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Gut microbiota-derived short-chain fatty acids (SCFAs) have been reported to result in a wide range of health benefits including improvements in body composition and reduced body weight. However, excess production of colonic SCFAs has been implicated in the promotion of obesity. In this study, we aimed to explore the interrelation between diet, SCFAs production and obesity. This study included 31 subjects divided into a lean group and an obese group. Their dietary habits were assessed by means of food-frequency questionnaire and 24-hour recall then blood samples were collected from all of them. Analysis of short-chain fatty acids (i.e., acetate, propionate, and butyrate) in serum was performed using gas chromatography-mass spectrometry (GC-MS). Dietary assessment revealed that obese subjects had a significantly higher intake of carbohydrate, fat and sodium while lean subjects had a significantly higher intake of dietary fiber. Serum levels of propionate were higher in lean subjects compared to obese subjects (P

Background Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR < 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, Conclusion In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction.

Background hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased operative difficulty. Objectives the purpose of this systematic review and meta-analysis was to review and study literature regarding conversion arthroplasty in patients with failed internal fixation of intertrochanteric fractures to evaluate the results, technical problems and complications, as well as the impact of different variable factors and age. associated with hip arthroplasty and to evaluate the functional outcomes and complications.. Materials and Methods A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were English-language studies that reported complications or functional outcomes after failed fixation of IT fractures with hip arthroplasty in adult subjects (>18 years of age). Results About 2041 articles were found using search keywords as shown in PRISMA flow chart, By filtration and screening of the title and exclusion of unrelated articles, about 109 articles were found, By applications of all inclusion and exclusion criteria, only 8 articles were fit to undergo this meta-analysis. Conclusion So this study showed a significant improvement in functional outcome of hip arthroplasty after failed intertrochanteric fixations despite the relative complication rate of this procedure.

Corresponding Background Wound healing Process and Scars are still a nightmare for the surgeon and the author: patient as well, because of the large number and wide variability of factors affecting the process itself. Plasma injection is a very promising futuristic therapy and can be superior to PRP injection having more abundant growth factors, fibrin and healing promoters. Aim of the Work to evaluate the effect of injection of the whole plasma components in the wound site intradermally immediately after primary wound closure on the process of wound healing. Patients and Methods This prospective co-operative study included 20 patients having wounds in different sites of the abdomen after approval of research ethical committee of the Faculty of Medicine, Ain Shams University at July 2018, The patients are divided into two groups: an interventional group (group A) 10 cases which are received plasma treatment together with the usual wound care, and a control group (group B) 10 cases which are received the usual wound care only without plasma treatment, in the period between August 2018 to March 2019. Results We have found a faster wound healing process, higher cosmetic results, better color match, more patients' satisfaction and lower susceptibility to complications in the interventional group (A) that received plasma injection than in the control group (B) which received only the usual wound care without plasma injection reflecting the positive impact of plasma injection on the wound healing process. Conclusion We concluded that there are reasonable amount of data that warrant continued research and usage of plasma in the process of wound healing.

Background Seborrheic dermatitis (SD) is a subacute or chronic superficial inflammatory skin condition, characterized by pruritic, erythematous plaques with greasy, yellow-gray scales, which appear on areas rich in sebaceous glands such as the face, scalp, upper chest, and back. Aim of the Work To identify Malassezia species that are involved in the development of SD in different body sites (face, scalp and trunk) and in different age groups, by using Chrom agar. Patients and Methods Forty nine patients with seborrheic dermatitis attending dermatology outpatient clinic in Ain shams university hospital the samples collected from December 2018 to June 2019. Results In this study, the most affected areas were the scalp and other sites as face and ears, which is concordant with the majority of studies worldwide. The role of sex in propensity to the development of Malassezia spp. Infection in SD is still unclear. Conclusion The distribution of Malassezia spp. on healthy and diseased skin shows significant variation and differences, although our knowledge of Malassezia yeasts has increased tremendously during the last two decades, their pathological roles remain ambiguous, and there is currently no conclusive evidence that any given species is responsible for a specific disease.

