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Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and

Background: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS, and determines blood loss during CS. Objective: The aim of the work was to compare spontaneous placental delivery with cord traction and manual removal of placenta as regards amount of blood loss during elective cesarean section. Patients and Methods: This prospective Cohort study included a total of 48 Women prepared for elective cesarean section, attending at Zagazig University Hospitals and Zagazig General Hospital. This study was conducted between April 2019 to October 2019. The included subjects were divided into two groups (24 each) regarding methods of placental delivery. Group A; placenta was allowed to be separated spontaneously and removed by gentle cord traction. Group B; placenta was removed manually by the surgeon’s hand introduced into the uterine cavity and cleavage plane was created between the placenta and decidua basalis following which the placenta was grasped and removed. With the use of oxytocin by intravenous infusion 20 units after delivery of the baby in both groups. Results: Blood loss in spontaneous placental separation group was (881.67 ± 74.54) ml, but in manual placental separation group was (962.79 ± 116.11) ml, (p < 0.01).The preoperative hemoglobin (g/dl) in spontaneous separation group was (11.3 ± 1.07) and in manual separation group was (11.63 ± 1.11), postoperative hemoglobin in spontaneous separation group was (10.3 ± 0.83) and in manual separation group was (9.42 ± 0.74). Conclusion: Manual removal of placenta only seems to be superior in saving the time taken to extract out placenta. Manual removal of placenta adds to the post-operative complications in form of greater blood loss and infections.

Background: Despite major advances in perinatal care, preterm delivery (PTL) is still the predominant cause of perinatal mortality and a major cause of neurological morbidity in surviving infants. Objective: the objective of this study is to find any association between maternal group B streptococcus (GBS) colonization and preterm delivery. Patients and Method: This study is a prospective study including 100 pregnant women between 28 – 36 weeks of gestation from those who attended the Emergency Department at Al-Galaa Maternity Teaching Hospital from April 2015 to August 2015. All patients were tested for genital colonization with Group B streptococcus (GBS) by taking low vaginal swab that was sent for microbiological examination. Results: In this study there was a significant difference between positive and negative cases as regard obstetric data. As regard preterm labor, 80% of positive swab cases had preterm labor compared to 46.2% of negative swab cases and this was statistically significant. Positive vaginal swab cases are at 7 times higher risk to have preterm labor compared to negative cases. Conclusion: GBS vaginal colonization was associated with premature labour in the studied population. Women with GBS vaginal colonization qualify for intrapartum chemoprophylaxis. The study results suggest that the early prenatal screening for GBS may identify pregnant women at risk of PTL.

Background: The liver is a vital organ that plays a key role in the detoxification of endogenous and exogenous substances. Variety of pathological factors including viral hepatitis (especially hepatitis B and C), alcohol and drug abuse, metabolic diseases, autoimmune diseases and congenital abnormalities can cause hepatic injury. Chronic hepatic disease is quite common in daily clinical practice. Liver cirrhosis is the final stage of all chronic hepatic diseases. Liver transplantation is the treatment of choice for chronic liver failure, although, it faces several difficulties. Aim of the work: to evaluate the toxic effect of carbon tetrachloride (CCL4) on the liver structure. Materials and methods: Twenty male rats of average weight 200 grams and aged 6-8 weeks were included in this study. The Rats were divided into the following two groups: Group I (control group): ten male rats were subdivided into two subgroups, one of them acted as negative control and the other received the equivalent volume of the solvent olive oil. Group II (experimental group): ten male rats were injected intraperitoneally (IP) by CCL4 twice weekly for four weeks. Results: Histological examination of liver specimens showed that CCl4 caused patchy and variable pathological changes in the liver tissue along with significant increase in collagen fiber content. Conclusion: The induced liver fibrosis by CCL4 in rats showed markedly pathological effects on hepatic stroma and parenchyma.

