Background Uterine involution is normally completed 6–8 weeks after giving birth. Despite the high variability in uterine involution from one to another parturient, indigent uterine involution has been found to be related to maternal illness. Objective The purpose of this study was to estimate the pattern of uterine involution through the use of symphysis-fundal distance (S-FD) to describe the normal pattern of uterine involution in terms of S-FD measurements. Patients and methods This was a prospective observational study conducted on 80 term primigravidae, who attended the labor ward of the Obstetrics and Gynecology Department at Al Shohada Central Hospital and followed up weekly after their delivery at the outpatient clinic of the same hospital. Results It has been shown that 2 weeks after delivery is the first time that S-FD becomes zero. S-FD becomes zero in the second week in 53 (66.3%) women. Results indicated that in those 3 weeks after delivery, complete involution of the uterus into the pelvis has happened in all cases. The involution rate per day ranged from 0.85 to 1.50 cm, with a mean ± SD of 1.12 ± 0.20 cm. Conclusion The upper limit of S-FD immediately after labor was 22 cm. In the first week, it was 15 cm and 6 cm in the second week postpartum. Three weeks after delivery, the entire involution of the uterus into the pelvis has occurred in all cases (S-FD = 0 cm). Different S-FD of initial uterine involution did not lead to different duration for destined involution.

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Objective The aim was to compare the effect of oral and vaginal sildenafil on endometrial thickness (ET), pattern, and blood flow, in patients with polycystic ovary (PCO) syndrome receiving clomiphene citrate (CC). Background Infertility is the failure to conceive after 1 year of practicing sexual intercourse without any contraceptive measures. Patients and methods A randomized controlled clinical trial was conducted on 300 women aged between 18 and 35 years old diagnosed with PCO at the Department of Obstetrics and Gynecology at Menoufia University Hospital and Shebin Elkom Teaching Hospital from May 2019 to May 2020. By using sildenafil 20-mg coated tablets and CC 50 mg, patients were divided into group A (study group): sildenafil + CC orally. Group B (study group): sildenafil vaginally + clomiphene orally. Group C (control group): patients who were given CC orally only. Primary and secondary follow-up was done. Results There was a statistically significant difference between the study groups regarding ET and uterine blood flow, overall pregnancy rate, on tolerability with treatment, and side effect of drugs. Conclusion Vaginal sildenafil has better ET, pattern, blood flow, and high pregnancy rate.

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Background The success of a first web-space contracture release is dependent on the individual parameters of thumb movement. Examining these parameters individually, it is possible to predict which components are important for providing successful outcomes. Objectives To study different options to the first web-space reconstruction. Patients and methods A clinical trial study was conducted, including 29 patients with the first-web deformities: group A included nine patients managed by five flaps. Group B included seven patients managed by posterior interosseous flap. Group C included three patients managed by the first dorsal metacarpal flap. Group D included six patients managed by Z-plasty. Group E included four patients managed by split-thickness skin graft (STSG). Results The results revealed that there was no significant difference between the studied groups regarding postoperative thumb opposition and abduction and the first web-space angle, however, there was a significant increase in thumb opposition and abduction and the first web-space angle postoperatively. Conclusion Success of a release is related to the amount of opposition obtained, and it is difficult to achieve equivalent opposition to the unaffected hand. Grip strength and opposition remain decreased following contracture release.

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Objectives This study aimed to compare the sensitivity and specificity of visual inspection with the acetic acid (VIA) test and Pap smear for detecting cervical intraepithelial neoplasia and cervical cancer. Background Cervical cancer is the fourth most common cancer in women and the seventh overall. VIA is a simple low-cost technique screening, based on the ability of the trained health care personnel to detect Opaque acetowhite lesions in the cervix. Patients and methods This study was carried out on 420 patients attending the family planning clinic, Alexandria, Egypt, and referred for colposcopy-guided biopsy to the women's health clinic from January 2019 to August 2020. VIA and Pap smear were performed for all patients; then, the participants who showed positive result with either Pap smear or VIA or both (98 participants) were referred for colposcopy-guided biopsy. Results Of the women screened, VIA was positive in 72 (17.14%) and 41 (9.8%) were positive on pap smear. The sensitivity, specificity, positive predictive value, and negative predictive value of VIA were 86.11, 89.32, 43.05, and 98.56%, respectively, while the Pap smears had a sensitivity of 52.78%, a specificity of 94.27%, a positive predictive value of 46.34% and a negative predictive value of 95.51%. Conclusion VIA has the advantage of being easy to learn, low cost, having high sensitivity in comparison with Pap smear and with immediate availability to assess results, and can be used as an alternative primary test to screen premalignant cervical intraepithelial lesions and subclinical early cancer of the cervix.

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Background In spite of the fact that the quality of life improved for most patients with a cardiac pacemaker implant, the pacing-induced left bundle branch block pattern can result in changes of the structure, function, and hemodynamics of the heart. Objectives To study the effect of different pacing modes on left ventricular (LV) global and regional longitudinal systolic strain (LSS) by two-dimensional (2-D) speckle-tracking echocardiography. Patients and methods This study was performed on 30 patients with a history of dual-chamber pacemaker implantation of more than 6 months duration and 30 healthy volunteers as controls. Conventional and 2-D speckle-tracking echocardiographies were performed to evaluate the LV global and regional systolic longitudinal strain in different pacing modes. Results Pacemaker programming from atrial sensed ventricular paced mode to atrial paced ventricular paced mode showed a significant decrease in global LV LSS (P = 0.021). Moreover, programming with asynchronous ventricular pacing (VVI mode) demonstrated a further significant reduction of global LV LSS when compared with other pacing modes (P = 0.014). Conclusion Permanent right ventricular apical pacing leads to marked changes of LV systolic function. Moreover, atrial pacing and asynchronous ventricular pacing may cause more deterioration of LV global and regional systolic longitudinal strain detected by 2-D speckle-tracking echocardiography.

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Objectives To assess the role of vaginal misoprostol before intrauterine device (IUD) insertion. Background Misoprostol is an effective method for the treatment of missed and incomplete abortion, induction of provocative abortion as well as for labor induction and prevention and treatment of postpartum hemorrhage. Moreover, several studies have shown the benefit of misoprostol as a cervical ripening agent in nonpregnant women. Patients and methods This is a randomized, clinical trial that included 80 females above the age of 18 years in their fertility period, who want to insert Copper T₃₈₀ IUD. They were randomly assigned into two equal groups: the first group for vaginal misoprostol and the second group for placebo before IUD insertion. Data were collected and tabulated. Results There was statistically significant difference between the misoprostol group and the placebo group regarding cervical ripening during sound examination and IUD insertion with a P value of 0.000. There was also significant difference in the occurrence of pain with a P value of 0.000 according to visual analog scale. Conclusion Vaginal misoprostol (400 μg) 3 h before IUD insertion in women with past history of cesarean section (no previous vaginal delivery) seems to be associated with higher successful rate of insertion and reduced complications of IUD insertion such as pain and bleeding.

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Objective The objective was to investigate the association of latent Toxoplasma infection and the underlying androgenic alopecia and acne vulgaris. Background Androgenic alopecia and acne vulgaris are common dermatological conditions that affect many persons and reflect on their life. The parthenogenesis of both diseases is multifactorial and are subjected to continuous researches. Hormonal role is among theories explaining parthenogenesis of both diseases. Meanwhile, their etiological factors share common grounds with endocrinal alterations that occur during Toxoplasma latent infection. Patients and methods Both Toxoplasma immunoglobulin G and free testosterone were measured with immunoassay method (enzyme-linked immunosorbent assay) for 30 androgenic alopecia and 30 acne vulgaris patient groups in serum samples that were well clinically diagnosed and subgroups according to severity. Results There were statistical significances between Toxoplasma seropositivity and androgenic alopecia and acne vulgaris severity, P value less than 0.001, 0.019, respectively. There was also a significant elevation of free testosterone in seropositive subgroups of both androgenic alopecia (median, 32.65 pg/ml; range, 0.40–44.80 and P = 0.001 for males and median, 4.45 pg/ml; range, 2.40–39.00, P = 0.001 for females) and acne vulgaris (median, 33.85 pg/ml; range, 0.40–49.80 for males, and median, 3.9; range, 2.20–30.00 in females). Compared with seronegative subgroups: for androgenic alopecia and acne vulgaris median of free testosterone 14.4 pg/ml (range, 1.60–26.30, in males: median, 2.10 pg/ml; range, 0.70–4.40 in females, respectively). There were statistical significances with free testosterone levels and the severity of female patients in androgenic alopecia and acne vulgaris P values were 0.025 and 0.001, respectively, and only in androgenic alopecia, male patients' P value was 0.02. Free testosterone was positive correlated to the severity of both diseases in males of seropositivity of toxoplasmosis (r = 0.658: r = 0.470). While in females, seropositivity values were r = 0.696 and r = 0.765. Conclusions The positive correlation of the free testosterone level and seropositivity of Toxoplasma and the severity of androgenic alopecia and acne vulgaris suggests a contributing role of Toxoplasma in both diseases by altering the free testosterone level. So, involvement of toxoplasmosis in the pathogenesis of acne vulgaris and androgenic alopecia should be focused since Toxoplasma latent infection is present worldwide.

