compared with cirrhotic normonatremic patients. There is an association between the presence of hyponatremia and the presence of certain liver cirrhosis complications such as hepatic encephalopathy, hepatorenal syndrome, and refractory ascites. Therefore, it was suggested that hyponatremia has a good predictive value of mortality in hepatic cirrhosis even with low MELD scores. Patients and methods In all, 100 patients with liver cirrhosis were enrolled in this study, 20% compensated and 80% decompensated. The decompensated group was subdivided into four subgroups according to the cause of admission. Results In compensated cirrhosis the prevalence of hyponatremia was 0/20 (0%), whereas that in decompensated cirrhosis was 47/80 (59%). Also the prevalence of hyponatremia differed according to the complication itself, being highest in hepatorenal syndrome and hepatic encephalopathy (74 and 71%, respectively) and the lowest in variceal bleeding (45%). In decompensated cirrhosis, there was strong inverse correlation between serum sodium and MELD score (r = −0.496 and P < 0.001), whereas there was no significant correlation in compensated cirrhosis (r = −0.324 and P = 0.163). Conclusion The importance of hyponatremia in advanced cirrhotic patients should not be overlooked because it may have a role in the prediction of survival in liver cirrhosis.

Objectives The aim of the study was to investigate the changes in serum hepcidin and ferritin level in chronic hemolytic anemia (β-thalassemia major and sickle cell disease) to clarify the relation between hepcidin level and iron regulation. Background The hallmark of hemolytic anemia is reduced life span of RBCs. In β-thalassemia there is excess α-globin chain relative to β-globin chain; α-globin tetramers are formed, and interact with RBC membranes and shorten RBC survival, leading to anemia and increased erythrocyte production. Sickle cell anemia is caused by an abnormal type of hemoglobin called hemoglobin S, which distorts the shape of RBCs, especially with hypoxia. Frequent blood transfusion without proper iron chelation causes hemochromatosis. Recently, the predominant negative regulator of iron absorption and iron release was discovered - namely, hepcidin, the 25-amino acid peptide produced by hepatocytes. Patients and methods The study was carried out on 55 children, categorized into 23 children with thalassemia major, 12 with sickle cell disease, and 20 apparently healthy control children, who were matched in age, sex, and socioeconomic standard. Complete blood count, analysis of serum ferritin, hemoglobin electrophoresis, liver and renal function tests, and evaluation of serum hepcidin level using enzyme-linked immunosorbent assay kits were performed. Results Ferritin level in thalassemia and sickle cell patients was significantly higher than in controls (P < 0.001). Hepcidin level in thalassemia and sickle cell patients was higher than in controls (P < 0.001). Serum ferritin showed significant negative correlation with serum hepcidin level in thalassemia patients (P < 0.05). Regarding sickle cell, there was no significant correlation between ferritin and hepcidin levels (P = 0.812). Conclusion In future, hepcidin level may allow more accurate assessment of the degree of iron overload and iron misdistribution.

Objective The aim of this study was to evaluate sexual and reproductive functions in men with Down's syndrome. Background Down's syndrome is a genetic condition that occurs due to an extra copy of chromosome 21. Affected children show characteristic features and associated diseases in different body systems. All of these diseases have received much interest of researchers and can be managed. However, sexually transmitted infections (STIs), the sexual development, associated congenital anomalies of the genital organs, sexuality, and reproductive disorders of these people have not gained much attention. Patients and methods A case-control study was carried out on 21 Down's syndrome male patients (patient group), aged 21-28 years. Another 21 healthy, age-matched volunteers were included as the control group. Full sexual history was obtained from all participants , including the age at puberty, desire of marriage and parenting children, practice of masturbation, and attraction to the other sex. Follicle-stimulating hormone, luteinizing hormone, prolactin, total testosterone, and estradiol levels were measured and the BMI was evaluated. Results Patients included in the study entered puberty and became fully sexually mature, but later than their healthy peers. More than half (57.1%) of Down's syndrome patients were sexually active, masturbated, were attracted to the other sex, and had the desire to marry. Down's syndrome patients showed a higher BMI. Follicle-stimulating hormone, luteinizing hormone and prolactin levels were significantly higher in Down's syndrome patients compared with the controls. They showed a lower serum total testosterone. The serum estradiol was normal. Conclusion According to our results, some men with Down's syndrome have normal sexual development. They can marry and father children.

