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The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation.Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6 ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4 ml 4% articaine hydrochloride with 1:100 000 adrenalin (n = 165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χBaseline variables were balanced between groups (p .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p .05). IOP intensity was associated with preoperative pain intensity and tooth type (p .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia.2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

The objective of this paper is to demonstrate the application of MRC drilling for an increase of production demand and enhancing reservoir management strategy. A case study is presented herein for a layered carbonate reservoir, undergoing redevelopment plan with water injection scheme, where MRC strategy was deployed to tackle challenges of pressure maintenance and water breakthrough mechanism and limited wells productivity in tight area, Average porosity 20-23% and Average Permeability 2-30 md. Drilling and evaluation of 3 MRC wells was carried out in phases. The Planning phase included the reservoir modelling, selection criteria. Simulation modelling evaluated prospective performance in terms of oil sweep and cumulative production and effective well length range. The completion design assessment called for limited entry liner (LEL) completions to assure effective acid stimulation. In the execution phase, optimized well placement via Geosteering tools and the LEL completion set up is illustrated. Post commissioning, the technical evaluation for the MRC cases included a thorough surveillance monitoring base line of PLTS and MRT analysis pre and post stimulation. The evaluation results of MRC cases with conventional wells proved the value of MRC to accelerate production reserves and pressure support with higher wells deliverability. The three MRC wells deployed showed promising performance. Oil producer (OP-X1) was able to produce at almost double rate of nearby wells with lower drawdown, no Water breakthrough detected, and PI doubled post stimulation. Water injector (WI -X2) met the injection target and was scheduled for stimulation as the PLT showed that approximately 25% of the wells length was not contributing. One additional WI-X3 proved successful without stimulation. In overall first application of MRC led to: Well count optimization during the redevelopment phase (reduction of 20% total wells).Reactivating inactive elongating well life by minimizing inverse coning.Increasing and accelerating rates, +2 times and well PI/II enhancement by more than two folds.Water injection capacity enhancement and accelerated pressure support.Uniform profile across Horiz drain with Leff more than ~75% with LEL design.Estimated Capex saving of +24 MM drilling/surface tie in cost. The analysis presented helps to propose actions to improve and define the best production/injection scenario for efficient MRC deployment. The promising results can be a guidance to extend the implementation of the MRC for field development/re-development plans tackling pressure maintenance issues and tight reservoirs WBT mechanisms. The case studies presented capitalizes on Reservoir management best practices displaying systematic approach to screen and assess MRC well candidates (pre- and post-deployment) to maximize probability of success.

Background Mizolastine (MZL) is a dual-action nonsedating topical antihistamine anti-inflammatory agent that is used to relieve allergic conditions, such as rhinitis and conjunctivitis. Solid lipid nanoparticles (SLNs) are advanced delivery system in ophthalmology, with the merits of increasing the corneal drug absorption and hence improved bioavailability with the objective of ocular drug targeting. Methods First, MZL was formulated as MZL-SLNs by hot homogenization/ultrasonication adopting a 32 full factorial design. Solid-state characterization, in vitro release, and stability studies have been performed. Then, the optimized MZL-SLNs formula has been incorporated into ocular hydrogels using 1.5% w/v Na alginate and 5% w/v polyvinylpyrrolidone K90. The gels were evaluated via in vitro release as well as in vivo studies by applying allergic conjunctivitis congestion in a rabbit-eye model. Results The optimized formula (F4) was characterized by the highest entrapment efficiency (86.5±1.47%), the smallest mean particle size (202.3±13.59 nm), and reasonable zeta potential (-22.03±3.65 mV). Solid-state characterization of the encapsulation of MZL in SLNs was undertaken. In vitro results showed a sustained release profile from MZL-SLNs up to 30 hours with a non-Fickian Higuchi kinetic model. Stability studies confirmed immutability of freeze-dried MZL-SLNs (F4) upon storage for 6 months. Finally, hydrogel formulations containing MZL-SLNs, proved ocular congestion disappearance with completely repaired conjunctiva after 24 hours. Moreover, pretreatment with MZL-SLNs-loaded hydrogel imparted markedly decreased TNF-α and VEGF-expression levels in rabbits conjunctivae compared with post-treatment with the same formula. Conclusion MZL-SLNs could be considered a promising stable sustained-release nanoparticulate system for preparing ocular hydrogel as effective antiallergy ocular delivery systems.

Objective: The objective of this study is to evaluate the clinical effect of two abutment materials with two different types of superstructure metal free restoration on the platform switched implant. Subjects and Methods: Twenty human patients with missing maxillary central incisor were selected for implant placement and divided randomly into two groups according to abutment type Titanium abutment and PEEK abutment( n= 10 in each) .Each group was subdivided into two subgroubs according to superstructure crown (PEEK and VITA ENAMIC crown, n=5) All groups were evaluated clinically through measuring implant stability, determining screw loosening and color stability at base line, 3, 6 and 12 months . Results: As regarding to implant stability , there was no significant difference between four groups Ti PEEK ,Ti VIT , PEEK PEEK and PEEK VIT group (73.40 ± 3.44,73.80 ± 2.17,76.0 ± 1.87,73.40 ± 2.30). There is no screw loosening of all tested group. PEEK VIT group show the highest color change between all groups but the change is not significant . Conclusion: PEEK abutment with PEEK crown gives better result but in general implant stability is comparable with other groups. There is no screw loosening occur in all group. Color stability was better when use titanium abutment however the difference between all group was non significant. VITA ENAMIC crown with PEEK abutment show the higher color change, however the difference is non significant.

Introduction Thyroidectomy is a common procedure. Certain swallowing problems could happen after this surgery and affect the quality of life of the patient. Objective To evaluate swallowing after thyroidectomy in the early and late postoperative periods and to correlate subjective and objective parameters. Methods A prospective study with100 patients who underwent total thyroidectomy at our institution from April 2018 to September 2019. Each patient was assessed by the Arabic version of the Eating Assessment Tool (EAT-10) questionnaire and the fiberoptic endoscopic evaluation of swallowing (FEES) preoperatively, and in the early postoperative (EPO) and late postoperative (LPO) periods. Results The rate of dysphagia was of 82% in the EPO period, and of 36% in the LPO period. Two groups were compared regarding vocal fold mobility using the FEES. Group I included 89 patients with normal vocal fold mobility, 42% of whom had early dysphagia, and only 22% had late dysphagia. Regarding swallowing, we found that in the EPO period, the rates of delayed triggering, aspiration, penetration and residue were of 12.4%, 0%, 0%, and 42.7% respectively. Group II (unilateral immobile vocal fold) included 11 patients in the EPO evaluation, and all of them had early dysphagia. Conclusion Swallowing problems can occur in patients after thyroidectomy regardless of alterations in larynx mobility, and they are characterized by delayed triggering and stasis of food, which are also noticed in the LPO period, though more frequently in the EPO period. Moreover, there is a highly significant correlation between the subjective and objective parameters of swallowing in both EPO and LPO periods.

