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BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound (LUS) as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. AIM: The aim of this study was to compare LUS versus pulmonary auscultation for detecting pulmonary edema in critically ill patients. PATIENTS AND METHODS: Sixty-one patients were included in this study, all included patients underwent clinical examination, chest auscultation of anterior and lateral (axillary) chest wall and back in each hemithorax in supine position was done, followed by LUS using Bedside LUS in Emergency (BLUE) protocol. LUS score was recorded; abnormal auscultation was defined as the presence of rales or wheezes. Laboratory tests were done on admission such as pro-BNP, renal function, and blood gases. Pro-BNP was used as diagnostic tool for volume overload and was correlated with LUS and stethoscope for detecting pulmonary edema. Pneumonia was excluded with normal total leukocyte counts, C-reactive protein, and absence of fever. RESULTS: This study included 61 patients with diagnosis of pulmonary edema, all data were recorded on admission and showed that there was statistically significant good positive correlation between LUS and Pro-BNP (p < 0.05), and Pearson correlation between LUS and Pro-BNP among the studied patients is statistically significant at the 0.01 level (two-tailed). Furthermore, we found that both LUS and Pro-BNP were statistically significant higher among patients with rales (p < 0.05) only 36 (59%) patients were positive as pulmonary edema with pulmonary auscultation (presence of rales) and 25 (41%) patients were negative for pulmonary edema (NO RALES) while they were positive for pulmonary edema with LUS (high LUS score)and pro-BNP. CONCLUSION: Pulmonary auscultation has poor sensitivity for pulmonary congestion while LUS had statistically significant higher sensitivity for pulmonary edema.

The most common neoplastic ovarian lesions in teens are mature cystic teratomas (MCTs) or dermoid cysts. Little is known about the cause of dermoid cysts. Elevated levels of estrogen and progesterone have been suggested to stimulate the sebum components of these tumors, which may explain why MCTs grow after puberty and stop growing after menopause. MCTs are often asymptomatic and are randomly identified during examination or diagnostic imaging. MCTs show a special appearance during ultrasonography. Most studies suggest that most ovarian dermoid cysts can be successfully treated surgically using laparoscopic surgery. Reduced adhesion formation is one of the benefits of laparoscopic treatment for dermoid cysts. Studies also suggest that laparoscopy causes less blood loss. Less hospitalization and less postoperative pain. And there are fewer postoperative problems than the laparotomy approach. In this article, we will look at the etiology, diagnosis, and treatment of dermoid cysts in the ovary.

This study was designed to evaluate the hepatoprotective effect of alcoholic and n-hexane extracts of crayfish Procambarus clarkii against CCl4 (4 mM) induced toxicity in the human hepatoma cell li...

Background Brachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline. Results Results of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block. Conclusion Both drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

The current experiment aimed to estimate some antioxidants ability mainly, selenium, vitamins B6 and C to overcome adverse effect of heat stress during summer months. Total of 360 one- day-old broiler chicks were randomly divided into 9 treatments with four replicates (10 chicks/each). The experiment period extended from 1 day to 40 days of age where ambient temperature ranged from 36 to 41°C and relative humidity ranged from 30 to 55%. The 1st group fed basal diet that satisfied strain requirement as control treatment. The 2nd group fed control basal diet supplemented with vitamin E (50 mg/kg diet) and acted as control plus to estimate efficiency of antioxidants. Experimental treatments from the 3rd to the 9th fed basal diet supplemented with 3 mg vitamin B6, 200mg vitamin C, 0.10 mg Se, 3 mg vitamin B6+ 200mg vitamin C, 3 mg vitamin B6 + 0.10 mg Se, 200 mg vitamin C + 0.10 mg Se, or 3 mg vitamin B6 +200mg vitamin C+ 0.10 mg Se respectively.. Parameters of growth performance, carcass characteristics, some plasma constituents, immunity and antioxidant status were investigated. Malondialdehyde was estimated in frozen (6 months at -20 °C) thigh muscles to determine antioxidant status. The results appeared significant improvement of growth performance and malondialdehyde were reduced in plasma and thigh muscles. Dressing, abdominal fat and giblets percentages did not affect. While, significant improvement was observed in some hematological parameters, cellular immunity and antioxidant status. In contrast antibodies titer against Newcastle Disease Virus and Avian flow Virus (H5N1) did not affect. Briefly, the overall experimental results showed that supplementing broiler diets with selenium combined with vitamin B6, vitamin C or both were more effective to improve growth performance, broiler meat quality, immunological and antioxidant status for broiler chicks reared during hot summer months.