Background Acne scars, is a challenge for dermatologists, despite having multiple treatment modalities like microneedling, dermabrasion, Fractional CO2 Laser, dermal fillers, etc. However, monotherapy has been hardly satisfactory because of the polymorphism seen with the scars. Objective Comparison between microneedling with platelet rich plasma versus Fractional carbon dioxide laser with platelet rich plasma in treatment of atrophic post acne scars. Patients and methods This study was carried out in department of dermatology, venereology and andrology, in Kobry El-Kobba Military complex during the period (from September 2018 to July 2020 ) on 20 patients of both sexes aged from 20 to 60 years old presenting with Goodman and Baron Grade II, III, IV acne scars . Results The study revealed a statistically significant difference (p = 0.017) between Goodman and Baron scar grades on the right side of the face before and after treatment indicating that microneedling with platelet rich plasma was effective in improving acne scars. Also, there is a statistically significant difference (p = 0.010) between Goodman and Baron scar grades on the left side of the face before and after treatment, indicating that fractional CO2 laser with platelet rich plasma was effective in improving acne scars. Conclusion and recommendation Further controlled and randomized studies are needed to validate our findings in a larger cohort of patients and longer follow up. Also, number of sessions might be more than 3 sessions.

Background Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Current estimates suggest that 44 million people live with dementia worldwide at present. This is predicted to more than triple by 2050 as the population ages. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people Treatment is currently targeted toward symptomatic therapy, although trials are underway that aim to reduce the production and overall burden of pathology within the brain. Recently, the Clustered Regular Interspaced Short Palindromic Repeats (CRISPR-cas9) has shown promise in certain neurological disorders, it provides a precise editing to human genome and reflect an efficient curative therapy. We aimed to investigate the efficacy of knock-out of the APP gene “Amyloid precursor protein gene(APBA2)that consequently modify the expression of Amyloid protein in leucocytes cell line using CRISPR-cas9 technology. Methods The gene expression profile of Alzheimer's disease was downloaded from biological bioinformatics databases,and based on bioinformatics analysis, we figured out that APP gene was overexpressed in Alzheimer's disease in both brain and peripheral tissues such as plasma, fibroblast and PMNLs. We used PMNLs as the source of gene for edition in our study .We knocked out the APP gene in leucocytes cell lines using CRISPR-cas9 technology. Finally, the gene editing efficacy was evaluated by cell viability assay, the gene expression was measured by qPCR and the Amyloid protein expression was proved by Immunofluorescence. Results knockout of APP gene int Leucocytes Cell line resulted in reduction in cell viability that was associated with marked reduction in the amyloid protein and gene expressions. Conclusion knockout of APP(APBA2) gene represents a promising therapeutic strategy in Alzheimer's disease.

Background Melasma is a chronic, acquired pigmentary disorder characterized by gray-brown macules and patches affecting photodistributed part of the face such as the bridge of the nose, cheek, upper lip, forehead, and mandible. It is seen mostly in women of reproductive age group and has an onset usually after pregnancy. However, in around 10% of the cases, males are also affected. Objectives The aim of our study was to assess and compare the therapeutic effects of tranexamic acid cream versus hydroquinone 4% cream in treating patients with melasma. Patients and Methods This prospective split face comparative study included thirty three patients with their age ranging from 18 to 40 years, participated for treatment of different types of melasma, recruited from outpatient clinic of Dermatology department Ain Shams University Hospitals during the period from January to June 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research. All patients received full information about description of the procedure of treatment, possible side effects, photo documentation and they all provided informed consent. Results Both topical TA and HQ 4% cream were efficient in treatment of different types of melasma as shown by significant decrease in Hemi MASI score, patient satisfaction score, significant decrease in average level of melanin measured by Antera 3D camera and significant decrease in area % of melanin by histopathological evaluation after 3 months of treatment, although slight recurrence of melasma was observed one month after stopping both treatments. Meanwhile, no significant difference was observed in treatment response of TA and HQ regarding Hemi MASI score, patient satisfaction score, average level of melanin (Antera 3D camera). This could be attributed to the small number of included patients. Conclusion We concluded that the TA appears to be a promising therapeutic option in the treatment of melasma. TA has fewer adverse effects, same or even better results in comparison with other melasma targeting therapies as hydroquinone cream.

