Background Basic ultrasound skills should be part of the staff of critical care. Therefore, the critical care community needs focused sonography for evaluation in real-time clinical decision making. Objective The aim was to highlight the emerging role of ultrasound and the recent updates as a routine diagnostic and procedural tool in the critical care unit. Data sources Medline databases (PubMed and Medscape) were searched, and all materials available on the Internet. The search was performed on April 2022. Study selection The initial search presented 120 articles. The number of studies that met the inclusion criteria was 21. The articles included the principles of ultrasound work, the devices used, and the various uses thereof, whether for evaluation or interventions in diseases of the lungs, heart, blood vessels, abdomen, and nervous system. Data extraction If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible study were independently abstracted in duplicate using a data collection form to capture information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Data synthesis Significant data were collected. Then, a structured review was performed. Findings In total, 21 potentially relevant publications were included. It was found that ultrasound allows the emergency physician to expedite care by decreasing time needed to obtain imaging and speak with consultants or to order additional tests or treatments based on the findings. Conclusion Ultrasound education is established as an essential part of all emergency medicine residencies, as well as some general surgery residencies, and is offered as an accredited fellowship. As physicians graduate from these training programs, the expectations of their ultrasound skills will grow. Bedside ultrasound is increasingly available, and emergency medicine physicians will continue to refine and optimize its use.

Objective To evaluate the relation between rs619586 metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) gene single nucleotide polymorphism (SNP) and hepatocellular carcinoma (HCC) risk on top of hepatitis C virus (HCV). Background HCC is a type of primary liver cancer. It has a multitude of etiological risk factors such as HCV. The MALAT1 is a long noncoding RNA. It affects tumor cell proliferation and migration in many types of malignancy. Patients and methods The study included 80 subjects: 40 patients with HCC on top of HCV and 40 healthy controls. Genotyping of MALAT1 SNP (rs619586) was performed by real-time PCR. Results There were no significant statistical differences regarding the genotypes or allele distribution of MALAT1 SNP (rs619586) on comparing HCC on top of HCV with controls. Conclusion This study found that there was no significant statistical difference regarding the genotypes or allele distribution of MALAT1 SNP (rs619586) on comparing HCC on top of HCV with controls.

Objective The aim of this study was to evaluate the correlation between serum levels of a specific matrix metalloproteinase, matrix metalloproteinase-9 (MMP-9), and the angiographic criteria of coronary artery ectasia (CAE). Background Previously, CAE was thought to be a possible manifestation of atherosclerosis, and the relation between matrix metalloproteinase in particular MMP-9 and presence and severity of CAE was not clearly established by previous investigators. Patients and methods A retrospective study of 100 eligible patients with CAE was studied regarding their clinical presentation, angiographic criteria, and relation of the severity of CAE to serum level of MMP-9. We included assessment of major cardiovascular risk factors. Results There were high serum levels of MMP-9 (>71 ug/dl) in 45% of patients with CAE, and there was a statistically significant relation (P = 0.035) of serum levels of MMP-9 with the number of ectatic vessels (100% for three-vessel disease vs. 43.38% for single-vessel ectasia). Moreover, we found a significant relation with the type of ectasia (83.33% for type 1 vs. 40% for type 2), with P = 0.015. Conclusions There is a considerable relationship between elevated levels of MMP-9 and CAE, as well as the relationship between levels of MMP-9 and severity of the CAE.

Objectives To study left ventricular (LV) mechanics in patients with severe mitral valve regurgitation (MR) before and after mitral valve replacement (MVR). Background Our study investigated the short-term follow-up of LV deformation mechanics twist and untwist and LV-global longitudinal strain as an LV function parameter affected by MVR in patients presented with severe mitral regurgitation. Patients and methods We assessed LV deformations by Speckle-tracking echocardiography in 30 patients who had preserved LV ejection fraction before, 1 week after, and 3 months after MVR surgery. Results Among the study population, 16 were men and the mean age was 54.9 ± 6.9 years. There was a significant decrease in LV ejection fraction, LV dimensions, and volumes during early follow-up, which recovered at 3-month follow-up. Right ventricular basal dimension, right ventricular systolic pressure, grade of tricuspid regurgitation, and functional capacity were significantly improved. There was significant deterioration of global longitudinal strain in the early postoperative period; however, it was improved 3 months later (P1 < 0.001, P2 < 0.001, and P3 < 0.001). There was a significant decrease regarding twist between preoperative, early, and late postoperative periods (P1 < 0.001, P2 < 0.001, and P3 < 0.001). There was a significant improvement regarding the untwist rate between preoperative and late postoperative periods (−103 ± 15.3 vs. −122.4 ± 15.3, P2 < 0.001). Conclusions In patients with severe MR, Speckle tracking is a useful technique for assessing LV deformation mechanics and detect subtle affection before conventional echocardiography.

Background Ventricular septal defect (VSD) leads left-to-right shunt with volume-overloaded left atrium (LA) and left ventricle. LA enlargement has been shown to be a reliable predictor of adverse cardiovascular outcomes. Objectives To assess LA function in VSD patients by two-dimensional speckle tracking echocardiography. Patients and methods This retrospective study included 30 VSD patients aged less than 6 years (group I) and 30 age-matched and sex-matched normal controls (group II). All included individuals underwent detailed history taking, thorough clinical examination, and 12-lead ECG. With transthoracic echocardiography, we measured the LA volume. Assessment of LA reservoir, conduit, and pump functions was done using two-dimensional speckle tracking imaging. Results There was a statistically significant greater (P = 0.002), LA volume, and a statistically highly significant lower (P < 0.001). LA global contractile strain among group I than group II. However, there were nonsignificantly higher and lower strain values for reservoir and conduit functions, respectively (P = 0.383 and 0.842, respectively) between both groups. There was a correlation between age and LA phasic functions and there was a statistically highly significant positive correlation between age and both peak atrial global reservoir strain and LA volume (P < 0.001) with a statistically significant negative correlation with LA contractile strain in group I compared with group II. Conclusion Hemodymically, VSD leads to LA volume overload that affects the LA mechanical function, especially reservoir and contractility. This effect increases with age progression if left uncorrected.

Background Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in the Western world. Autophagy is a self-degradative process that is essential for balancing the energy sources at critical times and in response to stress. BECN1 and phosphoinositide 3-kinase C3 (PIK3C3) genes are crucial for the initiation of autophagy process. SLAMF1 is a costimulatory molecule and microbial sensor involved in genetic pathways that adjust chemotaxis and autophagy. Objectives To study the role of BECN1 and PIK3C3 gene expression and assess SLAMF1 surface expression in CLL and correlate with disease characteristics. Patients and methods In this case–control study, 40 newly diagnosed patients with CLL were included as well as 10 age-matched and sex-matched apparently healthy control. RT-PCR was used to measure PIK3C3 and BECN1 genes expression. SLAMF1 surface expression was measured by flow cytometry. Results Patients with CLL had lower BECN1 and PIK3C3 gene expressions than the control group (P < 0.001). PIK3C3 showed a statistically significant correlation with CD38 (P = 0.012), whereas BECN1 showed a statistically significant difference with different Binet stages (P = 0.017). Otherwise, there was no significant correlation between expression of both genes and different clinical parameters. SLAMF1 surface expression was statistically lower in the patient group than in the control group (P < 0.001). In addition, it was found to be an independent prognostic marker in CLL, with higher expression being associated with a good prognosis. Conclusion Autophagy genes and SLAMF1 represent promising candidates for future studies with respect to their role in autophagy in CLL, and they may represent targets of treatment.

Objective This study aimed to investigate the antidepressant effect of simvastatin in the hydrocortisone model of depression. Background Depression is considered the most common psychiatric disorder that causes disability in our life. It puts a heavy burden on both human and society. Simvastatin therapy alone or with selective serotonin reuptake inhibitors has shown desirable effects in the treatment of depression. Material and methods Rats were divided into five groups treated for 3 weeks as follows: control group, hydrocortisone group received intraperitoneal injection of hydrocortisone 40 mg/kg/day to induce depression, fluoxetine group received fluoxetine 10 mg/kg/day orally in addition to hydrocortisone, simvastatin group received simvastatin 10 mg/kg/day orally in addition to hydrocortisone, and combination group received fluoxetine 10 mg/kg/day and simvastatin 10 mg/kg/day in addition to hydrocortisone. During the experiment, behavioral tests were done in addition to biochemical assessment in the hippocampal tissue. Results Hydrocortisone administration caused significant increase in immobility time in forced swim test, significant decrease in sucrose preference percentage in sucrose preference test, significant decrease in hippocampal brain-derived neurotrophic factor and serotonin, significant increase in hippocampal malondialdehyde, and significant decrease in hippocampal reduced glutathione. Treatment with fluoxetine and simvastatin showed a significant decrease in immobility time in forced swim test, significant increase in sucrose preference percentage in sucrose preference test, significant increase in hippocampal brain-derived neurotrophic factor and serotonin, significant decrease in hippocampal malondialdehyde, and significant increase in hippocampal glutathione. Conclusion Simvastatin alone or with fluoxetine could be a promising drug in the treatment of depression.

Objectives The aim of the study was to evaluate serum ghrelin in nonobese patients with moderate-to-severe acne vulgaris. Background Acne vulgaris is a multifactorial disease that affects mostly the adolescent population, but it is difficult to predict those who are prone to severe forms. Patients and methods A case–control study was conducted on 80 participants selected from the Dermatology Outpatient Clinic at Menoufia University Hospital during the period of study from March 2019 till December 2020. Full history taking and clinical and dermatological examinations were done. Serum ghrelin level was measured using the enzyme-linked immunosorbent assay. Results There was highly statistically significant difference between the two studied groups regarding serum ghrelin level. There was significant negative correlation between the severity according to The Global Acne Grading System with serum ghrelin level groups in terms of fasting glucose level, triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusion There is a relationship between acne vulgaris and the level of ghrelin hormone, which is decreased in the serum of acne patients.

Objective This study aimed to evaluate adipokines such as leptin and adiponectin in obese patients with acne vulgaris. Background Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit characterized by increased sebum production in response to androgens. The adipokines secreted from the sebaceous glands are considered novel factors affecting acne inflammation. Patients and methods This study was carried out at the Dermatology and Medical Biochemistry and Molecular Biology Departments of Faculty of Medicine, Menoufia University. Patients were grouped as follows: group I (patient group) included 60 obese patients with acne vulgaris, and group II (control group) included 30 healthy participants, age and sex matched with the patient group. Full history taking and complete clinical examination were done. Determination of acne vulgaris severity was done by the Global Acne Grading System. Assessment of serum leptin and adiponectin was done using enzyme linked-immunosorbent assay technique. Results There was a highly significant statistical difference between patients and controls regarding their adiponectin and leptin serum levels. The mean adiponectin level was significantly higher in patients than controls. The mean leptin was significantly lower in patients than controls. The mean disease duration was 2.63 years. The mean Global Acne Grading system was 37.7 and ranged from 7 to 71. Majority of patients had very severe form (40%), 31.7% were severe, 20% were moderate, and 8.3% were mild. Acne was related to food in 76.7% of patients. Conclusions The role of adipokines in obese patients with acne is still controversial. Adiponectin may have a role, whereas leptin may not have a role.

Objective To study the association between pre-pubertal acne and dehydroepiandrosterone (DHEA) level. Background Acne vulgaris is a common skin disease. Pre-pubertal acne is due to maturation of ovary and testis. During adrenarche (10–14 years old in females and 12–16 years in males), there is an increase in secretion of DHEA and DHEA sulfate by adrenal glands, leading to activation of sebaceous glands. DHEA and other adrenal androgens such as androstenedione, although relatively weak androgens, are responsible for the androgenic effects of adrenarche. Patients and methods A cross-sectional survey was carried out in Menoufia Governorate, Shebin El-Kom District, basic education schools (rural and urban). Students included both females and males. Results This study found that there was an increased level of DHEA hormone in pre-pubertal acne. The prevalence of acne among the studied group was 47%. The types of acne among acne-positive students were as follows: 48.9% were comedonal, 21.3% inflammatory, and 29.8% both comedonal and inflammatory. Sites of acne among acne-positive students were as follows: 14.9% were cheek, 27.7% chain, 42.6% forehead, and 14.9% nose. The current study showed an insignificant relation between acne and age. The percentage of males was the most predominant in acne-positive cases (57.4%). This study showed an insignificant relation between food consumption and acne. The current study showed that the percentage of present puberty signs was statistically significant lower among acne-positive than acne-negative. Conclusion There was a statistically significant increase in DHEA level among acne-positive compared with acne-negative cases.