Water has a pH of around (7.0), making it neither alkaline nor acidic. Alkaline is defined as a pH value greater than (7.0). The power of water to neutralize acids is measured by its alkalinity. The pH scale ranges from (pH = 0 to 14), with anything above (pH = 7.0) being alkaline, and anything below (7.0) being acidic. Much of the research up to now has been investigating the effect of adding alkaline substances to the water to increase the pH levels. Recent evidence suggests that using baking soda (sodium bicarbonate), which is an alkaline substance with a pH of about (9). While studies have shown that adding soda to water increases its alkalinity, it has a number of negative health consequences. For instance, Hypokalemia, Hypochloremia, High levels of sodium in the blood, Worsening kidney disease, Worsening heart failure, Muscle weakness and spasm, and Increased stomach acid production. The main aim of this study is to investigate a natural substance consisting of environmental elements i.e., it is derived from silica by the thermal fusion method (prepared by the authors) that raises the pH of water with a physical field of 80 cm without adding any components to the water. The results showed the effectiveness of this natural substance in its solid and liquid forms in raising the pH of water to reach 8.5 from a distance range = 80 cm, without any side effects on human health.

Purpose This study aims to assess the intra-operator repeatability and correlation of the Pentacam HR (device 1) and Sirius (device 2) in measuring anterior segment parameters and to evaluate the agreement of their readings and therefore their interchangeability in a clinical setting. Methods This is a prospective non-randomized study was conducted on the right eyes of 102 subjects coming to Eye World Hospital, Giza, Egypt. With each machine, four scans were taken by a single examiner. Each device was used to measure keratometric indices, corneal thickness, anterior chamber depth, anterior chamber angle, corneal diameter and corneal optical aberrations. Results Both devices show high repeatability for corneal thickness, corneal diameter, anterior chamber depth and keratometric indices (except for maximum keratometry, where device 1 shows high repeatability and device 2 shows low repeatability). On the other hand, both devices show poor repeatability for anterior chamber angle, Q-values, root mean square, spherical, coma and trefoil aberrations. The readings of the two devices are strongly correlated as regards only keratometric indices, corneal thickness and anterior chamber depth. In addition, the readings of the devices are in good agreement as regards only keratometric indices (except maximum keratometry), corneal thickness, anterior chamber depth, anterior chamber angle, root mean square, spherical and trefoil aberrations. Conclusion Both devices showed variable intra-observer repeatability, with the device 1 showing slightly higher repeatability. Despite the similarity between some of the readings of the two devices, caution is advised before considering them interchangeable. We therefore do not recommend using them in alternation in refractive surgery.

Detecting the accuracy of various posterior elevation (PE) indices of Pentacam HR, and correlating them with some possibly related factors or parameters, in a cohort with early keratoconus (KC).A cross sectional study that was conducted at Eye World Hospital, Egypt. One hundred and two corneas were enrolled, including two groups; group 1 (50 corneas) having forme fruste or early KC, and group 2 (52 corneas) for healthy controls. Corneas were scanned using Pentacam HR (Oculus, Wetzlar, Germany). The investigated PE parameters were: PE from best fit sphere (BFS), PE from best fit toric ellipsoid (BFTE), PE from exclusion map of Belin Ambrosio's display (BAD), and PE from difference map of BAD. The four PE values were correlated to age, thinnest corneal thickness "TCT," posterior aberrations, and posterior Q value.All the investigated indices were significantly different in group 1 compared to group 2 (p 0.001). Accuracy of PE parameters revealed the highest AUROC for PE from BFTE (AUROC = 0.989, and best cutoff 4 um with sensitivity 96.00% and specificity 96.15%). PE from difference map was the least accurate. Correlation coefficients showed a significant correlation between all the studied PE parameters and some of the posterior aberrations (root mean square of higher order aberrations, vertical coma, and spherical aberrations), besides a significant correlation with posterior Q value.PE indices are sensitive detectors of early ectasia. PE from BFTE had the highest deduced AUROC. Alterations in PE values can significantly alter many posterior corneal aberrations and the posterior Q.

