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

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Objective Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in the ICU. We studied the characteristics and risk factors of VAP in critically ill neonates. Background VAP, which was not present at the time of intubation, accounted for up to 30% of nosocomial infections in neonatal intensive care unit (NICU) patients. Patients and methods This study was carried out in the NICU in Benha Children's Hospital on 85 neonates with different diagnoses admitted from April to October 2012 who needed mechanical ventilation. All studied neonates were subjected to history taking, clinical examination, routine investigations (assessment of complete blood count, C-reactive protein levels, and arterial blood gas volumes, blood culture, and liver, serum albumin, and kidney function tests), and chest radiography daily, as well as to nonbronchoscopic alveolar lavage culture. Results Of 85 neonates who needed mechanical ventilation, 55.2% developed VAP. Prematurity, low birth weight, and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leukocyte count, C-reactive protein, and hypoalbuminemia were significantly present in the VAP group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO ₂ , and PaO ₂ . The microorganisms associated with bloodstream infection in the VAP-diagnosed group were Staphylococcus aureus (15%), Klebsiella spp.(8.5%), Candida spp.(6.5%), Pseudomonas spp. (4.2%), and Escherichia coli (4.2%); 61.7% of obtained blood cultures in VAP patients were sterile. The results of nonbronchoscopic bronchoalveolar lavage cultures revealed the presence of Klebsiella spp. (34%), Pseudomonas spp. (25.5%), S. aureus (17%), E. coli (17%), and Candida spp. (6.4%). K. pneumoniae was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition, and umbilical catheterization.

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Objective To study the risk factors for diabetic foot ulcers (DFUs) in Menoufia University Hospitals. Background Problems associated with the diabetic foot are prevalent worldwide. DFUs contribute significantly toward the morbidity and mortality of patients with diabetes mellitus. This study was carried out to evaluate the risk factors for DFUs. Patients and methods One hundred patients with diabetic foot were enrolled and 50 patients had foot ulcers. All were subjected to the following: assessment of full history, physical examination including foot examination through peripheral pulses including Doppler examination of dorsalis pedis and posterior tibial arteries, sensations, reflexes and callus, and routine investigations including HbA1c, fasting, and 2 h postprandial blood glucose. Results DFUs occurred mostly in patients who had had diabetes for a long duration more than 10 years (94%), smokers (50%), those with diabetic retinopathy (92%), those with previous ulcers (74%), those who had a previous amputation (42%), those with peripheral neuropathy assessed by [lost monofilament (100%), lost vibration sensation (100%), lost pinprick sensation (100%)], peripheral vascular disease assessed by [ankle brachial index≤0.9 (84%), Doppler examination detected ischemia (84%)], foot fissures (12%), foot callus (24%), foot deformities (36%), limited joint mobility (26%), dyslipidemia on the basis of elevated total cholesterol greater than 200 mg/dl (40%), and poor glycemic control on the basis of (hemoglobin A1C>7.5%). The types of ulcers were neuropathic (16%) and neuroischemic (84%). Age, sex, diabetic nephropathy, obesity detected by BMI, abnormal ankle reflexes, and elevated serum creatinine were not risk factors for DFUs. Conclusion Peripheral neuropathy, duration of diabetes, peripheral vascular disease, and poor glycemic control were significant predictors of DFUs.

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Objective The aim of this study was to identify the serum markers and the use of abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis C virus infection. Background HCC meets the criteria of a tumor that would benefit from a surveillance program, but the poor sensitivity and specificity of currently available tools have prevented widespread implementation of surveillance. Patients and methods This study included 110 patients, age from 23 to 70 years, from Menoufia University hospitals during the period from July 2011 to November 2013. They were classified into three groups: group I, non-HCC group (50 patients); group II, HCC group (40 patients with chronic hepatitis C virus infection); and group III, healthy controls (20 individuals). Members of the study were subjected to thorough history taking, complete physical examination, liver function testing (serum bilirubin, albumin, prothrombin time, serum transaminases), serum α-fetoprotein (α-FP), and transforming growth factor β1 (TGF-β1) level. Group I was subjected to serum TGF-β1 at 0-, 9-, and 18-month intervals. Results The mean age was 46.72 ± 9.03 years in the non-HCC group (group I), 58.70 ± 5.76 years in the HCC group (group II), and 42.15 ± 11.33 years in the control group (group III). The mean serum level of TGF-β1 was 232.25 ± 70.53 ng/ml in the HCC group, 42.16 ± 13.34 ng/ml in the non-HCC group, and 13.92 ± 7.73 ng/ml in the control group; there was a highly significant difference between all groups (P < 0.001). The mean value of α-FP was 334.40 ± 311.30 ng/ml in group II and 4.82 ± 2.18 ng/ml in group I; the HCC group had a shooting serum level of α-FP with a highly statistically significant difference. Conclusion This study recommends TGF-β1 as being more accurate than α-FP in differentiating patients with HCC from those with nonmalignant chronic liver disease.