Corrsponding author: Mahmoud Saied Mahmoud Badr. E-mail: mahmoudsaeed716@grnail.com

Aim and Objectives The aim of this study is to compare between clopidogrel and ticagrelor loading doses used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI. They were divided into 2 groups where the1st group 85 patients received clopidogrel loading dose (600mg) and the 2nd group 85 patients received ticagrelor loading dose (180mg). Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation (71.8% in the clopidogrel group and 50.6% in ticagrelor group). In the clopidogrel group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the ticagrelor group there was 2 patients with TIMI I flow and MBG I, s with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. There was no statistical significance between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion Ticagrelor loading before primary PCI resulted in improved TIMI flow, MBG but did not decrease incidence of in-hospital MACE.

Background Erectile dysfunction, as defined by the International Consultation on Sexual Medicine, is the consistent and recurrent inability to acquire or sustain an erection of sufficient rigidity and duration to engage in satisfactory sexual intercourse. Objectives The aim of this study was to identify the prevalence of MetS among patients with ED. Patients and Methods This was a cross sectional study conducted on 200 patients attending the Andrology clinic of Dermatology, Venereology and Andrology department, Ain-Shams University starting from March 2019 till December 2019. The 15-question IIEF Questionnaire is a validated, multi- dimensional, self-administered investigation that has been found useful in the clinical assessment of ED and treatment outcomes in clinical trials. Results The mean ± SD of age of patients with ED in our study was 58.3 ± 20.1 years. Out of the 200 patients, 110(55%) of them had BMI (25-29.9). and over 30 in 35(17.5%) patients. The mean ± SD of WC was 41.4±4.9 inches. Among the 200 patients, hypertension was present in 125(62.5%) and smoking in 165 (82.5%) patients. Among the 200 patients, 96 (48%) patients had MetS. Among 200 patients, 90 (45 %) had mild, 54 (27.0 %) had moderate. and 56 (28 %) had severe ED. A significant association was determined between the presence of MetS and severity of ED. The prevalence of moderate and severe ED was significantly higher in patients with MetS than patients without MetS. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP. Conclusion Among the 200 patients, 96 (48%) patients had MetS. Incidence of moderate to severe ED was higher among patients with MetS versus those without. There was a negative significant correlation between IIEF scores and age, systolic BP, and diastolic BP.

Background First identified in 1935, testosterone is the principal hormone controlling the development of androgenic-masculinizing effects in the male body, along with its anabolic properties that increase lean muscle mass. Objectives We aim at studying the influence of anabolic androgenic steroids on the semen parameters and serum sex hormonal levels in Egyptian male bodybuilders. Patients and Methods The type of study was cross sectional study. Study setting was conducted in Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. The study included 20 male body builders using AAS as the study group and 20 body builders who exercise only and not using AAS. 20 subjects who exercise only without androgenic anabolic steroids use. Results In the present study, there were statistical significant differences between ASS group and control group as regard semen volume, sperm concentration, total sperm count, sperm agglutination and rounded cells. Bodybuilders in ASS group had significantly lower semen volume, sperm concentration, total sperm count; and higher liquefaction, sperm agglutination, and rounded cells. Conclusion AAS has a negative impact on semen quality and sex hormone levels among male bodybuilders. In the present study, AAS users exhibited significantly lower plasma testosterone levels and increase FSH and decrease LH hormone higher frequencies of abnormal semen parameters than healthy control participants. These results should provoke concern, particularly because the use of anabolic steroids by exercising men for muscle building is based on self-designed personal schemes or is suggested by a partner, by field magazines, or by trainers at the gyms. Further, large-scale, studies are still needed to confirm our findings.

Background Psoriasis is a common immune-mediated disease of the skin, mostly characterized by red, scaly, sharply demarcated, indurated plaques. The immunopathogenesis of psoriasis is not fully understood as it is the result of a complex interaction between genetic, environmental and immunological factors. Furthermore, a large body of evidence has identified a dysregulated interplay between keratinocytes and infiltrating immune cells underlying cutaneous inflammation in psoriasis. Cytokines and other soluble factors such as antimicrobial peptides (AMPs) secreted by resident or infiltrating cells are essential elements in this process of cell-cell communication. Objective To measure serum level of elafin protein using ELISA technique in psoriasis vulgaris patients before and after narrowband ultraviolet therapy and detect its correlation with psoriasis severity. Subjects and Methods Sixty subjects; 30 patients with psoriasis vulgaris and 30 age and sex matched apparent healthy controls were included. Each patient was subjected to a detailed history taking and examination beside calculation of PASI score before and after treatment. Blood samples were also taken from all subjects to assess serum Elafin level by ELISA technique before and after treatment. NB-UVB treatment sessions were given for the patients group three times per week for 3 months. Results There was a highly significant correlation between serum Elafin level and PASI scores among patients with psoriasis before and after treatment, which indicates that serum Elafin level could be used as a diagnostic marker for psoriasis severity and a prognostic marker for different psoriatic treatments. Conclusion In conclusion measurement of serum Elafin protein level could be considered as a diagnostic and prognostic marker for psoriasis activity and a useful tool for evaluating the efficacy of treatment.