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Objectives To evaluate serum levels of anti-nucleosome and anti-C1q in systemic lupus erythematosus (SLE) patients, and their correlation with disease activity and lupus nephritis (LN) flare. Background SLE is a common chronic multiorgan affection autoimmune disease with loss of self-tolerance and unpredictable activity. Increased serum anti-nucleosome and anti-C1q levels may play pathogenic roles in SLE activity and LN immune aberration and disease flare. Patients and methods The study was carried out on 120 participants, 80 SLE patients and 40 non-SLE individuals as a control group. Of these, 55 patients were diagnosed as LN patients by kidney biopsy before enrollment into the study. Anti-nucleosome antibodies and anti-C1q were determined using a quantitative enzyme-linked immunosorbent assay. Results Anti-nucleosome and anti-C1q serum levels were statistically significantly high in SLE patients in comparison to the control group and statistically significantly high in active SLE patients (111.43 ± 43.97 and 68.62 ± 22.99 U/ml, respectively) than inactive SLE patients. They have significant positive correlations with the SLE disease activity index score (P < 0.001) and have a high sensitivity and specificity for SLE diagnosis and its activity (P < 0.001). Anti-nucleosome and anti-C1q serum levels were statistically significantly high in LN (113.89 ± 43.87 and 68.61 ± 24.49 U/ml, respectively) than in non-LN patients (P = 0.004, P < 0.001, respectively) with statistically significant positive correlations with SLE disease activity index-renal domain score (P < 0.001). They have high sensitivity and specificity for the diagnosis of active LN (P = 0.004, P < 0.001, respectively). Conclusions Anti-nucleosome and anti-C1q can be used as markers for the diagnosis of SLE disease activity and LN flare with high sensitivity and specificity.

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Objectives To investigate the role of serum copeptin level as a predictor of the severity of liver cirrhosis and its complications. Background Liver cirrhosis is the end result of chronic liver diseases. Progressive cirrhosis is related to circulatory and renal dysfunctions that are correlated with an elevated risk of morbidity and mortality. Despite that arginine vasopressin (AVP) is an important regulator of water balance that helps to maintain osmotic and cardiovascular homeostasis, its instability renders accurate measurement difficult and prohibits routine use. Copeptin, a glycopeptide made up of the AVP prohormone's C-terminal portion, could be applied instead of AVP measurement. Patients and methods This case–control study was conducted on 90 subjects, including 75 patients and 15 healthy controls with liver cirrhosis. Serum copeptin level was measured by enzyme-linked immunosorbent assay. Correlation of serum copeptin level with liver functions and clinical parameters was investigated. Results Regarding the severity of liver disease, 58.67% of patients were Child-C, 21.33% were Child-B, and 20% were Child-A. The mean value of copeptin was significantly higher in Child-C (8.591 ± 1.707 ng/m) cirrhotic patients than Child-B (6.794 ± 1.744 ng/ml) and Child-A (1.087 ± 0.391 ng/ml) patients. The cutoff values of serum copeptin as regards, gastrointestinal bleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome were > 5.9, > 5.9, and > 6.1 ng/ml, respectively. Conclusion Serum copeptin is a promising prognostic diagnostic for predicting the severity of liver cirrhosis and its associated complications.

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Objectives The study aimed to correlate the ultrasound-guided fine-needle aspiration cytology (US-FNAC) findings with histopathology results in the spectrum of thyroid lesions and to find the adequacy and diagnostic accuracy of US-FNAC, so that unnecessary thyroidectomies can be avoided in benign lesions. Background Thyroid nodules are common clinical findings, with a reported prevalence of 4–7% in the general population. US-FNAC is a useful diagnostic tool for different thyroid lesions. Patients and methods A retrospective study was carried out over the period of 4 years. The US-FNAC results were correlated with the available histopathological results to calculate the accuracy and determine the sensitivity, specificity, and predictive values of US-FNAC. Results On cytological examination, of 270 cases, 151 (55.9%) were benign, 24 (8.9%) were atypia of undetermined significance, 18 (6.7%) were suspicious for malignancy, four (1.5%) were malignant, and 73 (27%) were inadequate. On histopathology examination, 27 (42.2%) cases were multinodular goiter, and five (7.8%) cases were hyperplastic nodules, five (7.8%) cases were lymphocytic thyroiditis, six (9.4%) cases were thyroid adenoma, four (6.3%) cases were papillary microcarcinoma, 16 (25%) cases were papillary carcinoma, and one (1.5%) case was a medullary carcinoma. It was found that there is a significant correlation of histopathological with cytological findings. US-FNAC had 81.8% sensitivity, 79.3% specificity, and 80.3% accuracy. Conclusion US-FNAC is a good screening test that has high accuracy and is cost-effective to avoid unnecessary thyroidectomies.

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Objective To assess serum zinc level in patients presented with acute coronary syndrome and its relation to cardiac enzymes in acute myocardial infarction (AMI). Background Atherosclerosis is a well-known cause of myocardial infarction owing to accumulation of lipids and fibrous elements in arteries. It was found that there are highly efficient protective mechanisms in the cell, including metal-binding proteins as antioxidants and manganese superoxide dismutase and copper–zinc superoxide dismutase as enzymes. Zinc deficiency can reduce activity of superoxide dismutase linked to atherosclerosis. Patients and methods Our study was carried out in cardiac care units, Menoufia University Hospital, on 100 patients who presented with acute coronary syndrome and 100 other healthy participants. Routine electric-cardiogram, ECG, and full laboratory workup were done including serum zinc level. Results There was a statistically significant inverse correlation between serum zinc levels and cardiac biomarkers used, that is, creatine kinase, MB fraction of creatine kinase, and troponin I (cardiac troponin T) in the studied groups, where serum zinc levels were less than 57.38 μg/dl (26%), 57.38–69.70 μg/dl (24%), 69.70–79.73 μg/dl (26%), and more than or equal to 79.73 μg/dl (24%), respectively, when divided into four quartile groups, with a remarkable increase in the AMI prevalence. Conclusion Serum zinc levels were significantly negatively correlated with cardiac biomarkers. The AMI prevalence rate decreased with increasing zinc quartiles.

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Introduction The rate of cesarean section (CS) in developed and developing countries is a major problem for public health policymakers, especially regarding knowledge on their socioeconomic associated factors. Aim To know the prevalence and socioeconomic factors predictive of CS delivery among women in Ghana. Patients and methods This study was a descriptive cross-sectional survey relying on data from Ghana multiple indicator cluster survey 2017/2018. The analysis was done using SPSS, version 20 (IBM Corp., 2011). Results The prevalence of CS delivery recorded in this current study was 15.7%. Predictor variables identified were age group 25–34 versus 15–24 years [adjusted odds ratio (AOR)=1.55, 95% confidence interval (CI)=1.13–2.13)]; women of the age group 35 years and above versus 15–24 years (AOR = 2.13, 95% CI = 1.50–3.04); rural women versus urban a women (AOR = 0.70, 95% CI = 0.52–0.95); richest index quintile versus poorest index quintile (AOR = 2.36, 95% CI = 1.42–3.92); and finally, normal birth weight versus low birth weight (AOR = 0.56, 95% CI = 0.39–0.82). Conclusion The prevalence of CS delivery recorded in this current was high as compared with other previous studies. This implies that the practice is on increase.

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Objective To study uterine artery Doppler indices in uterine fibroid with or without abnormal uterine bleeding. Background Myomas or fibroids are the most common benign tumors of the female reproductive system, and although many remain asymptomatic, their effect on individual well-being can be significant. Patients and methods This prospective nonrandomized case–control study was carried out at the obstetrics and gynecology clinics of Menoufia University Hospital and Berkat Elsabaa General Hospital on 132 patients with uterine fibroids. Ethical approval of the study protocol was obtained from Menoufia Faculty of Medicine. All participants signed an informed consent form before commencing the study. The study included 132 women with uterine fibroids. They were divided into two groups. Group I included 66 women with uterine bleeding, and group II included 66 women without uterine bleeding. Results Our results found that 132 patients included in this study were perimenopausal, with age ranged from 40 to 45 years. Conclusion Transvaginal Doppler sonography as a sensitive, specific, and noninvasive method has a significant place in the diagnostic procedure for evaluation of uterine fibroid in females with or without abnormal uterine bleeding.