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Objective The aim of the study was to assess the effect of parental nutritional knowledge, attitude, and practice (KAP) on their children nutritional behavior and growth. Background Good nutrition is cornerstone for growing children during early childhood and school-age years; children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased. Participants and methods This was a cross-sectional study through multistage stratified random sampling technique. Bialla district of Kafr-Elsheikh governorate was selected randomly from 10 district of Kafr-Elsheikh governorate. Predesigned questionnaires that assess parents and children (KAP) were then given to parents and children and 120 pairs of completed questionnaires were returned. Results There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children (P>0.05), whereas there was a significant correlation between parent's knowledge score and healthy food intake in general by children (r = 0.222; P < 0.05). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. There was a highly significant correlation between social class of parents and their children nutritional behavior; in addition, there is significant correlation between father's education and mother's education and their children nutritional practice (χ² = 15.3 and 14.6; P = 0.018 and 0.023, respectively). Conclusion There is no relationship between parents knowledge, attitude, and healthy food intake by their children. Parents education and socioeconomic status constituted important determinants of healthy food intake by their children.

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Objective To investigate the effect of pentoxifylline (PTX) and pioglitazone (Pg), each alone and in combination with methotrexate (MTX), on rheumatoid arthritis (RA) induced experimentally in male albino rats. Background Individuals have long feared RA as one of the most disabling types of arthritis. It is estimated that over 46 million individuals have arthritis, ~1% worldwide. Material and methods One hundred and eighty adult male albino rats were used in the present study. MTX was administered intraperitoneally at a dose of 0.25 mg/kg daily. PTX was administered intraperitoneally at a dose of 150 mg/kg/rat/day, whereas Pg was administered orally at a dose of 3 mg/kg/day. All doses were administered for a period of 2 weeks. RA was induced by two methods: adjuvant-induced arthritis and pristane-induced arthritis (PIA). Adjuvant-induced arthritis was induced by an intradermal injection of 0.1 ml of complete Freund adjuvant. This type of arthritis appears about 8-12 days after injection. PIA was induced by a single intradermal injection with 0.2 ml pristane at the base of the tail. PIA develops in 2-3 weeks after injection and progresses with a relapsing course that persists for months. Results The anti-inflammatory properties of these drugs were confirmed by reduction of erythrocyte sedimentation rate, serum rheumatoid factor level, serum C-reactive protein level, serum tumor necrosis factor-a level, serum nitrite level, and blood superoxide dismutase level, whereas antioxidant activities were confirmed by an increase in the blood reduced glutathione level. Our study showed that Pg alone exerts portentous effects in the treatment of RA. However, it was more active in combination with MTX. Conclusion Our study showed that Pg was the most potent drug in treating arthritic rats, followed by PTX, with lesser potency in treating arthritic rats. When comparing the two combinations, the combination of Pg with MTX was the most potent one. The second combination was the combination of PTX with MTX.

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

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Objectives To study the pattern of serum lipids in β thalassemic children. Background β Thalassemia is a common chronic hemolytic anemia in Egypt. Iron overload is a common sequelae in these patients. Abnormal lipid profile patterns have been suggested to occur in thalassemic patients. Materials and methods Forty-two children with β thalassemia (22 thalassemia major and 20 thalassemia intermedia) were included in the present study with 30 matched controls. Complete blood count, kidney function tests (serum creatinine, blood urea), liver function tests (alanine aminotransferase, aspartate aminotransferase), serum ferritin, and 12-h overnight fasting Serum lipid profiles including total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) triglycerides were performed for patients and controls. Results The thalassemic children had significantly higher platelets count, WBCs count, serum ferritin, alanine aminotransferase, aspartate aminotransferase, and serum triglyceride levels, with significantly lower Hb level, RBCs count, total cholesterol, HDL-C, LDL-C levels, and LDL/HDL ratio compared with the control group. Conclusion β Thalassemic children are at risk of developing disturbed lipid profile patterns that could place them at risk for atherosclerosis and thromboembolic events.