Objectives Magnesium (Mg) is thought to be an important element in the pathogenesis of acute asthma attacks. This study aimed at investigating plasma and erythrocyte Mg of acute asthmatic children and correlating them with asthma severity. Background Continuous efforts are still exerted to understand the natural history and pathogenesis of acute asthma to alleviate its burden on children and their families. Mg is an abundant intracellular cation. It is involved in numerous physiological functions, including protein folding, intracellular signaling, enzymatic reactions involving protein and nucleic acid metabolisms, and enzyme catalysis. Mg is involved in pathophysiological reactions related to asthma; it has been shown to relax bronchial smooth muscles in vitro and to dilate asthmatic airways in vivo. It has been shown that intravenous administration or inhalation of Mg could alleviate symptoms in acute asthma. Patients and methods This case-control study included 43 Egyptian outpatients with acute asthma. A total of 21 apparently matched healthy children were included as controls. All candidates had measurements of plasma and erythrocytic Mg levels during an acute asthma exacerbation. Findings No significant differences were detected in plasma Mg levels between cases and controls (0.71 ± 0.12 vs. 0.76 ± 0.1 mmol/l, respectively, P = 0.14). However, erythrocytic Mg levels were significantly reduced in cases when compared with controls (1.2 ± 0.08 vs. 2.01 ± 0.14 mmol/l, respectively, P < 0.001). Conclusion Erythrocytic Mg levels were significantly lower during acute asthma, and were negatively correlated with severity of exacerbation, whereas plasma Mg did not significantly change.

Objective The aim of the study was to study the role of computed tomography (CT) in detection of complications of blunt chest trauma patients. Background Thoracic injuries are significant causes of morbidity and mortality in trauma patients. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Therefore, prompt diagnosis of blunt vascular injuries is imperative. Patients and methods This study included 100 patients, 66 male patients and 34 female patients with age distribution from 2 to 65 years. This study was conducted during the period from November 2012 to December 2013 at Menofyia University Hospitals and Shebin El Kom Educational Hospital. All patients subjected to blunt chest trauma presented to Menofyia Emergency Hospital and Shebin El Kom Educational Hospital during this given period were examined clinically. Those who had findings that suspect chest trauma on clinical examination underwent plain X-ray and CT examination. Finally, we compared between X-ray and CT in detection of complications of blunt chest trauma. Results CT has been shown to be useful for the evaluation of vascular, pulmonary, airway, skeletal, and diaphragmatic injuries as well. CT has overall greater sensitivity than radiography in the detection of pulmonary lacerations and pneumothoraces. In addition, it may be indicated in cases of suspected tracheobronchial injury . Conclusion Chest radiograph serves as the principle screening test for immediate assessment of the thorax after blunt chest trauma, whereas CT scanning, particularly with spiral capability, is highly sensitive than the supine chest X-ray at detecting intrathoracic injuries.

Background Psoriasis is a common chronic, recurrent, and immune-mediated disease of the skin and joints that follows a relapsing and remitting course. Psoriasis represents a T-cell-mediated inflammatory skin disease that includes the activation of both Th1, which produces interferon-g (IFN-γ), tumor necrosis factor-α, and interleukin-2 (IL-2), and Th17, which produces IL-17, tumor necrosis factor-α, IL-6, and IL-22. Objective We planned this study to determine probable associations between IFN-γ, Th1 cytokine, in the sera of psoriatic patients and the possible correlation to disease severity. Materials and methods We studied the level of serum IFN-γ in 40 cases of plaque psoriasis, erythrodermic, and guttatepsoriasis using PASI score for assessing the severity, and in the serum of healthy 40 controls. Results There was a statistically significant positive correlation between the PASI score and the level of IFN-γ in all clinical types. This can suggest that serum IFN-g is a psoriasis severity and prognostic marker. Conclusion Serum IFN-γ in psoriatic patients can be used as a severity and prognostic marker, and then anti-IFN-γ may eventually become a useful therapeutic approach in psoriasis.