Objectives: Tumor mutation burden (TMB) is an emerging predictive cancer biomarker. Few studies have addressed the prognostic role of TMB in non-small cell lung carcinoma, with conflicting results. Moreover, the association of TMB with different histological subtypes of lung adenocarcinoma has hitherto not been systematically evaluated. Here we studied the prognostic value of TMB and its distribution in different histological subtypes of lung adenocarcinomas in a retrospective cohort using the most recent updated classification guidelines. Materials and methods: 176 surgically resected stage I-IV lung adenocarcinomas were histologically reclassified according to WHO 2015 guidelines. A modified classification subdividing the acinar subtype into classic acinar, complex glandular and cribriform subtypes was further applied and potentially prognostic histopathological characteristics such as tumor-infiltrating lymphocytes were evaluated. 148 patients with stage I-III tumors and complete follow-up data were included in the survival analyses. TMB was determined by a commercial next generation sequencing panel from 131 tumors, out of which 105 had survival data available. Results: Predominant micropapillary, solid and complex glandular as well as nonpredominant cribriform histological subtypes were associated with significantly shorter survival. High TMB concentrated in micropapillary, solid and acinar predominant subtypes. Interestingly, TMB >= 14 mutations/MB conferred a stage- and histology-independent survival benefit compared to TMB

Purpose: The current standard-of-care for front-line therapy for acute myeloid leukaemia (AML) results in short-term and long-term toxicity, but still approximately 40% of children relapse. Therefore, there is a major need to accelerate the evaluation of innovative medicines, yet drug development continues to be adult-focused. Furthermore, the large number of competing agents in rare patient populations requires coordinated prioritisation, within the global regulatory framework and cooperative group initiatives. Methods: The fourth multi-stakeholder Paediatric Strategy Forum focused on AML in children and adolescents. Results: CD123 is a high priority target and the paediatric development should be accelerated as a proof-of-concept. Efforts must be coordinated, however, as there are a limited number of studies that can be delivered. Studies of FLT3 inhibitors in agreed paediatric investigation plans present challenges to be completed because they require enrolment of a larger number of patients than actually exist. A consensus was developed by industry and academia of optimised clinical trials. For AML with rare mutations that are more frequent in adolescents than in children, adult trials should enrol adolescents and when scientifically justified, efficacy data could be extrapolated. Methodologies and definitions of minimal residual disease need to be standardised internationally and validated as a new response criterion. Industry supported, academic sponsored platform trials could identify products to be further developed. The Leukaemia and Lymphoma Society PedAL/EUpAL initiative has the potential to be a major advance in the field. Conclusion: These initiatives continue to accelerate drug development for children with AML and ultimately improve clinical outcomes.

Purpose To investigate the relationship between corneal astigmatism and corneal image quality parameters (i.e., root mean square [RMS] of some major corneal higher order aberrations [HOAs] "namely RMS of coma aberrations, RMS of trefoil aberrations, and RMS of spherical aberration [RMS-SA]" and Strehl ratio [SR] of point spread function [PSF]) by using the Sirius topographer (CSO Italia, Florence, Italy). Patients and Methods This cross-sectional study used the Sirius topographer to evaluate the naive corneas of right eyes (n = 1,356). The study included three groups which were based on the mean anterior corneal astigmatism value (group 1, 2 D). Results The corneal astigmatism showed statistically significant (yet narrow clinical) differences among the groups regarding all the examined parameters (P