Objectives The current study aimed to evaluate the impact of breastfeeding on female sexual functions. Background Female sexual health is an important part of her quality of life. Several influencing variables are associated to impair female sexual functions, one among them is breastfeeding. Breastfeeding creates a great potential for change of female's sexuality due to hormonal, physical, and psychological affections. Patients and methods This study was cross-sectional study. It was conducted in the period between October 2021 and January 2022. It included 400 postpartum married women in the childbearing period. The study tool was a self-report questionnaire that was designed according to the female sexual function index (FSFI) questionnaire with addition of some questions that suit the current study under supervision of this study supervisor. The questionnaire consisted of 34 questions written in English and translated into Arabic. Results Out of 400 female participants, 53% started breastfeeding from less than 6 months. About 237 (60%) women used exclusive breastfeeding and 163 (40%) used partial breastfeeding. The FSFI score less than or equal to 26.5 is the cutoff point for women with sexual dysfunction. Mean total FSFI score was 19.0 ± 5.28 in this study. The female sexual functions were greatly affected postpartum especially after 2 months. In all, 88.3% (more than three-quarters) of the participating lactating females were at high risk for sexual dysfunction. Sexual dysfunction was higher in women who practiced exclusive breastfeeding (61.75%) than partial feeding (38.25%). Conclusion Exclusive breastfeeding had a negative impact on female sexual function. They had much lower desire, orgasm, lubrication, satisfaction, and overall scale score.

Background Vitiligo represents an acquired depigmented skin disorder. Disruption of aryl hydrocarbon receptor (AhR) and cytochrome P450 1A1 (CYP1A1) is linked to a variety of skin disorders. Objectives To evaluate the expression levels of AhR and CYP1A1 in patients with vitiligo and to explore their correlation with disease activity. Patients and methods This is a case–control study that included 30 patients with vitiligo and 20 controls. All patients were assessed by vitiligo disease activity (VIDA) score for activity and vitiligo area severity index score for severity. A quantitative real-time PCR approach was used to assess AhR and CYP1A1 mRNA expressions. Results Patients with vitiligo displayed significantly decreased AhR and CYP1A1 expressions (P < 0.001) compared with the controls, with a significant positive correlation between AhR and CYP1A1 expressions (r = 0.782, P < 0.001). Moreover, there was a substantial reduction in the expression of AhR and CYP1A1 in progressive vitiligo cases compared with stationary illness cases (P < 0.001 and P = 0.003, respectively) according to the VIDA score. AhR and CYP1A1 had a significant negative connection with the VIDA score (AhR, r=−0.728, P < 0.001, and CYP1A1, r=−0.702, P < 0.001). Conclusion Lower mRNA levels of AhR and CYP1A1 might have an active role in vitiligo etiopathogenesis and could be used as predictive indicators for disease activity.

Objective To measure levels of interleukin 8 (IL-8) in coronavirus disease 2019 (COVID-19)-infected patients with and without skin lesions in El-Bagour Hospital. Background Since the initial outbreak of COVID-19 in December of 2019, skin lesions have been a clinical sign of COVID-19. Hypercytokinemia (e.g. IL-8) has a vital role in the pathogenesis of COVID-19. Patients and methods This case–control study was done on 180 participants, including 60 COVID-19-infected patients having skin manifestations and 60 COVID-19-infected patients not having skin manifestations, besides 60 age-matched and sex-matched healthy participants as a control group. The participants comprised those attending El-Bagour Hospital COVID-19 isolation center from March 2020 to March 2021. The assay of IL-8 was done by the enzyme-linked immunosorbent assay technique. Results The mean value of IL-8 was markedly greater in COVID-19-infected patients than the controls (30.55 ± 48.70 vs. 1.85 ± 0.64 ng/ml). The mean value of IL-8 was significantly higher in COVID-19-infected patients with cutaneous manifestations than those without (52.49 ± 61.56 vs. 8.60 ± 3.65 ng/ml). Conclusion The mean value of IL-8 was markedly greater in COVID-19-infected patients, especially severe cases, than the controls and in COVID-19-infected patients with cutaneous manifestations than those without cutaneous manifestations. IL-8 serum value was an excellent marker for prediction of COVID-19-infected patients from the control group and for prediction of COVID-19-infected patients with skin lesions from those without skin lesions.

Objectives To evaluate the serum ischemia-modified albumin (IMA) level in patients with primary infertility as a useful marker for assessing oxidative stress. Background Infertility is a condition affecting 15% of the world's population. IMA is calculated through the evaluation of the binding of cobalt to albumin. Patients and methods This prospective study was conducted on 40 male patients of primary infertility with completely normal partner and 40 apparently healthy volunteers as a control group. Every participant was subjected to laboratory tests (complete blood count, liver and renal functions, hemoglobin A1c, measurement of serum IMA by enzyme-linked immunosorbent assay, and semen analysis) and scrotal ultrasound. Results IMA was significantly higher in the case group compared with the control group (P < 0.001). Sperm count per milliliter was significantly lower in the case group compared with the control group (P < 0.001). Red blood cell count was significantly higher in the case group compared with the control group (P = 0.002), whereas white blood cell count was significantly lower in the case group compared with the control group (P = 0.001). Conclusion Both RBC count and IMA were significantly higher in cases compared with the control group. IMA may be a good predictor for patients with oligozoospermia due to reactive oxygen species injury.

Objectives To evaluate the relationship between sexual myths and sexual function among women. Background Sexual myths are false beliefs about sexuality that are not related to proven scientific evidence. They are spread through the transmission of false and exaggerated information and are shaped and fueled by the imagination of the community. Patients and methods The current study was carried out after approval by the Dermatology and Andrology Department and Medical Ethics Committee, Faculty of Medicine, Menoufia University. Results There was no statistically significant relationship between sexual function and sexual myths among women, such as immoral woman initiates sexual activity, seafood increases desire, fatty meals increase desire, first sexual intercourse is always painful, blood is a sign of virginity, masturbation could rupture hymen, as well as masturbation is harmful (P > 0.05). There was no statistically significant relationship between sexual function and sexual myths among women such as oral sex is religiously forbidden, oral sex transmits infection, female sexual areas are dirty, genital cutting prevents sexual arousal, pregnancy decreases desire, intercourse is forbidden during pregnancy, as well as women have less sexual desire (P > 0.05). Conclusion From the results of the present study, we have found that participants had a high number of wrong beliefs. Despite the presence of these myths among women, there was no effect on sexual function, as majority of cases have fair sexual function.

Objectives This study aimed to assess serum brain-derived neurotrophic factor (BDNF) levels in female patients with acne vulgaris and to assess the relationship of this biomarker to the degree of psychological symptoms developed in these patients. Background Acne vulgaris is a benign self-limited condition. However, patients usually endure anxiety, depression, poor body image, frustration, anger, diminished confidence and self-esteem, social isolation, and restriction of activities because it commonly affects the face during a sociosexually critical age, causing a considerable cosmetic concern with adverse social and psychological consequences on the quality of life. Patients and methods Serum BDNF levels were measured in 60 female patients with acne vulgaris divided into three groups according to the severity and 30 age- and sex-matched healthy controls using enzyme-linked immunosorbent assay. Patients filled a Dermatology Life Quality Index questionnaire; both patients and controls filled a Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale-10 (PSS) questionnaires. Results Serum BDNF levels were significantly lower in acne patients when compared with healthy controls and those levels were lowest in the severe group. HADS and PSS scores of the patients were significantly higher than those in the control group. Statistically significant negative correlations were found between serum BDNF levels and scores. Conclusion Serum BDNF levels decreased significantly in acne vulgaris, indicating the role it may play in the development of psychological symptoms, which make patients with acne more liable to anxiety, depression, and stress.

Background Vitiligo is as an acquired, progressive disease marked by a selective loss of some or all melanocytes present in the interfollicular epidermis. Numerous immune system-related genes are connected to vitiligo susceptibility. Nonimmune tissue cells and monocytes produce interleukin-19 (IL-19), a newly discovered cytokine in the IL-10 family, when inflammation occurs. Objective To assess the role of IL-19 polymorphism and serum level in patients with vitiligo. Patients and methods A total of 80 patients with vitiligo and 80 healthy volunteers of similar age and sex participated in this case–control study. They underwent TaqMan allelic discrimination test technology (real time PCR) and blood IL-19 (rs2243188) levels using enzyme-linked immunosorbent assay method for genotyping. Results Cases had a serum IL-9 level of 94.918.7 ng/ml compared with 28.713.1 ng/ml for controls (P = 0.001), which was significantly higher. AC and CC genotypes were considerably greater in patients (P = 0.035), but AA genotype was significantly higher in controls (P < 0.001). IL-19 gene (rs2243188) polymorphism and increased IL-19 gene serum level in patients with vitiligo were strongly linked. Conclusion IL-19 C alleles might be used as an indicator for detection of vitiligo.

Objectives To assess the role of discoidin domain receptor 1 (DDR1) in keloid scar. Background Keloid scars are formed of inert masses of collagen. Therefore, expression of collagen and DDR1 may determine the nature and extent of tissue scarring. Patients and methods This case–control study was carried out on 20 patients presented with keloid and 40 age-matched, sex-matched, and site-matched apparently normal skin from apparently healthy volunteers. Skin biopsies were sent to the Pathology Department of Faculty of Medicine, Menoufia University, for histopathological assessment and immunohistochemical staining of DDR1. Results Epidermal expression of DDR1 was positive in all keloid cases (lesional and perilesional). Its intensity was mild in all lesional biopsies and in only 20% of perilesional ones. Dermal expression was positive in all perilesional cases and in only 30% of lesional biopsies. A significant difference was found between lesional and perilesional keloid regarding DDR1 expression intensity in the epidermis and dermis (P < 0.001). A significant difference was found between lesional and perilesional keloid regarding DDR1 expression H-score in the epidermis and dermis (P < 0.001). A significant positive correlation was found between lesional epidermal and lesional dermal groups regarding keloid H-score (r = 0.552; P = 0.012). In control group, positive epidermal expression of DDR1 was found in all biopsies, with cytoplasmic localization and basal topography. Mild intensity was seen in 52.5% and moderate intensity was seen in 47.5%. The mean ± SD values of H-score were 81.50 ± 39.52. Positive dermal expression of DDR1 was found in all biopsies, with cytoplasmic localization and basal topography. Mild intensity was seen in 50% and moderate intensity was seen in 50%. The mean ± SD values of H-score were 82 ± 27.38. Conclusion DDR1 expression in keloid scar is suspected in early pathogenesis.

Objectives This work aimed to study the effect of condom use on the sexual function of males and females, who use condoms in their sexual relations in Egypt. Background Sexual health is a state of physical, emotional, mental, and social well-being, not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. Patients and methods The current study was a cross-sectional study, which was carried out between October 2021 and January 2022 in the outpatient clinic of Menoufia University Hospital. The study included a questionnaire for 150 males and females, who use condoms in their sexual relationships. All study procedures were carried out and were approved by the Ethics Committee of Menoufia Faculty of Medicine. Results The condom decreased enjoyment in 46.7% of participants. Regarding condom problems, the condom slipped off in 27.3% followed by unsatisfied sex (23.3%) and dryness (22.7%) for females. For males, the unsatisfied sex was 34% followed by a slipped condom (20.7%) and loss of erection (20%). Participants of the study reported that 43.3% were obliged to use a condom because no other safe medical contraceptive method was available and 61.3% of their partners wanted to change the condom to a contraceptive method used by women. Unsatisfied sex with condom use was the main reason to shift to a contraceptive method used by wives in 37.3%. The majority of participants (83.3%) did not abuse their partners verbally on top of condom use. Conclusion Our study included condom discomfort and associated problems and reported problems of loss of sensation, erection problems, allergy to latex, condom size, dryness, and decreased sensation.

