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Background: Acute lymphoblastic leukemia (ALL) is a neoplastic disease of immature lymphocytes or lymphocyte progenitor cells either the B- or T-cell lineage. It is the most common malignancy diagnosed in patients younger than 15 years, and account for approximately 25-30% of adult acute leukemia. Objective: To evaluate some antioxidants as zinc, selenium, vitamin A (retinol) and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia and to compare it to that of a control population. Patients and methods: This case-control study was carried out at Oncology Unit of Pediatrics Department and Medical Biochemistry Department, Faculty of Medicine, Zagazig University Hospitals. This study consisted of two groups: Patients’ group (30 children patients with newly diagnosed ALL). As regard control group, it included 30 healthy children who were matched well with patients’ age and sex. Fasting levels of serum zinc, selenium, retinol and tocopherol were measured. Results: There was a high statistically significant decrease of vitamin E, selenium and zinc among all cases than their controls. While, there was a significant increase of vitamin A among all cases. Zinc level was statistically significantly increased with increased risk of disease, while no statistically significant relation between disease risk and other levels of serum antioxidant. Conclusion: Some antioxidants as zinc, selenium and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia are lower compared to that of a control population.

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: Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Sepsis is a common complication in the neonatal intensive care unit. It is caused by various organisms invading the blood stream, which may be by bacterial, viral, fungal and protozoal infections. Objective: The aim of this study was to diagnose neonatal sepsis early in order to reduce morbidity and mortality of newborn. Patients and methods: This study was a case-control study that included 132 participants divided into two groups, each group included 66 patients. 1st group included neonatal sepsis and 2nd group was control group without sepsis. They were admitted at Neonatal Unit of Pediatric Department at Zagazig University Hospitals during the period from 11/2019 to 11/2020.Investigations done for all these neonates, and included complete blood count [PLT, PDW, MPV and Platelet-large cell ratio (P-LCR)], CRP, ESR, blood culture, urine culture and chest x-ray. Results: There was statistically significant difference between the septic cases and control group regarding platelets distribution width (PDW) where 87.9% of the septic cases had elevated PDW while 45.5% of control group had elevated PDW. There was statistically significant negative correlation between platelets count with CRP, platelets distribution width, mean platelet volume and P-LCR (increased platelets count is associated with decrease in CRP, platelets distribution width, mean platelet volume and P-LCR) among the control group. Conclusion: Platelet indices, as part of a routine automated cell count, are cheap and readily available tests that can be used as valuable clues in the diagnosis of neonatal sepsis.

Background: Chronic ankle pain is considered a diagnosticchallenge because of variable causes including traumatic andnon-traumatic causes. MRI is considered an excellent methodof diagnosis of soft tissue abnormalities around ankle joint.Ultrasonography also can detect normal anatomic structureand assess ligamentous abnormalities, and provide dynamicevaluation of the soft tissues. Ultrasonography is more avail-able, cheap, fast, and safe method of diagnosis.Aim of Study: Was toevaluate the accuracy of both ultra-sonography and magnetic resonance imaging in diagnosis ofdifferent causes of chronic ankle pain.Patients and Methods: A comparative study conductedupon attendants referred from orthopedics clinic who com-plained of ankle pain.Results: In this study ultrasound successfully diagnosedand characterized 35 out of 40 patients (85%) while MRIdiagnosed and characterized 36 patients (87.5%). MRI is themodality of choice for optimal detection of most of osseousand; soft-tissue disorders of ankle with higher axial resolutionand multiplanar capabilities while ultrasound proved to beexcellent cost-benefit widely available imaging technique thathas high spatial resolution making it helpful tool in diagnosingmost of ankle soft tissue disorders with high diagnosticaccuracies almost equal to MRI values.Conclusion: Ultrasonography and MRI are two methodsof investigations with the former being used as primary toolof investigation and the latter done to confirm diagnosis andthe extent of the lesion especially when surgery is planned.

Background: The use of adjuvants in intravenous regional anesthesia [IVRA] for upper limb surgeries seems to increase efficacy and reduce side effects. Trials are continued to reach the ideal combination. Aim of the work: The study aimed to evaluate the efficacy and safety of IVRA for upper arm surgery using different adjuvants [atracurium and dexmedetomidine]. Patients and methods: 120 patients scheduled for elective upper limb surgeries were included. Patients were divided randomly into four equal groups. Group I received 40 ml lignocaine 0.5% alone, group II: received 40 ml [lignocaine 0.25% plus dexmedetomidine 50 μg], group III received 40 ml [lignocaine 0.25% plus atracurium 2 mg], and group IV received 40 ml [[lignocaine 0.25% plus dexmedetomidine 50 μg and atracurium 2 mg]. surgery duration, quality of anesthesia, postoperative analgesia, and hemodynamics were monitored. Results:The onset of sensory and motor block was significantly shorter in groups II and IV than in group I or III. Also, both sensory and motor block were significantly shorter in group IV when compared to group II [2.53±0.57, 3.60±0.62 vs. 3.33±0.54 and 5.20±0.84 respectively]. Besides, the pain was significantly lower in groups II and IV than groups I or III after deflation at 5, 15, 30, 60 minutes, and up to 8 hours. The need for postoperative analgesia was significantly higher among groups I and III when compared to groups II and IV [56.7%, 63.3% vs. 30.0% and 20.0%, respectively]. No major adverse events were reported. Conclusion: The use of dexmedetomidine as an adjuvant had a significantly better postoperative analgesia, longer duration of sensory and motor block, and earlier onset of action. In addition, the use of atracurium besides dexmedetomidine improves the quality of IVRA.