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Objectives To study the comorbid psychiatric disorders among substance abusers in Menoufia and to identify whether there is a correlation between the type of substance and the comorbid disorder that occurred, and also to determine whether there are specific risk factors that can cause this comorbidity. Background A dual diagnosis presents a challenging problem to clinicians as substance use disorders occurring together with mental health disorders represent a major health problem. Participants and methods Study participants comprised 120 Egyptian substance abusers. They were subjected to the following: semistructured interview sheet, Fahmy and El Sherbini Social Classification scale, semistructured clinical interview for DSM-IV (SCID) both SCID-I for Axis-I diagnosis and SCID-II for Axis-II diagnosis, Addiction Severity Index scale, and a urine screening for substance abuse. Results The findings of the study suggested that 20% of the studied participants were tramadol abusers, 10% were both alcohol and cannabis abusers, 23% were other substances abusers, and 37% were polysubstance abusers. With respect to psychiatric comorbidity, 63.3% of the participants had comorbid psychiatric disorders and comorbid personality disorders (PDs). On studying risk factors for substance abuse, major depressive disorder was found to be the strongest predictor of alcohol abuse. Dependent PD and schizophrenia were the strongest predictors of cannabis abuse. Major depressive disorder and borderline PD were the strongest predictors of opioid abuse. Anxiety disorders and borderline PD were the strongest predictors of sedative abuse. On studying risk factors for comorbid psychiatric disorders in the participants studied, young age (<25 years) and being single were found to be the strongest predictors of comorbid Axis-I disorders. Conclusion Individuals with psychiatric disorders are at an increased risk of having a comorbid substance abuse disorder and vice versa.

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Objective The aim of this study was to evaluate the possible protective effect of omega-3 on testicular tissue damage induced by antidepressant drug (fluoxetine), in adult male albino rats. Background Fluoxetine is a selective serotonin reuptake inhibitor drug commonly used in the treatment of depression, but it causes structural changes of testicular tissue. Omega-3 has a range of anti-inflammation and antioxidation. Materials and methods This animal study was carried out during the period from December 2016 to June 2017 on 50 adult male albino rats that were kept in the animal house of the Faculty of Medicine, Menoufiya University, and divided into four groups: group I (control); Group II (omega-3); group III, subdivided into two subgroups – IIIa (fluoxetine) and IIIb (recovery); and group IV (fluoxetine and omega-3). All groups received drugs orally for 4 weeks, and the recovery subgroup was left untreated for another 4 weeks. Then, animals were sacrified and weighted. Testis samples were obtained for histological and immunohistochemical study. Results Fluoxetine-treated rats showed a highly significant decrease of body and testis weight (P < 0.001). Fluoxetine led to distortion of seminiferous tubules, germ cell degeneration with sloughing, and vacuolation. The interstitium appeared wide containing degenerated Leydig cells, congested blood vessels, and acidophilic material. Fluoxetine induced intense expression of caspase-3, decrease in the mean number of positive proliferating cell nuclear antigen immunostaining, and negative expression of androgen receptor. The recovery group still showed persistence of some changes. Fluoxetine and omega-3 groups showed marked improvement. Conclusion Omega-3 alleviates testicular damage induced by fluoxetine more than arresting fluoxetine.

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Objective The aim of this study was to determine the histological, histochemical, and immunohistochemical effects of monosodium glutamate (MSG) on the ovaries of adult female albino rats and the possible protective role of green tea. Background MSG is a commonly used food additive. It plays an important role in the pathogenesis of anovulatory infertility. Materials and methods A total of 35 female adult albino rats were used in this study. The rats were divided into four groups: groups I-IV. Group I was the control group. In group II (MSG treated) 10 rats were treated with MSG at a dose of 4 mg/g body weight by subcutaneous injection daily for 14 days. The rats were killed 24 h after MSG treatment. In group III [combined green tea extract (GTE) and MSG treated] 10 rats were treated with GTE and MSG for 14 days. MSG was given at the same dose as that in group II and GTE was given at 300 mg/kg body weight orally daily. The rats were killed 24 h after MSG and GTE treatment. In group IV (GTE treated) five adult rats were treated with GTE only for 14 days and then killed. Results MSG-treated rats showed degenerative changes of the ovary with many atretic follicles. The stroma appeared vacuolated. The medulla showed multiple vacuoles with congested blood vessels. However, combined treatment of GTE and MSG in group III showed amelioration of the histological changes in the ovary. Conclusion It has been concluded that GTE improves the histological changes caused by MSG in the ovary.