Objectives The aim of this study was to measure the serum level of lipocalin 2 (LCN2) and compare it with the intensity of itch in psoriatic patients. Background Psoriasis is a chronic, inflammatory, hyperproliferative skin disease. Itching is a common symptom of psoriasis that significantly alters the patients' daily functioning and psychosocial well-being. LCN2 has been identified as an adipokine present in the circulation that is related to the modulation of immune responses, inflammatory reactions, and increased cell proliferation. Patients and methods This is a case–control study that was conducted on 44 patients with plaque psoriasis and 44 healthy controls. The patients were diagnosed according to their clinical features. Disease severity was evaluated by psoriasis area and severity index (PASI). The degree of itch was assessed by a visual analog scale (VAS). Serum LCN2 concentrations were measured by enzyme-linked immunosorbent assays in all participants, and then the correlations between LCN2 and VAS and PASI were analyzed. Results Serum LCN2 concentrations were significantly higher in patients with psoriasis than in healthy controls and also significantly higher in psoriatic patients who had itching than those who did not. LCN2 levels were found to be significantly correlated with VAS but not with PASI. Conclusion Serum LCN2 levels were higher in patients with psoriasis than in healthy controls. There was a correlation between LCN2 serum level and intensity of itching in psoriatic patients, which reflects its relationship with the pathogenesis of itching in psoriasis.

Objectives This study evaluated BioEnterics intragastric balloon (BIB) short-term outcomes in overweight patients in Kuwait. Background BIB is a popular procedure that is frequently performed in Kuwait, but with limited publication. Patients and methods BIB was placed according to the guidelines of the manufacturing company. Patients can go home 2 h after balloon insertion on an oral anti-emetic, an anti-spasmodic, and a proton pump inhibitor. Oral fluids can be given for the first 48 h, then soft diet for 48 h, then 1000 kcal solid diet was allowed. Patients were followed for postplacement symptoms or complications, comorbidities, and weight measurement. After 6 months, balloon can be removed. Patients who completed 6-month follow-up after balloon insertion filled up a satisfaction four-point scale from 1 to a maximum of 4. Results A total of 145 patients were included in this study (17 males/128 females), with a mean age of 32.86 ± 9.29 years. Their mean baseline body weight was 97.94 ± 20.49 kg. Median time of BIB positioning was 10 min (6–90 min). There was significant reduction in patients' BMI from 37.15 ± 6.21 to 33.44 ± 6.6 kg/m². All patients showed no complications, without any mortality. Conclusion BIB is considered a better option for short term or alternative for who refuse or are unsuitable for bariatric surgery owing to its very low rate of complications, as seen in obese Kuwaiti patients.

Objectives The aim was to assess the role of leukocyte estrase reagent strips and myeloperoxidase (MPO) for diagnosing spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Background Liver cirrhosis represents one of the major causes of death worldwide. Cirrhotic patients with ascites show a higher susceptibility to bacterial infections with SBP that is the most frequent infectious complication. The gold standard for diagnosing SBP is a polymorphonuclear neutrophil count of 250 cells/μl in ascitic fluid. Urine reagent strips have been proposed as a rapid and inexpensive alternative. MPO has a preoxidant–proinflammatory property and its level increases in cases of infection. Patients and methods In total, 90 patients with decompensated chronic liver disease and ascites participated in this study, including (Group I) 20 patients having no symptoms and PMN count (<250 cells/mm³), (Group II) 35 patients with a picture of SBP and PMN count <250 cells/mm³, and (Group III) 35 symptomatic patients with PMN count >250 cells/mm³. Ascitic PMN count and MPO level were measured. Also, ascetic fluid samples were assessed by leukocyte esterase reagent strips (LERS). Results The mean value of MPO was statistically significantly higher in group III (1640.1 ± 480.6 ng/ml) than group II (595.4 ± 201.3 ng/ml) than group I (479.2 ± 236.2 ng/ml). The cutoff value of ascetic MPO was greater than 959.7 ng/ml with accuracy 100%. The mean value of LERS was significantly higher in group III (230 ± 210.8) than group I (14 ± 10.2) and group II (13 ± 9.9). The cutoff value of LERS was greater than 15 leukocytes/μl with accuracy 76%. Conclusion Rapid bedside diagnostic tests for SBP could be performed using MPO and LERS.

Background Radiation proctitis is a pelvic radiation-induced complication that leads to endothelial dysfunction and neovascular lesions. Recently, argon plasma coagulation (APC) is an innovative electrocoagulation technique for treatment of hemorrhagic radiation proctitis. Aims To study the efficacy and safety of APC for the treatment of pelvic radiotherapy-induced rectal angiodysplasias. Patients and methods A prospective study on 50 patients complaining of post-pelvic radiation rectal angiodysplasias was conducted. Colonoscopy was done initially for all patients to detect presence of mucosal vascular complications and then at 1 and 6 months later to follow-up the degree of response, efficacy, and safety of the treatment. According to colonoscopic findings, patients were classified into three groups: group I included 16 patients who had angiodysplasias associated with bleeding per rectum, group II included 16 patients with angiodysplasias without bleeding per rectum, and group III included 18 patients who had no angiodysplasias. Patients who had angiodysplasia with evidence of bleeding or not have been treated by APC (ERPE VIO 200D) with power of 40 W, interval of 2 s, and flow rate of 1.5–2 l/min. Results The mean age was 59.3 years, and 78.1% were males. Last radiotherapy session was 9.53 months ago. Prostate cancer constituted 62.5% of the studied patients. APC was successful in reducing clinical symptoms in 16 (100%) patients with angiodysplasia and healed mucosa after single APC session in group II, and 14/16 in group I has improved clinical picture and healed rectal mucosa during follow-up periods. In group I, 31.3, 62.5, and 6.3% of patients required single, two, and three sessions, respectively. However, 93.8% of patients in group II achieved treatment success after only a single session. The mean number of sessions was significantly higher in group I than group II (1.75 ± 0.57 vs. 1.06 ± 0.25, respectively; P = 0.001). APC-induced adverse events were minimal with only two (6.3%) patients having abdominal pain and three (9.3%) patients had distension. Conclusion APC is an effective and safe procedure with minor adverse effects for treatment of hemorrhagic radiation proctitis.

Objectives This work aimed to evaluate the diagnostic role of point shear wave elastography (PSWE) for the differentiation of benign and malignant hepatic focal lesions (HFLs). Background Elastography is a medical imaging modality that maps the elastic properties and stiffness of soft tissue. The main applications of PSWE in the liver are assessment of fibrosis and characterization of HFLs. Patients and methods The current study included 135 patients in addition to 20 healthy volunteers. These participants were divided into four groups: group I (50 patients with nonmalignant HFLs), group II (70 patients with malignant HFLs), group III (15 patients with liver cirrhosis) and group IV (20 healthy volunteers as a control group). Demographic, laboratory, and imaging data were collected, and then elastographic assessment of the HFLs and the surrounding liver parenchyma using point quantification elastography (ElastPQ) (iU22x MATRIX, Philips) was done. Results ElastPQ (iU22x MATRIX, Philips) has shown respectable ability to differentiate between hepatocellular carcinoma and other malignant HFLs by calculation of SWE of HFL to SWE of surrounding liver parenchyma ratio (P < 0.001). ElastPQ has shown its ability to differentiate between regenerative liver nodule and different benign HFLs (P value <0.001). ElastPQ had the ability to differentiate between hemangioma and focal nodular hyperplasia (P < 0.001) and also hemangioma and hepatic abscess (P = 0.005). Cystic lesions demonstrated lower stiffness in comparison with hepatocellular carcinoma. Conclusion Although PSWE is a noninvasive quantitative and nonradiating safe imaging machine, it lacks sensitivity, specificity, and accuracy in differentiation between malignant and nonmalignant focal liver lesions.

Objectives To investigate serum beta-2 microglobulin (B2M) as a noninvasive marker for disease progression in chronic hepatitis C virus (HCV)-infected patients and to study its role as a tumor marker in diagnosis of hepatocellular carcinoma (HCC). Background HCV is a hepatotropic RNA virus that causes progressive liver damage, which might result in liver cirrhosis and HCC. Patients and methods From January 2020 to January 2022, this prospective study was carried on 136 participants who were classified into four groups: group I, 22 patients with noncirrhotic chronic hepatitis C; group II, 70 HCV-related cirrhotic patients; group III, 25 patients with HCC on top of HCV; and group IV, 19 healthy controls. Serum B2M was quantitatively measured in all of the studied groups. Results B2M was significantly higher in diseased groups than the control group, and it was significantly higher in cirrhosis and HCC groups than the chronic HCV group (P<0.001). The B2M cutoff value for HCC with cirrhosis group was 7.35, with sensitivity of 72.4% and specificity 60.1%, whereas the cutoff value for cirrhosis with chronic HCV group was 6.25. The sensitivity for HCC diagnosis increased upon combining B2M and alpha-fetoprotein, to be 96.4%, and specificity was 80%. Conclusion Serum B2M level was elevated in HCV-related chronic liver diseases and may be used as a marker for HCV disease progression toward cirrhosis and HCC.

Objectives To assess the platelet (PLT) indices, such as mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW), in pulmonary embolism (PE) prediction. Background PE is the third most frequent cardiovascular disease worldwide. The changes in PLT indices (MPV, PDW, and PCT) are gold standard markers for the pathogenesis in different cardiovascular diseases. Patients and methods A total of 100 patients with venous thromboembolism and 50 controls were recruited. Overall, 46 patients presented with first episode of deep venous thrombosis (DVT) without PE (group I) and 54 patients with PE (group II). Results MPV was significantly higher in patients with PE (10.72 ± 2.05 fl) than patients with DVT (9.25 ± 1.31 fl) (P = 0.02). Similarly, PDW was significantly higher in patients with PE (24.78 ± 6.76 fl) than patients with DVT (22.39 ± 4.33 fl), with P value of 0.04. The cutoff values of MPV and PDW for prediction of PE at presentation were 10 and 17.5 fl, respectively, with sensitivities of 77 and 83%, respectively, and specificities of 87 and 80%, respectively. PCT was significantly higher in the PE (0.25 ± 0.09 ng/ml) group and DVT (0.26 ± 0.07 ng/ml) group compared with the control (0.22 ± 0.04 ng/ml) group. PLT count was significantly lower in the PE group (229.39 ± 67.98 × 10³/μl) than DVT (249.85 ± 54.7 × 10³/μl) and control (279.13 ± 61.83 × 10³/μl) groups. White blood cell were significantly higher in patients with PE (9.36 ± 3.67 × 10⁹/l) than DVT (8.01 ± 2.53 × 10⁹/l) and control (8 ± 2.37 × 10⁹/l) groups. The highest values of MPV, PDW, right ventricular dimensions, pulmonary pressure, and cardiac troponin I level were significantly correlated to the severity of PE. MPV and PDW were directly related to thrombus size in Doppler ultrasonography finding in patients with DVT and to the level of obstruction of pulmonary vessels in computed tomography pulmonary angiogram for patients with PE. Conclusion The current study suggested that serial measurements of MPV, PDW, and PLT count are reliable markers for predicting the occurrence of acute PE in patients with first episode of acute proximal DVT.

Objective To explore the possible relation between serum growth differentiation factor 15 (GDF-15) level and carotid intima-media thickness (CIMT) test in patients with rheumatoid arthritis (RA). Background GDF-15 plays an important role in cell growth and apoptosis regulation. GDF-15 is connected to RA, suggesting that it is a proinflammatory cytokine and etiologic factor for both RA and cardiovascular disease. Patients and methods This was a case–control study conducted on 50 patients with RA who were compared with 25 sex-matched and age-matched control group. GDF-15 levels were measured in blood samples from patients and controls by enzyme-linked immunosorbent assay, and CIMT was measured using Doppler ultrasonography. Medical data were collected regarding the patients' clinical manifestations, comorbidities, and treatments. The disease activity score-28 was used to evaluate the disease activity of RA. Results Median GDF-15 level showed a significant increase in patients with RA (246.3 pg/ml) compared with controls (130.6 pg/ml), with P value less than 0.001. Right CIMT and left CIMT were significantly higher in patients with RA (P = 0.016 and 0.006, respectively). GDF-15 level showed a significant positive correlation with CIMT (P < 0.05). Age, disease duration, total cholesterol, and GDF-15 were independent risk factors for an elevated CIMT, with an odds ratio of 5.376, 4.659, 4.472, 1.905, 8.816, and 5.366, respectively. Conclusion Patients with RA had considerably greater levels of GDF-15 and CIMT than controls. Furthermore, in RA, GDF-15 was linked to an increased risk of subclinical atherosclerosis in those patients.