Background: The association between endocrine control and ejaculatory reflex is still not completely elucidated. Serum dihydrotestosterone (DHT) concentrations have been reported to be lower in premature ejaculation (PE) patients. We hypothesized that homeostasis between testosterone (T) and their metabolites; dihydrotestosterone (DHT) and estradiol (E2); could be involved in orchestration of the ejaculatory process. Aim: To test this hypothesis, we aimed to investigate any possible relationship between DHT/ E2 ratio and T/E2 ratio in a cohort of patients consulting for premature ejaculation (PE). Methods: This prospective hospital-based cross-sectional case-control study has been carried on 104 PE patients (30 patients with primary lifelong PE and 74 patients with acquired PE) compared to 90 healthy men as controls. Results: DHT levels were significantly higher in secondary PE compared to primary PE group (p = 0.011). Besides, serum E2 showed significant higher level among both primary and secondary PE groups compared to the control group (p=0.001). Moreover, both total testosterone (TT)/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE compared to the control group (p=0.001 for both). Furthermore, DHT/E2 ratio showed fair discriminating ability between PE and healthy controls (AUC = 0.749, p=0.001). Conclusions: Both TT/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE subjects suggesting a role of hormonal imbalance in this context. Although this link seems likely, large-scale studies are needed to confirm these findings.

Objective: The objective of this study is to evaluate the radiographic effect of two abutment materials with two different types of superstructure metal free restoration on the platform switched implant. Subjects and Methods: Twenty human patients with missing maxillary central incisor were selected for implant placement and divided randomly into two groups according to abutment type titanium abutment and PEEK abutment, (n= 10 in each) Each group was subdivided into two subgroubs according to superstructure crown (PEEK and VITA ENAMIC crown, n=5 in each) .All groups were evaluated radiographically. Preapical radiographs were taken by parlling technique at base line, 3, 6 and 12 months . Results: The mean value of marginal bone level were determined that PEEK PEEK group showed a lower Mean marginal bone loss , followed by PEEK VIT , followed by Ti PEEK, Ti VIT was the highest(0.64 ± 0.03, 0.67 ± 0.02, 0.96 ± 0.04, 1.01 ± 0.05) respectively. Regarding with each other PEEK PEEK and PEEK VIT groups were significantly lower than Ti VIT group. Conclusion: PEEK abutment is considered a better alternative to titanium abutment in relation to hard tissue response in addition to has a good role in occlusal force distribution, as marginal bone loss was reduced when use PEEK abutment than titanium abutment regardless the type of suberstructure crown.

Background: Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of controverse. This research aims to study the early and mid-term postoperative influence of tricuspid repair on the clinical outcomes and right ventricular functions. Methods: This is a retrospective cohort study of 92 patients with moderate STR who underwent tricuspid valve repair between October 2014 and December 2017, in the cardiothoracic surgery department, Menoufia University Hospital. Patients were assessed clinically and by echocardiography at one month and after 24 months postoperatively for the degree of tricuspid regurgitation (TR), right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: In this study, mean age of patients was 58.33 ± 4.06 years. We had a significant improvement in the grade of TR from preoperative period to follow up data observed at 1-month postoperative and 2-years follow-up (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decreased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE was from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was significant increase in late postoperative value. Conclusion: We highly recommend repair for moderate TR during mitral valve surgery to avoid progression of TR. Tricuspid repair was able to reduce the grade of regurgitation after two years of surgery and improved right ventricular functions.

Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with non- impacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study’s findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.

Background Tramadol dependence is prevalent across Egypt. The allegation that it can improve sexual function is the main reason for its popularity among young men. This study aims to determine the serum level of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in tramadol abusers. Results Serum testosterone (5.18 ± 1.95) and LH (7.79 ± 1.63) of abusers showed highly significant lower levels than control subjects, while FSH showed no significant difference between abusers and controls. There was no significant difference of hormonal levels in subjects according to the duration of abuse and dose of tramadol. Conclusions The results indicate that tramadol abuse causes a pronounced lowering of testosterone and LH levels that is not correlated to the duration of abuse and dose of tramadol.

Background: Male urogenital tract infection is one of the most important causes of male infertility worldwide. Infection processes may lead to impairment of sperm quality, and obstruction of the seminal tract. On the light of this, there is a need to institute a microbiological intervention to detect the probable causative microbial agents.Objective: The aim of the work was to detect the common bacteria causing pyospermia in a cross-section of infertile men and the sensitive antimicrobials against these bacteria.Patients and methods: This study included 205 infertile men who were recruited from the outpatient clinic, Andrology Unit, Dermatology and Andrology & STDs Department, Mansoura University Hospital for management of infertility. Patients with grade II or grade III varicocele, more than 60-year, smoker, drug abuser and those who were treated with antibiotics during last 3 months were excluded from the study.Results: Over the period of the study, out of 205 infertile male patients with documented pyospermia, 95.6 % of semen samples revealed bacteriologic growth. It was obvious that gram positive bacteria (75.1%) were common than the gram-negative bacteria (20.5%). Six bacterial species (Staphylococcus aureus, Streptococci, Enterococci, E. coli, Klebsiella and Pseudomonas) were isolated from semen samples. The most common causative organisms were Staph. Aureus (49.3%) followed by Streptococci (22.4%) then E. Coli (8.3%), Klebsiella (8.3%) then Pseudomonas (3.9%) and finally Enterococci (3.4%).Conclusion: It could be concluded that semen analysis with peroxidase stain and semen culture are an important diagnostic tool in all patients undergoing fertility investigations to detect genitourinary infections and pyospermia.

Background: High grade serous ovarian carcinoma has a heterogenous morphology and marked genomic instability with aggressive behavior and poor overall prognosis. A molecular classification of HGSOC demonstrated 4 subtypes; C1, C2, C4 & C5 as a trial to correlate this molecular classification with patient prognosis. A correlation between these molecular subtypes, clinical data, histopathological criteria and immunohistochemical features needed to be established aiming at individualization of the treatment of each patient to achieve the best outcome. Aim: Investigating for a correlation between the histopathological classification of high grade serous ovarian carcinoma (HGSOC), clinicopathological parameters, and immunohistochemistry. Methods: Eighty five cases of high grade serous ovarian carcinoma were revised for their clinical data regarding their age, pathological staging, CA 125 levels, ascites, and chemotherapy regimen taken. The cases classified into four groups. Paraffin-embedded HGSOC specimens were re-cut at 5 microns thickness sections and stained with haematoxylin and eosin stain and examined for the different histopathological criteria. The tissue sections were also stained immunohistochemically with antibodies against Ki67, CD8, E cadherin, Vimentin, ER & PR. Results: HGSOC could be classified into 4 groups (mesenchymal, immunoreactive, Proliferative & differentiated type either with SET features or papillary features). Ki 67 & CD8 had a strong significant correlation with the proliferative subtype & immunoreative subtype respectively (P< 0.001). Low PR expression was also correlated with advanced stage disease in cases underwent 1ry debulking surgery (P=0.03). in cases received neoadjuvant treatment, differentiated subtype with SET features showed a statistically significant correlation with high CD8 expression.