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Objective This study compared clinical outcomes and complications in patients with humeral shaft fractures treated using two methods of fixation by means of plating. Background Plate osteosynthesis has been the treatment of choice for humeral shaft fractures when operative treatment is required. However, plate osteosynthesis of comminuted humeral fractures is a challenging operation, which requires surgical experience and meticulous attention to soft tissue. Minimally invasive plate osteosynthesis (MIPO) is an emerging procedure for the treatment of humeral shaft fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods Thirty patients were analyzed and divided into two groups. Group 1 (n = 15) patients were treated with MIPO and group 2 (n = 15) with open reduction and internal fixation (ORIF). The major characteristics of the two groups in terms of age, sex, mode of injury, fracture location, and associated injuries were similar. Results Primary union was achieved in all patients in the MIPO group and in 14 of 15 in the ORIF group. The mean time to union was similar in the two groups. The mean operation time in the MIPO group (80 min) was shorter than that in the ORIF group (125 min) (P < 0.0001). Bone grafting was performed in one patient in the ORIF group, but in no patients in the MIPO group. There was one case of deep infection in the ORIF group. There was one case of postoperative radial nerve palsy in the MIPO group and two cases in the ORIF group. Functional outcome was satisfactory in both groups. Conclusion The MIPO technique achieves comparable results with the ORIF method in simple and complex fractures of humeral shafts. Although MIPO potentially has a radiation hazard, it reduces perioperative complications with shortened operation time and minimal soft tissue dissection.

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Objective The aim of the study was to compare between endoscopic and microscopic trans-sphenoidal approach regarding surgical outcome and postoperative complications. Background Pituitary adenomas are the third most common intracranial tumors in surgical practice, accounting for ~10-25% of intracranial tumors. These tumors may gain large size before producing hormonal or visual symptoms. There are many surgical approaches for these tumors. Patients and methods Over the last 3 years, 40 patients with pituitary adenoma either microadenoma or macroadenoma were operated through trans-sphenoidal approach either microscopically or endoscopically. Patient consent was obtained followed by careful clinical history, symptoms, signs, and preoperative radiological evaluation. Operative and postoperative events were noted with 3 months follow-up. Results A total of 40 patients with pituitary adenomas were operated trans-sphenoidally. The mean age was 35.9 years (range 21-60 years). The number of men was 23 (57.5%) and women was 17 (42.5%). The most common presenting symptom was headache in 25 (62.5%) patients and visual complaints in 24 (60%) patients. Amenorrhea and acromegaly were in eight (20%) patients for each; Cushing syndrome was present in three (7.5%) patients. Hyperthyroidism and infertility were in two (5%) patients for each. Conclusion Surgical outcome in endoscopic trans-sphenoidal approach is better than microscopic approach regarding postoperative nasal complications.

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

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Objective: The aim of this work is to assess the prevalence rate, etiology, and risk factors for end-stage renal disease (ESRD) in Assiut governorate, Egypt, during the year 2014. Background: ESRD is one of the main health problems in Assiut governorate. Currently, hemodialysis represents the main mode of treatment of ESRD in Assiut governorate, Egypt. The epidemiology of ESRD in Assiut has never been examined before 2014. Assiut is located in upper Egypt. The total area of Assiut is 13 720 km2, and the province has a population of 4 263 719 million individuals. Patients and methods: Patients with ESRD from the entire Assiut governorate were interviewed and questionnaires were filled out by the investigators. The questionnaire included personal and sociodemographic data, history of relevant diseases, dialysis frequency, investigations performed, and other data investigating the causes. Results: All patients (n= 1559) with chronic renal failure surviving on renal replacement therapy, definitely those on hemodialysis in Assiut governorate during 2014, were distributed in 14 units of hemodialysis across all 10 Assiut districts. These units were governmental. Only 1109 (71%) patients in 13 hemodialysis units agreed to participate in this study (729 men, 65.7%) and 380 (34.3%) women. The prevalence of ESRD in Assiut governorate is 366 per million populations (pmp) of the population. The etiology of ESRD was unknown in 25% of cases, whereas hypertension was responsible in 21.4% of cases, obstructive uropathy in 11% of cases, chronic glomerulonephritis in 8% of cases, analgesic nephropathy in 3% of cases, chronic pyelonephritis in 8.9% of cases, diabetic nephropathy in 14.9% of cases, toxemia of pregnancy in 2% of cases, and polycystic kidney disease in 0.7% of cases. Conclusion: The prevalence rate of ESRD in Assiut governorate during the year 2014 was 366 pmp. Unknown etiology and hypertension are the major known causes of ESRD. A unifying system of an electronic data registry should be established in each governorate to constitute the national Egyptian data registry.