Oropharyngeal squamous cell carcinoma (OPSCC) is subclassified by the World Health Organization into two different entities: human papillomavirus (HPV)-positive and HPV-negative tumors. HPV infection promotes the epithelial-to-mesenchymal transition (EMT) and transformation of keratinocyte stem cells into cancer stem cells. EMT is a crucial process in the carcinogenesis of epithelial-derived malignancies, and we aimed to study the role of its markers in OPSCC. This study consists of 202 consecutive OPSCC patients diagnosed and treated with curative intent. We examined E-cadherin, β-catenin, and vimentin expression using immunohistochemistry and compared these with tumor and patient characteristics and treatment outcome. We found that the cell-membranous expression of β-catenin was stronger in HPV-positive than in HPV-negative tumors, and it was stronger in the presence of regional metastasis. The stromal vimentin expression was stronger among HPV-positive tumors. A high E-cadherin expression was associated with tumor grade. No relationship between these markers and survival emerged. In conclusion, β-catenin and vimentin seem to play different roles in OPSCC: the former in the tumor tissue itself, and the latter in the tumor stroma. HPV infection may exploit the β-catenin and vimentin pathways in carcinogenic process. More, β-catenin may serve as a marker for the occurrence of regional metastasis

Background: Crystal deposition is one of the most common arthropathies among the elderly. Similarly, osteoarthritis (OA) considers the most common joint pathology amongst the elderly; it is usually associated with significant pain, disability, and even synovitis. Objective: The aim of the work was to detect Crystals in Non-symptomatized crystal arthropathy in cases of primary knee Osteoarthritis. Patients and Methods: 50 patients with primary knee osteoarthritis who diagnosed according to the American College of Rheumatology classification criteria for osteoarthritis. Patients underwent to history taking, clinical examination, laboratory examination, knee US, plain radiography and synovial fluid analysis. Results: Fifty patients (35 females, 15 males) were enrolled. Mean values were 65.4 years ± 13.5 SD for age and 50.7 months ± 35.5 SD for disease duration. Plain radiography revealed chondrocalcinosis in 4 patients (8%). Crystals were detected by US in 36 knees (72%), 24 patients had calcification characteristic of CPPD and 12 patients had calcifications characteristic of MSU crystals deposition. synovial fluid examination revealed crystal deposition in 38 knees (76%), it was MSU in 12 patients and CPPD in 26 patients. The sensitivity of US for the detection of calcification was (83.3%) while that of plain X-ray was (22.2%), and the specificity was (93.8%) and (90.2%) respectively. There is statistically significant difference between patients with crystal deposition and patients without crystal deposition as regard WOMAC stiffness score. Conclusion: Subclinical crystals were detected in a significant number of Primary Knee Osteoarthritis Patients. US showed high specificity and acceptable sensitivity for the diagnosis of Crystal Arthropathy.

To assess the agreement between Orbscan 3, Pentacam HR and ultrasound pachymetry (Palm Scan AP 2000) in measuring central corneal thickness. Prospective observational cross-sectional study of ninety-two eyes of 48 patients with normal corneas was conducted. Central corneal thickness was measured via Pentacam HR, Orbscan 3 and ultrasound pachymetry. Bland–Altman analysis was used to demonstrate agreement between various methods. Ninety-two eyes of 46 subjects were enrolled. The mean age was 29.67 years (18–59). The average measurements of central corneal thickness were 545.73 ± 29.35 μm, 549.34 ± 29.14 μm and 545.78 ± 31.48 μm for the Pentacam HR, Orbscan and ultrasound pachymetry, respectively. The three devices measurements are closely correlated, with Pearson correlation coefficient ranging from 0.868 to 0.929. The 95 % limits of agreement were 25.2 to − 18 μm between Orbscan and Pentacam central corneal thickness, 25.2 to − 25.7 μm between Pentacam and pachymetry central corneal thickness and 34.4 to − 27.2 μm between Orbscan and pachymetry central corneal thickness. In spite of advancement of Orbscan 3, still there are wide agreement limits between CCT measurements obtained via Orbscan 3, Pentacam HR and ultrasound pachymetry; thus, interchangeable use in clinical practice is not recommended.