Background Naringin is a promising anti-inflammatory drug against various disorders including ulcerative colitis. However, its oral bioavailability is low (8%) possibly due to cleavage at the upper gut. Consequently, colon targeting would be necessary for drug protection at the upper gut, enhanced oral bioavailability and potentiated cytoprotection against colitis. Methodology This study involved the formulation of compression-coated tablets of naringin employing mixtures of pH-sensitive Eudragit L100-55 (EUD-L100-55) and different time-dependent polymers including ethyl cellulose (EC), sodium alginate (ALG) and sodium carboxymethyl cellulose (SCMC). Drug-polymer interaction during release was assessed using Fourier transform-infrared spectroscopy (FT-IR) and differential scanning calorimetry (DSC). Tablets were evaluated in vitro. Surface morphology of the optimized tablets either before or after exposure to the different release media was examined employing scanning electron microscopy (SEM). Cytoprotection potential of the optimized tablets against indomethacin-induced colitis in rabbits was screened and compared to core tablets through a histopathological examination of colon, measurement of serum perinuclear antineutrophil cytoplasmic antibodies (pANCA) and immunohistochemical localization of tumor necrosis factor-alpha (TNF-α). Results FT-IR and DSC results may indicate drug-polymers interaction during release. Release retardation could be related to polymer swelling that was in the order of SCMC > ALG > EC. SEM examination indicated more porous coats at the buffers relative to the acidic medium. Colon targeting was expected in case of coats of 5% ALG, 5% SCMC and 10% EC (w/w) in combination with EUD-L100-55; thus, they were selected for in vivo evaluation. Effective cytoprotection of selected tablets against indomethacin-induced colitis was indicated by a significant (P

Background: Substance abuse is a major challenge in Egypt due to changing pattern of abuse and its threating to health, social and economic build of the community. Aim of the work: the present work aims to demonstrate the pattern of substance abuse in Assiut governorate. Also to study the liver, kidney functions and electrocardiographic changes among addicted patients admitted to Addiction Management Unit of Neurology and Psychiatry Hospital at Assiut University. Patients and methods: the study was done on 80 male in-patients, who are addicted for at least one year and 41 healthy non-abusers. All Patients fulfilled a questionnaire of drug dependence and were subjected to a thorough clinical examination beside measurement of liver functions, kidney functions, electrocardiogram recordings, and urine toxicological screen. Results: Forty-three patients (53.75%) were 25–35 years of age. Their mean of age was 30.47±6.91 years. Multiple substance abuse represented 57.5% (46 cases) and tramadol was the most commonly abused drug. Tramadol was abused alone in 32.5% (26 cases). The technical school (47.5%) was the most common educational level. Family history of abuse was positive in 47.5% of cases. HCV was positive in 15 (18.75%) of cases, 13 of HCV positives cases used injection for substance abuse. There was no significant association between liver and kidney functions changes and addiction duration. However, a correlation was established between liver functions changes and infective hepatitis. There was a high percentage of ECG abnormalities among abusers (53.75%), those abnormalities were in the form of an inverted T wave in 13 patients (30.23%). Conclusion: This research shows that ECG abnormalities are frequently encountered in substance abusers. The results also point out the risk of hepatic damage due to infective hepatitis in injection drug users. Measures to control the spread of substance abuse should be implemented.

Tumor boards are part of standard care of patients with complex cancers, but appropriate multidisciplinary expertise and infrastructure are often not available in low- and middle-income countries (LMIC) for pediatric cancers, such as neuroblastoma. Our goal was to review results of a Global Neuroblastoma Network (GNN) tumor board accessible to LMIC.De-identified clinical cases presented via internet conference during a weekly GNN virtual tumor board from 2010 through 2020 were evaluated in a standardized format, including diagnostic imaging, pathology, therapy information, resource limitations, and questions for discussion. Information summarized included the presentations, a survey of the impact on care, and a resource questionnaire.Registered GNN participants included 575 individuals from 77 countries, with a median of 39 participants per session. Total 412 cases were presented from 32 countries, including 351 unique neuroblastoma patients, 52 follow-up cases, and nine non-neuroblastoma diagnoses. Twenty-eight educational sessions were presented. Limited critical resources for diagnostics and staging of cases included MYCN analysis (54.7%), metaiodobenzylguanidine (MIBG) scans (38.7%), and International Neuroblastoma Pathology Classification (49%). Therapies were also limited, with markedly decreased use of radiation and autologous stem cell transplant for high-risk cases, and no availability of anti-GD2 antibody in LMIC. Limited sampling with a post-presentation survey showed that 100% found the GNN helpful, and 70% altered the care plan based on the discussion.This report shows the utility of an international tumor board for LMIC focused on a challenging solid tumor where local expertise may be limited, with international multidisciplinary expert participation and educational sessions.

Ghada Ahmed El-Emam,1 Germeen NS Girgis,1 Mohammed Fawzy Hamed,2 Osama Abd El-Azeem Soliman,1 Abd El Gawad H Abd El Gawad1 1Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt; 2Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, EgyptCorrespondence: Ghada Ahmed El-EmamDepartment of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, EgyptTel +20 10-9059-0989Email ghadaelemam26@yahoo.comBackground: Mizolastine (MZL) is a dual-action nonsedating topical antihistamine anti-inflammatory agent that is used to relieve allergic conditions, such as rhinitis and conjunctivitis. Solid lipid nanoparticles (SLNs) are advanced delivery system in ophthalmology, with the merits of increasing the corneal drug absorption and hence improved bioavailability with the objective of ocular drug targeting.Methods: First, MZL was formulated as MZL-SLNs by hot homogenization/ultrasonication adopting a 32 full factorial design. Solid-state characterization, in vitro release, and stability studies have been performed. Then, the optimized MZL-SLNs formula has been incorporated into ocular hydrogels using 1.5% w/v Na alginate and 5% w/v polyvinylpyrrolidone K90. The gels were evaluated via in vitro release as well as in vivo studies by applying allergic conjunctivitis congestion in a rabbit-eye model.Results: The optimized formula (F4) was characterized by the highest entrapment efficiency (86.5± 1.47%), the smallest mean particle size (202.3± 13.59 nm), and reasonable zeta potential (− 22.03± 3.65 mV). Solid-state characterization of the encapsulation of MZL in SLNs was undertaken. In vitro results showed a sustained release profile from MZL-SLNs up to 30 hours with a non-Fickian Higuchi kinetic model. Stability studies confirmed immutability of freeze-dried MZL-SLNs (F4) upon storage for 6 months. Finally, hydrogel formulations containing MZL-SLNs, proved ocular congestion disappearance with completely repaired conjunctiva after 24 hours. Moreover, pretreatment with MZL-SLNs–loaded hydrogel imparted markedly decreased TNF-α and VEGF-expression levels in rabbits conjunctivae compared with post-treatment with the same formula.Conclusion: MZL-SLNs could be considered a promising stable sustained-release nanoparticulate system for preparing ocular hydrogel as effective antiallergy ocular delivery systems.Keywords: mizolastine, solid lipid nanoparticles, 32 full factorial design, sustained release, in vivo study