Objectives This study was conducted to evaluate the effect of insulin resistance and insulin-like growth factor-1 (IGF-1) on the prevalance and the prognosis of cancer in type 2 diabetic patients detected by clinical examination and laboratory investigations. Background Diabetes and obesity are emerging as avoidable causes of cancer mortality. Many biological mechanisms link obesity and diabetes to cancer development through direct or indirect effects of obesity on insulin and IGF-1, sex hormones, adipokines, and inflammation. The activation of these mechanisms promotes an environment of increased proliferation, inhibited apoptosis, and increased genomic instability. Patients and methods Patients were categorized into three groups 'diabetic patients with cancer, diabetic patients without cancer, and nondiabetic patients with cancer'. They underwent evaluation in the form of thorough history taking, complete physical examination including anthropometric measurement, laboratory investigations including the fasting insulin level and C-peptide to detect insulin resistance by calculating the homeostasis model assessment of insulin resistance (HOMA-IR), the serum lipid profile, and serum IGF-1 by the enzyme-linked immunosorbent assay test. Results Results show a higher serum level of IGF-1, a higher fasting insulin and C-peptide and HOMA-IR among diabetic patients with cancer compared with nondiabetic patients with cancer. Diabetic patients with cancer (group I) had a significantly higher fasting insulin, fasting blood glucose, and HOMA-IR than nondiabetic patients with cancer (group II), who had a higher fasting insulin, fasting blood glucose, and HOMA-IR than diabetic patients without cancer (group III). Group I had a significantly higher C-peptide and IGF-1 than group III; group I had a significantly higher C-peptide than group II, whereas group II had a significantly higher IGF-1 than group III. This means that the presence of high insulin resistance and a high level of serum IGF-1 increase the incidence of cancer in diabetic patients. Conclusion The present study reported a profound effect of diabetes mellitus and insulin resistance on the incidence and the severity of cancer in type 2 diabetic patients. Diabetic patients with cancer had a significantly higher IGF-1 and HOMA-IR, and higher markers of insulin sensitivity, elevated glucose, elevated triglycerides, elevated low-density lipoprotein, and low high-density lipoprotein, compared with diabetic patients without cancer.

Objectives The aim of this work was to show the value of MRI in evaluation of patients suffering from wrist pain. Background Wrist pain is a common clinical complaint. The most common causes of wrist pain are traumatic and nontraumatic abnormalities involving avascular necrosis, ganglia, and triangular fibrocartilage lesions. MRI serves as a problem-solving technique to assess the cause of wrist pain. It also plays an important prognostic role. Materials and methods This study was conducted on 50 patients complaining of wrist pain. The patients were referred to the Radiology Department from the outpatient clinics and the Orthopedics Department of Menoufia University Hospital. All patients were examined by radiography and conventional MRI. Data of soft tissue and osseous lesions were collected, analyzed, and correlated with findings on laboratory and arthroscopic examination. Results There were 32 male patients and 18 female patients; their ages ranged between 17 and 60 years (mean age, 38 years). The most affected age group was between 20 and 40 years (60%). Avascular necrosis was the commonest nontraumatic lesion found in 10 patients (26%). Conclusion MRI has a marked impact on the diagnosis and assessment of variety of wrist disorders. It is noninvasive and ideal modality to demonstrate the complex anatomy and pathological conditions of the wrist.

Objective The aim of the study was to investigate the effect of probiotics and prebiotics in infantile gastroenteritis. Background Gastroenteritis is a major cause of childhood morbidity and mortality worldwide. Administration of probiotic microorganisms and prebiotic fibers has a role in the prevention of and remediation against a range of intestinal disorders. Patients and methods Sixty-five infants with acute gastroenteritis were randomized to receive either probiotic and prebiotic supplementation (supplementation group; n = 50) or no supplementation (nonintervention; n = 15). Results Probiotics and prebiotics reduced the duration of vomiting to 3.4 ± 0.9 days in the supplementation group, compared with 4.9 ± 0.8 days in the nonintervention group (t = 5.44, P 0≤ 0.001). Probiotics and prebiotics reduced the duration of fever to 2.9 ± 0.9 days in the supplementation group, compared with 3.9 ± 0.7 days in the nonintervention group (t = 3.93, P ≤ 0.001). The results showed that probiotics and prebiotics reduced the duration of hospital stay to 5.5 ± 1.9 days in the supplementation group, compared with7.0 ± 1.8 days in the nonintervention group (t = 2.61, P = 0.01). Probiotics and prebiotics reduced the duration of diarrhea to 4.5 ± 1.4 days in the supplementation group, compared with 6.1 ± 1.4 days in the nonintervention group (t = 3.94, P ≤ 0.001). Conclusion Probiotic and prebiotic supplementation has a role in the treatment of gastroenteritis by decreasing the duration of vomiting, fever, diarrhea, and length of hospital stay.

Objectives The aims of this study were to evaluate the immunohistochemical expression of tenascin-C (TN-C) in lichen planus (LP) and to highlight its hypothesized role in the etiopathogenesis of this disease entity. Background LP is an inflammatory disease of the skin and the mucous membrane, the exact etiology of which is not known; however, multiple theories have been proposed. TN-C is an extracellular matrix glycoprotein that plays different roles, mediating both inflammatory and fibrotic processes. However, little information about its role in LP exists. Patients and methods Thirty patients with LP and 10 age-matched and sex-matched volunteers as controls were included. They were subjected to complete history taking, and general and dermatological examination. Skin biopsies were taken from the lesional skin of LP patients and the normal skin of controls. Biopsies were subjected to routine hematoxylin and eosin staining and immunostaining for TN-C. Results Forty-three percent of LP cases showed epidermal expression, whereas most of the cases (77%) showed a positive dermal expression. Dermal expression of TN-C is significantly elevated in cases than in controls (P = 0.01). Positive correlations between the dermal expression of TN-C and the intensity of lymphocytic infiltrate and the severity of pruritus were demonstrated. Dermal TN-C expression is significantly elevated in hypertrophic LP cases and in cases with leg lesions. Epidermal expression of TN-C showed no significant correlation with any of the clinical or pathological features. Conclusion Prominent TN-C expression in LP lesions magnifies its role in the pathogenesis of this disease.