Chylothorax is an infrequent type of pleural effusion, typically exudative, caused by obstruction or laceration of the thoracic duct by malignancy, trauma, or thoracic surgery. Transudative chylous pleural effusions are extremely rare. We report a case of a 63-year-old male with recurrent transudative chylothorax secondary to cirrhosis that completely resolved with transjugular intrahepatic portosystemic shunting (TIPS). Transudative chylous pleural effusion is an extremely rare entity with only a few cases reported in the literature to date. Transudative chylothorax can occur in patients with liver cirrhosis. Recognizing this association will prevent unnecessary testing and procedures. Timely diagnosis and early initiation of treatment are pivotal in preventing complications from malnutrition and infection by preventing loss of electrolytes, immunoglobulins, and T-lymphocytes.

Purpose Many topography/tomography devices are available, and their interchangeable use is frequently questioned. This study aimed to compare the analogous indices of Orbscan 3 and Pentacam HR to detect whether the interchangeable use of the 2 devices is feasible. Methods This retrospective study was conducted at Eye World Hospital, Giza, Egypt. Displays of Orbscan 3 (Bausch & Lomb; Technolas Perfect Vision GmbH) and Pentacam HR (Oculus Optikegrate) for 660 healthy right eyes were explored for various analogous indices. Bland-Altman plots with 95% limits of agreement (LoA) were used for comparisons. Results The highest systematic error and lowest agreement existed in the front and back elevations from the best fit sphere (mean differences of 4.7 and 9.2 μm, respectively, and 95% LoA of -2.5 to 12.0 and -10.0 to 28.6, respectively). There was a relatively wide 95% LoA for each pachymetry at the corneal apex (-18 to 22 μm) and at the thinnest location (-22 to 22 μm), anterior chamber depth (-0.88 to 0.95 mm), flattest keratometry (-0.44 to 0.62 D), and steepest keratometry (-0.71 to 0.89 D). By contrast, the lowest systematic error and highest agreement existed for front and back best fit sphere radii of curvature (mean difference of 0.08 mm and 95% LoA of -0.08 to 0.24 and mean difference of 0.03 mm and 95% LoA of -0.17 to 0.23, respectively). Conclusions This study negates the accuracy of the use of devices interchangeably regarding most parameters. Therefore, examinations with the 2 devices should not be regarded comparable.

Purpose To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management. Patients and methods This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively. Results Forty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by

Purpose To determine the normative and the cut-off values of various indices available in the MS 39 Anterior Segment Optical Coherence Tomography (MS-39 AS-OCT) for keratoconus (KC) diagnosis, and to detect the accuracy of the variable available parameters. Methods This cross sectional observational study was conducted at Dr Rifay Ophthalmology Center, Rabat, Morocco, on 172 eyes with KC (group 1) and 248 eyes of healthy controls (group 2). Participants were screened using MS-39 AS-OCT (CSO, Firenze, Italy). The investigated indices included: keratometric indices, pachymetric indices, elevation indices, Keratoconus Summary Indices (KSI), aberration indices, and epithelial mapping evaluation. Results Most of the studied indices were significantly different between both groups (P value 0.950, eight of which were from the KSI. The indices with the highest AUROC values were: Root Mean Square (RMS) for the front corneal surface at 6 mm circle (AUROC = 0.996, and best cut-off >1.69 with sensitivity of 97.67% and specificity of 97.98%) and RMS per unit of area for the front surface at 6 mm circle (AUROC = 0.996, and best cut-off >0.06 with sensitivity of 97.67% and specificity of 97.98%). Epithelial thickness-derived metrics were not among the parameters with the highest accuracy. Conclusions This study presented the mean and the cut-off values for a plethora of parameters available in the MS-39 AS-OCT. The results of this study show that MS-39 AS-OCT is a valuable equipment for diagnosing keratoconic corneas, with a high accuracy detected for many parameters.