To examine the urethral plate and the underlying tissues in children with proximal hypospadias associated with severe chordee.The urethral plate and the underlying tissue specimens were excised to correct severe chordee in 17 children with proximal and perineal hypospadias with severe chordee. The median age was 20 months (range 8-36). Sections samples were marked and examined from proximal to distal. Specimens were examined histologically using hematoxylin-eosin (H/E) and Elastic van Gieson (EvG) stain. Histochemical examination was also performed using smooth muscle actin (SMA) and factor 8 antibodies. For control, samples from four patients with hypoplastic urethra proximal to the meatus including the hypoplastic segments until the normal urethra were taken. In addition, the urethra of an adult patient with penile tumor was used as control.The average size of the 17 tissue samples was 0.5 cm × 0.5 cm x 0.3 cm in depth. There was a common pattern that was seen in all the 17 specimens with a variable degree of expression. H/E staining showed that the epithelial lining changed from pseudostratified epithelium at the proximal intact urethra to non-keratinized stratified squamous epithelium at the urethral meatus to keratinized stratified squamous epithelium distally at the urethral plate level. EvG staining showed overall very few elastic fibres that increased slightly in the distal urethral plate. SMA staining showed a circular pattern of smooth muscle cells in the proximal intact urethra that changed to a U-shaped pattern at the level of the meatus, to a triangle shaped pattern just distal to the meatus. The distal urethral plate showed an irregular, disorganized rather flat pattern of the smooth muscles. Factor 8 antibodies staining the blood spaces revealed dysplastic unorganized large blood sinusoids underneath the urethral plate that were different from normal capillaries surrounding the proximal urethra.The urethral plate and the underlying tissues in patients with severe chordee have different structure from normal urethra as compared to available literature and the adult control patient. The lack of elastic fibres may help to explain the rigidity of the ventral penis causing chordee. The disorganized irregular distribution of the smooth muscle fibres is suggestive of the hypoplastic corpus spongiosum. The abnormal large blood sinusoids may explain the poor healing quality of the ventral penis in patients with perineal and proximal patients associated with severe chordee. This may explain persistent/recurrent chordee observed later in those patients with severe chordee when dorsal plication is used. The study also supports the recent trend of 2 stage procedure as a plan of management for patients with proximal and perineal hypospadias with severe chordee and excision of all the dysplastic tissues during the first operation.

Background Dysphagia is the medical term that is used to describe the difficulty of swallowing and the feeling of difficulty in passage of solids or semisolids or liquids from the mouth to the stomach. Objectives The aim of this work is to evaluate swallowing after different types of thyroidectomy operations. Subjects and Methods This study is a prospective, randomized trial on evaluation of swallowing after different types of thyroidectomy operations. This thesis study was conducted on 100 patients underwent different types of thyroidectomy operations, recruited from otorhinolaryngology and general surgery outpatient clinic Ain Shams university hospital from April 2018 to September 2019. An informed consent was obtained from each patient or their legal guardians before enrolment in the study. Each patient assessed by A EAT-10 Questionnaire and FEES(functional endoscopic evaluation of swallowing) both (pre-operative, early post-operative(EPO) and late postoperative(LPO). Results The study include 100 patient and mean age of study cases was 37.4 ±10.1; females represented 94% of cases. Total thyroidectomy was performed in 94% of cases. Among our cases, we found that Dysphagia was scored 0% at pre-operative questionnaire, 82% at early post-operative questionnaire and 36% at late post-operative questionnaire. Two groups were compared by FEES: Group I with normal vocal fold mobility(NVFM) and Group II with abnormal vocal fold mobility(AVFM) (unilateral fixed vocal fold). Group I included 89 patients, Forty two percent of them had early Dysphagia, while only 22% of them had late dysphagia. As regard swallowing; we found that early post-operative delayed triggering, early post-operative aspiration; early postoperative penetration and early postoperative residue were 12.4%, 0%, 0% and 42.7% respectively. While late postoperative examination revealed that there was improvement of 6 patients and the number of patients of this group became 95 who had normal vocal fold mobility. And the swallowing evaluation revealed that as regard late post-operative delayed triggering, late post-operative aspiration; late post-operative penetration and late post-operative residue were 11.6%, 0%, 0% and 6.3% had respectively. Group II included 11patients at the early postoperative evaluation, all of them had early Dysphagia (100%). As regard the swallowing evaluation, we found that early post-operative delayed triggering, early post-operative aspiration early postoperative penetration and early postoperative residue were 100%, 54.5%, 100% and 45.5% respectively. But the late post-operative evaluation showed that 45% only of the cases of this group (5 cases) still had abnormal vocal fold mobility (unilateral fixed vocal fold). And as regard swallowing; we found late postoperative delayed triggering, late postoperative aspiration, late post-operative penetration and late post-residue were 100%, 100%, 80% and 0% respectively. Conclusion Dysphagia occurs in patients after thyroidectomy operations (regardless of larynx mobility alteration) and characterized by delayed triggering and stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

Aim of the work To test the reliability of fibroscan in detection of fibrosis in patients with Budd Chiari syndrome before and after endovascular intervention (after elimination of hepatic congestion). Background transient elastography (TE) is a noninvasive methodology that has been used to monitor liver stiffness in patients with chronic viral hepatitis. One of the limitations for accurate assessment of liver fibrosis by TE is the liver congestion. Liver congestion can result from Budd Chiari syndrome (BCS).The treatment of BCS is through restoring the flow of the blood between the portal vein to the inferior vena cava, which will lead to decongestion of the liver.TE, will be tested after liver decongestion for proper detection of liver fibrosis. Patients and methods This was a prospective cohort study conducted on 25 Egyptian patients with confirmed diagnosis of primary Budd-Chiari Syndrome (BCS) in the period from June 2017 to September 2019. TE was performed three days before endovascular intervention and three months after it. Liver biopsy was taken during the intervention for assessment of METAVIR score. Comparison was done between TE assessments before and after intervention in detection of the degree of liver fibrosis in comparison to METAVIR score measured in liver biopsy. Results FVLM was the most common hypercoagulable cause in the involved patients. There was significant drop in Liver Stiffness Measurements (LSM) measured three months post-intervention indicating improvement of liver fibrosis after relieving liver congestion but still not correlated to the METAVIR scores measured in the liver biopsy. Conclusion Liver congestion has high impact on Liver stiffness measurement giving overestimation which improves significantly after decongestion of the liver by the endovascular intervention.

Background and aim: For a long time, the connection between liver cirrhosis (LC) and infections ‎had been studied extensively. Because of their weakened immune system, ‎cirrhotic patients are more likely to contract infectious diseases. Cirrhotic ‎patients are more likely to undergo invasive diagnostic or surgical ‎procedures that can change the host's protective barrier, putting them at a ‎higher risk of contracting an infection‎‎. Patients and Methods: ‎The study was conducted over one year duration between January and ‎December 2019 at intensive care unit (ICU). It enrolled all patients with ‎decompensated LC but patients with compensated LC or underlying ‎chronic chest disease were excluded. Baseline evaluation with laboratory ‎data was done in all patients. Blood and sputum cultures were achieved in ‎patients with suspected NCI‎.‎ Results: ‎845 patients with LC were admitted to ICU but 345 of them were excluded ‎so, 500 patients were enrolled in the analysis. NCI occurred in 100 (20%) ‎patients. The most frequent isolated organisms were Klebsiella species ‎‎(32%), Candida albicans (19%), Strept.pneumoniae (12%) and ‎Staph.aureus (10%). All of these infections were in form of pneumoniae. ‎Up to 65% of patients with NCI were died. Based on the current study the ‎predictors of NCI were; old age spontaneous bacterial peritonitis and low ‎serum albumin‎‎. Conclusion: Patients with liver cirrhosis are liable to infections secondary to ‎dysregulated immunity. NCI in cirrhotic patients has serious outcome. ‎Hospitalized cirrhotic patients should be screened for NCI‎.