Objectives The aim of the study was to determine the incidence and severity of osteoporosis in chronic obstructive pulmonary disease (COPD) patients at different grades of disease. Background COPD is a widely prevalent disease with high morbidity and mortality and is associated with important pathologies, among which is osteoporosis. However, osteoporosis is often undiagnosed in these patients. Participants and methods This study was conducted on 30 patients with COPD and 10 healthy controls (the control group). They were selected from Al-Mahalla Chest Hospital from April 2012 to March 2013. All participants were subjected to detailed clinical history taking, a thorough clinical examination, plain chest radiography (posteroanterior and lateral views), blood sampling for complete blood picture, erythrocyte sedimentation rate, and serum calcium and phosphates, ventilatory function tests (spirometry), and measurement of bone density using dual-energy X-ray absorptiometry. Results The results of this study revealed highly significant reduction in most ventilatory function tests in the COPD group compared with the control group (P ≤ 0.01). Prevalence of osteoporosis was higher in the COPD group compared with the control group (P ≤ 0.05). Prevalence of osteoporosis increased with increasing severity of COPD (P ≤ 0.05). Conclusion Osteopenia and osteoporosis are more prevalent in COPD patients than in healthy controls and the severity of osteoporosis increases with increasing severity of COPD.

Objective This study is designed to evaluate the serum level of tumor necrosis factor-α (TNF-a) in patients with liver cirrhosis and determine the possible relation between TNF-α and various complications of liver cirrhosis. Background TNF is a pleiotropic cytokine, mainly produced by monocytes and macrophages and implicated in several physiological and pathological conditions. Several studies have shown that serum levels of TNF-α are significantly elevated in patients with liver diseases. Patients and methods This study was conducted on 70 cirrhotic patients (group I) who were divided into three subgroups according to the Child-Pugh scoring system: group Ia comprised 15 patients with Child A; group Ib comprised 15 patients with Child B; and group Ic comprised 40 patients with Child C. The study also included 10 healthy controls (group II). The serum level of TNF-α was evaluated in all patients. Results A highly significant increase in the mean value of serum TNF-a was found in the liver cirrhosis group with significant positive correlation between serum level of TNF-α and Child-Pugh score. There was a highly significant increase in the mean value of serum TNF-α in encephalopathic patients in comparison with nonencephalopathic patients in the cirrhotic subgroups, with significant positive correlation between clinical grades of hepatic encephalopathy (HE) and TNF-α. Serum TNF-α was the only independent predictor for the development of HE. Conclusion Serum levels of TNF-α correlate positively with the severity of hepatic dysfunction and with the severity of HE in patients with liver cirrhosis. TNF-α may be a possible mediator in the pathogenesis of HE in cirrhotic patients.

Objectives The aim of this work was to assess the left atrial function by speckle tracking in patients with systolic heart failure. Background Heart failure is a clinical syndrome characterized by impaired structure and/or function of the heart, leading to dyspnea and fatigue at rest or with exertion. The pathophysiology of heart failure is complex and there is no single lesion. The left atrial function contributes toward left ventricular filling by means of its three components: a reservoir component; a passive conduit component; and a pump component, with active contraction. Changes in atrial function during the different phases of the cardiac cycle can be assessed noninvasively by the new 2D strain, derived from speckle tracking, that allows us to identify these three components of atrial function. Materials and methods This study included 50 randomly selected individuals: 30 with systolic heart failure and ejection fraction (EF) less than 50% (patient group) and 20 normal individuals (control group). Left ventricle (LV) volumes were measured. Left atrium (LA) volumes were measured at the end of systole, LA maximum volume (Max AV), at the end of diastole, LA minimum volume (Min AV), and preceding atrial contraction (VPre-A). LA total emptying volume (LAEV), LA total emptying fraction(LAEF), LA passive emptying volume (LApEV), LA passive emptying fraction (LApEF), LA active emptying volume (LAAEV), and LA active emptying fraction (LAAEF) were calculated in both apical four-chamber and apical two-chamber views. Peak atrial longitudinal strain, peak atrial contraction strain, and LA strain at the end of LA contraction (Post-A) were measured. The LA contraction systolic index was calculated. LV global strain was measured in apical four-chamber, two-chamber and three-chamber views. LV strain rate was determined, and the LV peak systolic, early diastolic, and late diastolic strain rate were measured. Results Patients with systolic heart failure showed a significant increase in LV volumes and LA volumes (Max AV, Min AV, and VPre-A volumes) compared with the control group. A significant decrease in LA peak atrial longitudinal strain, peak atrial contraction strain, Post-A, and LA contraction systolic index was observed in patients with systolic heart failure (P < 0.001). Also, there was a decrease in LAEV, LAEF, LApEV, LApEF, LAAEV, and LAAEF in patients with systolic heart failure compared with the control group. Conclusion Increased LA volumes and decreased LA function were measured by strain and volumetric parameters in patients with systolic heart failure compared with controls.