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Objective To Assess serum trace elements and electrolytes in Egyptian children with autism. Background The relationship between plasma levels of trace elements in patients with autism spectrum disorder (ASD) has polarized the interest of many physiologists in recent years owing to the evidence that the impaired homeostatic regulation of trace elements, their levels in the bloodstream, and their potential neurotoxicity, altogether contribute to the ASD etiology. Patients and methods It is a cross-sectional study. The study was conducted on 60 children aged 3–12 years old, both sexes, and all social classes. Results The study showed a highly significant decrease in serum zinc in patient sample, which was 75.53 ± 18.585, in comparison with the control sample, which was 106.27 ± 14.714. It is highly significant, P value is less than 0.001. There was a highly significant difference between zinc/copper ratio and copper/zinc ratio. Zinc/copper ratio of patient was 0.5747 ± 0.14793, whereas for control was 0.9233 ± 0.18102 with P value less than 0.001. Copper/zinc ratio of patients was 1.8433 ± 0.45360, whereas the ratio for the controls was 1.0980 ± 0.17993, with P value less than 0.001. Our study showed that there were no significant differences in serum level of iron, magnesium, sodium, potassium, and calcium, as well as copper between ASD and control groups. Conclusion The study showed a highly significant decrease in serum zinc between ASD and control groups. There was a highly significant difference between zinc/copper ratio and copper/zinc ratio. There was a highly significant difference regarding zinc/copper ratio between ASD and control groups. There was no significant difference in serum level of copper, iron, magnesium, sodium, potassium, and calcium between ASD and control.

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Objective To estimate the incidence of myocardial infarction with nonobstructive coronary arteries (MINOCA) among Egyptian cases with acute myocardial infarction (AMI) and to evaluate the role of neutrophilic elastase in AMI cases. Background Previous research studies have declared that MINOCA is a syndrome with angiographic normal or near-normal coronary arteries but had evidence of MI clinically, which has many causes. Patients and methods To reach the goal of this research, a group study was designed. A total of 627 cases admitted at Cardiology Department of Faculty of Medicine Menoufia University and National Heart Institute in the period from February 2019 to July 2019 were included. Cases were divided into two groups: group 1 included AMI cases with obstructive coronary artery disease group, and group 2 included AMI cases with nonobstructive coronary artery disease (MINOCA group). All cases were subjected to (a) full history taking; (b) clinical examination; (c) laboratory investigations, such as serum HbA1C, cardiac enzymes (total creatine kinase, creatine kinase-myocardial band, and troponin), and serum neutrophil elastase; and (d) other investigations, including ECG and coronary angioplasty. Results There were 627 acute coronary syndrome cases, and 49 cases were diagnosed as MINOCA. Regarding the risk factors, diabetes mellitus and smoking showed a significant difference in-between both studied groups (P = 0.038 and 0.014, respectively). Conclusion Our study concluded that ~7.8% of the Egyptian cases that presented with AMI for primary percutaneous coronary intervention have MINOCA. High serum neutrophilic elastase concentration is a sensitive marker, suggesting the existence of complex atheromatous plaques in AMI cases.

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Objective We aimed to find out the frequency of alloimmunization in multitransfused β-thalassemic patients, the most common alloantibodies involved, factors contributing to their development, and their impact on severity of the disease. Background Thalassemia is a major health problem in Egypt. It is an inherited hemolytic disorder. Blood transfusion, despite being a life-saving process, it is associated with inherent risks of alloimmunization against red-blood cell antigens. Patients and methods Blood samples from 200 multitransfused β-thalassemic patients who were regularly transfused with leukodepleted packed red-blood cells, matched only for ABO-Rh (D) antigens, were analyzed. The antibody screening and identification were performed by column-agglutination method. To detect autoantibodies, autocontrol and direct antiglobulin test was carried out in all patients. Adsorption test was not employed as there were not autoantibodies detected in any patient. Results Alloantibodies were detected in 18/200 (9.0%) patients. The most frequent alloantibodies were anti-Kell system (50%), Rh system (anti-D and anti-E are 16.75% for each). Alloimmunization significantly differed with gender, ABO and Rh blood group, frequency of blood transfusion, age at first transfusion, the number of blood units transfused, and serum ferritin (P < 0.01). Conclusion Alloimmunization was detected in 9.0% of patients. Most alloantibodies were anti-Kell followed by anti-Rh system. Serum ferritin level was significantly high in alloimmunized patients, which impacts on the severity of the disease. Antibody screening has to be done before each transfusion and extended red-cell phenotyping must be performed once diagnosed to prevent complications.

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Objective This study aimed to investigate the effect of closure of subcutaneous tissue at cesarean section (CS) on wound complications and cosmesis. Background Each year, CS are performed on millions of women worldwide, typically resulting in significant skin scarring. To date, there is insufficient evidence to favor one method of skin closure. Patients and methods A randomized-controlled clinical trial was conducted at the Department of Obstetrics and Gynecology at Menoufia University Hospital and Shebin El Kom Teaching Hospital on pregnant women who were planned for CS. The women were subdivided into two groups. In group A (study group), suture closure of the subcutaneous tissue was performed with three to five interrupted sutures using an absorbable 3–0 Vicryl 26 needle (Indian). In group B (control group), no closure of the subcutaneous tissue was performed. CS was performed according to the Pfannenstiel–Kerr technique. The primary and secondary outcomes were determined. Results Our results showed that there was a statistically significantly higher occurrence of hematoma in the studied groups 24 h postoperatively and statistically significantly higher scar retraction after 2 months. However, there were no statistically significant differences between the groups according to the observer scar assessment scale and the patient scar assessment scale after 2 months and 6 months. On the Vancouver scar scale, there was an increase in the mean values in group A. Conclusion In women with subcutaneous fat less than 2 cm, closure of subcutaneous tissue at CS led to a decrease in the incidence of postoperative hematoma and scar retraction, with no effect on wound disruption, surgical-site infection, seroma and/or need for reclosure.

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Objectives To assess computed tomography (CT) blood clot thickness, aneurysmal site and size as predictors for vasospasm after subarachnoid hemorrhage (SAH). Background Cerebral vasospasm and delayed cerebral ischemia are common factors of poor outcome following SAH. Patients and methods Forty patients with acute aneurysmal SAH. Outcome was assessed clinically by Glasgow coma scale, Hunt and Hess scale, radiologically by cerebral CT [modified Fisher's scale (MFS)], cerebral CT angiography, and transcranial Doppler (follow-up on the first, third, fifth, seventh, and tenth day from SAH onset) for the appearance of vasospasm. Results There is no significant difference between the amount of blood detected by CT (MFS) and cerebral aneurysm sites as U = 0.513, P = 0.972. Early vasospasm was detected in 13 cases in middle cerebral artery, seven cases anterior communicating, four posterior communicating, and the least was internal carotid and posterior cerebral (two cases and one case, respectively). Univariate logistic regression and receiver-operating characteristic curve showed that the predictors for vasospasm were systolic and diastolic blood pressure (DBP) (systolic blood pressure with diagnostic accuracy = area under the curve=[95% confidence interval (CI)=0.82, P = 0.0001, cutoff point >195 and DBP: 95% CI = 0.87, P = 0.0001, cutoff point >95 for DBP], hemoglobin A1C (95% CI = 0.89, P = 0.0001, cutoff point >7), Glasgow coma scale (95% CI = 0.80, P = 0.001, cutoff point <14), Hunt and Hess scale (95% CI = 0.80, P = 0.001, cutoff point >2), MFS (95% CI = 0.70, P = 0.045, cutoff point >1) and aneurysmal size (95% CI = 0.77, P = 0.0003, cutoff point >7) but aneurysmal site and smoking P = 0.995 and 0.99, respectively were not predictors in spite of association. Conclusion Clinical severity of SAH, blood clot thickness, aneurysmal size, systolic blood pressure and DBP, and glycated hemoglobin seem to be important predictors for cerebral vasospasm after SAH.