Dalia Mohamed Fawzy Mohamed,1 Nihal Adel Hassan,2 Amr Abdellatif Osman,2 Moataz Hamed Osman21Department of Ophthalmology, National Institute of Diabetes, Cairo, Egypt; 2Faculty of Medicine, Cairo University, Giza, EgyptPurpose: To evaluate subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) using spectral domain OCT (SD-OCT).Materials and methods: Ninety eyes were divided into three equal groups: group A, non-proliferative diabetic retinopathy (NPDR) with no DME; group B, NPDR having DME; and group C, non-diabetic patients. The central subfield retinal thickness (CSRT) and SFCT were measured using spectral domain OCT.Results: There was a moderate negative correlation between age and SFCT in group B (r=−0.455, P=0.012). We found no significant correlation between best corrected visual acuity (BCVA) and SFCT in all groups (for groups A, B, and C, respectively: r=0.189, P=0.316; r=−0.195, P=0.302; and r=−0.181, P=0.337). There was no significant correlation between duration of diabetes and SFCT (r=−0.118, P=0.534 and r=−0.136, P=0.475 for groups A and B, respectively). The CSRT was 229.13±16.2, 336.4±74.85, and 223.13±16.9 μm in groups A, B, and C, respectively. The mean SFCT was 260.6±49.2, 259±50.8, and 252±50 μm in groups A, B, and C, respectively. We found no significant correlation between CSRT and SFCT in all groups (for groups A, B, and C, respectively: r=−0.049, P=0.796, r=0.239, P=0.204, r=−0.021, P=0.914). There was no significant difference in SFCT between group B (DME) on one hand and groups A and C on the other hand (P=0.9 and 0.59, respectively).Conclusion: There is no significant correlation between CSRT and SFCT in DME. Choroidal thickness assessment is not an indicator of the severity of DME and cannot be used as a monitor of its progression.Keywords: diabetic retinopathy, macular edema, optical coherence tomography, choroidal thickness, diabetes

Purpose: To evaluate subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) using spectral domain OCT (SD-OCT). Materials and methods: Ninety eyes were divided into three equal groups: group A, non-proliferative diabetic retinopathy (NPDR) with no DME; group B, NPDR having DME; and group C, non-diabetic patients. The central subfield retinal thickness (CSRT) and SFCT were measured using spectral domain OCT. Results: There was a moderate negative correlation between age and SFCT in group B (r=-0.455, P=0.012). We found no significant correlation between best corrected visual acuity (BCVA) and SFCT in all groups (for groups A, B, and C, respectively: r=0.189, P=0.316; r=-0.195, P=0.302; and r=-0.181, P=0.337). There was no significant correlation between duration of diabetes and SFCT (r=-0.118, P=0.534 and r=-0.136, P=0.475 for groups A and B, respectively). The CSRT was 229.13±16.2, 336.4±74.85, and 223.13±16.9 µm in groups A, B, and C, respectively. The mean SFCT was 260.6±49.2, 259±50.8, and 252±50 µm in groups A, B, and C, respectively. We found no significant correlation between CSRT and SFCT in all groups (for groups A, B, and C, respectively: r=-0.049, P=0.796, r=0.239, P=0.204, r=-0.021, P=0.914). There was no significant difference in SFCT between group B (DME) on one hand and groups A and C on the other hand (P=0.9 and 0.59, respectively). Conclusion: There is no significant correlation between CSRT and SFCT in DME. Choroidal thickness assessment is not an indicator of the severity of DME and cannot be used as a monitor of its progression.

—In several fields, including higher education and scholarly practices, social media has a critical role to play. Over the years, exploring the facilities available for emerging technology for universities, educators, and students has increasingly become important for all of us employed in higher education. The Educational Data Mining (EDM) is considered as one of the new fields that is concerned with the expansion of the different techniques aiming to discover information from educational environments either over the traditional or distance learning. Over the last decade, increasing research interests in the use of data mining in education have been reported with a focus on various aspects of the educational process. Therefore, this review aims to construct a system to predict the efficacy of social media classrooms by applying input from students with Data Mining Techniques (DMT). The system consists of three main phases to test the developed prediction model, which are the pre-processing phase, the data mining phase, and the evaluation phase. Reasonable results are shown by the proposed model statistics. Keywords — Classroom; Social Media; Data Mining Techniques; Decision Tree; Prediction Model

In spite of annual mass vaccination programs with polyvalent inactivated vaccines, the incidence and economic impact of foot-and-mouth disease (FMD) in Egypt is high. Viruses of the A, O and SAT 2 serotypes are endemic and repeated incursions of new lineages from other countries lead to an unstable situation that makes the selection of appropriate vaccine antigens very difficult. In this study, whole genome sequencing of a 2016 serotype A isolate from Egypt revealed a recombination event with an African serotype O virus. Based on available vaccine matching data, none of the vaccines currently used in Egypt are expected to sufficiently protect against this virus or other viruses of this lineage (A/AFRICA/G-IV) circulating there since 2012. In addition to the risk of vaccine failure caused by strain mismatch, the production of inactivated FMD vaccines is dangerous if adequate biosafety cannot be maintained. Using a high-throughput sequencing protocol optimized for short nucleic acid fragments, the composition of a local inactivated vaccine was analyzed in depth. The serotype O strain identified in the vaccine was genetically identical to viruses found in recent FMD outbreaks in Egypt.

Eman Ebrahim El Naggar,1 Elham Abdelmonem Mohamed,2 Thanaa Mohamed Borg,2 Ahmed Ramadan El-Sheakh,3 Mohammed Fawzy Hamed4 1Department of Pharmaceutical Technology, Faculty of Pharmacy, Horus University, New Damietta, Eygpt; 2Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia, Egypt; 3Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahlia, Egypt; 4Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Dakahlia, EgyptCorrespondence: Elham Abdelmonem MohamedDepartment of Pharmaceutics, Faculty of Pharmacy, Mansoura University, EL Gomhoreyaha St., Mansoura City 35516, EgyptTel +201065690987Fax +20502247496Email elham.mabdelmonem@gmail.comBackground: Naringin is a promising anti-inflammatory drug against various disorders including ulcerative colitis. However, its oral bioavailability is low (8%) possibly due to cleavage at the upper gut. Consequently, colon targeting would be necessary for drug protection at the upper gut, enhanced oral bioavailability and potentiated cytoprotection against colitis.Methodology: This study involved the formulation of compression-coated tablets of naringin employing mixtures of pH-sensitive Eudragit L100-55 (EUD-L100-55) and different time-dependent polymers including ethyl cellulose (EC), sodium alginate (ALG) and sodium carboxymethyl cellulose (SCMC). Drug–polymer interaction during release was assessed using Fourier transform-infrared spectroscopy (FT-IR) and differential scanning calorimetry (DSC). Tablets were evaluated in vitro. Surface morphology of the optimized tablets either before or after exposure to the different release media was examined employing scanning electron microscopy (SEM). Cytoprotection potential of the optimized tablets against indomethacin-induced colitis in rabbits was screened and compared to core tablets through a histopathological examination of colon, measurement of serum perinuclear antineutrophil cytoplasmic antibodies (pANCA) and immunohistochemical localization of tumor necrosis factor-alpha (TNF-α).Results: FT-IR and DSC results may indicate drug–polymers interaction during release. Release retardation could be related to polymer swelling that was in the order of SCMC > ALG > EC. SEM examination indicated more porous coats at the buffers relative to the acidic medium. Colon targeting was expected in case of coats of 5% ALG, 5% SCMC and 10% EC (w/w) in combination with EUD-L100-55; thus, they were selected for in vivo evaluation. Effective cytoprotection of selected tablets against indomethacin-induced colitis was indicated by a significant (P< 0.05) reduction in mucosal damage, serum levels of pANCA and TNF-α expression compared to untreated colitis and core-pretreated groups. Compared to EC, higher cytoprotection potential of ALG- and SCMC-based tablets was reflected by lower concentration (5% w/w) to provide cytoprotection against indomethacin-induced colitis.Keywords: naringin, colon targeting, compression-coated tablets, Eudragit L, release retardants, colitis