Objective This mini-review attempted to highlight the recent progress in understanding of the cellular and molecular pathways leading to renal fibrosis and discussed the challenges and opportunities in developing therapeutic strategies. Background Renal fibrosis, characterized by tubulointerstitial fibrosis and glomerulosclerosis, is the final manifestation of chronic kidney disease. Renal fibrosis is characterized by an excessive accumulation and deposition of extracellular matrix components. There are many causes of tubulointerstitial fibrosis ranging from the effects of hypertension, glomerulonephritides, and pyelonephritis to conditions causing heavy proteinuria and any process that incites glomeruli or proximal tubules to produce proinflammatory mediators as occurs in acute or chronic allograft rejection. Epithelial to mesenchymal transition (EMT) of tubular epithelial cells that are transformed to mesenchymal fibroblasts migrating to adjacent interstitial parenchyma constitutes principal mechanism of renal fibrosis along with local and circulating cells. Proteinuria as well as hypoxia are included among the main mechanisms of EMT stimulation. Transforming growth factor-β1 through the SMAD pathway is considered as the main modulator regulating the EMT molecular mechanism, probably in cooperation with hypoxia-inducible factors. Hepatocyte growth factor and bone morphogenetic factor-7 are inhibitory to EMT molecules, which could prevent at experimental and clinical level the catastrophic process of interstitial fibrosis. Interesting data emerge indicating that hepatocyte growth factor and bone morphogenetic factor-7 administration prevents the peritoneal fibrosis of mesothelial cells. Many promising targets for the treatment of renal fibrosis have been validated in various animal models, and even more new targets have been identified. Angiotensin-converting enzyme inhibitors and angiotensin II receptor type 1 blockers are undisputedly the first-line drugs in combating renal fibrosis. These drugs, however, are not able to halt the progression completely. Methods Data about the patient are collected from different sources that deal with renal fibrosis, including references text books, pictures and presentations, medical journals, and concerned web sites. Conclusion Renal fibrosis characterized as a progressive detrimental connective tissue deposition on the kidney parenchyma appears as a harmful process leading inevitably to renal function deterioration.

Objective The main objective of this study was prevention of diabetic retinopathy (DR), and specifically to determine its prevalence among type 2 diabetic patients. Background DR is one of the leading causes of blindness in the world. It develops in nearly all individuals with type 1 diabetes and in more than 75% of individuals with type 2 who survive for over 20 years with the disease. Patients and methods This is a cross-sectional comparative study. It was conducted on all registered type 2 diabetic patients in Al-Shoaar FHU and Kafr-Shokr FHC; both were randomly selected to represent the urban and rural areas of Qaluobia governorate during the period from January to November 2013. The study included 105 patients with type II diabetes mellitus. They were subjected to a predesigned questionnaire, and their data were retrieved by checking their files. Results The prevalence of DR in type 2 diabetic patients was 51.3%, and 62.8% of the patients had never undergone a fundus examination before this study. In 57% of the patients, the barrier for DR screening was negligence and lack of awareness about its importance. Prevalence of DR depends on the duration of and degree of control of diabetes. Conclusion Most of the diabetic patients are aware of its complications; however, there is little awareness about the importance of screening for DR, which together with negligence constitutes the main barriers for its screening. Therefore, the family physician plays an important role in increasing patients' awareness.