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Objective To assess vestibular function in multiple-sclerosis (MS) patients using vestibular-evoked myogenic potential (VEMP) and videonystagmography and to evaluate the role of VEMP in the detection of brain stem dysfunction in MS patients. Background Vertigo and imbalance are the common symptoms of MS. Patients and methods This case–control study was carried out on 60 participants, divided into two groups: 30 normal participants not complaining from any dizzy symptoms and 30 MS patients fulfilling the criteria for definite MS. All participants in the study were submitted to audiological and vestibular assessment. Results There was a statistically significant difference in the latency and amplitude of cervical VEMP (cVEMP) and ocular VEMP (oVEMP) between the control and the MS group (P < 0.001), 45% of the MS patients had cVEMP abnormalities, 50% had oVEMP abnormalities. Abnormal VEMP, either cVEMP or oVEMP, was reported in 60%. Abnormal videonystagmography results were reported in 53% of patients in the current study. There was a statistically significant relationship between VEMP abnormalities and higher frequency of attacks (P < 0.01), duration of MS (P < 0.001), Expanded Disability Status Scale (P < 0.01), and the presence of audiovestibular symptoms (P < 0.03). There was a statistically significant relationship between brain stem lesions in MRI and VEMP findings (P = 0.01 for cVEMP and P = 0.002 for oVEMP). Conclusion Vestibular abnormalities are frequently encountered in MS patients, VEMP abnormalities are associated with brain stem lesions in MRI. Abnormal VEMP may be reported in patients without brain stem affection in MRI.

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Background Hypertension (HTN) and its complications are an important public health problem all over the world. It is identified as the third ranked factor for disability-adjusted life years, as nearly one-quarter of the adult population worldwide lives with HTN. Most of hypertensive patients are unaware that they had HTN, whereas those who are aware have uncontrolled blood pressure. HTN also leads to substantial health care costs, accounting for almost half of all direct cardiovascular disease health care spending. Health-promoting behaviors, identified as activities motivated by a desire to protect or promote health and well-being, are essential for prevention and control of HTN and its complication. Objectives This study aimed at estimating the rates of positive health-promotion behaviors and their associated factors among hypertensive patients. Patients and methods A hospital based cross-sectional study was conducted on 250 hypertensive patients who visited an outpatient clinic throughout 5 months using structured interview. Sociodemographic and clinical data were collected. The health-promoting behavior was measured by the Arabic version of Health Promoting Lifestyle Profile II. The questionnaire includes four subscales with 30 items in total. A score for overall health-promoting lifestyle behaviors was obtained by calculating a mean of the individual's responses to all 30 items. Results The percentages of positive behaviors reported were 25.2, 32.4, 16.4, 45.6, and 34.8% for lifestyle, health responsibility, physical activity, nutrition, and stress management. The independent predictors for positive lifestyle health-promotion behaviors were normal weight, less than 5 years duration of HTN, monitoring of blood pressure, and secondary education and above, with 95% confidence interval and adjusted odds ratio of 3.5 (1.9–6.5) and 3.0, 14.3 (6.2–33.2) and 6.3, 8.5 (4.1–17.3) and 3.1, and 27.5 (11.2–67.9) and 13.0, respectively. Conclusions The prevalence of positive health-promoting behavior is low among hypertensive patients. Health education and counseling are necessary for all hypertensive patients as part of their treatment plans, and special attention should be paid for those at high risk of low health-promoting behavior.

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Objectives To compare three-dimensional (3D) turbo-spin-echo (TSE) isotropic sequences with two-dimensional (2D) sequences in the detection of meniscal tears and compare it with arthroscopic findings which was the gold standard method. Background MRI is the most common, noninvasive, and accurate imaging modality for knee injuries. The purpose of the study was to compare 3D TSE isotropic sequences and conventional 2D TSE at 3T MRI in the detection of meniscal tears. Patients and methods This study was a retrospective study on 95 patients [42 (44.2%) females and 53 (55.8%) males] with suspected meniscal injury who had undergone knee 3 T MRI sequences, including a series of 2D conventional sequences with additional 3D isotropic TSE sequence in the period from April 2018 to March 2019. Results The sensitivity and specificity of 3D TSE is higher (100 and 100%) compared with 2D TSE sequence (67 and 96%) with statistical significance (P<0.003) in radial tears. For other types of meniscal tears, both 3D TSE and 2D TSE sequences had similar diagnostic accuracy with nonstatistical significance between the sensitivity and specificity of both techniques. Conclusion We concluded that 3D TSE is a useful and reliable technique that has a diagnostic performance like the routine 2D TSE MR protocol for detecting meniscal tears at 3 T with superior detection of radial tears.

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Objective This study aimed to investigate the antiamnestic effect of losartan and/or donepezil in a l-methionine model of vascular dementia (VaD). Background VaD is a major public health problem worldwide. It is the second most common cause of dementia after Alzheimer disease. Combination therapy involving an acetylcholinesterase inhibitor with other neuroprotective agents has shown better desirable effects in the prevention of dementia. Materials and Methods Rats were divided into five groups treated for 4 weeks as follows: control group, l-methionine group, which received l-methionine 1.7 g/kg/day orally to induce VaD, donepezil group, which received donepezil 2.5 mg/kg/day in addition to l-methionine, losartan group, which received losartan 2.25 mg/kg/day in addition to l-methionine, and the combination group, which received both losartan 2.25 mg/kg/day and donepezil 2.5 mg/kg/day in addition to l-methionine. After 4 consecutive weeks of treatment, behavioral tests, biochemical parameters, and histopathological assessment of brain tissues were performed for all groups. Results Pretreatment with losartan and donepezil showed a significant increase in the number of crossed squares/5 min in the open-field test, a significant increase in the memory index in the novel object recognition test, a significant decrease in transfer latency in the elevated plus maze test, a significant decrease in serum malondialdehyde and a significant increase in serum glutathione-s-transferase, and nitric oxide. Improvements in histopathological changes of VaD were observed. Conclusion Donepezil and losartan may play a role in neuroprotection in l-methionine-induced VaD. Combined treatment showed better antiamnestic effect than either treatment alone.

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Objective To assess the expression of nuclear localization leucine-rich-repeat protein 1 (NLRP1) inflammasome and interleukin 1 beta (IL-1β) in lesional and perilesional skin of patients with vitiligo compared with their expression in healthy controls. Background Vitiligo is an acquired depigmentation disorder that occurs owing to destruction of melanocytes. The exact mechanisms of vitiligo have not yet been fully elucidated; however, autoimmune mechanism is most accepted one. Patients and methods This case–control study was carried out on 60 participants (30 patients with vitiligo, including lesional and perilesional vitiligo, and 30 controls) selected randomly from the outpatient dermatology clinic. Controls were selected from persons attending the plastic surgery department. Results There were highly significant differences among the three studied groups and NLRP1 and IL-1β immunohistochemical expression, as most of control group and lesional vitiligo group showed lower grade of expression (grades 1 and 2) in comparison with perilesional group. There was a statistically significant association between lesional H score of NLRP1 expression and positive family history. Moreover, there was a statistically significant difference between low-grade lesional expression of IL-1β and mild dermal inflammatory infiltrate and between low-grade IL-1β lesional expression and high vitiligo area severity index score. Conclusion The significant association between high NLRP1 and IL-1β in perilesional area of vitiligo in comparison with lesional area and control group might indicate their role in the pathogenesis and progression of active vitiligo. Moreover, it might be used as a target therapy for patients with vitiligo.

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Background Vascular end othelial growth factor (VEGF) is a heparin-binding homodimeric glycoprotein. It plays a key role in the pathogenesis of diabetes mellitus (DM) and its complications, particularly those linked with poor vascularization and hypoxia. The VEGFA gene encodes VEGF, and several genetic variants have been identified in the VEGFA gene, some of which affect VEGF secretions. Objectives To investigate the association between serum levels of VEGF and VEGFA gene variants, −583C>T(rs3025020) and +936 C/T (rs3025039), with microvascular complications in type 2 diabetics. Patients and methods This cross-sectional study was conducted on 104 patients with type 2 DM who were classified into four groups (each comprised 26 patients): diabetic nephropathy, neuropathy, and retinopathy groups, and an uncomplicated DM group as a case–control group. Clinical, neurological, and fundus examinations, as well as biochemical laboratory investigations were done for all patients. The serum VEGF assay was done by ELISA. VEGFA genotyping was performed by allelic discrimination using a real-time PCR system. Results VEGF was significantly reduced in diabetic nephropathy group than in uncomplicated DM group, especially those with C/C and C/T of rs3025020 (P = 0.04 and P = 0.02, respectively) and the C/T genotype of rs3025039 (P = 0.01). There was a significant difference in distribution of rs3025039 and its both alleles (C and T) in diabetic nephropathy (P = 0.001) compared with other studied groups. The C/T genotype of rs3025039 and its T allele had a significant high frequency in diabetic nephropathy (odds ratio = 4.2 and 6.9, respectively) than in uncomplicated DM. Conclusion A reduction in VEGF level occurred in diabetic nephropathy than in uncomplicated DM, especially those with C/T genotypes of studied variants. C/T genotype and its T allele of rs3025039 had a higher frequency in diabetic nephropathy, so it was considered a risk gene for only diabetic nephropathy.