Objectives This work aimed to assess the efficacy of computed tomography angiography (CTA) in comparison with ultrasound carotid duplex (USCD) to find out, assess, and evaluate carotid artery disease in patients with ischemic stroke. Background Stroke is the third most common cause of death worldwide. Strokes can be ischemic or hemorrhagic. Carotid artery stenosis is considered a major cause of ischemic stroke. Patients and methods A cross-sectional study was done on 50 patients with ischemic stroke to compare ultrasound duplex of the carotid system and CTA regarding stenosis percentage and degree and the plaque characteristics (site, dimensions, nature, number, and hemodynamic affection), including intima-media thickness. All of the study procedures were carried out and approved by the ethics committee of the Faculty of Medicine, Menoufia University, in June 2021. Results Regarding the degree of stenosis, USCD showed more stenosis percentage than CTA (47 vs. 43%, respectively, for first lesion, 60 vs. 40%, respectively, for second lesion, 55 vs. 45%, respectively, for third lesion, and 80 vs. 20%, respectively, for fourth lesion). Regarding the plaque nature, USCD showed almost close results to CTA (47% soft atheromatous plaques vs. 46% in CTA, and 50% calcified plaques in both). Regarding the plaque number, USCD detects more plaques than CTA (20 cases have no plaques in CTA vs. nine in USCD). Conclusion The study recommends the combination of USCD and CTA in patients with ischemic stroke, as CTA is more sensitive regarding the degree of stenosis and USCD provides more descriptive data about the plaque characteristics.

Objectives The aim was to investigate emotional clarity in opioid-dependent patients. Background: emotional clarity refers to individual's awareness of his/her feelings. Individuals with low levels of emotional clarity may resort to strategies to alleviate distress rapidly. Patients and methods A total of 40 adult male opioid-dependent patients were recruited in the present study. The research data were collected from demographic information, Structured Clinical Interview for Axis I Disorders, and Difficulties in Emotion Regulation Scale. Statistical analysis was performed using one-sample t test and P value. Results Findings demonstrated that opioid-dependent patients lacked emotional clarity. Conclusion Given the emphasis on emotional regulation as the main mechanism of change, lack of emotional clarity was associated with substance use disorders.

Background Acute kidney injury (AKI) is a serious complication in critically ill children. It is a risk factor for mortality, prolonged stays in the ICU, and prolonged mechanical ventilation. Objectives To investigate urinary neutrophil gelatinase-associated lipocalin (NGAL) concentrations as an early biomarker of prerenal AKI in severe dehydrated pediatric patients with acute gastroenteritis. Patients and methods A cross-sectional study was conducted during the period study from August 2020 till March 2021, on 69 children, aged from 1 to 108 months, at the pediatric ICU) of Faculty of Medicine, Menoufia University, after obtaining consent from their parents and caregivers. Results NGAL level was highly significantly increased in the death group (1550.00 ± 57.74) than in the failure group (1425.00 ± 27.39), the injury group (929.76 ± 31.18), the risk group (866.36 ± 15.89), and the normal group (810.12 ± 37.42) (P < 0.001). Conclusion Urinary NGAL is a promising biomarker of AKI before a rise in serum creatinine) occurs. Severe dehydrated children have higher urinary NGAL concentrations compared with controls even in early stage with normal creatinine levels. So, urinary NGAL levels can be used for the early prediction of tubular renal impairment in children with severe dehydration better than creatinine.

Background Till now, salivary C-reactive protein (CRP), mean platelet volume (MPV), and neutrophil-lymphocyte ratio (NLR) have not been studied as markers for diagnosis of neonatal sepsis. Objectives To assess the applicability of salivary CRP, MPV, and NLR as diagnostic markers in preterm neonates with neonatal sepsis. Patients and methods A case–control study was conducted on 184 newborns from the neonatal ICU at Menoufia University Hospital and Qwesna General Hospital from 2021 to 2022. All selected newborns were divided into group I, which included 92 neonates diagnosed as having neonatal sepsis, and group II, which included 92 apparently healthy neonates. Full history taking; thorough clinical examination; laboratory investigations such as complete blood count, leukocyte count, platelet number, NLR, platelet-lymphocyte ratio, serum CRP, salivary CRP, and blood culture; and radiological investigation such as chest radiograph and cranial ultrasound were done. Results Salivary CRP, MPV, and NLR were significantly increased in the case group than the control group. The cutoff values of MPV, NLR, and salivary CRP were 8.4, 1.87, and 8.0, respectively, with sensitivity of 82.6, 97.8, and 98.9%, respectively, and specificity of 97.8, 98.9, and 100%, respectively, for detection of neonatal sepsis. Conclusion Salivary CPR, MPV, and NLR were significantly increased in neonatal sepsis than healthy neonates. However, platelet-lymphocyte ratio was not significant in neonatal sepsis.

Background Hyperbilirubinemia is the most common condition requiring evaluation and treatment in newborns. Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life. Objectives To assess the role of carboxyhemoglobin (COHb) as an early predictor for pathological hyperbilirubinemia in preterm neonates. Patients and methods This prospective cohort study was conducted on 74 preterm newborns of less than 37 weeks gestation of both sexes, admitted in the first day of life at the neonatal ICU of Menoufia University Hospital from August 2019 to August 2020. All included newborns had serum COHb percentage and total serum bilirubin levels measured just after admission and then were followed up for developing pathological hyperbilirubinemia for 72 h. The case group included 40 preterm neonates who developed pathological hyperbilirubinemia from 24 to 72 h of life while the control group included 34 preterm neonates who did not develop pathological hyperbilirubinemia within the first 72 h of life. Results Both COHb percentage and total serum bilirubin level just after admission were significantly higher in cases than in controls (COHb 1.14 ± 0.28% in cases vs. 0.82 ± 0.22 in controls with P < 0.001). Receiver-operating characteristic case analysis showed that the cutoff point of COHb percentage just after admission more than 1.13% had 77.5% sensitivity and 80.2% specificity for cases with significant neonatal hyperbilirubinemia. Conclusion Serum COHb percentage at admission is a sensitive and specific method to predict preterm neonates who will develop pathological hyperbilirubinemia.

Background Copeptin is a promising biomarker for determining the prognosis of many diseases such as vasopressin-dependent fluid disorders. Objective To assess the role of serum copeptin measurement in critically ill hyponatremic children admitted to the pediatric ICU. Patients and methods This prospective cohort study was conducted on 80 critically ill children and 80 healthy controls. Serum copeptin was measured within the first 24 h of pediatric ICU admission using enzyme-linked immunosorbent assay kits. Results Serum copeptin was significantly elevated among critically ill patients compared with the control group (P < 0.001). There was no significant difference between serum copeptin levels concerning the type of hyponatremia according to volume status, plasma tonicity, or even syndrome of inappropriate antidiuretic hormone secretion diagnosis (P = 0.69, 0.20, and 0.62, respectively). There was no significant difference in serum copeptin levels between survivor and nonsurvivor patients (P = 0.26). On the contrary, there was a significant increase in C-reactive protein, pediatric sequential organ failure assessment, and creatinine in nonsurvivors compared with survivors (P < 0.001, P < 0.001, and P = 0.01, respectively). Moreover, there was a positive correlation between serum copeptin and maximum serum sodium level during the first week (r = 0.394, P < 0.001) and a negative correlation between serum copeptin and serum albumin (r=−0.409, P < 0.001). Conclusion Serum copeptin level, though, is a promising diagnostic and prognostic biomarker for pediatric critical illness, its role in the differential diagnosis of hyponatremic disorders is still limited, and further studies should be done.

Objective To assess the diagnostic and prognostic values of ischemia-modified albumin (IMA) in neonates with transient tachypnea of the newborn (TTN). Background TTN results from failure of the newborn to effectively clear fetal lung fluids after birth. TTN represents a common etiology of respiratory distress in term newborns. IMA is a modification of serum albumin and results from oxidative stress that occurs during ischemic events regardless of its tissue specificity. Patients and method This prospective case–control study was conducted on 88 full-term newborns, who were admitted to the neonatal ICU of Menoufia University Hospital. They were divided into two groups, group I 'cases' (n = 44) included newborns more than or equal to 37 weeks gestational age diagnosed as TTN and were managed with nasal O₂ (group Ia, n = 28) or with continuous positive airway pressure (group Ib, n = 16) and group II 'control' (n = 44) healthy, full-term newborns, age-matched and sex-matched with group I, with no respiratory distress. All newborns were subjected to full history, clinical examinations, and laboratory investigations. Blood sample was collected during the first 24 h. Results Levels of IMA were found to be significantly higher in group I than in group II at a cutoff point more than or equal to 188 ng/ml for the diagnosis of TTN (sensitivity 95.4%, and specificity 97.7%) (area under the curve = 0.997, P < 0.05). Also, levels of IMA were found to be significantly higher in group Ib when compared with group Ia at a cutoff point more than or equal to 295 ng/ml for the assessment of disease severity (sensitivity 92.8% and specificity 87.5%) (area under the curve = 0.972, P < 0.05). Conclusion IMA was a sensitive marker for the diagnosis of TTN at cutoff point more than or equal to 188 ng/ml and was able to predict disease severity at cutoff point more than or equal to 295 ng/ml.

Objectives To assess the diagnostic value of the urinary intestinal fatty acid-binding protein (iFABP) in neonatal necrotizing enterocolitis (NEC) in the early stage of the disease. Background NEC is a severe acute gastrointestinal disease affecting preterm newborns. iFABP has been associated with injury to the intestinal mucosa common to NEC. Patients and methods This cross-sectional study included 40 preterm neonates divided into two groups: group I included 20 preterm neonates with suspected NEC according to Modified Bell Staging Criteria for NEC and group II included 20 preterm neonates with non-NEC. All the included participants underwent full history taking, full examination, routine laboratory investigations, and assessment of urinary iFABP. Results The mean urinary iFABP level was 17.26 ± 3.69 ng/dl in group I and 8.39 ± 2.49 ng/ml in group II. This difference was significantly higher in the suspected NEC group (P = 0.001). The iFABP level at a cutoff more than 9.25 ng/ml had significant power of discrimination of NEC cases at an early stage (P = 0.001) with a sensitivity of 96.0% and specificity of 71.0%. Linear regression revealed that the sampling time was a significant measure for prediction of iFABP (P = 0.001). Conclusion There was an association between elevated iFABP levels in urine and NEC, suggesting that iFABP may be useful as a diagnostic biomarker for earlier identification of NEC.

Objectives To assess fluid imbalance among critically septic children and its relation to the prognosis of these critically ill children. Background Fluid imbalance is a common adverse event in critically ill children, which may lead to oxygenation failure, mortality, and in bad need for more fluid for resuscitation. Patients and methods This prospective cohort study was conducted on 74 critically septic children admitted into the Pediatric Intensive Care Unit. Pediatric Index of Mortality II, Pediatric Risk of Mortality, and Pediatric Sequential Organ Failure Assessment scores were calculated. Fluid measurements were assessed daily for 5 days. Children were subgrouped regarding the balance of fluid into a balanced fluid versus unbalanced fluid either hypovolemia or hypervolemia. Results Normovolemic cases represented 43 (58.1%) children, 14 (18.9%) children were in the hypovolemic group, and 17 (23%) children were in the hypervolemic group. There was a highly significant increase in mechanical ventilation need, Pediatric Sequential Organ Failure Assessment, and incidence of mortality in hypovolemic children compared with other groups (P < 0.001 for all); moreover, Pediatric Risk of Mortality and Pediatric Index of Mortality II showed a significant increase in hypovolemic children compared with the other two groups (all P < 0.05). Pediatric Intensive Care Unit showed a significant increase in hypervolemic children compared with other children (P = 0.041). Conclusion Fluid imbalance is a common adverse effect during fluid therapy in septic children and is linked to substantial morbidity and mortality.