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Objectives: This study aimed to evaluate the effect of mode of delivery on the haematological parameters of newborns (caesarean section against normal vaginal delivery). Background: Complete blood count (CBC) correlates highly with gestational age, birth weight, blood sampling site, crying, physical therapy, mode of delivery and other factors. Participants and methods: This study was carried out on 72 neonates. Group I included 31 neonates delivered vaginally. Group II included 41 neonates delivered by caesarean section. CBC was performed on these neonates from umbilical cord blood immediately after birth. Results: Haemoglobin, red blood cell count, haematocrit, platelet, total leucocyte count, neutrophils, eosinophils and basophils in full-term neonates delivered vaginally were significantly higher than those of neonates delivered by caesarean section. However, there was no significant difference in the mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width, lymphocytes and monocytes. There was a significant increase in haemoglobin, red blood cell count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, red cell distribution width, platelets, total leucocyte count, neutrophils, eosinophils and lymphocytes in preterm neonates delivered vaginally than those delivered by caesarean section, whereas there was no significant difference in the mean corpuscular haemoglobin concentration, basophils and monocytes. Conclusion: Mode of delivery is one of the perinatal factors that affects neonatal CBC.

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Background Adherence to therapies is the corner stone of treatment success. Medication nonadherence in geriatric patients leads to substantial worsening of disease, increased healthcare costs, and death. Knowledge about the drug's indication, side effects, and interactions with other drugs may constitute a barrier to drug adherence. Objective The aim of this study was to assess the effect of medication knowledge as a determinant factor of medication adherence in elderly patients living in their own houses. Participants and methods This is a cross-sectional study of a random sample of 438 geriatric patients aged 70–85 years, living in their own homes in Serse Elian City, Menoufia Governorate. Patients' information was collected from the prescriptions in the file of the patient and home visits were carried out to examine their daily drug consumption. Results Male geriatric patients were found to be more adherent to their medications than female patients (63.9 vs. 36.1%). Correct knowledge regarding the name of the drug, it's timing, the correct dose, and indications constituted a statistically significant difference among adherent and nonadherent groups, whereas awareness about side effects of the drug did not have a significant effect on medication adherence. Conclusion Knowledge about medication in general constituted a significant determinant of medication adherence in elderly patients.

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Objective The aim of this study was to evaluate the effects of different techniques of fat grafting on improving the esthetic outcome of facial scars. Background Control of facial scarring is one of the most difficult challenges in surgical practice, and represents a difficult therapeutic problem facing plastic surgeons to achieve good results. To date, no gold standard exists for the treatment of scar tissue. Autologous fat grafting has been introduced as a promising treatment option for scar tissue-related symptoms. However, the scientific evidence for its effectiveness remains unclear. Patients and methods This study was conducted on 30 patients with obvious facial scars. Patients' age ranged from 8 to 48 years. Patients were selected randomly to be treated with fat grafting. The abdomen and thigh were the most commonly chosen donor sites. Fat was processed to be injected at the dermohypodermal junction (microfat grafting) or intradermal injection (nanofat grafting) was used. Results Fat grafting proved to have a significant role in scar remodeling. This was measured clinically by the Vancouver Scar Scale. Regarding patient satisfaction with cosmetic appearance, 15 cases were evaluated as excellent, eight cases were evaluated as good, and five cases were evaluated as fair. Conclusion Autologous fat grafting has a significant role in facial scar remodeling and provides a beneficial effect on facial scar tissue and scar-related conditions with not only esthetic results but also functional results. Significant improvement in scar appearance, skin characteristics, and restoration of volume and three-dimensional contour is reported.