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Objective To evaluate pediatric patients with anterior hypospadias without chordee who were planned for surgical repair. Background Failed hypospadias repair refers to any hypospadias repair associated with complications or causes patient dissatisfaction. It includes meatal stenosis, fistula, urethral stricture, and glans dehiscence. Patients and methods The study included 150 failed distal hypospadias repair patients. Patients were divided into two groups: previously failed hypospadias group (100 patients who were previously repaired (only one attempt of surgical repair) from June 2004 to October 2014) and de novo hypospadias group (50 patients). Their age ranged from 9 months to 6 years. Tubularized incised plate repair was applied for 87 cases, Mathieu technique for 20 cases, onlay technique for 13 cases, and meatal advancement and glanduloplasty incision for 30 cases. All 150 patients had undergone repair from October 2014 to October 2017 and were followed up for immediate and delayed complications. Results The incidences of meatal stenosis, fistula, neourethral stricture, and glanular dehiscence were 68, 50, 20, and 0%, respectively, in the previously failed hypospadias group compared with 82, 20, 16, and 16%, respectively, in the de novo hypospadias group. Our overall results showed that 87% of cases with shallow glanular groove had meatal stenosis, 51.3% of cases had neourethral stricture, 38.5% had fistula, and 15.4% had dehiscence. Conclusion The study showed a correlation between the glanular groove and the outcome of hypospadias repair, as the deeper the glanular groove, the lowest incidence of failed hypospadias repair.

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Objective The aim was to measure serum levels of Dickkopf-1 (DKK1) in ankylosing spondylitis (AS) patients and to study its relation with vertebral fractures, bone mineral density (BMD), and disease activity. Background AS patients have an increased risk of bone loss and vertebral fractures, which might be related to the activity of the Wingless signaling pathway, and the serum levels of its circulating inhibitors, especially DKK1. Patients and methods This cross-sectional study included 80 participants, 40 patients diagnosed with AS and 40 healthy sex-matched and age-matched volunteers as controls, from 2018 to 2020. All patients and controls were evaluated for the presence of vertebral fractures using conventional radiography of the spine (lateral view), and lumbar spine BMD was assessed with dual X-ray absorptiometry. Serum levels of DKK1, erythrocyte sedimentation rate, and C-reactive protein were measured. Results Serum DKK1 levels of the AS patients were significantly higher than those of the healthy controls. Patients with vertebral fractures had significantly higher DKK1 levels. DKK1 serum levels were inversely correlated to lumbar spine Z-score BMD. A positive correlation was found between DKK1 serum levels and erythrocyte sedimentation rate, C-reactive protein, and disease activity scores. Conclusions Serum DKK1 levels were significantly higher in AS patients than in healthy controls and positively correlated with bone loss and vertebral fracture incidence.

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Background Hepatocellular carcinoma (HCC) is a leading cause of cancer death. Because alpha-fetoprotein (AFP) has low diagnostic accuracy, we studied a novel diagnostic biomarker for HCC diagnosis. Objectives To evaluate plasma level of highly upregulated in liver cancer (HULC) long noncoding RNA as a biomarker for HCC diagnosis. Patients and methods This case–control study included 75 participants in three groups: patients with HCC on top of hepatitis C virus (group I), hepatitis C virus cirrhotic patients (group II), and healthy controls (group III). Clinical examination, radiological and laboratory investigations were done for all cases. HULC was measured by real-time quantitative PCR. AFP and viral markers were determined by enzyme immunoassay based on electro-chemiluminescence. Liver function tests were done on Cobas 6000 analyzer. Results The study included 75 participants in three matched groups of age and sex (no of each group = 25 participants). The parameters that showed significant difference (P ≤ 0.05) by univariate analysis were model for end-stage liver disease, Child–Pugh, lower limb edema, ascites, international normalized ratio, alanine aminotransferase, aspartate aminotransferase, total bilirubin, creatinine, AFP, HULC level, albumin, and platelet count. However, multivariate analysis demonstrated that high AFP and HULC levels were the parameters that could independently diagnose HCC. The mean ± SD of HULC of the three groups was 2.1 ± 1.6, 0.5 ± 0.4, and 0.1 ± 0.05, respectively. HULC level at cutoff point of 1.08 ng/ml had sensitivity of 72% and specificity of 92% to diagnose HCC. AFP at cutoff point of 25.55 ng/ml had sensitivity of 68% and specificity of 88%. HULC level was significantly correlated with HCC tumor size, tumor number, and presence of portal vein thrombosis. Conclusion HULC level could act as a novel biomarker for HCC diagnosis.

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Objective To assess the presence of metabolic risk in women with hirsutism and to determine if the site of hirsutism can be a predictor of metabolic syndrome. Background Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) are the most common causes of hirsutism. Patients and methods A total of 90 women were included. They were divided into group 1, which included 30 women with IH; group 2, which included 30 women with PCOS; and group 3, which included 30 healthy women representing a control group. Participants underwent examination including hirsutism assessment and investigations, including fasting plasma glucose, fasting insulin, and lipid profile. Results Waist circumference and diastolic blood pressure were higher in PCOS group than in control group (P = 0.028 and 0.005, respectively), and systolic blood pressure was higher in PCOS than in the IH group and control group (P = 0.015 and 0.002, respectively). Total cholesterol, low-density lipoprotein, and triglycerides were higher in PCOS group than in control group (P = 0.01, 0.013, and 0.049, respectively). Fasting plasma glucose, fasting insulin, and insulin resistance were higher in IH group than in control group (P = 0.004, P < 0.001, and P < 0.001, respectively) and were higher in PCOS group than in control group (P < 0.001, <0.001, and < 0.001, respectively). A total of 25 (27.78%) women had the diagnostic criteria for metabolic syndrome, with no significant difference between groups 1and 2 (P = 0.058). The most significant predictor of metabolic syndrome in all hirsute women based on hirsutism sites was the thigh (t=−10.319, P < 0.001). Conclusions Women with hirsutism carry a high metabolic risk; the thigh area was the optimum predictor of metabolic syndrome regardless of the etiology.

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Objective This work was designed to study the role of periostin in children with atopic dermatitis (AD) and to correlate its level with the severity and chronicity of AD. Background Periostin is a recent mediator in chronic states of allergic diseases and has significant roles in tissue remodeling in allergic inflammation. It has a unique function as an intrinsic mediator in amplifying and preserving allergic skin inflammation and might be a virtual molecule in the development and occurrence of chronicity. Patients and methods The current work examined 40 children with AD and 40 age- and sex-matched healthy controls. Patients underwent full history-taking, clinical examination, eosinophil count, and measurements of biochemical markers such as total immunoglobulin E and periostin by the ELISA technique. Results Serum periostin level was significantly higher in the AD group in comparison with the controls (P < 0.001), and serum periostin level was observed to have a positive correlation to SCORing-AD score (r = 0.3, P = 0.02). Moreover, a significant association existed between serum periostin level and the severity of AD; the more severe the AD, the higher the level of periostin (P = 0.01). Conclusion Serum periostin level appears to be a novel chemical biomarker to determine the severity and chronicity of AD in children.

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Objectives To compare the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) in diagnosing pancreatic focal lesions as regarding location, size, nature, nodal staging, vascular invasion, and distant metastases. Background Pancreatic cancer (PC) is one of the deadliest cancers all over the world, the appropriate screening and early diagnosis of PC is quite challenging. EUS was introduced in the clinical field for better identification of the pancreas. Patients and methods This study was done on 44 patients with indeterminate pancreatic lesions from December 2018 to December 2019. Patients with pancreatic lesions were identified incidentally through imaging such as US, CT, MRI, or clinical manifestations, for example, jaundice. CT and EUS with or without fine-needle aspiration were done for all participants. Results This study showed that the detection rate for pancreatic focal lesions (PC) by EUS was 97.7%, with good detection for tumors less than 2 cm in diameter. EUS is an accurate preoperative tool in assessing regional nodal staging with 65.9 and 50% for CT, and also regarding vascular-invasion respectability in patients with pancreatic adenocarcinoma. CT has the upper hand in detection of distant pancreatic metastasis. Conclusion EUS helps in early detection of PC, thus, it would decrease the morbidity and mortality. EUS–fine-needle aspiration establishes the tumor type with high accuracy and fewer complications, and useful for differential diagnosis. EUS staging should be the standard of care along with CT to diagnose and to evaluate the patients with PC preoperatively.