Background Enhancement washout technique in solid renal masses using multidetector computed tomography (MDCT) can differentiate different type of lesions. 99 Patients who are presenting with suspected renal masses or renal tumour for staging are included in this study. CT examination are carried out at urology and nephrology centre using MDCT. The attenuation values (Hounsfield Unit) will be assesed for each lesion on the pre enhanced, corticomedullary, nephrographic and delayed phases. Washout ratio will be calculated for each phase of enhancement in comparison to the unenhanced attenuation value. The characteristics of enhancement-washout will be correlated with the final histopathological diagnosis. Results Early enhancement and washout pattern was noted in 54 renal lesions (54.5%) representing 4 types of renal lesions; Oncocytoma (n = 13), clear cell renal cell carcinoma (n = 16), Chromophobe renal cell carcinoma (n = 15) and unclassified renal cell carcinoma (n = 10).Prolonged enhancement pattern was noted 45 lesions (45.4%); PRCC (n = 14), 10 case of lipid poor AML (n = 10), metanephric adenoma (n = 10) and Xp11 RCC (n = 11). High pre-contrast attenuation was noted in Xp 11RCC showing attenuation value 41.7 ± 6.823HU. The highest CMP values were noted in CCRCC (151.9 ± 20.4) followed by oncocytomas (137.6 ± 19.15HU) and then CHRCC (123.6 ± 16.6 HU)while the lowest values were noted in Metanephric adenoma)57.1 ± 17.4HU)and followed by PRCC (59.9 ± 4.8)and followed by lipid poor AML (79.17 ± 13.666) and RCC unclassified (89.06 ± 18.1). Conclusions Four-phase MDCT (the unenhanced, corticomedullary, nephrographic, and excretory phases) evaluate role of MDCT in differentiation of solid renal masses.

Aims Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system. Patients and Method Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team. Results SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others. Conclusions A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.

Background Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced. Aim of the Work To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units. Patients and Methods The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019. Results The study has included 60 patients comprising males and females. Conclusion We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Background:Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia.Objective:The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery.Methods:A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data.Results:The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7vs.3.9 ± 1.0 min,p< 0.001; 2.3 ± 0.7vs.4.4 ± 1.2 min,p< 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0vs.43.0 ± 8.5 min,p< 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0vs. 4.0,p< 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0%vs. 25.9%,p< 0.001).Conclusion:Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

Background: The treatment of degenerative spinal diseases remains focused on dealing with symptoms, using both conservative and surgical methods. Though surgery is considered an effective treatment for many cervical disorders, at times it leads to significant problems including adjacent level disease. Objectives: The aim of this study was to correlate the functional, radiographic and sagittal balance outcome in surgically treated patients for the degenerative cervical disc diseases, outline the advantages, disadvantages and the effect of the sagittal balance on the patient function and activities. Patients and Methods: This study included a total of thirty patients who had degenerative disc disease of the cervical spine at multiple levels treated by microscopic anterior cervical decompression. The average age of participants was 43.267 ± 10.780 years (26– 64). 18 patients (60%) were females and 12 patients (40%) were males. All patients were assessed and classified before and after surgery using the neck disability index and visual analogue scale. This assessment was done for both neck and arm disability. Results: The average neck disability index at the last follow-up was 17.74 ± 2.135, which was statistically significant (P < 0.05) among groups and visual analogue scale improved from 7.4 ± 0.926 to reach 3.6 ± 0.35 six months postoperatively. Full recovery was obtained between three and six months. All patients underwent a rehabilitation protocol and found no postoperative neurological deficit in this series. Conclusions: It could be concluded that cervical sagittal imbalance arising from regional and/or global spinal sagittal malalignment plays an independent role in exacerbating adjacent segment pathomechanics after multilevel fusion and should be considered during cervical fusion surgical planning. Also, it concludes that surgery significantly led to improvement of symptoms three months post operatively.