Background: MV is an important part of NICU care today. MV, nevertheless, is linked to higher risks of VAP. The 2nd most frequent hospital acquired infection is VAP, which develops in mechanically ventilated cases after 2 days of MV. Aim: The aim of this study was to determine the incidence of VAP and to assess risk factors of VAP in neonatal intensive care unit in Al-Ahrar teaching hospital. Methods: This study was a prospective observational study which conducted at the neonatal intensive care unit in Al-Ahrar teaching hospital on 84 neonates on MV. All patients were subjected to full history taking. Full Clinical Examination and Laboratory Investigations were done and included complete blood count (CBC), C-reactive protein (CRP), liver function tests, kidney function tests, serum albumin level and blood culture. Chest radiograph was done on admission and repeated as required. Results: the percentage of the VAP was (54.8 %). There was a statistically significant decrease in gestational age, weight, and serum albumin among VAP than non-VAP cases. Conclusion: The high prevalence of VAP in the intubated neonates poses a serious risk. Diagnosis, risk factor identification, precautions, and empirical treatments are all important strategies for VAP. VAP was found in a high percentage of mechanically ventilated newborns.

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) emergence and dissemination, is an important healthcare concern due to its limited therapeutic options. Ceftazidime/avibactam (CAZ/AVI) is a recently approved antibiotic combination that may be effective in treating these resistant infections. The aim of the current study was to determine the prevalence of CRKP amongclinical isolates from neonatal intensive care unit (NICU) and to evaluate the in-vitro activity of CAZ/AVI against them. Methods: A total of 255 clinical samples were collected from neonates with suspected sepsis. All Klebsiella pneumoniae isolates were identified by standard methods. Antibiotic susceptibility testing, screening for Extended-spectrum β lactamase (ESBL) production, carbapenem resistance, carbapenemase production and susceptibility to CAZ/AVI were done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the 255 neonates clinically suspected as neonatal sepsis, only 136 (53.3%) had positive culture results, out the 136 culture-proven cases, 72 (52.9%) were positive for Klebsiella pneumoniae, of them ESBL producers were 92% (n=66) and CRKP were 32% of isolates (n=23). All of the CRKP were carbapenamase producers (39% serine-type and 61% metallo-β-lactamases (MBL) type). Serine carbapenamase and MBL producers showed high resistance against CAZ/AVI with a percentage of 77.8% and 100% respectively. Conclusion: The prevalence of CRKP is alarming in our NICU especially in the presesnce of neonatal risk factors like; neutropropenia, central line fixation and premature rapture of membranes. Ceftazidime/avibactam is an unsuitable option for the treatment of this type of resistant bacteria because of its high resistance.

Objective: Dialysis-associated steal syndrome (DASS) is a complication that may occur in >4% of patients with arteriovenous fistula. The best treatment method for this condition is up till now controversial. Aim of the work: The purpose of this study was to evaluate two common procedures to treat this condition; Distal Revascularization with Interval Ligation (DRIL) or Revision Using Distal Inflow (RUDI) aiming at preservation of both the function of the fistula and the limb. Patients and methods: Fourteen patients having native brachiocephalic or brachiobasilic hemodialysis AV fistula complicated by dialysis associated steal syndrome (DASS), were randomly divided according to treatment method into DRIL and RUDI groups with 7 patients in each group. Patients with proximal or distal arterial disease and those with low-flow steal were excluded Short term access patency and limb salvage were set as primary endpoints. In all patients great saphenous vein was harvested from the thigh. Early post-procedural follow up and mid-term follow up were after one and three months. Results: From November 2011 to March 2013, 14 patients presented with (DASS). In DRIL group (7 patients), the mean age was 49.2 years, 4 females and 4 diabetics while in RUDI group (7 patients), the mean age was 52.3 years, 5 females and 7 diabetics. All fistulas were brachiocephalic and only one was brachiobasilic AVF in DRIL group. All patients in both groups presented with pain, pallor, coldness and cyanosis of the hand Stage III DASS {rest pain) was present in 2 cases of each group, whereas Stage IV small superficial ulcers were present in 3 vs 4 and digital gangrene in 2 vs. 1 in DRIL vs. RUDI respectively In group 1 (DRIL) technique; 5 patients (71.4%) had marked improvement of pain, cyanosis, capillary refill and coldness. Pallor improved in all cases. Distal pulses returned in 4 patients, remained weak in one patient and failed to return in 2 (28.6%). Closure of the access was necessary in 2 patients due to infection in one and due to risk of limb loss in the other; access patency was (71.4%) and limb salvage was (100%). In RUDI cases, pain, hand coldness, pallor and cyanosis greatly improved in all cases post-operatively. Distal pulses and capillary refill returned and became comparable to the healthy side in 6 patients (85 7%). Limb salvage and access patency were achieved in all cases (100%). Conclusion: RUDI procedure incorporates most of the advantages of other access and hand-preserving procedures. In contrast to DRIL procedure, it is the fistula that is placed at risk by ligation and revascularization, not the native arterial supply to the ischemic hand RUDI may become the procedure of choice for patients with dialysis-associated steal syndrome after a brachial artery-based arteriovenous fistula.