Background Acne is a chronic inflammatory disorder of the pilosebaceous unit. Oral isotretinoin is a highly effective treatment for patients with moderate and severe, but causes significant side effects. Objective To estimate homocysteine level in acne patients after treatment with isotretinoin. Patients and Methods The prospective study was conducted at Ain Shams University Faculty of Medicine, Egypt, from June 2017 to November 2017, including male or non-pregnant female patients more than 18 years of age, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne. Isotretinoin was started in a dosage of 0.5 mg/kg/day, and 1.0mg/kg/day in moderate and severe acne patients respectively. Baseline homocysteine level, liver function tests, serum cholesterol and lipid profile were tested before and after 3 months. Results There was significant difference (p = 0.001) in homocysteine level among all cases Moreover, homocysteine serum level in patient's group who received high dose isotretinoin (1 mg/kg/d) showed highly significant results (p = 0.001) in contrast to patient's group who received low dose isotretinoin (0.5 mg/kg/d) = 0.003). A significant increase in lipid profile and liver function test was seen in all cases. Conclusion low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and homocysteine serum levels than high dose.

Background Dermoscopy is a non-invasive technique that allows the visualization of subtle clinical features of the skin surface and appendages details not visible to the naked eye, allowing magnifications of up to 200x. It is widely used for evaluating and diagnosing all nail diseases, as it provides important information. As any other examination, nail dermoscopy (onychoscopy) requires a good knowledge of nail anatomy & physiology and the pathogenesis of the nail diseases, and it is helpful for the diagnosis of numerous nail diseases and tumors. Nail disorders are defined according to their appearance and the part of the nail affected (from distal to proximal): hyponychium, onychodermal band (ODB), nail bed, nail plate, lateral nail folds (perionychium), lunula (distal part of the matrix), cuticle, nail matrix and proximal nail fold. Objective To study the dermoscopic findings of subtle nail changes in patients with chronic plaque psoriasis and compare it with that nail changes in healthy controls by both polarized and non polarized mode of dermoscope, aiming to assist clinicians in correctly evaluating and diagnosing nail changes with the help of dermoscopy. Methods We conducted a comparative descriptive study on 50 patients having chronic plaque psoriasis, 26 were males (52.0%) and 24 were females (48.0%), as well as 50 normal healthy control subjects, 31 were males (62.0%) and 19 were females (38.0%). Patients and controls were randomly recruited from the outpatient clinic of dermatology department at Ain Shams University Hospitals, during the period from February 2018 till September 2018. And the age of both groups ranged from 14 to 70 years. Results Our study revealed that the most common fingernail changes found in psoriatic patients were nail plate thickening and crumbling followed by Dilated nailbed capillaries at the onychodermal band, Oncholysis, Subungual hyperkeratosis, Pitting, Longitudinal ridges, Scales, Salmon patch, Leukonychia, Splinter hemorrhage, Lunula red spot and Trachyonychia. And the most common toenail changes found in psoriatic patients were Subungual hyperkeratosis followed by Nail Plate Thickening &Crumbling, Oncholysis, Pitting, Longitudinal ridges, Scales, Salmon patch, Trachyonychia, Dilated nailbed capillaries at the onychodermal band, Splinter hemorrhage, Leukonychia and Lunula red spot. We found there was no difference between polarized and non polarized mode of dermoscope in examination of fingernails and toenails except that the non polarized mode showed the changes of the Dilated capillaries at the onychodermal band more obviously. And also, there was no difference between wet and dry method of polarized mode of dermoscope. Conclusion This study confirms that a handheld dermoscope is a very efficient and simple tool for detection of any nail abnormality.