This trial aimed to assess the efficacy of on-demand oral dapoxetine versus topical lidocaine treatments for lifelong PE. Cases with lifelong PE were randomised to start treatment by oral dapoxetine 60 mg or topical lidocaine 10% spray. The intravaginal ejaculatory latency time (ILET), validated Arabic Index for PE (AIPE), Sexual Health Inventory for Men (SHIM) and frequency of intercourse/week were recorded at the baseline and after 12 weeks treatment period of the first medication before two weeks washout period and then crossing over to the other one for another 12 weeks. Results showed that both medications significantly increased both IELT and AIPE scores compared with the baseline being significantly better with topical lidocaine (63.44 s, 179.4 s versus 21.87 s, p < .05). Significant decrease of SHIM score was recorded with lidocaine but not with dapoxetine. Global Efficacy Question for the patient's assessment of the effectiveness of drugs showed that lidocaine was described as being effective by 43 cases and ineffective by 12 cases, oral dapoxetine was described as being effective by 16 cases and ineffective by 39 cases. From these accumulated data, it is concluded that topical lidocaine is more effective on-demand therapy for lifelong PE compared with oral dapoxetine.

Irhan Ibrahim Abu Hashim,1 Noha Fawzy Abo El-Magd,1 Ahmed Ramadan El-Sheakh,2 Mohammed Fawzy Hamed,3 Abd El-Gawad Helmy Abd El-Gawad1 1Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 2Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 3Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt Abstract: The goal of the current study was to explore the potential benefits of Acitretin (Act) nanovesicular gel as a prospective antipsoriatic topical delivery system counteracting the drug challenges in terms of its extremely low aqueous solubility, instability, skin irritation, and serious systemic adverse effects. Act-loaded niosomes were successfully developed, entirely characterized, and optimized. Further evaluation of the optimized formula was conducted regarding its stability and ex vivo cytotoxicity on different cell lines. The optimized niosomal vesicles were then incorporated in gel base matrix and investigated by sequential ex vivo (skin permeation and deposition) and in vivo (skin irritation and antipsoriatic activity using mouse tail model) experiments. The optimized Act-loaded niosomes (span 60:cholesterol molar ratio 1:1) were spherical in shape and exhibited the highest entrapment efficiency (90.32±3.80%) with appropriate nanosize and zeta potential of 369.73±45.45 nm and –36.33±1.80 mV, respectively. Encapsulation of the drug in the nanovesicles was further emphasized by differential scanning calorimetric and powder X-ray diffraction studies. After 3 months storage at 4±1°C, the optimized formula preserved its stability. Act nano niosomal gel produced a remarkable enhanced ex vivo permeation profile up to 30 h and significant drug deposition in the viable epidermal–dermal layers compared with those of Act gel. The pronounced antipsoriatic activity of the medicated nano niosomes was proved ex vivo in HaCaT cells (a keratinocyte cell line). Topical application of Act nano niosomal gel to mouse tail model further established its distinct in vivo antipsoriatic superiority in terms of significantly higher orthokeratosis, drug activity, and reduction in epidermal thickness compared with the control and other gel formulations. Also, negligible skin irritation and better skin tolerability of Act nanovesicular gel were revealed by primary irritation index and histopathologic examination. Keywords: Acitretin, nanovesicular gel, drug deposition, HaCaT cells, mouse tail model, antipsoriatic activity

Background Chronic urticaria is a common immunological disorder, with a prevalence of 15–25%. Several exogenous and endogenous causes have been proposed as causative agents; one of them is infection of the gastrointestinal tract. Despite thorough investigation, the etiology remains unresolved in more than 80% of the cases. Objective The aim of the present study was to assess the prevalence of chronic idiopathic urticarial (CIU) patients presented with Helicobacter pylori infection and to study the effect of H. pylori eradication on the skin lesion in patients with CIU. Methodology This prospective study was carried out at the outpatient clinic of Dermatology Department of Al Azhar Assuit University Hospital on 30 patients with chronic urticaria (20 women and 10 men); their ages ranged from 16 to 65 years. The duration of the disease ranged from 6 weeks to 18 years. A primary diagnosis of CIU was made when an etiological factor accounting for the majority of the lesions could not be elucidated during the history-taking and physical examination. All the patients were subjected to careful history-taking at initial visit; physical examination to assess the number of urticaria wheals, size, and distribution, and associated angioedema; gastroscopy to obtain gastric mucosal biopsy from the antrum; and histopathological assessment of the gastric mucosal biopsy using hematoxylin and eosin, and Giemsa stains. The patients were scored according to the severity of disease (number of wheals, area of distribution, and the duration of the disease; itching and style of life; history of angioedema). The patients were treated for 2 weeks with amoxicillin (1 g/twice daily), metronidazole (500 mg/three doses daily), and omeprazole (20 mg/twice daily). All patients were followed up during the study duration of 3 months. To assess eradication efficacy, a repeated H. pylori stool antigen test was carried out for each patient 6 weeks after the end of anti-H. pylori therapy. Statistical analysis of the data was performed by using the SPSS_16 software. Results Fourteen patients (46.7%), aged less than 30 years, and 16 patients (53.3%), aged equal to or more than 30 years, were included in the present study. The mean of the ages of all patients was 34.9 years, and their age ranged from 16 to 65 years. There were 10 men (33.3%) and 20 women (66.7%). The mean of the duration of disease in all cases was 4 years, and ranged from 2 to 15 years. Nineteen patients presented with gastric symptoms. Seven patients (23.3%) had mild urticaria, 15 (50.0%) had moderate urticaria, and the remaining 8 (26.7%) had severe urticaria. Treatment results showed that 13 patients (43.3%) had complete remission, 12 patients (40.0%) had partial remission, and five patients (16.7%) showed no response. There was no statistically significant difference between age, sex, duration of illness, and gastric symptoms on the prognosis of urticaria after treatment. In addition, the results showed a highly statistically significant (P

Our aim was to evaluate the function and take rate of the butter cartilage technique (BCT) for reconstruction of small-sized and medium-sized tympanic membrane (TM) perforation by comparing it with temporalis fascia (TF). Repair of the TM was carried out in 40 patients with unilateral Chronic Suppurative Otitis Media (CSOM) with small-sized and medium-sized TM perforation. The patients were divided into two groups: group ‘A’, in which the BCT was used, and group ‘B’, in which TF graft was used. During the follow-up period, we found that the graft take-up rate was 90% in the BCT, whereas it was not complete in TF cases. There was marked improvement in hearing in both groups. We concluded that the BCT is optimal in the reconstruction of small-sized and medium-sized TM perforation because it is excellent to obtain high take rate with good hearing results.