E. coli infections in avian species have become an economic threat to the poultry industry worldwide. The objective of this study is to determine whether the immunization using commercially available living Escherichia coli vaccines as Nisseiken Avian Colibacillosis Vaccine (Nisseiken Co., Ltd., Ome, Tokyo, Japan) and O78 aroA deleted vaccine (Poulvac ® E.coli, Zoetis) are protective against APEC challenges or not. Ninety eight chicks (Arbor, Acres) of both sexes were divided into seven groups (14 birds/each); two groups were vaccinated at day 1 of age by spray route using Nisseiken Avian colibacillosis Vaccine, then one of them challenged intratracheally with homologous E.coli O78 and the other with heterologus O1 at day 14, the other two groups were vaccinated at day 1 of age by eye drop route using Poulvac ® E.coli, Zoetis vaccine then one of them challenged intratracheally with homologus E.coli O78 and the other with heterologus O1 at day 14. The other two groups were positive control (challenged, unvaccinated); one challenged with O78 and the other with O1 at day 14 using intratracheal route. The last group served as environmental control (non vaccinated, non challenged). At day 28, birds were necropised and examined to evaluate the efficacy of both of the two different vaccines. The best obtained results were recorded to the vaccinated challenged groups with the homologous and heterologous strains and vaccinated by spraying and eye drop methods which showed a decrease in organ lesion scores in comparison to the other groups (non-vaccinated, challenged broilers). These results suggest that the two different vaccines used in our study are efficient in reducing lesion scores against homologous and heterologous challenge using spray and eye drop methods that could lead to minimizing the time for treatment and cases of condemnation in processing plants.

Egypt has successfully eliminated malaria during 2010–2013, however, between May to mid-June 2014, an outbreak was reported in Al-Adwa village, Aswan Governorate indicating that malaria may be potentially re-emerging in the country. The aim of this work was to reevaluate malaria in Al-Adwa and surrounding villages, 1 year after malaria cases have been reported through entomological and human screening in collaboration with the Ministry of Health and Population. Four trips were conducted during the period from March 2015 to March 2016. Mosquitoes were collected, sorted and identified. Anopheles species were processed for detection of Plasmodium by polymerase chain reaction (PCR), and engorged abdomens in blood-fed mosquitoes were analyzed for host preference using multiplex PCR. Thick and thin blood films were prepared from all apparently healthy children (n = 188) attending El-Sheikh Mostafa preparatory school. Results showed that Anopheles genus existed only in East Al-Adwa village. A total of 38 Anopheles mosquitoes were collected and identified as Anopheles multicolor 70% (A. multicolor), A. sergenti 20% and A. pharoensis 10%. The latter showed 100% human blood preference compared to A. sergenti (20%) and An. multicolor (0%). All female Anopheles were 100% negative for Plasmodium DNA, and all blood films showed no detectable parasite. The absence of Plasmodium in the area under study does not rule out the risk of future infections as the vector is still present together with the imported cases and carriers. Regular screening for the presence of Plasmodium in the area is absolutely paramount for early warning.

Background: With the development of scientific technology, applications of high-resolution ultrasound have rapidly developed in biomedical fields. High-resolution sonography clearly depicts peripheral nerve size spaces occupying lesions and anatomic variants along the entire length of the normative nerve Aim; Assessment of efficacy of ultrasound in evaluation of degree of traumatic nerve injury methods This prospective study was carried out during the period from June 2019 to April 2020 and included a hundred participants. All patients were referred to the radiology department of Benha university from the emergency department and outpatient clinic of surgery department of Benha university hospital. Results: diagnosis and characterization of turmeric peripheral nerve injury using ultrasound Conclusion; US can be used to facilitate the preoperative diagnosis and planning of the optimal treatment strategy as it can permit tracing the injured nerve at the lesion site and the neuroma’s extension. Finally, US has high accuracy for detection, diagnosis, assessment and treatment planning of traumatic peripheral nerve lesions.

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.