Background: strabismus is a condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles. Strabismus can present as manifest (heterotropia), apparent, latent (heterophoria) varieties. Objective: the present study aimed to compare the minimally invasive strabismus surgery (MISS) as an alternative to limbal approach for horizontal concomitant strabismus. Patients and Methods: the study included 50 patients of different ages and sexes, presented with transverse strabismus, for elective surgical correction. They allocated into two equal groups; the first group included 25 cases who were managed by MISS (patients group); the second group included the other 25 cases who were managed by limbal approach (control group). Results: the results were evaluated at one week, three week and six week as regards to visibility of surgical wound, post-operative conjuntival redness, patient discomfort, surgical opening related complications and post-operative correction at first week, third and six months. Few complications were seen with the MISS technique and they were mostly related to the surgery not to the technique itself. Conclusion: the minimally invasive strabismus surgery has the same effect as limbal approach as obvious by the similar success rate. Its stability is as good as the stability of limbal incision. It has the advantages of sparing perilimbal episcleral vessles which make it a good choice instead of limbal approach whenever there is fear of anterior segment ischemia.

Background: shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period. It is a frequent, unpleasant, and undesirable complication occurring after sub-arachnoid block (SAB), secondary to vasodilatation as a result of sympathetic blockade. The incidence of shivering has been reported to be about 36-85% after spinal anesthesia. The present study was designed to compare the efficacy of diclofenac sodium and pethidine on reducing postoperative shivering following sub-arachnoid block. Objectives: the aim of this study was to investigate the ability of intravenous infusion of diclofenac sodium (1mg/kg maximally 75mg) to treat established post-spinal shivering. Patients and Methods: after approval from departmental ethics committee in Ain shams university and written informed consent from the patient, a randomized study was conducted on ninety adult patients with American society of anesthesiologists (ASA) physical status I, II and III aged from 18 to 65 years. The study was conducted from September 2017 to February 2018. The study was a randomized, prospective, double-blind, placebo-controlled study. All patients were informed about the study design and objectives as well as tools and techniques. Informed consent was signed by every patient prior to inclusion in the study. Results: after approval of the department of anesthesiology, intensive care and pain management at Ain Shams University ethical committee, this randomized study was conducted on ninety patients who were scheduled to have surgery with spinal anesthesia. The design of the study included three groups, each constitutes of 30 patients (n= 30). Conclusion: the data showed that pethidine infusion was more effective than diclofenac sodium infusion in management of shivering after spinal anesthesia. However diclofenac sodium was better than placebo in non-significant way. Keywords: Diclofenac Sodium Infusion, Post-Spinal Shivering, pethidine infusion INTRODUCTION Shivering is a frequently occurring post-anesthesia complication. It occurs after both general and regional anesthesia. It is estimated to follow more than 40% of all cases receive anesthesia. Shivering is defined as involuntary, spontaneous, oscillatory muscular activity. It is one of main cause of patient discomfort in the immediate postoperative period. Oxygen consumption increases with the intense of shivering. It may resemble a mild exercise but in some severe cases oxygen consumption may rise to 600%. Post-anesthesia shivering may be caused by different factors. It is considered a physiological response to core hypothermia that accompanies anesthesia. Core hypothermia is attributed mainly to redistribution of warm core blood to cold peripheral compartment after peripheral vasodilatation that starts immediately after induction of anesthesia. Other factors help hypothermia include cold room temperature and intravenous fluids used intraoperatively. Other factors that may lead to shivering include transfusion reactions, bacteremia and sepsis and drug reaction(1). The incidence of shivering has been reported to be about 36-85% after SAB. Shivering has detrimental effects like interference in monitoring of pulse rate, blood-pressure (BP), and ECG, increase in oxygen consumption, catecholamine secretion, carbon dioxide production, metabolic rate increase by 400%, increase intraocular pressure (IOP), Intra-cranial pressure (ICP), and lactic acid