Aim Ceftriaxone is a commonly used antibiotic among the paediatric population. Various reports have associated high doses of Ceftriaxone with the development of nephrolithiasis; our aim was to test this association with a 5 day course of treatment. Methods Our study group consisted of 120 patients divided into two groups. The first group included 60 patients who underwent treatment with Ceftriaxone therapy that was started empirically and continued for 5 days at the dose of 80 mg/kg per day. The second group (60 patients) who received treatment with other antibiotics (other than Ceftriaxone), as recommended by hospital protocols. Patients with urinary tract infections (UTI) were excluded as UTI may be a predisposing cause for nephrolithiasis. Baseline and follow up after 5 days were done with; abdominal ultrasound, serum urea, creatinine, serum calcium, 24 h urinary calcium and urinary calcium/ creatinine ratio. Extended metabolic tests were done for cases that developed nephrolithiasis. Results Five cases out of the 60 patients treated with Ceftriaxone developed calculi; that were small and were eliminated spontaneously in four cases at mean duration of 3 weeks. In these cases renal ultrasonography examinations were normal prior to treatment; and none of them had metabolic disturbances or risk factors leading to stone formation. By multiple regression analysis, only age was related to nephrolithiasis formation being higher in the group that has developed stones. Conclusion Only patients who underwent Ceftriaxone therapy have developed renal stones, even with a short course of therapy (5 days), and in the absence of a known predisposing cause for nephrolithiasis. We have thus concluded that Ceftriaxone by itself maybe a predisposing factor for nephrolithiasis.

Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a benign lympho-histiocytic proliferative disorder initially described with bilateral painless lymphadenopathy (90 %), fever, leukocytosis, elevated ESR, anemia, and polyclonal hypergammaglobulinemia (90 %). Extranodal forms occur in 43% of cases, the skin being the most common site. Around 10% of patients have skin lesions and in 3%, the disease is limited exclusively to the skin. Here, we report a male patient who presented with pure cutaneous lesions which mimic eruptive xanthoma clinically. However, the diagnosis was established histo pathologically. So, high level of clinical suspension is critical to avoid missing such cases.

Elham Abdelmonem Mohamed,1 Irhan Ibrahim Abu Hashim,1 Rehab Mohammad Yusif,1,2 Ahmed Abdel Aziz Shaaban,3 Ahmed Ramadan El-Sheakh,3 Mohammed Fawzy Hamed,4 Farid Abd Elreheem Badria5 1Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 2Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia; 3Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 4Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt; 5Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt Abstract: Naringin is one of the most interesting phytopharmaceuticals that has been widely investigated for various biological actions. Yet, its low water solubility, limited permeability, and suboptimal bioavailability limited its use. Therefore, in this study, polymeric micelles of naringin based on pluronic F68 (PF68) were developed, fully characterized, and optimized. The optimized formula was investigated regarding in vitro release, storage stability, and in vitro cytotoxicity vs different cell lines. Also, cytoprotection against ethanol-induced ulcer in rats and antitumor activity against Ehrlich ascites carcinoma in mice were investigated. Nanoscopic and nearly spherical 1:50 micelles with the mean diameter of 74.80±6.56nm and narrow size distribution were obtained. These micelles showed the highest entrapment efficiency (EE%; 96.14±2.29). The micelles exhibited prolonged release up to 48 vs 10h for free naringin. The stability of micelles was confirmed by insignificant changes in drug entrapment, particle size, and retention (%) (91.99±3.24). At lower dose than free naringin, effective cytoprotection of 1:50 micelles against ethanol-induced ulcer in rat model has been indicated by significant reduction in mucosal damage, gastric level of malondialdehyde, gastric expression of tumor necrosis factor-alpha, caspase-3, nuclear factor kappa-light-chain-enhancer of activated B cells, and interleukin-6 with the elevation of gastric reduced glutathione and superoxide dismutase when compared with the positive control group. As well, these micelles provoked pronounced antitumor activity assessed by potentiated in vitro cytotoxicity particularly against colorectal carcinoma cells and tumor growth inhibition when compared with free naringin. In conclusion, 1:50 naringin–PF68 micelles can be represented as a potential stable nanodrug delivery system with prolonged release and enhanced antiulcer as well as antitumor activities. Keywords: naringin, pluronic F68, polymeric micelles, in vitro cytotoxicity, antiulcer, antitumor activity

To examine the safety and efficacy of quartz head laser ablation of the prostate (QLAP) in the treatment of large and huge prostates as compared with small- and medium-sized ones.Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were included in the study, of which 210 patients were evaluable. Patients were divided into 2 groups: group A: patients with BPH volume of 80 mL (120 patients) and group B patients with gland size ≥80 mL. All patients were subjected to QLAP procedure. They were evaluated perioperatively and 1 week; 1, 3, and 6 months; and every 6 months thereafter postoperatively.Patients' demographics and preoperative data were similar except for the gland size (group A, 54.96 ± 15.49 mL [20-79 mL] and group B, 124.68 ± 40.88 mL [80-233 mL]). Operative time corrected to gland volume was shorter in group B. Only 10% of all patients needed 2 fibers. There was no significant electrolyte change in both groups. Hemoglobin has minimally decreased in both groups but was statistically significant. Group B outcome was significantly better regarding International Prostate Symptom Score, International Prostate Symptom Score quality of life, and uroflowmetry. Prostate size decreased by 47 ± 2% and 62.7 ± 2% at 6 months post operatively for groups A and B, respectively.QLAP demonstrated good efficacy and safety in treating large and huge BPH. It possessed no added risk as compared with small prostates. It can be a good alternative to open prostatectomy especially in patients with significant comorbidities.

Objective Early tumor recurrence, either local or intrahepatic distant recurrence (IDR), after successful radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remains a significant problem. The study aimed to determine the potential risk factors for IDR within one year after successful RFA in HCC patients. Methods In total, 105 patients with 138 lesions who underwent RFA and were followed up for at least one year were included in this study. The patients' data was retrospectively reviewed. Multiple host and tumoral potential risk factors were analyzed. Results IDR was found in 62 (59.0%) of all patients. Cumulative IDR-free survival rates in all patients studied were 81.9%, 45.4% and 35.2% at 1, 2 and 3 years, respectively, after RFA. Univariate and multivariate analysis showed that both tumor size >2.8 cm and primary multinodular tumors were significant risk factors for IDR within one year after RFA. Conclusions Patients with tumors of >2.8 cm in diameter or multinodular HCC should be closely monitored for early recurrence after RFA. Combined or systemic therapies should be tried for these patients to improve their disease-free and overall survival.