Objective To assess whether the disseminated intravascular coagulation (DIC) score is more valuable than other mortality scores in predicting in-hospital mortality in septic children admitted to the pediatric intensive care unit (PICU). Background Sepsis is one of the most common causes of death among hospitalized children in the PICU. Patients and methods This prospective observational study was conducted on 96 critically ill children. Laboratory and clinical data were measured within 24 h of PICU admission. Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality II (PIM II), and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated. DIC score was recorded. Results The nonsurvivor group showed a highly significant increase in scores of DIC, pSOFA, PRISM, and PIM II (P = 0.005, 0.001, 0.001, and 0.001, respectively). The mechanical ventilation rate was increased in nonsurvivors than in survivors (P < 0.001). Using univariate analysis, PRISM, PIM II, pSOFA, DIC scores, and total hospital stay were predictive of mortality, and when the multivariate analysis was performed, it demonstrated that DIC score was the best predictor of hospital mortality (odds ratio = 2.11). Conclusion PRISM, PIM II, pSOFA, and DIC scores are predictive of mortality. The DIC score was the best predictor of hospital mortality among hospitalized children in the PICU.

Objective To determine potential diagnostic and prognostic values of programmed death receptor-1 (PD-1) expression in neonatal sepsis. Background In neonatal ICUs across the world, sepsis is a frequent disease associated with high rates of death and morbidity. In sepsis, chronic immunosuppression following a fast proinflammatory response results in high rates of morbidity and death. PD-1 (CD279) is an immunoglobulin superfamily cell surface receptor that inhibits proinflammatory activity. Patients and methods This prospective observational study was carried out on 102 newborns. They were divided into two groups: group I (cases group) (n = 52) included newborns with suspected or proven sepsis, while group II (control group) (n = 50) included age and sex-matched newborns, who did not develop neonatal sepsis. Group I was further subdivided into group Ia (n = 42), which included the surviving newborns and group Ib (n = 10), which included the nonsurviving newborns. Results Mean fluorescence intensity for PD-1 was significantly higher in cases than in controls (P < 0.05). Mean fluorescence intensity with a cutoff point more than 1610.1 has the highest sensitivity (71.15%) and specificity (60%) for the prediction of sepsis, negative predictive value (66.7%), and positive predictive value (64.9%). PD-1 percentage on lymphocytes has the highest sensitivity (80%) and specificity (66.67%) in the prediction of mortality with a cutoff point more than 3.09. Conclusion The expression of PD-1 on lymphocytes may serve as a diagnostic marker for newborn sepsis and a mortality predictor.

Objectives To evaluate nucleated red blood cells (nRBCs) as a prognostic value in critically ill neonates. Background nRBCs are premature red blood cells, are an indicator of hematopoiesis in a newborn infant, and have been known to be associated with intrauterine hypoxia. Patients and methods This cohort study included 94 newborn infants who presented to the neonatal ICU in Menoufia University and Shebin El-Kom Teaching Hospital and fulfilled the following inclusion criteria: infants with sepsis, hypoxic ischemic encephalopathy, necrotizing enterocolitis, patent ductus arteriosus, and preterm infants. Infants were only excluded if they did not perform a complete blood count during their admission. All of them were subjected to full history taking, physical examination, and laboratory investigations including C-reactive protein, complete blood count, and blood film stained with Leishman stain for counting of nRBCs manually. Results In our study, among all patients admitted to the neonatal ICU, the presence of an elevated nRBC value was associated with increased mortality in a quantitative manner (P < 0.05), with high sensitivity to predict mortality (87.5% of nonsurvivors presented with nRBCs in the blood film in comparison with 61.5% of survivors), which was statistically significant. Conclusion nRBC count may be used as a prognostic factor in critically ill neonates.

Objectives To measure bone mineral density (BMD) in patients with juvenile idiopathic arthritis (JIA) and to relate it to disease activity. Background Low BMD is a common finding in children with JIA. It is associated with a high risk of osteopenia and osteoporosis, which increases the risk of fracture. Dual-energy radiograph absorptiometry (DEXA) of the lumbar spine using the Z score is used for measurement of BMD in pediatrics. Patients and methods The study included 50 patients diagnosed and assessed clinically as JIA (20 females and 30 males). The patients were diagnosed as having JIA according to the criteria of classification of the International League of Associations for Rheumatology. BMD was measured in the lumbar spine using the Z score. The results were correlated with juvenile arthritis disease duration, disease activity, and serum level of bone turnover markers, vitamin D3, parathyroid hormone, calcium, phosphorus, and magnesium. Clinical disease activity was evaluated by juvenile arthritis disease activity score 27. Results The study showed that 36% of patients had low BMD (Z score of <−2) by DEXA of lumbar spine, 64% of patients had normal BMD (Z score >−2), and no patient was given a diagnosis of osteoporosis (BMD Z score ≤−2 and a significant fracture history). There was a significant negative correlation between BMD (DEXA Z score) and juvenile arthritis disease activity score 27, bone turnover markers, and duration of JIA. Conclusion Osteoporosis and osteopenia are common in patients with JIA. BMD decreases among patients with JIA with high disease activity.

Background Calcium-channel blockage effect of diltiazem and antioxidant effect of quercetin may combat against monosodium glutamate (MSG)-induced liver dysfunction in rats. Objective The aim was to study the protective effects of diltiazem and quercetin administration on possible MSG-induced changes of liver functions in adult rats. Methods Fifty adult male Wistar rats were divided into five equal groups: control group (C), MSG-treated group (G), diltiazem and MSG-treated group (DG), quercetin and MSG-treated group (QG), and combined diltiazem, quercetin, and MSG-treated group (DQG). The duration of concomitant administration of treatments was 6 weeks. Then, fasting blood samples were collected to measure serum alanine transaminase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and serum malondialdehyde. Last, antioxidant activities of glutathione peroxidase and superoxide dismutase were measured in liver tissue homogenate. Hematoxylin and eosin staining and Bcl2 immunohistochemical staining of rat liver was assessed for detection of structural changes and apoptosis, respectively. Results In DG, QG, and DQG groups, alanine transaminase, aspartate aminotransferase, gamma-glutamyl transferase, and malondialdehyde in serum were significantly lower (P < 0.001) than G group denoting significant improvement in hepatic parameters and oxidative stress. In addition, these three groups caused significant increase (P < 0.001) in hepatic tissue glutathione peroxidase and superoxide dismutase activities. Hematoxylin and eosin staining and Bcl2 immunohistochemical staining of rat liver of these three groups showed significant decrease in structural damage and apoptosis when compared with G group. Conclusion Diltiazem and quercetin reduce hepatic oxidative stress and tissue damage induced by MSG, and improve liver dysfunctions, with better effect of their combination.

Objective To detect the degree of illness in a computed tomography (CT) scan of coronavirus disease 2019 (COVID-19) infection based on disease lobe lesions and correlate that value with the patient's blood oxygen saturation level to further predict oxygen therapy needs. Background The indicators of lung lesions in COVID-19-infected patients help manage and speed up the entire hospital workflow, as patients with higher severity scores require early therapeutic intervention and critical care. Patients and methods This was a prospective descriptive study done at our Department of Radiology. It included 100 patients who underwent a chest CT scan without contrast from June 2020 to November 2021 and were confirmed to have COVID-19 infection by PCR. All patients underwent complete medical history, laboratory tests, pulse oximetry, and radiological examination using high-resolution CT technology. Results There was a statistically significant increase in CT chest score in severe disease cases compared with mild severity cases. There was a statistically significant increase in CT score in cases with decreased oxygen saturation compared with those with normal oxygen saturation (O₂) saturation. There was a statistically significant relation between the severity of lung affection and O₂ saturation. Conclusion O₂ saturation and CT chest are the first lines for rapid evaluation and patient stratification of COVID-19-infected patients. These cases require careful and close monitoring, as their strong correlation with oxygen saturation helps predict the need for oxygen therapy throughout the disease.

Objective To assess the role of multidetector computed tomography (MDCT) in patients with chronic obstructive pulmonary disease (COPD). Background The use of MDCT in COPD has evolved over the last decades and has provided new insights into the pathophysiology of COPD. Patients and methods This was a prospective study conducted on 30 patients who were clinically suspected of COPD and were referred for further assessment by MDCT of the chest. Results Using MDCT, COPD patients were classified phenotypically into airway dominant, emphysema dominant, and mixed representing 50, 30, and 20%, respectively. We reported that MDCT is significantly able to differentiate between the three phenotypes. There were significant positive correlations between pulmonary function tests and upper, middle, and lower lobes of the left lung densities while no correlation was found between pulmonary function tests and lung density of any lobes of the right lung. We found a statistically significant association between lung density and COPD phenotype (P < 0.001). There was statistically significant difference between airway phenotype and both emphysema (P = 0.0002) and mixed (P = 0.026) phenotypes as regards lung density. However, there was no statistically significant difference between emphysema phenotype and mixed phenotype regarding lung density. Conclusion MDCT is a major noninvasive tool that can precisely detect the location and extent of lung pathology in COPD patients.

Background Short TI inversion recovery (STIR) sequence is one of the inversion recovery (IR) pulse sequences and is the most commonly used. The addition of a coronal STIR sequence is thought to be useful in detection of extraspinal etiologies of sciatica that may be missed on routine imaging protocol. Objective To assess the value of adding coronal STIR images to routine MRI protocol of lumbosacral spines aiming to detect extraspinal causes of sciatica. Patients and methods This prospective observational study was carried out between December 2019 and June 2020 on 300 patients (169 males, representing 56%, and 131 females, representing 44%). They presented with low back pain and were referred to perform routine lumbosacral spine MRI examination. We added a large field of view coronal STIR sequence to the routine protocol to investigate its capability to detect extraspinal causes of sciatica. Results Additional coronal STIR images detected extraspinal abnormalities in 21.3% of the patients, thereby downgraded normal studies from 40.7 to 24.7%. The extraspinal abnormalities included osteoarthritic abnormalities and stress fractures (n = 25; 39.1%), soft tissue abnormalities (n = 2, 4.5%), neurological abnormalities (n = 4, 6.3%), gynecological abnormalities (n = 31, 48.4%), and miscellaneous (n = 4, 6%). Conclusion Additional coronal STIR images helped to identify extraspinal abnormalities that were overlooked on routine MRI protocol in patients presenting with sciatica.

Objective To assess the diagnostic performance of lung ultrasound (LUS) compared with chest radiograph (CXR) in critically ill patients with pleuropulmonary diseases. Background LUS is an interesting and effective diagnostic tool for major pleuropulmonary diseases that can obviate the need of unnecessary radiations. Patients and methods This prospective study took place in the duration from October 2020 to October 2021 on 50 patients admitted to ICU at Menoufia University Hospital, comprising 27 (54%) males and 23 (46%) female. All patients were subjected to LUS, CXR, and computed tomography as the gold standard test for diagnosis. Results The overall accuracy of LUS was higher and statistically significant compared with CXR in the diagnosis of pleural effusion, pneumonia, pulmonary edema, and pneumothorax (94.29, 94.83, 95, and 98.87%, respectively). Conclusion LUS is a precise, safe bedside diagnostic tool for pleuropulmonary diseases that offers a comparable accuracy to computed tomography in ICU patients.

Objective To compare cancer detection rates of digital breast tomosynthesis (DBT) plus conventional digital mammography (DM) with those of conventional DM alone. Background DBT is a recent evolution of full-field digital mammography (FFDM) involving quasi-three-dimensional (3D) transformation of breast images. Patients and methods The study was conducted on 35 females who were eligible for examination by 3D DBT, who were referred to the National Cancer Institute – Female Imaging Unit in the duration from May 2020 to May 2021. Full history taking and complete clinical examination were performed on all patients. All patients were examined by FFDM and wide-angle 3D DBT. Results The diagnostic performance of combined DBT + DM outcome, when compared with the results of histopathological assessment of lesions biopsies, was as such: sensitivity (92.6%), specificity (87.5%), positive predictive value (96.2%), negative predictive value (77.8%), and accuracy (91.4%), which indicates statistically significant agreement between the two tests as their yielded weighted κ value is 0.767, which indicates a substantial agreement with a highly significant P value. However, it is only, in case of DM alone, a weighted κ value of 0.449 indicates a moderate agreement with a significant P value. Conclusion DBT showed better detection of subtle spiculations and enhanced ability of multifocality identification due to its ability to overcome tissue overlapping unlike DM alone.