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Objective To compare surgical outcomes of abdominal hysterectomy (AH) versus total laparoscopic hysterectomy (TLH) in diabetic patients. Background Diabetes mellitus is considered a multisytemic disease affecting mainly the small vessels (diabetic vasculopathy). Diabetes mellitus and comorbidities associated with it are well-known factors that negatively affect surgical outcomes. Hysterectomy is one of the most frequent gynecological surgical procedure, having different routes, either abdominal, vaginal, or laparoscopic. AH is correlated to more complications such as wound infection and longer postoperative hospital stay in diabetic patients. However, TLH may be particularly well suited to diabetic women as they can avoid the postoperative complications and ensures more rapid recovery and shorter period of hospitalization than AH. Patients and methods This randomized controlled study was conducted at Tanta University from January 2017 till January 2021. One hundred and thirty cases were enrolled and randomly allocated into study (TLH) or control group (AH). Blood loss, operative time and postoperative complications were the study outcomes. Results There was no significant difference between both groups regarding age, BMI, glycemic control, or hemoglobin levels. Regarding surgical outcome, there was significant difference between both groups regarding the mean operative time in TLH versus AH and the intraoperative blood loss, and a highly significant difference as regards the postoperative need for analgesics and the length of hospital stay. Wound complications were minimal in TLH while severe complications occurred in AH. Conclusion TLH is superior to AH in diabetic women. Shorter hospital stay and good wound healing was highly superior in the TLH group.

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Objectives This study was carried out to assess the efficacy of a pectoral nerve block in female patients undergoing a mastectomy. Background Pain after breast surgery could be managed in many ways such as by opioid administration. However, there has been an increasing trend toward the application of nerve block techniques to decrease opioid consumption. We carried out this research to evaluate the efficacy of a pectoral nerve block in female patients undergoing a mastectomy. Patients and methods This prospective randomized study included 50 patients preparing for breast cancer surgery who were allocated into two equal groups: group A included 25 patients who received a sham pectoral nerve block and group B included the remaining patients who received a pectoral nerve block. The postoperative visual analog scale was our primary outcome, whereas intraoperative and postoperative opioid consumption, nausea, and vomiting were the secondary outcomes. Results Despite the absence of significant differences between the two groups in patient and operation characteristics, group B showed a significant reduction in intraoperative fentanyl consumption, together with total doses of postoperative paracetamol and nalbuphine and lower visual analog scale values compared with the controls during the first 10 h after surgery. The first analgesic request was delayed in group B, which also showed a significant decrease in postoperative nausea and vomiting. Patient satisfaction was significantly better in the same group. Conclusion Pectoral nerve block is a safe and effective technique that offers effective pain relief after breast surgery. It leads to decreased analgesic consumption and increased patient satisfaction.

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Background Protein-energy malnutrition is very common in cirrhosis and associated with increased risk of mortality and morbidity. Simple bedside parameters to identify malnutrition are essential to diagnose and manage the nutritional deficit early to improve the prognosis of cirrhotic patients. This study aims to assess the nutritional status of hepatic cirrhotic patients using different tools to determine the prevalence of malnutrition among them, and to compare the different used methods of assessment. Patients and methods This is a cross-sectional study, conducted at the National Liver Institute, Menoufia University. All patients are adults with cirrhotic liver. Nutritional status assessment was conducted through five methods: subjective global assessment (SGA), BMI, arm muscle area measurement, hand-grip strength, and bioelectrical impedance analysis (BIA). Results In total, 460 patients (374 males and 86 females) with mean age 56.8 ± 9.4 years were included in the study. Hepatitis B/C-virus infection was the main cause of cirrhosis in 87.8% of them. Nearly half of them (55.9%) were Child–Pugh class A. The percentage of malnutrition ranged from 10.7% using modified BMI to 64.6% using phase angle. In comparison with Child–Pugh score, all methods showed statistical significance (P < 0.05). Comparison of nutritional assessment tools with Child–Pugh score showed that SGA has the highest sensitivity (83%), followed by phase angle of BIA (65%). Conclusion Nutritional assessment of cirrhotic patients is challenging due to the presence of edema, and the absence of a validated gold standard. This study revealed marked discrepancies between different methods of nutritional assessment of cirrhotic patients. SGA followed by BIA were the best-used measures in relation to Child–Pugh scoring system.

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Objective To present a new technique to reconstruct the lower-quadrant breast cancer excision defects with superior pedicle-reduction mammoplasty reshaping in order to obtain a satisfactory esthetic outcome together with a safe oncological outcome. Background The application of oncoplastic surgery into breast-conservation surgery affords many procedural options to achieve the acceptable esthetic results as well as oncological safety outcome. Lower-quadrant breast cancer radical excision with a high satisfactory esthetic outcome represents a challenge for breast surgeons. Patients and methods During the period from May 2018 to March 2021, 23 patients with a lower quadrant's breast cancer were operated. Postoperative complications, resection margins, and cosmetic outcome were assessed. Results At a mean follow-up of 12 months, the complication rate was 17.39% (two cellulitis and two margin-skin necrosis). Surgical margins of resection were negative in all cases. The overall satisfaction was considered excellent in 21 (91.3%) patients, good in two (8.69%) patients, and fair in one (4.34%) patient. Conclusions This technique represents a good solution for the reshaping that is needed following lower-quadrant breast cancer as regards oncological safety outcome and excellent cosmetic results.

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Objectives To elucidate the serum level of microRNA (miRNA)-192 in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). Background Early diagnosis of HCC presents a challenge owing to lack of reliable biomarkers, stressing the need for new early diagnostic tools. The identification of new high-sensitivity and high-specificity markers for HCC is essential. We aimed to identify serum miRNA-192 as a biomarker to be used in diagnosing HCV-related HCC. Patients and methods We investigated serum miRNA-192 expression in 40 patients with HCC, 40 HCV-infected patients, and 20 healthy controls. An initial screening of miRNA-192 expressions by Illumina sequencing was performed using serum samples pooled from patients with HCC, HCV-infected patients, and controls. Quantitative reverse-transcriptase PCR was used to evaluate the expression of miRNA-192. Demographic, radiological, and laboratory analyses were recorded. Results MiRNA-192 was significantly increased in HCC group in comparison with HCV and control groups, with cutoff level of 62.06. Conclusion MiRNA-192 could be used as a diagnostic biomarker for early detection of HCC in HCV-related cirrhosis, as it showed significant upregulation in patients with HCC in comparison with non-HCC patients.

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Objectives To compare the efficacy of intraumbilical oxytocin injection and sublingual misoprostol on the third stage of labor and their effects on maternal outcome. Background The most common complication accompanying the third stage is postpartum hemorrhage owing to uterine atony. WHO recommends active management of third stage, which consists of prophylactic administration of 10 IU oxytocin in 2 min after delivery of the fetus. Patients and methods This randomized trial included three groups: group 1 (control group) and two active group 2 and group 3. Group 1 had the usual active management of the third stage in the form of prophylactic administration of 10 IU of intramuscular oxytocin in 2 min after delivery of the fetus, group 2 received 10 IU oxytocin injected through umbilical vein using umbilical catheter, and group 3 received 400 μg of sublingual misoprostol after delivery of the fetus. In addition to the previous interventions, both group 2 and group 3 also had received the usual active management steps of the third stage. Results There was no significant difference in the duration of the third stage among the three groups, as P value was 0.08. There was also no significant difference in the amount of blood loss in the third stage of labor, as P value was 0.317. Conclusion The use of intraumbilical oxytocin injection or sublingual misoprostol along the third stage of labor did not lead to significant statistical reduction either along the duration of third stage or amount of blood loss.

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Objectives To evaluate the feasibility of using a dermal fat graft immediately after conservative breast surgery and the factors that may increase the possibility of complication incidence after surgery. Background Breast cancer is considered as one of the most common cancers affecting women and remains one of the world's biggest killers. Once diagnosed as a breast cancer patient, a woman is exposed to psychological trauma. Breast reconstruction is an integral part of treatment of breast cancer after surgery. Reconstruction may be either immediate at the time of mastectomy or delayed until after adjuvant treatment. The advantages of immediate reconstruction have proved to be much higher than the possible disadvantages, including less psychological effect and reduced cost due to one-stage surgery, superior cosmetic results, and shortening the time to start radiotherapy. Patients and methods This study was conducted on 40 female patients admitted to Surgical Oncology Unit, Menoufia University Hospitals, in the period between January 2020 and February 2021. They were diagnosed as having early breast cancer and were eligible for conservative breast surgery. Patients who had contraindication to breast conservative surgery were excluded from this study. Results Of 40 patients, six (15%) patients had complications within 1 month after surgery; delayed wound healing was seen in two patients, hematoma in two patients, and surgical site infection in two patients. Multiple complications were observed in one diabetic patient who had surgical site infection within 1 month and fat necrosis within 6 months after surgery. Conclusion Immediate breast volume replacement using a free dermal fat graft after conservative breast surgery can be done for selected patients with breast cancer to avoid postoperative complications.