Objective The aim of this work was to assess the value of multislice computed tomography (CT) urography in patients presenting with obstructive uropathy. Background Obstructive uropathy is a structural impedance to the flow of urine anywhere along the urinary tract. Multidetector computed tomography urography (MDCTU) has the advantage of being able to detect not only the level of obstruction but also its cause, including urinary stones, pelviureteric junction stenosis, ureteric strictures, ureteric injury, retroperitoneal fibrosis, and pelvic masses. Patients and methods This study included 30 patients of variable ages, complaining of urinary tract obstruction manifestations referred from urology and urosurgery clinics. MDCTU was performed for all patients. Results Causes of obstructive uropathy as detected by MDCTU were as follow: 14 (46.6%) cases caused by urinary tract stones, four (13.3%) with urinary bladder masses involving ureteric orifices, three (10%) with pelviureteric junction obstruction (PUJ) obstruction, three (10%) with compression of ureters, three (10%) with ureteric injuries, two (6.6%) with bladder neck obstruction, and one (3.3%) case with ureteric stricture. Conclusion MDCTU enabled an accurate diagnosis of the level of obstruction and its etiology, including nephroureterolithiasis, pelviureteric junction stenosis, ureteric strictures, ureteric injury, retroperitoneal fibrosis, and pelvic masses.

Aim of the work The aim of this observational study was to quantify the incidence of urinary tract infections (UTI) among diabetic patients and to compare this risk to patients without diabetes in Damietta hospital. Patients and methods This study included one thousand individuals (500 diabetic and 500 nondiabetic) examined for potential infections; assessment of history including age, sex, duration of diabetes, and treatment of diabetes, urine analysis and culture, total leukocyte count, blood sugar, serum creatinine, and glycated hemoglobin A1c was performed for each patient. Results The prevalence of UTI was 52.2%/500 diabetic patients, which was significantly higher than the prevalence of UTI in nondiabetic patients (22.4%/500 nondiabetic patients) (P < 0.001). There was a significant difference in the distribution of UTI in the diabetic and the nondiabetic group according to the history of previous UTI and total leukocytic count as diabetic patients had more previous UTI and increased total leukocytic count compared with nondiabetic patients (P < 0.001). In terms of the distribution of uropathogens in diabetic and nondiabetic patients with UTI, Escherichia coli was the most prominent uropathogen in both the diabetic and the nondiabetic group. Conclusion UTIs are more prevalent in individuals with diabetes mellitus (DM). The main risk factors for UTI in DM are inadequate glycemic control, duration of DM, diabetic microangiopathy, impaired leukocyte function, and anatomical and functional abnormalities of the urinary tract.

Objective The aim of this study was to determine the incidence, risk factors, clinical presentation, and complications of postpartum psychiatric disorders and the correlation between psychosocial stressors and postpartum psychiatric disorders. Background Postpartum psychiatric disorders are important factors that affect the quality of life - for example, employment rates, interpersonal and interfamilial communications, maternal skills, and many other social-cognitive functions - in different ways. Patients and methods This study was conducted on 250 women in their postpartum period who were recruited from Kfr El-Zayat General Hospital (Gharbia Governorate); of them, 50 patients fulfilled the Diagnostic and statistical manual of mental disorders, 4th ed., (DSM-IV) criteria of postpartum psychiatric disorders. All participants were evaluated by means of clinical evaluation according to DSM-IV criteria and psychometric evaluation using the Holmes and Rahe Stress Scale, the Quality of Life Scale, the Stress Level Assessment Questionnaire, the Edinburgh Postnatal Depression Scale, and the Global Assessment of Functioning Scale. Results In our study, 50/250 (20%) women fulfilled the DSM-IV criteria for postpartum psychiatric disorders and were classified into the following groups: postpartum blues, 68% (34/50); postpartum depression, 20% (10/50); postpartum panic disorder, 8% (4/50); and postpartum generalized anxiety disorder, 4% (2/50). Conclusion The postpartum period is a critical period during which time women are vulnerable to many postpartum psychiatric disorders. The incidence of postpartum psychiatric disorders in new Egyptian mothers is similar to that in many countries. The most frequent postpartum psychiatric disorder is postpartum blues. Marital, social, and economic factors play a major role in the development of the observed postpartum psychiatric disorders.

Objective To study serum hepcidin level in children with chronic renal failure (CRF), either on hemodialysis (HD) or on conservative therapy, and its role in anemia in chronic kidney disease (CKD) patients. Background The role of hepcidin in the occurrence of anemia in children with CKD. Patients and methods Serum samples were obtained from 30 healthy individuals and from 10 patients with chronic renal diseases, and 20 patients with CRF. The levels of serum hepcidin, serum ferritin, and serum hemoglobin were determined and the correlation between them was studied. Results There is a significant increase in the serum hepcidin levels in group I and group II than the control group. There was significant correlation between hepcidin and serum ferritin, and there was a negative correlation between serum hepcidin and hemoglobin and serum creatinine and clearance of serum hepcidin by HD. Conclusion CRF showed an increase in the serum hepcidin level that increased in severity with the increasing duration of HD, C-reactive protein, ferritin serum level and hemoglobin level. Hepcidin may serve as a marker for diagnosis and monitor anemia in CKD patients either on HD therapy or on conservative therapy. Standard dose of HD clear the serum hepcidin by about 35%.