Objectives To compare the perioperative analgesic efficacy of serratus anterior plan block (SAPB) versus paravertebral block in patients undergoing mastectomy surgery. Background Patients undergoing mastectomy surgery often experience severe postoperative pain. Inadequate control of this pain increases the risk of postoperative complications and may develop into chronic pain. Patients and methods This prospective randomized trial was carried out on 60 female patients, American Society of Anesthesiologists I–III, 30–60 years old, scheduled for modified radical mastectomy, between April 2020 and March 2021. The patients were randomly allocated into one of two groups (30 patients each). Group S received ultrasound-guided SAPB and group P received ultrasound-guided thoracic paravertebral block (TPVB). In both blocks, the injectate was 20-ml bupivacaine 0.25% with epinephrine (5 μg/ml) and fentanyl (2 μg/ml). Both blocks were performed as a single injection after general anesthesia induction. Intraoperative fentanyl consumption, postoperative visual analog scale scores, time-to-first ketorolac request, total postoperative ketorolac consumption, and patients' satisfaction were recorded. Data were analyzed by SPSS, version 26, Mann–Whitney test, Student t test, and variance test. Results Both groups had comparable intraoperative fentanyl consumption (P = 0.15). However TPVB was associated with significantly lower postoperative analgesic requirements, longer time to first analgesic request, and higher grade of patient satisfaction (P < 0.001). Visual analog scale scores were significantly lower in group P at 2, 3, 8, and 17 h (P < 0.001) while being comparable at the remaining time points. Conclusion TPVB and SAPB were associated with comparable intraoperative analgesic efficacy; however, TPVB was associated with a better postoperative analgesic profile and patient satisfaction.

Objectives We aimed to assess the analgesic efficacy of the ultrasound-guided block of rectus sheath (RS) versus subcostal transversus abdominis plane (TAP) versus quadratus lumborum in laparoscopic cholecystectomy. Background Regional anesthesia has become an essential component of multimodal analgesia to reduce stress-induced physiologic responses. Patients and methods A prospective randomized trial was carried out on 66 patients who were divided into three equal groups, with 22 patients each. Group R received a block of the RS. Group T received a block of the subcostal TAP. Group Q received a posterior quadratus lumborum block. All of them were given a dose of 20-ml bupivacaine 0.25% bilaterally using ultrasound guidance. We assessed the severity of pain postoperatively by the visual analog scale, the time for the first request for rescue analgesia, and the total amount of postoperative ketorolac consumption. Results Group Q had significantly lower visual analog scale score values than the others and group T than group R. Time for the first request for analgesia in group Q was significantly longer than the others and in the T group than in the R group. Ketorolac consumption was significantly lower in group Q than the others and in group T than group R. Postoperative nausea and vomiting were significantly higher in group R than in the others. Conclusion Quadratus lumborum block was the most effective analgesic technique after laparoscopic cholecystectomy compared with subcostal TAP and RS blocks.

Background Despite the development of numerous new modes of mechanical ventilation (MV), there is still uncertainty about the best methods for weaning from MV. Objectives To compare between three modes of MV: pressure support ventilation (PSV), volume support ventilation (VSV), and mandatory minute ventilation (MMV) in difficult weaning. Patient and methods We conducted a randomized controlled trial in 105 patients requiring MV with difficult weaning. Patients were randomized into three groups: PSV, VSV, and MMV groups. The primary outcome was the 'rate of successful weaning,' defined as successful removal of MV for at least 48 h after extubation. Results There was no significant difference in the rate of successful weaning among the three groups [number of patients (%)=13 (37.1%), 14 (40.0%), and 11 (31.4%) for PSV, VSV and MMV, respectively; P = 0.749]. However, there was significantly sme [mean ± SD weaning time (days)=7.38 ± 2.89, 7.46 ± 1.87, and 5.43 ± 1.44 for PSV, VSV, and MMV groups, respectively; P = 0.049], shorter ICU stay [mean ± SD ICU stay (days)=17.03 ± 3.33, 15.83 ± 3.43, and 15.04 ± 3.56 for PSV, VSV, and MMV groups, respectively; P = 0.018], and higher sleep hours per day in most of days (P < 0.05) in the MMV group. Additionally, there was significantly lower number of ventilator manipulations per day in MMV and VSV groups in most of days (P < 0.05). Conclusion Despite there was no difference in the rate of weaning success among the groups, MMV showed better improvements on weaning time, sleep hours, need for ventilator setting manipulation, and ICU stay.

Aim The aim was to assess right ventricle function in septic shock patients using transthoracic echocardiography after resuscitation at the emergency department. Background Because septic cardiomyopathy has no formal definition due to complexity of the cardiovascular system, variable methods of assessment, and variations in the preseptic state of the heart, early assessment of right ventricle function may reduce mortality of septic shock patients. Introduction Cardiac contractility is impaired during early phases of septic shock and early invasive assessment methods were of limited utility to emergency physicians, so using of echocardiography in the emergency department is available, noninvasive, and easily repeatable method for evaluation of septic cardiomyopathy. Patients and methods This is a prospective observational study done on 60 septic shock patients, who presented to the Emergency Department of Menoufia University Hospital during the period from January 2020 to December 2020. Results Patients were categorized into three groups according to right ventricle fractional change (RVFAC%) and left ventricle ejection fraction (LVEF%). Group I (28) patients have normal RV function, Group II (17) patients have isolated RV dysfunction, and Group III (15) patients have combined RV and LV systolic dysfunction. There were statistically significant differences between studied groups in their mean arterial pressure readings (P = 0.001) and mean arterial pressure was higher in group I than group III (P₂ = 0.001). Also, there was a statistically significant difference between groups in their HCO₃ (P = 0.014) and it was significantly higher in group I than group III (P₂ = 0.023). And statistically significant differences between the three studied groups in their tricuspid annular plane systolic excursion (P = 0.011). Tricuspid annular plane systolic excursion was higher in group I more than group III (P₂ = 0.019) and higher in group II more than group III (P₃ = 0.026). Conclusion Myocardial dysfunction is frequent in patients with severe sepsis and septic shock and presents in a wide spectrum, including left ventricle and/or right ventricle dysfunction.

Objectives The purpose of this study was to compare the patency rate and associated complications using different types of synthetic grafts used in hemodialysis access. Background Polytetrafluoroethylene (PTFE) recently gained popularity as a graft material for hemodialysis access. PTFE has been modified by many ways such as adding rings [ringed polytetrafluoroethylene (rPTFE)] or adding an outer layer of polyethylene terephthalate [hybrid polytetrafluoroethylene (hPTFE)]. Modifications in PTFE have been developed to improve the outcome; however, to date no PTFE graft has demonstrated clear superiority over competitive products. Patients and methods The study was performed as a prospective observational cohort study between January 2019 and January 2022 at Menoufia University Hospitals. In all, 50 patients underwent brachio-axillary straight graft using different graft type's rPTFE, standard polytetrafluoroethylene (sPTFE), and hPTFE (fusion graft). Patency and complications rates were compared between the three groups. Results We found that rPTFE grafts have lower thrombosis and infection rates than hPTFE and sPTFE grafts. Also, there was no pseudoaneurysm or postdialysis subcutaneous hematoma formation in the rPTFE group during the follow-up period. Also, the 1-year primary patency rates were 73.3, 73.7, and 81.3% in the hPTFE, sPTFE, and rPTFE groups, respectively. Conclusion The feasibility and superiority of externally supported arteriovenous graft in comparison to nonsupported arteriovenous graft for primary patency in dialysis access has been shown by this study.

Objectives The aim of this study was to assess the value of using irrigation with sodium bicarbonate in relieving pain after laparoscopic cholecystectomy. Background Laparoscopic cholecystectomy is considered as the treatment of choice for symptomatic cholelithiasis. Few studies reported about the clinical significance of pain control after laparoscopic surgery. This randomized clinical trial was designed to determine whether it is possible to reduce postlaparoscopic pain by neutralizing acidic peritoneal environment (created by CO₂ insufflation) using peritoneal irrigation with sodium bicarbonate. Patients and methods This double-blinded randomized clinical trial was carried out on 32 patients undergoing elective laparoscopic cholecystectomy. Results The time of pneumoperitoneum in sodium bicarbonate group ranged from 27 to 67, with mean ± SD of 49.81 ± 11.55, whereas in the nonwashing group, the time of pneumoperitoneum ranged from 26 to 63, with mean ± SD of 45 ± 11.21, with no statistically significant difference (P = 0.241) between the two groups. Visual analog scale at 24 h in the sodium bicarbonate group ranged from 2 to 6, with mean ± SD of 3.56 ± 1.09, whereas in the nonwashing group, the visual analog scale score at 24 h ranged from 2 to 9 with mean ± SD of 5.81 ± 1.87, with a highly statistically significant difference (P ≤ 0.001) between the two groups. Regarding the sites of pain, there was no significant difference between the two studied groups (P = 0.858). Conclusion Intraperitoneal irrigation of sodium bicarbonate is a simple and safe method that provides pain relief in the postoperative period after laparoscopic cholecystectomy compared with nonwashing. Moreover, intraperitoneal irrigation of sodium bicarbonate was found to have a better pain relief profile compared with normal saline.

Objective To evaluate the different factors affecting the surgical outcome of intradural spinal tumors. Background Among the intradural spinal tumors, meningiomas, ependymomas, astrocytomas, and nerve sheath tumors are the most common. Early surgical intervention with the use of technical adjunctives and postoperative adjuvant therapy has improved the outcome. Patients and methods A prospective study was done on 30 consecutive patients with an age group ranging from 20 to 60 years. All patients underwent surgery for intradural spinal tumors at Menoufia University and Alexandria Armed Forces Hospital. Data were collected regarding histopathological diagnosis, clinical presentation, tumor location, operative data, and postoperative complications. A functional outcome was assessed using the modified McCormick Scale (MMS). Results There were 16 (53.3%) patients with extramedullary tumors and 14 (46.7%) patients with intramedullary tumors. Guided tissue regeneration (GTR) was achieved in 21 (70%) patients, mostly meningioma and ependymoma. Extramedullary locations are more likely to achieve GTR and are associated with better outcomes than those with intramedullary locations. The mean preoperative MMS (2.70 ± 0.88) showed marked improvement compared with the mean 2.20 ± 1.42, 2.0 ± 1.51, and 1.93 ± 1.51 immediately postoperatively, 6-month, and 1-year follow-up, respectively. The complication rate was 33.3% (10 patients), and cerebrospinal fluid leak was the most common complication. Conclusion The use of adjunctive (cavitron ultrasonic aspirator, IOM), the extramedullary location, low preoperative MMS, GTR, and low tumor grade were associated with better postoperative outcomes.

Objective To investigate the association between Helicobacter pylori infection and pregnancy-induced hypertension (PIH) among pregnant women. Background PIH is a major pregnancy complication as well as a risk for maternal morbidity and mortality. It is estimated that 9.1% of maternal deaths in Africa are due to hypertensive disorders of pregnancy. H. pylori is a gram-negative bacterium. Furthermore, it was recently observed that H. pylori-seropositive patients with PIH were characterized by a more severe inflammatory status. Patients and methods A prospective study was conducted on 150 patients at the inpatient ward and outpatient clinic of the Department of Obstetrics and Gynecology, Al-Shohadaa Central Hospital, and Obstetrics and Gynecology Department, Menoufia University Hospital, during the period study from September 2020 till August 2021. Results We found that there was a highly significant difference between the studied groups regarding H. pylori, which was significantly increased among hypertensive group than nonhypertensive group. Moreover, there was a significant difference between H. pylori-positive and H. pylori-negative cases according to the degree of severity among PIH groups. Conclusion There was a direct role for H. pylori infection during pregnancy in the etiopathogenesis of PIH. In addition, there was a powerful correlation between H. pylori and grades of severity of PIH among the studied groups.