We report the results of clinical exome sequencing (CES) on >2,200 previously unpublished Saudi families as a first-tier test. The predominance of autosomal-recessive causes allowed us to make several key observations. We highlight 155 genes that we propose to be recessive, disease-related candidates. We report additional mutational events in 64 previously reported candidates (40 recessive), and these events support their candidacy. We report recessive forms of genes that were previously associated only with dominant disorders and that have phenotypes ranging from consistent with to conspicuously distinct from the known dominant phenotypes. We also report homozygous loss-of-function events that can inform the genetics of complex diseases. We were also able to deduce the likely causal variant in most couples who presented after the loss of one or more children, but we lack samples from those children. Although a similar pattern of mostly recessive causes was observed in the prenatal setting, the higher proportion of loss-of-function events in these cases was notable. The allelic series presented by the wealth of recessive variants greatly expanded the phenotypic expression of the respective genes. We also make important observations about dominant disorders; these observations include the pattern of de novo variants, the identification of 74 candidate dominant, disease-related genes, and the potential confirmation of 21 previously reported candidates. Finally, we describe the influence of a predominantly autosomal-recessive landscape on the clinical utility of rapid sequencing (Flash Exome). Our cohort’s genotypic and phenotypic data represent a unique resource that can contribute to improved variant interpretation through data sharing.

Background: Earlobe keloids are usually recalcitrant to treatment and have a high rate of recurrence. Verapamil is a calcium channel antagonist that has been shown to inhibit the synthesis/secretion of extracellular matrix molecules and increase collagenase. Objectives: This prospective study was designed to evaluate the results of treatment of recurrent earlobe keloids using keloidectomy with core fillet flap and intralesional verapamil injection. Methods: Nineteen keloids in 16 patients were treated using this technique with intralesional verapamil injection given intraoperatively, then every 2 weeks for 3 months, with postoperative follow-up for 18 months. Results: Fourteen patients completed the study. Ten patients (71.4%) showed response to treatment. Four (28.6%) cases showed recurrence, two (14.2%) at the wound bed and another two (14. 2%) at the incision line. Eighty percent of responders were highly satisfied with their treatment. Conclusion: Keloidectomy with core fillet flap and intralesional verapamil injection is a reliable and cost-effective method in the treatment of recurrent earlobe keloids with a low rate of recurrence and high patient satisfaction.

Multi-Layer Perceptron (MLP) is one of the Feed-Forward Neural Networks (FFNNs) types. Searching for weights and biases in MLP is important to achieve minimum training error. In this paper, Moth-Flame Optimizer (MFO) is used to train Multi-Layer Perceptron (MLP). MFO-MLP is used to search for the weights and biases of the MLP to achieve minimum error and high classification rate. Five standard classification datasets are utilized to evaluate the performance of the proposed method. Moreover, three function-approximation datasets are used to test the performance of the proposed method. The proposed method (i.e. MFO-MLP) is compared with four well-known optimization algorithms, namely, Genetic Algorithm (GA), Particle Swarm Optimization (PSO), Ant Colony Optimization (ACO), and Evolution Strategy (ES). The experimental results prove that the MFO algorithm is very competitive, solves the local optima problem, and it achieves a high accuracy.

Ceftriaxone is a commonly used antibiotic among the paediatric population. Various reports have associated high doses of Ceftriaxone with the development of nephrolithiasis; our aim was to test this association with a 5 day course of treatment.Our study group consisted of 120 patients divided into two groups. The first group included 60 patients who underwent treatment with Ceftriaxone therapy that was started empirically and continued for 5 days at the dose of 80 mg/kg per day. The second group (60 patients) who received treatment with other antibiotics (other than Ceftriaxone), as recommended by hospital protocols. Patients with urinary tract infections (UTI) were excluded as UTI may be a predisposing cause for nephrolithiasis. Baseline and follow up after 5 days were done with; abdominal ultrasound, serum urea, creatinine, serum calcium, 24 h urinary calcium and urinary calcium/ creatinine ratio. Extended metabolic tests were done for cases that developed nephrolithiasis.Five cases out of the 60 patients treated with Ceftriaxone developed calculi; that were small and were eliminated spontaneously in four cases at mean duration of 3 weeks. In these cases renal ultrasonography examinations were normal prior to treatment; and none of them had metabolic disturbances or risk factors leading to stone formation. By multiple regression analysis, only age was related to nephrolithiasis formation being higher in the group that has developed stones.Only patients who underwent Ceftriaxone therapy have developed renal stones, even with a short course of therapy (5 days), and in the absence of a known predisposing cause for nephrolithiasis. We have thus concluded that Ceftriaxone by itself maybe a predisposing factor for nephrolithiasis.

Background Malignant pleural effusions continue to be a common problem in patients with metastatic disease, leading to a significant reduction in quality of life with progressive dyspnea, dry cough, chest pain and reduced physical activity. This study was conducted to compare the efficacy, safety, and outcome of Talc Powder Pleurodesis (TPP) with Povidone-iodine Pleurodesis (PIP) through a chest drain as a palliative preventive treatment of recurrent malignant pleural effusion. Methods A total of 39 neoplastic patients with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Twenty-one patients received Talc pleurodesis (group A), and eighteen patients (group B) received Povidone-iodine pleurodesis. The continuous variables were expressed as mean values ± standard deviation (SD) and compared using the unpaired t-test. The discrete variables were expressed as percentage and compared using the chi-square test (χ2) test. p-values of less than 0.05 were considered significant. Results Our study included 11 males and 28 females, the mean age was (71.0 ± 5.0) years for group A and (70.9 ± 5.1) years for group B (non-significant). Post-procedure analgesic requirements were recorded in both groups. Four patients in each group had fever (>38°C) within 48 hours of the procedure. Both groups achieved good symptomatic relief. There were no in-hospital deaths. The mean post-procedure hospital stay was (4.7 ± 1.2) days for group A and (4.2 ± 1.0) for group B (non-significant). At follow-up recurrence of significant pleural effusion requiring intervention was noted in four and five patients in group A and group B, respectively (non-significant difference). Conclusion Povidone-iodine pleurodesis can be considered as a good alternative to Talc pleurodesis for recurrent malignant pleural effusion. The drug is available, cost effective, safe and can be administered through an intercostal drain and repeated if necessary.

Early tumor recurrence, either local or intrahepatic distant recurrence (IDR), after successful radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remains a significant problem. The study aimed to determine the potential risk factors for IDR within one year after successful RFA in HCC patients.In total, 105 patients with 138 lesions who underwent RFA and were followed up for at least one year were included in this study. The patients' data was retrospectively reviewed. Multiple host and tumoral potential risk factors were analyzed.IDR was found in 62 (59.0%) of all patients. Cumulative IDR-free survival rates in all patients studied were 81.9%, 45.4% and 35.2% at 1, 2 and 3 years, respectively, after RFA. Univariate and multivariate analysis showed that both tumor size2.8 cm and primary multinodular tumors were significant risk factors for IDR within one year after RFA.Patients with tumors of2.8 cm in diameter or multinodular HCC should be closely monitored for early recurrence after RFA. Combined or systemic therapies should be tried for these patients to improve their disease-free and overall survival.