Objectives The aim of the study was to assess parents' satisfaction in as well as utilization of school healthcare services provided for their children. Background School healthcare services provide education and counseling in a variety of health and wellness topics and aid in controlling the spread of communicable diseases, serving as a medical resource in the development of policies and procedures in the school. Thus, improving school healthcare services will have a remarkable effect on children's health and on the community at large. Participants and methods This is a cross-sectional study involving 230 children older than 10 years chosen randomly from two grades from two schools, one from an urban area (Taha Hussein School in Shebin El Kom City, Menoufia Governorate) and the other from a rural area (Meet masoad primary school in Meet Masoad village, Menoufia Governorate), both schools having been chosen at random. This age group was selected so that the children were old enough to understand and help their parents fill up the questionnaire. The predesigned questionnaires were sent home with children to their parents and only 200 (86.95%) completed questionnaires were returned. The questionnaire include data on measurements of satisfaction in different services provided in the healthcare unit of the school, quality of school healthcare services, availability of school healthcare services, and degree of utilization of these services. The obtained data were tabulated and analyzed statistically. Results The study showed that there was no statistically significant difference between urban and rural areas with regard to the availability of school healthcare services. The study also showed that about 74% of parents in the rural area seek medical advice in primary healthcare, represented by the family health unit. Question No. 8 in our questionnaire asked about the type of medical care that was the participant's first choice (private clinic, hospital, or primary healthcare). Participants whose first choice was primary healthcare were classified as regular utilizers and the other participants were classified as nonregular utilizers. All 200 children were utilizers of school healthcare services. The study showed that differences in residence and parent satisfaction were highly significantly different between regular utilizers and nonregular utilizers (P < 0.01), whereas differences in availability of school healthcare services were nonsignificant between the two groups. The study showed that 35% of rural parents considered the services to be expensive compared with 11% of urban parents. Conclusion The quality of school healthcare services is poor, as evaluated through the responses in our questionnaire. We recommend regular measurement of satisfaction in services provided to children in order to improve quality as well as provide regular training programs for medical staff to update their knowledge and improve their performance.

Introduction Skin diseases are common among the general populations and account for a high percentage of all diseases faced by family physician. Skin diseases represent a significant health problem in developing countries. The aim is to improve the health status of skin of patients attending the family healthcare facilities and empower the role of family physician in dermatological care of their patients versus the specialists. Patients and methods The study was carried out on 100 patients from the primary healthcare services (group A) and 100 patients from the Outpatient Clinic of the Dermatological Department of Menoufia University Hospital representing the secondary healthcare services (group B). All patients were interviewed after giving consent. They were subjected to full history taking, dermatological examination, and filling the questionnaires for an assessment of the patient satisfaction, compliance, and rights. Results The prevalence of skin diseases seen by family physician was 175, 30% of total patients (552) in outpatient clinic of primary healthcare. Patients who visited family physician for a skin lesion said that their lesions were 'better'. Moreover, patients said that they were satisfied with their care. However, there were difficulties in management of allergic and cancerous lesions by family physician; hence, these cases were referred for dermatologists. Conclusion For better healthcare utilization, patients with skin diseases should first visit the primary healthcare sites, where they will be subjected to complete comprehensive examination and treated properly or referred to the dermatologist in complicated cases or in difficult diagnosis and recur again for a well-constructed continuity of care.

Objectives The aim of the study was to perform systematic review to summarize the role of family physicians in travel medicine. Data sources Medline, articles in Medscape, AAFP, and PubMed were searched. The search was performed on 1 January 2014 and included all articles with no language restriction. Study selection The initial search presented 320 articles. The number of studies that met the inclusion criteria was 15. The articles included historical background definition, health services, and role of family physician in travel medicine. Data extraction 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. Recent findings The family physician is the one who can best implement the travel medicine services. Conclusion Five articles were review articles, and one systematic review summarized the clinical importance of travel medicine. Two studies showed the importance of pretravel assessment. Many studies showed the importance of implementation of travel medicine in primary healthcare services presented by family physicians through a multidisciplinary approach where travel medicine lends itself well to the family physician's broad training, counseling skills, and focus on prevention and continuity of care.