A fourteen-years-old male, suffered generalized abdominal pain, vomiting & non-bloody diarrhea, a week later, GTCs occurred He was diagnosis as encephalitis, but was anuric, edematous & hypertensive. Investigations were done and showed anemic with NO thrombocytopenia but with impaired KFT. Renal biopsy revealed TMA/TTP. He received 12 TPE with partial improvement then he developed bleeding/Rectum not responding to medical management, lower GIT endoscopy revealed: Cobble stone appearance in transverse colon & active IBD (Croh’s) so Pentasa & Immuran started GTCs developed again, MRI brain showed PRESS. KFT deteriorated again with oliguria, so 10 TPE sessions with infliximab & FDS were given with partial improvement. Two weeks later, more deterioration occurred. New Investigations: • Non-microangiopathic Non-hemolytic anemia • Normal platelet & TLC • Coomb’s test: negative • eGFR: 25 ml/min/1.732 • Normal Complements • ANA, Anti-DNA-Ab, ANCA: negative • Protein-C, S & Anti-thrombin-III: Normal • ADMATS13 level: Normal • Urinalysis: hemaruria & Heavy proteinuria • MRI: encephalitis vs ischemic areas 2ry to Vasculitis Revision of biopsies: § Colonic: Leukocytoclastic vasculitis § Renal: TMA A diagnosis of MULTI-SYSTEMIC LEUKOCYTOCLASTIC-VASCULITIS was established and started: 1. Pulse steroid 5 doses then oral FDS then withdrawal till reaching the lowest dose 2. MMF 1.2 gm/m2/day Marked improvement of his renal, GIT and CNS condition had achieved: Clinically: No GIT bleeding, convulsion Laboratory: GFR: 75ml/min/1.732, Urinalysis: trace albumin Radiologically: Normal MRI, A & V.

Background Modified ilioinguinal approach was introduced to manage anterior acetabular fractures to reduce the morbidity & complications of the classic ilioinguinal approach, a less invasive anterior approach consisting of a medial window combined with the lateral window of the ilioinguinal approach. Aim of the Work a systematic review to determine whether the modified ilioinguinal approach is better the classic ilioinguinal approach in managing traumatic acetabular fractures by comparing the results in each study. Materials and Methods 5 studies(from 2010-2017) were included & reviewed the results of 147 patients operated by modified ilioinguinal approach in terms of: operative details, intraoperative & postoperative complications, postoperative reduction quality & final clinical outcome assessment, & results was analyzed & pooled together to reach a satisfactory outcome. Results Modified ilioinguinal approach showed operative time (123.2±6.83 minute), relatively small amount of blood loss (200-1000 ml) & better quality of reduction (84.8% had anatomical reduction, 10.9% had fair reduction, and 4.3% had poor reduction). However there were no significant differences in terms of postoperative complications & final clinical outcome assessment between different studies. Conclusion It was concluded that the modified ilioinguinal approach allowed reduction of anterior column and pelvic ring fractures without requiring dissection through the inguinal neurovascular structures. Results showed that its possible with this approach to reach safe reduction and stable fixation.

Purpose The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations; however, the relationship between the BMI and outcomes following total knee arthroplasty (TKA) is extensively debated. We aimed to evaluate the effect of the BMI at different cutoff values on the outcomes following primary TKA. Methods Electronic databases (PubMed/Medline, Embase and Web of Science) were systematically searched for studies investigating the association between the BMI and outcomes following primary TKA. Two investigators independently reviewed studies for eligibility. A meta-analysis was performed using Review Manager 5.2 software from the Cochrane Collaboration. Results Thirteen articles were identified. The postoperative Knee Society Score appeared to trend lower in obese (BMI ≥ 30 kg/ m2) patients than in non-obese (BMI < 30 kg/m2) patients. The meta-analysis showed that revision with follow-up ≥2 years, any infection, superficial infection and deep vein thrombosis occurred statistically more frequently in obese patients. Conclusion Patients with a BMI ≥ 30 kg/m2 are at a higher risk of lower functional scores and developing complications following primary TKA. It appears reasonable to encourage obese patients to lose weight before selective TKA.