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Background Coronavirus disease-2019 (COVID-19) disease was primarily described as a pandemic of respiratory illness, however, with the disease progression, variable cases with extrapulmonary manifestations have been reported all over the world. Severe acute respiratory-syndrome coronavirus- 2 infection can affect different body systems with the neurologic, abdominal, thromboembolic, cardiac, mediastinal, and hematological manifestations that had been reported in many literatures. The understanding of this multisystemic involvement is being better understood as the pandemic progresses. Objective The aim was to study the different neuroimaging findings in patients with severe acute respiratory- syndrome coronavirus-2 infection and their clinical and epidemiological characteristics. Patients and methods Our study was a retrospective study in the period between April 1 and August 30, 2020. It included 98 patients who were proved to be COVID-19 and showed neurological manifestations with neuroimaging abnormalities on computed tomography and/or MRI studies. Results This study included 98 COVID-19 patients that have neurological manifestations and acute neuroimaging abnormalities. There were 78 (88.7%) males and 20 (20.3%) females with mean age 58 ± 10.18 years old, ranging from 2 to 81 years. The most common neurologic manifestations were alteration of consciousness 71.4% (70 cases), confusion 31.6% (31 cases), and agitation 18.4% (18 cases). The most frequent MRI findings were acute infarcts 38 cases (38.7%) and cortical fluid- attenuation inversion-recovery signal abnormality 33 cases (33.7%). Extensive and isolated white matter microhemorrhages are seen in three patients (3.1%). Hemorrhagic brain lesions were associated with more severe clinical presentation, especially in ICU patients. Conclusion Many neurological complications of COVID-19 infection were encountered with a wide spectrum of neuroimaging findings. Different imaging modalities (computed tomography/MRI) have a great role in the assessment of these neurological complications to avoid any untreated causes of morbidity/mortality.

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Background Recent changes in epilepsy definition included the first nonprovoked seizure with a high risk of recurrence (>60%) in the next 10 years. A single nonprovoked seizure with EEG showing epileptiform discharge carries a high risk of seizure recurrence and so is sufficient for epilepsy diagnosis. Objectives The authors investigated if EEG monitoring for a longer period (6 h) can increase the likelihood of epileptiform discharge and so predict the risk of seizure recurrence for early diagnosis, treatment, and hence better outcome for people with epilepsy in Egypt. Patients and method A nonrandomized prospective case-control study was conducted on 70 healthy volunteers and 70 adult patients with first attack of nonprovoked seizure who were recruited from Kobry El-Qobba Armed Forces Medical Complex and Menufia University Hospitals between January 2020 and June 2021. They underwent 6-h EEG, where the first 30 min were compared with the whole record, and were followed up for any epileptic event through 6 months. Results The mean age at first seizure was 25.9 ± 14.7 years. The rate of EEG abnormalities in cases was 38.6%. The seizure recurrence risk at 6 months was 32.9%. Six-h EEG had higher sensitivity than 30-min EEG in prediction of seizure recurrence (65.22% and 30.43%, respectively) with specificities of 89.36% and 7 4.47%, respectively. Overall, 22.9% of cases had abnormal neuroimaging. There was no significant association between abnormal imaging and seizure recurrence (P = 0.291). Conclusion Abnormal long-term EEG was a strong risk factor for seizure recurrence.

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Objective Assessment of the efficacy and clinical outcome of posterior cervical foraminotomy in patients suffering from cervical polyradiculopathy. Background Posterior cervical procedure was the first method for management of cervical disc disease, until the appearance of anterior cervical discectomy and fusion, but in recent years, posterior cervical foraminotomy has a comeback as it does not entail fusion. Patients and methods Thirty patients suffering from cervical polyradiculopathy were operated through posterior cervical foraminotomy at Menoufia University Hospital. Results A total of 30 patients were operated, the most common level affected in this series was C5/C6 presented in 23 (31.5%) cases, followed by C6/C7 level presented in 21 (28.7%) cases, 15 (20.5%) cases with C4/C5, and 14 (19.2%) cases with C3/C4 affection. In this study; 26 (86%) cases had excellent and good outcomes according to Odom's criteria of outcome grading, while four cases had a fair outcome. Conclusion Posterior cervical foraminotomy is a safe and effective motion-preserving approach for treatment of cervical radiculopathy in well-selected cases. It has comparable outcomes to anterior cervical discectomy and fusion approach with avoidance of possible complications associated with anterior approaches.

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Background Ulnar nerve entrapment at the elbow (UNE) is a compression of the ulnar nerve at the elbow level that is mainly diagnosed clinically and confirmed by electrodiagnostic testing as well as diagnostic imaging of the ulnar nerve. Objectives To evaluate the diagnostic accuracy of nerve conduction studies (NCSs) versus ultrasonography (US) in the early diagnosis of UNE. Patients and methods This cross-sectional study included 160 patients: 80 patients with symptoms suggestive of UNE for less than or equal to 6 weeks and a control group of 80 healthy adults. Both groups were clinically examined and assessed using a self-administered questionnaire of UNE. Furthermore, motor and sensory NCS and short-segment nerve conductions of ulnar nerve in both groups with measurement of ulnar nerve cross-sectional area using US in the case group were performed. Results A high sensitivity of using NCSs for early diagnosis of UNE measuring conduction velocity and amplitude was exhibited via traditional 10-cm NCSs (95 and 82.5%, respectively) and short-segment nerve conductions (97.5 and 90%, respectively). US has showed a decrease in the sensitivity (40%) in comparison with short-segment amplitude drop, with an accuracy of 91% as well as a specificity of 99%, and there was a high sensitivity of short-segment amplitude drop D2/ME (80%) when compared with US at P2, which exhibited an accuracy of 91% and specificity of 92%. Conclusion Herein, electrodiagnostic in addition to the US studies would play a vital role in increasing the accuracy of diagnosis of UNE; additionally, it will help in precise localization of the site of pathology.

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Objectives To measure the perioperative fetal and maternal outcomes and the postoperative analgesic effects when using intrathecal nalbuphine as an adjuvant to bupivacaine and intrathecal adenosine as an adjuvant to bupivacaine controlled by fentanyl as an adjuvant to bupivacaine during spinal anesthesia for elective cesarean section. Background Spinal anesthesia for cesarean delivery is the best anesthetic technique as it is simple to perform with rapid onset of anesthesia and complete muscle relaxation. Lower incidence of failed block, less drug doses, minimal neonatal depression, and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Patients and methods After obtaining approval from the ethical committee for our study, patients admitted to El Menoufia University Hospital for cesarean delivery were enrolled in this study. We calculated that the minimum proper sample size was 25 patients in each group to be able to reject the null hypothesis with 80% power at α=0.05 level using one-way analysis of variance test. Results Level of sensory block was assessed using loss of cold discrimination (ice test) and motor block (assessed by Bromage scale: 0 = none, 1 = just able to move the knee but not the hip, 2 = able to move the foot only, and 3 = unable to move the knee or foot). All patients included in the study had sensory level from T4 to S5. Conclusion Nalbuphine showed better maternal and fetal outcomes than adenosine in spinal anesthesia for elective cesarean section as an adjuvent to bupivacaine intrathecally and in comparison with fentanyl.

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Objective The aim of this study was to demonstrate the occurrence of vitreoretinal interface changes in patients with macular edema secondary to branch retinal vein occlusion (BRVO) and diabetic macular edema (DME) after intravitreal injection (IVI) of aflibercept (anti-vascular endothelial growth factor). Background IVI of aflibercept is an effective treatment for macular edema (ME) secondary to BRVO and DME. Patients and methods This prospective comparative case series study was carried out on 50 eyes of 30 patients coming to the Ophthalmology Department of Menoufia University Hospitals. Patients included had ME secondary to BRVO and DME. Patients were randomly enrolled into two groups. Group A included 16 eyes which had ME secondary to BRVO. Group B included 34 eyes which had ME secondary to DME. Results The results revealed that there was no significant difference between the studied groups regarding postoperative visual outcome and central macular thickness. However, there was a significant increase in epiretinal membrane complication in BRVO group than DME group postoperatively. Conclusion After IVI of aflibercept for ME, there was a significant improvement in visual acuity, all over the period of follow-up. Moreover, the optical coherence tomography improved significantly. The rate of complications was higher in the BRVO group than the DM group. The presence of vitreoretinal interface abnormalities affected the effectiveness of anti-vascular endothelial growth factor and final visual outcome.