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Introduction Iron is one of the essential minerals that is required for a variety of molecules to maintain their normal structures and functions. Although it is essential, iron can also be toxic in excess amounts. Oxidative stress is one of the major causative factors for diabetes and diabetic complications. Increasing evidence has indicated that iron overload not only increases risks for insulin resistance and diabetes but also causes cardiovascular diseases in nondiabetic and diabetic individuals. Objective The aim of this study was to investigate the role of iron in diabetes mellitus and its complications. Data analysis Data sources: Data were collected from medical text books, medical journals, medical websites that had updated research with keywords (iron and diabetes mellitus) in the title of the paper. Study selection: Systematic reviews that addressed diabetes mellitus and studies that addressed the role of iron in the pathogenesis of diabetes and diabetic complications were selected for study. Data extraction: A special search was carried out at midline with keywords (iron and diabetes mellitus) in the title of papers and extraction was made, including assessment of quality and validity of papers that met with the prior criteria that describe the role of iron in the pathogenesis of diabetes and diabetic complications. Data synthesis: Each study was reviewed independently and the obtained data were rebuilt in new language according to the need of the researcher and arranged in topics through the article. Recent findings: Iron overload not only increases risks for insulin resistance and diabetes but also accelerates diabetic complications. Conclusion Oxidative stress is one of the major causative factors for diabetes and diabetic complications. Increasing evidence has indicated that iron overload not only increases risks for insulin resistance and diabetes but also causes cardiovascular diseases in nondiabetic and diabetic individuals.

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Objective The aim of the study was to determine the prevalence and risk factors of proteinuria among type 2 diabetic patients in Menoufia governorate. Background Type 2 diabetes is the leading cause of end-stage renal disease worldwide. Microalbuminuria or incipient diabetic nephropathy is one of the initial clinical manifestations of early diabetic nephropathy. Patients and methods A total of 234 type 2 diabetic patients were included in this study; they attended the outpatient clinics of the Family Health Center of 'Kafr Tanbedy' and Internal Medicine Department of Faculty of Medicine, Menoufia University, for routine follow-up. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR < 30 mg/g creatinine), microalbuminuria (ACR = 30 to <300 mg/g creatinine), or macroalbuminuria (ACR≥300 mg/g creatinine). The three groups were compared to analyze the association between albuminuria and its risk factors. In addition, independent predictors of albuminuria were determined using multivariate logistic regression and presented as an odds ratio. Results Prevalence of microalbuminuria (incipient diabetic nephropathy) was 34.2% and that of macroalbuminuria (overt diabetic nephropathy) was 12.8% in the studied group. Conclusion The overall prevalence rate of albuminuria was considerably high (47.01%) among the studied diabetic patients. Therefore, regular screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).

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Objective The aim of the work was to assess the prevalence of obesity among children of primary schools in Alexandria governorate. Background Childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among children aged 6-11 years increased from 6.5% in 1980 to 19.6% in 2008. Participants and methods A cross-sectional study was carried out on 3500 Egyptian children to calculate prevalence of overweight and obesity among primary school children at age of 6-12 years living in Alexandria governorate. Four schools from urban areas and two from rural areas including both sexes were selected randomly in this study. They were subjected to physical examination and anthropometric measurements including BMI. Data were expressed in terms of Z-scores using the WHO Z-score cutoff points. Conclusion Pediatric obesity is a prevalent and rapidly increasing problem that poses a serious risk to the health and well-being of the nations' youths. Overweight and obesity were relatively high among age group 6-12 years. It was more common in female individuals than male individuals. It was more common in urban than rural areas. It was common in private schools than in governmental schools. Children of high socioeconomic level were more obese than other children.