Objective To determine the benefit of assessment of cervicovaginal placental alpha-microglobulin 1 (PAMG-1) with the cervical biometry in prediction of preterm labor (PTL). Background Many screening methods are now used for the diagnosis of PTL. Short cervix in the second trimester, detected by transvaginal ultrasound, was significantly related to PTL. The presence of PAMG-1 in cervicovaginal discharge of women with clinically intact membranes is indicative of imminent delivery. Patients and methods This prospective longitudinal study was conducted on 90 pregnant women and divided into two equal groups: group A included 45 pregnant women between 24+0 and 36+6 weeks with threatened PTL and short cervix, and group B included 45 pregnant women at the same age group without threatened PTL symptoms and with normal cervical biometry. Results Women of preterm group had statistically significant shorter cervical length (15.6% <15 mm, 48.9% between 15 and 20 mm, and 35.6% between 20 and 24 mm; P ≤ 0.001) and more detectable positive cervicovaginal fluid PAMG-1 (32 vs. 0; P < 0.001). Cervical PAMG-1 had a sensitivity of 71.11%, a specificity of 100.0%, a positive predictive value of 100%, a negative predictive value of 77.59, and an accuracy of 85.56%. Moreover, there was a strong correlation between positive PAMG and time of delivery, as 18.8% gave birth in first 48 h, 50.0% gave birth between 2 and 7 days, and 31.3% gave birth after 7 days. On the contrary, all women with negative PAMG gave birth after 7 days. Conclusions Regular use of the two tests described could help identify low-risk patients and lower the number of unnecessary hospitalizations and treatments.

Objectives To compare elective induction of labor at 39 weeks' gestational age in uncomplicated pregnancies with expectant management of up to 41 weeks' gestation and induction of labor in undelivered mothers. Background Late-term and postterm pregnancies are associated with increased maternal and fetal risks, thus several studies have considered induction of labor between 39 and 41 weeks' gestational age. Patients and methods This study was a randomized case–control study on 194 pregnant women at 39 weeks for labor induction at Menoufia University Hospitals and Elsalam Specialized Hospital during the period between December 2020 and June 2022. Results In the present study, there was highly statistically significant (P < 0.001) increased Apgar score at 5 min in group A (interquartile range = 8–9) when compared with group B (interquartile range = 8–8) and statistically significant (P = 0.048) increased birth weight in group B when compared with group A. The cesarean section rate was statistically significant (P = 0.005) in group B (39.1%) than in group A (20.6%). Conclusion Labor induction at 39 weeks should be offered to low-risk women. That policy is associated with fewer cesarean section and other complications. If woman chooses spontaneous labor onset she should have regular fetal monitoring as several studies have suggested increased risk of perinatal death by increasing gestational age.

Objective The aim of this work was to evaluate the accuracy of fetal kidney length (FKL) to estimate gestational age (GA) and its correlation with the established parameters in the late second and third trimesters of pregnancy. Background Determination of GA is a mainstay to enable the obstetrician to provide successful management of to provide the patient with successful management. The FKL has exhibited a steady increase during pregnancy and it is not affected by abnormalities of growth. Patients and methods This was a cross-sectional study that was conducted on 400 pregnant women during their 24–40 weeks of pregnancy. Patients were examined by transabdominal ultrasound. The fetal biparietal diameter, femur length, abdominal circumference, and transcerebellar diameters were measured using the standard techniques. FKL s were measured. Results The right kidney length ranged from 24.1 to 40.4 mm with a mean of 34 ± 4.2 mm, and the left kidney length ranged from 24.3 to 42.5 mm, with a mean of 34.3 ± 4.1 mm. A gradual increase in the length according to each gestational week was evident. The constructed histograms showed a rather normal distribution. Statistically highly significant correlations were found between the GA and the kidney length as well as the other established parameters. FKL was able to predict the GA with a highly statistically significant difference (P < 0.001). Conclusion The renal length of the fetus can be an additional tool to determine the GA when menstrual dates are uncertain.

Background Patients who develop dry eyes after refractive surgery also have elevated risks of developing subsequent refractive regression and ocular surface damage. Objective To measure the level of dryness after small incision lenticule extraction (SMILE) in comparison with the level of dryness after femtosecond laser using the tear film break-up time test and Schirmer test. Patients and methods The study was conducted as a prospective (cohort) study on 52 patients who were recruited before and after the surgery from the outpatient clinic, Faculty of Medicine, Menoufia University. All participants included in this study were divided into group I, which included 26 patients (52 eyes) who were examined before and after SMILE surgery, and group II, which included 26 patients (52 eyes) who were examined before and after femtosecond-laser assisted in situ keratomileusis (femto-LASIK) surgery. History of dry eye symptoms including stinging, burning sensation, foreign body sensation, and sensitivity to light before surgery was obtained by direct patient interview and by follow-up after 1 and 6 months postoperatively. Results Dryness symptoms were greatly improved in both groups 6 months postoperatively compared with the symptoms detected after 1-month postoperatively, but the SMILE group had significantly better results than the LASIK group, where 48 patients had no symptoms in the SMILE group versus 39 in the LASIK group, with a significant difference. Conclusion The SMILE procedure had no profound harm on the ocular surface compared with femto-LASIK. Therefore, it reduces the incidence of dry eye disease and rapidly improves the quality of life after refractive surgery.

Objective The aim of the study was to investigate the correlation between the retinal layer metrics and visual acuity (VA) in diabetics with and without diabetic macular edema (DME). Background Diabetes is known to cause alterations in retinal microvasculature that progressively lead to visual impairment. In the current study, we determined the association between VA and retinal layer metrics derived from optical coherence tomography images in patients with and without DME. Patients and methods A case–control study was conducted on 216 eyes at the Department of Ophthalmology, Menoufia University Hospital. Group 1 included 40 eyes of type I diabetics, group 2 included 68 eyes of type II diabetics, and group 3 included 108 eyes of controls. Two subgroups of diabetic patients comprised 49 eyes with DME and 59 eyes without DME. Each patient underwent ophthalmic examination, VA, and optical coherence tomography. Results Our results revealed significant differences in best-corrected VA, a significant increase in the central foveal thickness, a significant increase of the temporal retinal nerve fiber layer thickness in diabetics, which was associated with reduced VA, and a significant thinning of the superior ganglion cell layer thickness. In patients with DME, we found a significant increase of the superior ganglion cell layer thickness and thinning of the nasal retinal nerve fiber layer thickness. These measurements as well as macular thickening were associated with reduced VA. Conclusion The variations in retinal layer thickness were associated with reduced VA with and without DME.

Objective This study aimed to assess health-related quality of life (HR-QOL) in children with chronic uveitis. Background Pediatric uveitis is an inflammatory ocular disease that can lead to severe ocular complications. It can significantly affect the HR-QOL of children and daily function. Patients and methods In this case–control study, HR-QOL was evaluated in 20 children with chronic uveitis and 20 children without chronic uveitis. The cases were recruited from the Ophthalmology Department in Menoufia University, and controls were recruited from a school. HR-QOL was evaluated by the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0). Results Uveitis-related data are dependent on full ocular examination by using a slit lamp, fundus examination, visual acuity, and measuring intraocular pressure. Cases had significantly higher scores of three child domains, with P value less than 0.001, whereas there was no significant difference between cases and controls according to the last child domain (emotional functioning), with P value of 0.320. There were no significant differences between the two studied groups according to the parent domains. Conclusion The visual prognosis of a child is severely affected by chronic uveitis, so regular assessment and adequate care can protect visual function. In this study, we found no significant correlation between the presence of uveitis, visual acuity, and quality of life, which was assessed by the PedsQL 4.0. This may be owing to the small size of the sample. Prospective studies on larger samples are needed to confirm these results.

Objectives This study aimed to evaluate the peripapillary retinal nerve fiber layer (RNFL) changes following retinal detachment repair with silicone oil (SO) tamponade by optical coherence tomography. Background SO has a well-established part in vitreoretinal surgery. With the enhancement of microsurgical strategies, it allows prolonged intraocular tamponade, and because of its optical clarity, it provides adequate postoperative assessment and good evaluation of visual acuity. Patients and methods This cross-sectional case series study was performed at two vitreoretinal centers; 30 patients underwent successful vitrectomy for primary rhegmatogenous retinal detachment with the macula of less than 1 month of using SO (5000 centistokes) as a tamponade. Data were collected after oil removal with or without phacoemulsification. Peripapillary RNFL thickness and central foveal thickness were measured using spectral-domain-optical coherence tomography. Results We divided the patients into two groups: 15 patients underwent silicone oil removal before 6 months (group I) and 15 patients after 6 months (group II). We compared best-corrected visual acuity between group I and group II and showed that there was a statistically significant difference in visual gain between the two groups. Also our study included the comparison of central macular thickness between the affected eye and the sound eye. Conclusion Patients with rhegmatogenous retinal detachment who had successful eye repair using SO tamponade are showing better visual outcomes with a tamponade period of fewer than 6 months with statistically significant difference of central foveal thickness than those with more than 6 months tamponade. However, the RNFL thinning did not have any statistically significant difference between both groups.

Background The eye shares striking structural, developmental, and genetic pathways with the kidney, suggesting that kidney disease and ocular disease may be closely linked. Objectives To assess retinal and choroidal thickness in patients with chronic kidney disease (CKD) using spectral-domain optical coherence tomography. Patients and methods This was a cross-sectional study conducted at Menoufia University Hospital Ophthalmology Department on 144 eyes of 72 CKD patients, who were divided into three groups according to the stage of CKD as follows: group 1: CKD stage 1–2, estimated glomerular filtration rate (eGFR) more than 60 ml/min/1.73m², group 2: CKD stage 3, eGFR 30–59 ml/min/1.73m², and group 3: CKD stage 4–5, eGFR less than 29 ml/min/1.73m². Each subject underwent a full ophthalmologic examination followed by optical coherence tomography assessment of retinal, retinal nerve fiber layer, and choroidal thickness. The procedure was achieved with pupillary dilatation. Results Retinal thickness and choroidal thickness were reduced in group 2 and group 3 compared with group 1 (for retinal thickness P = 0.015 for group 3 vs. group 1 and P = 0.022 for group 2 vs. group 1; for choroidal thickness P < 0.001 for group 2 and group 3 vs. group 1). This reduction was more in group 3 than in group 2. Conclusion This study revealed that chorioretinal thinning in CKD is associated with a lower eGFR, a higher serum C-reactive protein, and greater proteinuria. Larger studies, in more targeted groups of patients, are now needed to clarify whether these eye changes reflect the natural history of CKD. Similarly, associations with arterial stiffness, inflammation, and endothelial dysfunction warrant further examination.

Objectives To determine the effects of phacoemulsification surgery on corneal endothelial cell density and corneal thickness in patients undergoing cataract surgery. Background Phacoemulsification cataract surgery with implantation of an intraocular lens is the most common procedure for cataract extraction, which may have several complications. Patients and methods This was a descriptive prospective study for comparative analysis of corneal endothelial changes using Tomey EM-3000 noncontact specular microscope held on selected patients with senile cataracts who attended the outpatient clinic of Menoufia Ophthalmology Center (MOC) for cataract surgery in the period from October 2021 March 2022. Cataract extraction using phacoemulsification and intraocular lens implantation was done on all patients. Results There was a significant reduction in mean endothelial cell density after phacoemulsification compared with baseline, with P value less than 0.001. There was also a significant postoperative reduction in mean endothelial cells number as compared with baseline, with P value less than 0.001. Mean endothelial cell hexagonality was reduced significant (P < 0.001). Central corneal thickness showed a significant increase postoperatively (P < 0.001). Conclusion Despite healthy cornea, no previous surgical history, and no corneal abnormalities before surgery, there was marked endothelial loss by phacoemulsification. This is particularly important in patients, especially with harder nuclear density.

Objectives To present the various adverse effects of topical prostaglandin analogs on the periorbita. Background The authors studied the prostaglandin-related adverse effects on the periorbita and compared each analog in a sample of patients with glaucoma. Patients and methods A case series study was performed on the adverse effects on the periorbita noticed in glaucomatous patients who were controlled by prostaglandin in Menoufia University Hospital and Cairo Fatemic Hospital. The study was done on 100 patients aged from 18 to 75 years at outpatient clinics. Results A total of 100 patients were found to have a variety of disorders, including deepening of the superior sulci (42/100), hypertrichosis (23/100), lengthening of eyelashes (48/100), and hyperpigmentation of the skin surrounding the eye (40/100). Conclusion Although topical prostaglandin analogs are well tolerated by many patients, some individuals who use these medications complain of structural changes in the periorbita, resulting in a variety of cosmetic and eyelid disorders, such as lengthening of eyelashes, hypertrichosis, hyperpigmentation of the skin surrounding the eye, and deepening of sulci.