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Objectives This study aimed to assess the clinical outcome of moderate aortic incompetence after mitral valve replacement in patients with severe rheumatic mitral stenosis. Background The fate of aortic valve disease after mitral valve surgery for rheumatic mitral stenosis still needs to be investigated more. In addition, appropriate management of moderate aortic incompetence is required during and after replacement of the stenotic mitral valve. We aimed to evaluate the early-term fate of moderate aortic incompetence and the need for aortic valve surgery after mitral valve replacement in rheumatic patients. Patients and methods Fifty rheumatic heart disease patients, with combined severe mitral stenosis and moderate aortic incompetence, underwent mitral valve replacement. We followed them up for 1 year with serial transthoracic echocardiography to assess the fate of aortic incompetence. Results Preoperatively, the aortic incompetence mean vena contracta was 0.46 ± 0.049 cm. Postoperatively, after 1-year follow-up, we detected a significant increase in the aortic regurgitation mean vena contracta to 0.49 ± 0.077 cm (P = 0.001). However, both figures are still in the moderate category (0.4–0.6 cm). In terms of the aortic incompetence jet size ratio, the preoperative mean was 48 ± 3.350 and after 1 year follow-up, it was 49.2 ± 9.613; an insignificant increase was found (P = 0.387). The ejection fraction showed a significant decline at 1 year postoperatively, with a value of 56 ± 4.651, in comparison with the preoperative value of 60.4 ± 8.809 (P < 0.0001). There was no perioperative mortality or aortic valve replacement after 1 year. Conclusion In patients with rheumatic severe mitral stenosis and moderate aortic incompetence, the aortic incompetence will progress with time. Also, a decrease in the ejection fraction will occur. These findings lead surgeons to repair or replace the aortic valve at the time of mitral surgery.

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Objective To evaluate the outcome of Koyanagi technique modification using dartos muscle as a second layer, because it has a high vascularity, very thin, easily elevated, and leaves no complications. Background One-stage urethroplasty through parameatal foreskin flap (OUPF) available for all types of hypospadias was first described by Tomohiko Koyanagi (1983), although high complication rates were reported. The aim of this study was to straighten the results of this method after adding dartos muscle flap between the constructed urethra and covering skin. Patients and methods This study was conducted in the Plastic Surgery Department at Menoufia University, during the period of April 2017–April 2019. Thirty cases for proximal hypospadias were included in this study. After chordee release, urethra was constructed using Kusanagi technique and adding scrotal dartos muscle flap as a second layer. Results Patient's age ranged from 1 to 4 years with mean age of 2.83 ± 1.17 years. All of the 30 cases with proximal hypospadias had severe chordee. Early complications were detected, such as bleeding in two (6.6%) patients. One (3.3%) patient reported for retention due to obstruction of the inserted catheter. Another case (3.3%) showed wound infection. The reported late complications were fistula in six (20%) patients, meatal recession in five (16.6%) patients, meatal stenosis in three (10%) patients, and diverticulum in one (3.3%) patient. Conclusion The modified Koyanagi one-stage repair of proximal hypospadias is an innovative technique and realizes many criteria for the expected effective operating results. The use of dartos muscle flap as a cover for the urethroplasty improves the results and minimizes complications.

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Objectives To assess the outcome of the extended dorsal metacarpal artery (DMCA) flap and its modifications for coverage of finger defects distal to the proximal interphalangeal (PIP) joint. Background The extended DMCA flap is a reliable solution for resurfacing soft-tissue defects in hand surgery. However, limited studies have used it to reconstruct defects beyond the PIP joint. This study reports a novel experience applying this flap for various finger defects distal to the PIP joint. Patients and methods This study was conducted on 21 patients who underwent an extended DMCA flap transfer. Flap length was measured from the pivot point (midpoint of the proximal phalanx) to the distal border of the extensor retinaculum. The donor length was traced to the recipient-site fingers to determine the coverage area. All patients with single or multiple finger defects over volar/dorsal surface up to the Distal interphalangeal joint (DIP) joint were included. Patients with associated injury in the skin of the dorsum of the hand and thumb defects were excluded. Results All flaps survived, and the average flap size was 9.31 ± 3.49 cm² (range, 4.5–15 cm²). All donor sites were primarily closed, and skin grafting was not needed to close the donor defect. Complications recorded were venous congestion in six flaps, and no arterial insufficiency was recorded. Conclusions The extended DMCA flap is a simple and pliable flap with minimal donor-site morbidity and can be used to cover soft-tissue defects up to the DIP joint.

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Objective The aim was to estimate the serum levels of anticeramide antibodies (ACAs), interleukin-4 (IL-4), and tumor necrosis factor (TNF) in patients with leprosy and their possible role in the anticipation of leprosy complications. Background Leprosy is a disease that primarily involves the peripheral nerves and skin. Nerve damage is concomitant with multibacillary (MB) leprosy, and as ceramide is an element of the myelin sheath, ACAs can be a marker in the nerve destruction evaluation. Cytokine estimation can anticipate inflammation instigated by infections or trauma. The authors aimed to detect the role of serum levels of ACA, IL-4, and TNF-α for the anticipation of leprosy complications. Patients and methods A total of 100 patients with leprosy and 100 controls were included. Lesions were examined microbiologically and then classified according to WHO as paucibacillary if no detected bacilli and MB if positive skin smear. ACA, IL-4, and TNF-α were quantified by enzyme-linked immunosorbent assay. Results The study included 63 patients who had MB, and 37 patients with paucibacillary leprosy, as well as 100 age-matched and sex-matched healthy controls. Serum ACA, IL-4, and TNF-α levels were the highest in MB cases. They represented 97 ± 24 ng/ml, 359 ± 238 pg/ml, and 314 ± 259 ng/l, respectively, in patients with MB; 46 ± 32 ng/ml, 79 ± 71 pg/ml, and 38 ± 26 ng/l, respectively, in controls; and 48 ± 17 ng/ml, 122 ± 74 pg/ml, and 78 ± 51 ng/l, respectively, in patients with paucibacillary. The cutoff values were 50 ng/ml, 126 pg/ml, and 39 ng/l, respectively, for distinguishing neural complications, with sensitivity and specificity of 80 and 49%, respectively, for ACA, 67 and 64%, respectively, for IL-4, and 93 and 49%, respectively, for TNF-α. Conclusion Serum levels of ACA, IL-4, and TNF-α may be markers of leprosy nerve damage.

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Objective The aim was to assess the impact of ostium size on endoscopic dacryocystorhinostomy success and determine the ideal ostium size that can provide a sufficient postoperative ostium patency. Materials and Methods Four databases were searched in this study, including Scopus, PubMed, Google Scholar, and Web of Science from January 2000 to December 2020. Studies assessed anatomical success by measuring ostium dimensions and functional success by irrigation and dye-disappearance test after endoscopic dacryocystorhinostomy for patients with nasolacrimal duct obstruction. If the studies did not meet inclusion criteria, they were excluded, for example, external dacryocystorhinostomy or assessment without measuring ostium dimensions through follow-up. Study-quality assessment included whether ethical approval was gained, eligibility criteria specified, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings In total, 10 potentially relevant publications were included, an ostium measuring greater than or equal to 8 × 5 mm should be a satisfactory large size. There is no significant shrinkage of the ostium after the fourth week of the operation. Conclusion Functional success should be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is required, while it is believed that ostium size does not affect functional surgical success.

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Background Sentinel lymph-node biopsy (SLNB) has been established as the standard management for pathologic evaluation of the axilla in patients with operable breast cancer and clinically negative axilla (cN0). However, whether SLNB should be performed for patients with node-positive disease after neoadjuvant chemotherapy (NAC) is still controversial. Patients and methods This is a clinical multiinstitutional prospective study conducted on 340 patients with operable breast cancer selected from the multidisciplinary breast clinic at Menoufia University Hospital and Tanta Oncology Centre to evaluate the suitability of SLNB for patients with node-negative (group A) and node-positive (group B) breast cancer after NAC. The study was performed from October 2016 to October 2020. Results The identification rate for SLNB after NAC was 90.45% and the false-negative rate was 12.5%. The sensitivity, specificity, positive predictive value, and negative predictive value were 98, 91, 90, and 93.5%, respectively. The overall accuracy for SLNB after NAC was 95%. Conclusion SLNB after NAC has acceptable false-negative rate, identification rate, and lower in both morbidity and cost. Patients with no initially involved nodes (cN0) with a negative SLN after NAC could safely be spared an unnecessary axillary lymph-node dissection with a low risk of relapse.

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