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Objectives The aim of the study was to assess the quality of drinking water of different sources in Menoufia Governorate. Background Access to safe drinking water is one of the basic human rights and is essential for healthy life. Failures in water treatment processes and recontamination of treated drinking water are the major causes of morbidity and mortality worldwide. Therefore, monitoring of drinking water from source to tap is an essential step toward hygiene safety. Materials and methods A cross-sectional study was carried out in Menoufia Governorate. Five towns and five villages were chosen randomly. Ten samples were taken from the main water stations in these areas and 150 samples were taken around each station. Five samples were taken from private stations, five samples were taken from water carts, and another five samples were taken from home filters. Results Parameters of water quality of studied samples were within the Egyptian standards, except for turbidity, iron, manganese, free available chlorine, coliform group, and total bacterial count. Seventeen samples have exceeded the Egyptian standards for turbidity. Regarding manganese and iron, there were 34 and 44% of the samples that exceeded the Egyptian standards for manganese and iron, respectively. Free available chlorine of 41 samples was outside the standards. In all, 22% of the samples showed count above the standard level of total coliforms. In addition, 28% of the samples showed total bacterial count greater than 50 cells/cm ³ . Conclusion Parameters of water quality of studied samples were within the permissible limit of the Egyptian standards except for increased levels of turbidity, ammonia, iron, and manganese in addition to presence of residual chlorine concentrations lower than the standards. Similarly, drinking water was also contaminated with coliform bacteria. Therefore, we advocate regular water quality monitoring with special emphasis on water distribution system and private water stations for the safety of public health.

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Objective The aim of this study was to compare between laparoscopic and laparotomy repair of perforated duodenal ulcer in terms of operative time, postoperative pain, postoperative complication, hospital stay, and resuming normal activity. Background Laparoscopic surgery has become a standard of care in many of the elective procedures; however, it is still gaining popularity in conditions associated with peritonitis, such as perforated duodenal ulcer. Materials and methods This is a prospective study that included 50 patients with perforated duodenal peptic ulcer admitted to the General Surgery Department in Menoufia University Hospitals from October 2012 to April 2014. The patients were divided by random serial number method into two groups: group A consisted of 25 patients for laparoscopic procedure, and group B consisted of 25 patients for open repair. Results In group A, 21 patients underwent successful laparoscopic surgery, and four patients were converted to laparotomy, and in group B, 24 patients were evaluable, and one patient died on the fourth postoperative day not related to surgical cause. Operating time was significantly longer in the laparoscopy group, 145 ± 8.4 versus 110 ± 13 min. Patients who underwent laparoscopic repair were associated with lower morbidity, with P-value less than 0.05. No significant difference was found regarding leak or intra-abdominal abscess. Hospital stay was significantly shorter in the laparoscopic group, 6.9 ± 2.2 versus 8.9 ± 3.3 days. Patients who underwent laparoscopic procedure resumed normal activity earlier than the patients in the laparotomy group, 14 ± 1.9 versus 20.5 ± 3.9 days, with P-value less than 0.001. Conclusion Laparoscopic correction of perforated peptic ulcer causes less postoperative pain, postoperative complications, and hospital stay.

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

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Objective The aim of this study was to compare the accuracy of optical biometry and applanation ultrasound measurement of the preoperative intraocular lens (IOL) power calculation formulas (Haigis, SRK/T, and Hoffer Q) of highly myopic eye. Background Implantation of an IOL is the cornerstone in modern day cataract surgery, which is no longer used for just visual rehabilitation but has also become a form of refractive surgery in which the final refractive result can define visual outcome. Accurate biometry necessitates proper axial lens measurements. Patients and methods This study included 60 eyes of 52 patients (nine cases of bilateral and 42 cases of unilateral cataract) [27 female (45%) and 33 male (55%)] with extreme myopia and axial lengths longer than 26.0 mm with cataract as the only ocular pathology. Patients were divided into two groups. Group 1 (the optical biometry group) included 30 patients and group 2 (the A-scan ultrasound group) included 30 patients. Eyes with significant cataract suitable for phacoemulsification and primary in-bag implantation of posterior chamber IOL were included. All patients underwent clear corneal phacoemulsification by the same surgeon and implantation of the one-piece soft hydrophobic acrylic IOL (EYECRYL-600L) IOL (power range −5.0.0 to +15.0 D). Results This study was carried out on 60 eyes of 52 highly myopic patients presenting with cataract. Patients were divided into two groups: group 1, which included 30 eyes that underwent optical biometry using Zeiss 5000 IOL Master, and group 2, which included 30 eyes that underwent A-scan ultrasound biometry using Sonomed PAC SCAN 300 AP. Conclusion Haigis formula with the Zeiss IOL Master using partial coherence interferometry gives significantly better IOL power prediction in highly myopic eyes with cataract compared with US biometry.

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