Background: Implantation failure after intracytoplasmic sperm injection (ICSI) is related to either maternal factors or embryonic causes. The maternal factors include uterine anatomic abnormalities either congenital or acquired. Three-dimensional transvaginal ultrasound allows detailed evaluation of pelvic organs. Office hysteroscopy is the gold standard tool for visualization of intracavitary lesions and the cervical canal in an office-based environment. Aim of The Work: It was to compare between three-dimensional ultrasound (3D USS) and hysteroscopy for evaluation of the intrauterine cavity after trial of ICSI and to study the accuracy of diagnostic test in a tertiary care facility. Patients and Methods: It was a prospective; blinded; controlled clinical trial comparative study. Both hysteroscopy and 3D USS procedures were done for uterine cavity assessment after failed attempt of ICSI treatment for fifty-two asymptomatic infertile women. Results: Seventeen cases of our studied patients were without intracavitary or cervical lesions. From all studied cases, lesions (n=66) were seen either by hysteroscopy or by 3D USS where lesions (n=24) were seen by hysteroscopy and seen by ultrasound. Lesions (n=34) were seen by hysteroscopy. Lesions (n=36) were seen by ultrasound. Measure of agreement of Kappa was 0.273. Overall sensitivity of 3D USS was 70.59% and specificity 62.50% with positive predictive value (PPV) 66.67% and negative predictive value (NPV) 66.67%, accuracy was 66.67%, positive likehood ratio (LR+ve) 1.88% and negative likehood (LR-ve) 0.47%. The p-value was 0.026, which is statistically significant. Conclusion: It is important to investigate the uterine cavity in infertile women with history of unsuccessful ICSI. 3D USS has a good sensitivity and specificity for diagnosis of uterine cavity abnormalities and it could be used before hysteroscopy as a first line of investigation of intrauterine lesions.

Purpose: To assess the efficacy, safety and stability of LASIK surgery for treatment of low to moderate degree hyperopia and hyperopic astigmatism. Patients and methods: The study included 34 eyes in 17 patients (7 males, and 10 females) with bilateral low to moderate degree hyperopia or hyperopic astigmatism. Their mean age + SD was 26.7 + 4.1 years. Range of hyperopia was between +1.75 to +5.50 D, astigmatic errors range was 0.00 to -1.50 D while the spherical equivalent refraction ranged from +1.4 to + 4.8 D. Patients included in this study had a stable refraction for at least one year. All patients underwent bilateral LASIK surgery in the same session in Dr Soliman Faqeeh Hospital (DSFH) and the Eye Subspecialty Center (ESC) using the ALLEGRETTO EYE - Q Excimer Laser machine. Results:UCVA after one year was 20/20 or better in 30 eyes (88.2%), 20/30 or better in 32 eyes (94.1%) and 20/40 or better in 34 eyes (100%), while BCVA was 20/20 or better in 33 eyes (97.1%) and 20/40 or better in 34 eyes (100%). There was no decrease in UCVA after LASIK surgery. One eye (2.9%) showed 2 lines drop in BCVA after LASIK surgery due to broad wrinkles of the flap. The flap was lifted after one day; trial to flatten the wrinkles showed incomplete resolution. One eye (2.9%) showed diffuse lamellar keratitis (DLK) at one week after LASIK surgery. There was regression in the manifest spherical equivalent refraction one year after LASIK surgery as compared with that at one month, but the difference was statistically insignificant (P=O.46). The mean score of patient satisfaction was 9.4 at one year postoperatively. Conclusion: LASIK surgery is a safe, predictable, stable and effective for treatment of mild to moderate degree hyperopia and hyperopic astigmatism. No significant regression in UCVA, BCVA or manifest refraction was reported up to 12 months follow up.