Objectives The aim of this study was to detect the prevalence of tramadol HCl dependency among substance abusers, assess the severity of addiction, recognize comorbid psychiatric disorders, and identify risk factors to start tramadol abuse. Background An increasingly alarming phenomenon of tramadol drug abuse has been demonstrated in the Egyptian community. Participants and methods The studied group had 330 Egyptian substance abusers. They were subjected to the following: a semistructured interview sheet, a structured clinical interview for DSM-IV (SCID-I) to diagnose psychiatric disorders, the addiction severity index scale, and urine screening for substance abuse. Results The prevalence of tramadol HCl dependency according to all substance abusers was 49%. The prevalence of comorbid psychiatric disorders was 43%. On studying risk factors for tramadol abuse we found sexual purpose and pleasurable effect were the strongest predictors. Conclusion The increase in the prevalence of tramadol HCl dependency over other substances in the Egyptian community calls for more attention from family and educational and health institutes.

Objectives To evaluate both angiographic and clinical outcomes in patients with acute coronary syndrome (ACS) presenting with isolated anterior ST-segment depression on 12-lead ECG. Background ACS is an umbrella term used to cover a spectrum of events caused by acute myocardial ischemia. Patients and methods The study included 50 consecutive patients with ACS. All patients had isolated ST depression in the anterior leads on admission ECG. Coronary angiography and assessment of cardiac biomarkers were performed at baseline. According to TIMI flow grade in the culprit artery and the result of cardiac markers, patients were subdivided into three groups: group I: TIMI flow grade 0/1 and positive markers, group II: thrombolysis in myocardial infarction (TIMI) flow grade 2/3 and positive markers, and group III: TIMI flow grade 2/3 and negative markers. In-hospital and 30-day outcome were reported. Results On the basis of coronary angiography findings and results of cardiac markers, 12 patients (24%) had totally occluded culprit artery plus positive markers (group I) and 10 patients (20%) had TIMI flow II/III plus subtotal occlusion in the culprit artery and positive markers (group II), whereas 28 patients (56%) patients had TIMI flow II/III and negative markers (group III). In-hospital and 30-day outcomes did not differ between groups. Conclusion Among patients with ACS presenting with isolated anterior ST-segment depression, about one-quarter had an occluded culprit artery and elevated cardiac markers.

Objectives Quantitative assessment of the recovery of regional and global left ventricular systolic function after reperfusion in acute myocardial infarction. Background Left ventricular systolic function is an important predictor of the outcome after acute myocardial infarction. Patients and methods The study included 60 patients with first-time acute myocardial infarction: 30 were treated with fibrinolytic therapy (the pharmacological subgroup) and 30 with emergency percutaneous coronary intervention (the invasive subgroup). Evaluation was performed at 1 week and after 30 days by conventional echocardiography, tissue Doppler imaging, and two-dimensional strain (global longitudinal peak systolic strain). Results About 47% of the study population was considered as having a significant recovery in systolic function by 1 month (60% of the invasive subgroup and 40% of those who had fibrinolysis). Conventional echo parameters showed an insignificant difference from 1 week to 1 month as well as between the two subgroups. There was a significant improvement in the systolic wave by tissue Doppler from 5 ± 4 cm/s at 1 week to 7 ± 3 cm/s at 1 month, and it was higher in the invasive subgroup compared with the pharmacological subgroup (8 ± 2 vs. 5 ± 2 cm/s, P = 0.02). The global longitudinal peak systolic strain showed a significant improvement from −13.5 ± 7% at 1 week to −15 ± 8% at 1 month. It was better in the invasive group than in the pharmacological group at baseline (−15.2 ± 5 vs. −11.9 ± 4%, P = 0.04). At 1 month, the global longitudinal peak systolic strain improved to −12 ± 4 and −16 ± 3% in the pharmacological and the invasive subgroups, respectively (P = 0.04). Conclusion The global longitudinal peak systolic strain and tissue Doppler parameters detected the recovery of left ventricular systolic function after myocardial infarction. Moreover, better recovery was reported in invasive reperfusion than in the pharmacological group.

Objectives This study was carried out to assess the effect of the proposed range-of-motion program on the reduction of low back pain among sciatic patients. Background Exercises are superior to minimal intervention for the reduction of pain in individuals with nonspecific low back pain. Materials and methods A sample of 30 patients suffering from lower back pain due to sciatica were included in the study. The study was carried out at the Physical Therapy Outpatient Clinic at Menoufia University Hospital, Egypt. Three tools were utilized for data collection. Tool 1: a structured interviewing questionnaire to assess patients' knowledge and medical data. Tool 2: an observation check list, which was developed by the researcher to observe patient performance related to the performance of the proposed range of motion. Tool 3: a visual analogue pain scale (orthopedic pain management needs). Results Results revealed that there was statistically significant improvement in the total knowledge score (P = 0.001) and the pain level of the studied participants after implementing educational intervention about the range of motions as compared with preintervention (P = 0.00). Conclusion The range-of-motion program had a highly significant effect on the knowledge and the pain among patients with sciatic pain.