Objectives Evaluation of treatment of type-I retinopathy of prematurity (ROP) detected by early screening of preterm infants by intravitreal injection of Ranibizumab. Background Retinopathy of prematurity is a childhood-blindness disease. Considering Ranibizumab might have a better safety profile for preterm infants, some authors shifted IVB to intravitreal injection of Ranibizumab to treat ROP. Patients and methods A clinical trial was performed between January 2021 and May 2022 in the neonatal ICU and Department of Ophthalmology, Menoufia University on 131 preterm infants. Type-I ROP cases were diagnosed and treated with intravitreal injection (IVI) of antivascular endothelial growth factor Ranibizumab 0.25 mg/0.025 ml. Injection was done 1.5 mm posterior to limbus. Both eyes were injected in the same sitting with different sterile sets. Follow-up was performed after 1 day to IVI, 1 week, and then according to stage of ROP. Results Thirty patients developed ROP severe enough to require intervention. Five (38.50%) cases had stage 2, five (38.50%) cases had stage 3, and three (23.10%) cases had aggressive posterior retinopathy of prematurity. The mean gestational age for type-1 ROP cases was 30 ± 1.8 weeks (28–35 weeks), mean birth weight was 1.3 ± 0.3 (0.950–1.6), and mean postmenstrual age was 34 ± 2. The mean follow-up time was 14 ± 1.37 months (range, 12–24 months). The efficacy of IVI of Ranibizumab in our study is 21 (80.7%) of 26 and recurrence requiring treatment occurred in five eyes from 26 (19.2%) eyes. Conclusion Single dose of Ranibizumab improving type-I ROP as regression of plus disease and newly formed vessels, and allows for continued vessel growth into the peripheral retina.

Background The greater tuberosity (GT) of the humerus position and morphology represented by the greater tuberosity angle (GTA) has an important role in rotator cuff tear. Objectives To evaluate the relationship between GTA and degenerative rotator cuff tear, which measures the position of the GT in relation to the humeral head center of rotation. Patients and methods From June 2021 till March 2022, a case–control study was carried out at Menoufia University Hospital that included 94 patients who were divided into a case group (47 patients with degenerative rotator cuff tear) and a control group (47 patients with other shoulder pathology). Patients with traumatic rotator cuff tear, skeletally immature, previous shoulder surgery, healed fractures around shoulder, and isolated subscapularis tear were excluded, and GTA was measured on an anteroposterior shoulder radiograph image with the arm adducted to body, forearm supinated, and palm of hand facing forward. Results GTA in the case group measured 72.5 ± 2.5, whereas measured 65.2 ± 4.1 in the control group (P < 0.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P < 0.001). Conclusion GT morphology is a contributing factor for degenerative rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions.

Objective To evaluate the clinical and radiological outcomes of treating patients with cervical spondylotic myelopathy (CSM) with cervical laminoplasty using the open-door technique with stabilization of titanium miniplates. Background CSM is a frequent cause of spinal cord impairment in the elderly. Cervical laminoplasty is a lamina-preserving procedure that decompresses the spinal cord with preservation of the cervical spine motion. Patients and methods This was a retrospective review of 532 patients with CSM who had open-door cervical laminoplasty from July 2015 to July 2019. Detailed history and complete clinical and neurological examinations were done. Plain radiography, computed tomography, and MRI of the cervical spine were obtained. Functional evaluation of neurological status was done using the Japanese Orthopaedic Association score. The pain intensity was evaluated using the visual analog scale. Results A total of 532 patients, comprising 345 (66.8%) males and 187 (35.2%) females, with CSM who underwent open-door cervical laminoplasty were included. The mean Japanese Orthopaedic Association score increased from 10.2 ± 1.3 (range, 9–13) preoperatively to 14.1 ± 0.9 (range, 12–16) at the end of a minimum follow-up period of 1 year, which was statistically significant (P = 0.022). Satisfactory results were achieved in 439 (82.5%) patients. The mean visual analog scale was reduced from 5.9 ± 2.3 (range, 3–7) preoperatively to 2.3 ± 3.4 (range, 0–4) at the last follow-up (P < 0.001). Conclusions Open-door cervical laminoplasty for patients with CSM has satisfactory functional and radiological outcomes.

Objectives To evaluate the diagnostic role of ankle arthroscopy in the management of chronic lateral ankle instability and evaluation of clinical and functional outcomes of chronic lateral ankle ligament repair in the management of chronic lateral ankle instability. Background Ankle sprain is one of the most common injuries encountered in work and sport. It is caused by untreated or badly managed acute lateral ankle ligament injuries. Patients and methods This is a prospective study carried out on 24 patients, who were evaluated by diagnostic ankle arthroscopy prior to repair of chronic lateral ankle ligament, conducted in the Department of Orthopedics and Traumatology, Menoufia University Hospital between June 2020 and June 2021. Patients included in this study were evaluated by diagnostic ankle arthroscopy prior to repair/reconstruction of lateral ligaments of the ankle. All patients were postoperatively evaluated according to pain (visual analog scale score), range of motion, and functional scoring system (American Orthopaedic Foot and Ankle Society) score. Result Postoperatively, there was high statistically significant improvement in pain, function, and total American Orthopaedic Foot and Ankle Society scores. On the other hand, there was no statistically significant difference in alignment preoperatively and postoperatively. Conclusion The results of this study show the excellent efficacy of arthroscopic surgical procedures in the treatment of chronic lateral ankle instability.

Background Tennis elbow is a tendinosis with angiofibroblastic degeneration of the wrist extensors' origin with extensor carpi radialis brevis; the tendinous origin is the main part to be affected 2 cm distal to lateral epicondyle. Objectives To compare the short-term effects of extracorporeal shockwave therapy (ESWT) versus corticosteroid injection (CI) in patients with chronic tennis elbow who failed previous conservative treatment using the patient-related tennis elbow evaluation system. Patients and methods This prospective study was performed at the Orthopedic Surgery Department and Rheumatology and Rehabilitation Department of Menoufia University Hospitals and Talkha Central Hospital. The study included patients diagnosed with tennis elbow who failed conservative treatment. The patients showed positive clinical history and positive clinical examination, demonstrating tennis elbow. Results The success rate in the ESWT group at 3-month follow-up was 89.7% and at 6-month follow-up was 93.1%. The ESWT group had a 0% recurrence rate, where the patient experienced improvement during the 3-month follow-up followed by reappearance of the symptoms. The success rate in the CI group at 3-month follow-up was 89.3% and at 6-month follow-up was 75.0%. The CI group had a 25% recurrence rate, where the patients experienced improvement during the 3-month follow-up followed by reappearance of the symptoms. Conclusion Our results propose that although ESWT and CI were effective in the treatment of chronic lateral epicondylitis at 12 weeks of follow-up, ESWT was superior to CI owing to its effect on pain and improving function at short-term and long-term follow-up.

Objectives This study aimed to validate the translation of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) in Arabic and to show the relation between QUALEFFO-41 and the audiovestibular symptoms in osteoporotic females. Background Osteoporosis could lead to reduced physical, social, and mental functioning and loss of personal independence. Moreover, audiovestibular symptoms may affect the quality of life in osteoporotic postmenopausal females. Patients and methods A total of 34 postmenopausal osteoporotic female patients and 34 postmenopausal healthy females participated in this case–control research. With cross-cultural adaption, the QUALEFFO-41questionnaire was translated into Arabic. To evaluate test–retest reliability, caregivers completed the questionnaire at their initial consultations and again 1 month afterward. Full audiovestibular history taking was done for the cases. Results QUALEFFO-41 showed internal consistency and reliability, with Cronbach's α value being 0.904. Test–retest reliability was excellent in all domains and the total score. It was assessed by intraclass correlation coefficient, which ranged from 0.954 to 0.998. A highly significant difference between the case and control groups had been shown for all QUALEFFO-41 items and their total score. The presence of audiovestibular symptoms was significantly associated with higher score of pain domain, activities of daily living domain, general health perception domain, and total score of QUALEFFO-41. Conclusion The Arabic QUALEFFO-41 version is reliable, valid, sensitive, and predictive for examinations of health-related quality of life in patients with osteoporosis. The score of QUALEFFO-41 was worse in patient with audiovestibular symptoms.

Background Radical cystectomy (RC) is the gold standard in the treatment of muscle-invasive bladder cancer. Objectives To compare the pathologic response and perioperative morbidity of neoadjuvant chemotherapy (NAC) with cystectomy against RC alone as a treatment for muscle-invasive bladder cancer. Patients and methods This randomized controlled clinical trial took place between December 2020 and December 2021. The study enrolled 40 patients with muscle-invasive transitional cell carcinoma of the urinary bladder. Patients were randomized into two treatment groups: group I (20 patients) was treated with RC alone, and group II (20 patients) received three cycles of NAC with cystectomy. Results Of 20 patients of group II, only 16 patients completed NAC. Pretreatment patient criteria were comparable between both groups. Downstaging in postcystectomy specimen was significantly higher in group II than group I (pT0 12.5 vs. 0% and pT1 12.5 vs. 0%, respectively). There was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone, with an overall complication rate of 68.8 and 66.7% in groups II and I, respectively. Conclusion NAC with RC is helpful in downstaging of the bladder cancers without increasing the perioperative morbidity related to RC.

Objective The aim was to assess and compare the efficacy and safety of semirigid and flexible ureteroscopy (URS) for the management of renal stones. Background Treatment modalities for renal stones have changed significantly in recent years, and alternative, minimally invasive methods have gained importance. Patients and methods A prospective nonrandomized study was undertaken of all cases with renal stones between 2019 and 2021 performed at a single academic hospital. Ureteroscopic stone treatment was attempted in 77 patients. Semirigid URS was routinely performed in all cases. If the renal stones were accessible with the semirigid ureteroscope, they were then treated with holmium laser under direct vision (group 1). If the stones were not accessible, a single-use flexible URS was performed (group 2). Patient demographics, intraoperative data, and postoperative outcomes were evaluated. Results The study included 30 (39%) male and 47 (61%) female patients. The mean stone size was 19 (±8) mm for group 1 and 15 (±9) mm for group 2. A stone-free status was observed in 29 (67.4%) patients for group 1 and 29 (85.3%) patients for group 2. Postoperative urinary tract infection was observed in five (11.6%) patients in group 1 and five (14.7%) patients in group 2, and postoperative hematuria in two (4.6%) patients for group 1 and two (5.8%) patients for group 2, all were treated conservatively. Conclusion Retrograde intrarenal stone treatment represents a minimally invasive alternative, it is safe and effective for treating renal stones not amenable to less invasive techniques.

Objectives To compare the safety and efficacy of tadalafil versus tadalafil with silodosin in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) and their effect on erectile function. Background Lower urinary tract symptoms and erectile dysfunction are two commonly associated conditions in patients with BPH and lead to worsening of the quality of life in the male population. For such cases, alpha-blockers and phosphodiesterase five inhibitors are used. Patients and methods A total of 100 men, having lower urinary tract symptoms owing to BPH with moderate and severe international prostatic symptom score (IPSS), were randomly divided into four equal groups of 25 patients each. The IPSS and International index of erectile function-5 (IIEF-5) were scored for all patients together with measuring postvoid residual urine (PVR) and maximum urine flow rate (Q-MAX) at the first visit and then follow-up was done on the third, sixth, and 12^th weeks, with same parameters added to inquiry about any adverse effects. Results Tadalafil monotherapy statistically improved IPSS, IIEF, and Q-MAX, with P value less than 0.001 in groups I and III. Moreover, it showed a statistically significant reduction in PVR in the same groups, with P value less than 0.001. The same findings were in groups II and IV receiving the combination therapy, with P value less than 0.001, with numerically better results in all aspects of the study. Conclusion All patients tolerated both protocols of treatment with no statistically significant adverse effects. The combination therapy was superior to monotherapy in all aspects regarding IPSS, IIEF, PVR, and Q-MAX.