Objective:is to determine whether follicular aspiration and flushing increase the number of oocytes yield and pregnancy outcome over aspiration alone in women undergoing ICSI. Study design: prospective randomized controlled trial. One hundred eighty five infertile women who underwent ICSI were included in the study. They were randomized into two groups 92 cases in (aspiration and flushing group) and 93 cases in (aspiration only group),during the period from September 2011 to September 2013. Intervention(S):Controlled ovarian hyperstimulation using long GnRH agonist was the standard protocol, hCGadministrated 10000 iu when three or more follicles were at least 18 mm in largest diameter, Trans-vaginal follicular aspiration performed 34-36 hours after hCG trigger.In the aspiration alone group, a 16 gauge single lumen needle used, with suction continue until a small amount of blood stained fluid appeared in the tubing or flow stop, When flushing accompany aspiration of follicular fluid in the study group, the same needle used with a double-way tap allowing flushing of (2 ml) of embty follicleby Earl's medium till oocyte retrieved or maximum two times. Results:The study observed 60.5 % oocyte recovery rate with aspiration only compared with 80.9 % with follicular aspiration and flushing.Operative time (minutes) was significantly longer among flushing group,the retrieval time was 1.3 fold higher among those undergoing follicular flushing. Pregnancy was non-significantly more frequent among flushing. Implantation rates non-significantly more frequent among flushing group than non-flushing group (31.6% versus 26.3%, P= 0.424) and ongoing clinical pregnancy non-significantly more frequent among flushing group (27.4% versus 21.1% , P= 0.31). Conclusion, flushing non-significantly increase implantation and clinical pregnancy outcome and associated with a significant increase in the procedure time for oocyte retrieval, so patient groups where a small number of oocytes are available for retrieval may represent patients most likely to benefit from follicle flushing as only one extra oocyte may affect the outcome.

Aim of the Work: The aim of this study is to evaluate and compare the epi-on versus the epi-off techniques of corneal collagen cross linking as regards their safety and efficacy for treatment of mild to moderate degree keratoconus. Design: Prospective, non randomized study. Patients and Methods: Thirty eyes in 15 patients (9 males and 6 females) with bilateral mild to moderate degree keratoconus were included in this study. Their mean age ± SD was 26.2 ± 3.9 years. Diagnosis of keratoconus was based on clinical evaluation as well as pentacam examination. All patients were subjected to corneal collagen cross linking. According to the technique used, eyes were classified into 2 groups: Group I: Included 15 eyes in 15 patients, where cross linking was performed after removal of the corneal epithelium (Epi-off). Group II: included the other 15 eyes of the same patients, where cross linking was performed with intact epithelium (Epi-on). Comparison between the two groups as regards visual outcome, keratometric readings, least corneal thickness, refraction outcome and corneal haze was done. Results: No intra operative complications were reported in our study. Re-epithelialization in eyes of group I was reported within a week except three eyes were re- epithelialization was reported after 10,14and 21 days. There was a statistically significance improvement in best corrected visual acuity in both groups (0.36 before versus 0.60 six months after surgery) but the difference between both groups was not significant. As regards refraction, there was reduction in spherical error 6 months after surgery in both groups (-6.14D before,-5.22D 6 months after surgery) as well as cylindrical error (4.87D before 3.79 D 6 month after surgery). Differences between both groups were statistically not significant. There was increase in the least corneal thickness after surgery (448.6 microns before surgery versus 451.9 microns 6 months after surgery) but statistically the difference was not significant (P=0.75) and the difference between both groups was also not significant. Changes in keratometric readings were statistically not significant, and the difference between both groups was also not significant. Corneal haze was observed one month post operatively in four eyes in group one versus 3 eyes in group II. Persistent haze at the end of follow up was reported in three eyes in group I versus two eyes in group II. The incidence of haze as well as its density was higher in group I than group II with statistical significant difference. Conclusion: Both epi-on and epi-off techniques of corneal collagen cross linking are safe and effective in stabilization or even improvement of mild to moderate degree keratoconus as regards best corrected visual acuity, refraction, keratometric readings, and least corneal thickness. The epi-on technique is easier and more tolerable by the patient with less postoperative corneal haze.