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Background: Cases of rheumatoid arthritis [RA] are characterized by a decreased life expectancy, as well as a 50% are at greater risk of developing cardiovascular diseases [CVD] compared to other subjects. Precocious myocardial dysfunction can be detected more accurately and faster with speckle -tracking Echocardiography.The aim of the work: This study attempts to evaluate the function of myocardial Left ventricular [LV] systole via Speckle Tracking Echocardiography [STE] strain imaging in RA cases with the absence of [CVD] and to correlate the results with the disease features.Patients and Methods: A case control study, which recruited 60 RA cases [with a median age of 46.22 ± 8.14 years] without known CVD, as well as 60 healthy controls.Results: Assessment of speckle-tracking for [LV] systolic function revealed diminished Global Longitudinal Strain [GLS] in patient group [-16.80% vs. -22.35%, PP

Reconstruction of the external ear is a challenging problem encountered by plastic surgeons. Causes of external ear deformities can be of various etiologies (human bites, animal bites, fights, burns, infections, accidents, or even sports injuries). Full-thickness defects, which cannot be treated by approximating the wound edges, show good results with Antia-Buch’s chondro-cutaneous flaps. A 34-year-old male presented with a history of human bite to his right external ear. The patient had brought the amputated part with him. There was complete amputation of the superior part of the helix with exposed cartilage with a 2 cm defect on examination. The amputated part was an unhealthy crushedavulsed tissue. The patient underwent debridement and washout. Reconstruction of the external ear was done by Antia-Buch helical advancement flap designed over the posterior skin. Post-operatively, the external ear reconstruction yielded good cosmetic results. Animal or human bite defects used to be left open for fear of severe infections, and closure was planned later, but this can be complicated by fibrosis and can result in a change in the shape of the external ear. Primary repair using an Antia-Buch flap and appropriate antibiotic treatment shortens the hospital stay and dressing changes and improves the cosmetic outcome. Keywords: Amputation, Cartilage, External ear, Fibrosis, Human Bite, Reconstructive Surgical Procedures

Objective This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO). Data sources A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of science and Cochrane Library was conducted in June 2021 for articles in the literature till this year. Study selection Studies are published in English language, conducted on human subjects, concerned with comparison of CI and stapes surgery in the management of FAO, not Laboratory study and not Opinion study. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). Data extraction Twenty-six studies were included with 334 patients in CI group and 241 patients in stapes surgery group. Comparison between both groups was done in terms of postoperative complications, audiological outcomes, rete of revision surgery and patients’ satisfaction rate. Results Postoperative complications rate was significantly lower in CI (13.6%) than stapes surgery (18.6%). CI had a significantly lower rate of revision surgery (8.1%) than stapes surgery (16.4%). CI had a better mean for pure tone average (29.1 dB) than stapedectomy (52.3 dB) while stapes surgery had a higher mean for recognition of monosyllables and disyllables than CI. CI had significantly higher satisfaction rate than stapes surgery. Conclusion Both Stapes surgery and CI are reliable treatment options for FAO with close success rates. Statistics of CI are greater than stapes surgery and CI has a consistent improvement in audiometric outcomes in comparison to stapes surgery.

Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Background: The continuous rise in the number of patients suffering from Helicobacter pylori is probably due to the changes in modern life. Nowadays, patients suffering from gastrointestinal problems are diagnosed through invasive and non-invasive techniques. The choice of a diagnostic test is influenced by factors such as the tests' sensitivity and specificity, the clinical conditions, and the cost-effectiveness of the testing strategy. This study aimed to compare molecular detection methods of H. pylori by polymerase chain reaction (PCR) targeting the 16S rRNA, ureA and glmM genes with an invasive histopathological technique. Methods: 290 gastric biopsies were collected using gastrointestinal endoscopy from patients with gastritis symptoms in different hospitals in Khartoum state. Two gastric biopsies were collected from each patient for PCR and histopathology. Results: A total of 103 (35.5%) samples were positive by histopathological examination, 88 (30.3%) by 16S rRNA, 39 (13.4%) by glmM gene, and 56 (19.3%) by ureA gene. The highest sensitivity was observed in 16S rRNA (46.6%), followed by glmM (24.3%) and ureA (23.3%). While the best specificity was observed in glmM gene (92.5%), followed by ureA (82.3%) and 16S rRNA (78.6%). Conclusion: PCR test targeting the 16S rRNA gene exhibited the best results for molecular detection of H. pylori compared to other genes.