TOPIC: Transplantation TYPE: Medical Student/Resident Case Reports INTRODUCTION: Immunosuppressed lung transplant recipients (LTxRs) are predisposed to severe SARS-CoV-2 disease, impaired virus clearance, and increased mortality. Successful recovery from SARS-CoV-2 infection after reduction of immunosuppression (IS) has been reported in kidney and heart transplant recipients [1,2]. We report a case of favorable allograft outcome after reduction of IS in an LTxR with SARS-CoV-2 pneumonia despite prolonged virus shedding. CASE PRESENTATION: A 58-year-old bilateral LTx recipient (July 2020) with blood type A+ was admitted for a positive SARS-CoV-2 RT-PCR result from a nasal wash on July 31, 2020 (day 1). He exhibited fever, increasing shortness of breath, a productive cough, and bilateral radiographic infiltrates, but normal oxygen saturation on room air and stable pulmonary function tests (FVC and FEV1 at 3.17 and 2.65 liters, respectively). Shortly after hospitalization, his dyspnea and oxygen requirement increased (3 LPM) and inflammatory markers were elevated (nadirs of lymphocyte 2.7 thousand/µL and platelet 158 thousand/µL;peaks of D-dimer 260 ng/mL, CRP 75.2 mg/L, ferritin 219 ng/mL, pro-calcitonin 0.22 ng/mL, and LDH 215 U/L). Imaging favored progression of SARS-CoV-2 pneumonia. DSA against DP1 measured 1350 MFI, and immunoglobulin therapy was started. The patient was managed with intravenous corticosteroid pulse, Remdesivir, and convalescent plasma along with appropriate antibiotic therapy due to additional concern for superimposed infection. On day 8 of illness onset, the patient no longer had clinical symptoms, and he was discharged on room air and steroid taper. On outpatient follow-up, the patients' endurance had increased;PFTs improved (FVC and FEV1 at 3.9 and 3.39 L, respectively);DSAs were reassuring;and radiographic changes had resolved by day 42 (Figure 1: serial chest imaging from illness onset to day 42). Of note, the ImmuKnow result at illness onset was 64 ng/mL, and mycophenolate (MMF) was reduced to 500 mg BID, after which the ImmuKnow result increased to 560 ng/mL. Seroconversion for SARS-CoV-2 IgG was mounted on day 26 (index 1.56), and MMF was resumed to baseline dose of 750 mg BID on day 35. Remarkably, prolonged viral shedding in nasal wash was noted with the first negative RT-PCR for SARS-CoV-2 on day 47. DISCUSSION: Our patient had excellent recovery with intact graft function despite prolonged virus persistence. Although an immunosuppressed state may have predisposed our patient to bacterial superinfection, reduction of MMF possibly augmented the antiviral response. Despite reduced IS, seroconversion and virus clearance may have been impacted. CONCLUSIONS: Immunosuppressed LTxRs with SARS-CoV-2 pneumonia may demonstrate prolonged viral shedding. Reduction in IS may facilitate allograft recovery despite delayed PCR conversion. Isolation measures should be considered due to possible prolonged infectivity. REFERENCE #1: Li F, Cai J, Dong N. First cases of COVID-19 in heart transplantation from China. J Heart Lung Transplant. 2020 May;39(5):496-497. REFERENCE #2: Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, Chen Z, Chen G. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020 Jul;20(7):1859-1863. DISCLOSURES: No relevant relationships by Ashwini Arjuna, source=Web Response No relevant relationships by Ross Bremner, source=Admin input No relevant relationships by Ericka Charley, source=Web Response No relevant relationships by Hesham Mohamed, source=Web Response No relevant relationships by Kristine Nally, source=Web Response No relevant relationships by Ashraf Omar, source=Admin input No relevant relationships by Deepika Razia, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=H noraria Speaker/Speaker's Bureau relationship with Grifols Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Shire Please note: $1001 - $5000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Astellas Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria

Purpose: To determine the accuracy of various corneal parameters in keratoconus diagnosis using Scheimpflug camera combined with Placido disk corneal topography (Sirius, CSO). Methods: One hundred and fifteen keratoconic eyes (group1) and a 111 normal eyes (group2) were assessed prospectively between March 2018 and July 2019 for: corneal keratometric indices (K1, K2, sim K, apex curvature) at different corneal rings of both corneal surfaces, central corneal thickness (CCT), thinnest corneal thickness (TL), corneal asphericity (Q), elevation at thinnest point, root mean square (RMS), and root mean square per area (RMS/A) in spherical, aspheric and aspherotoric reference for both corneal surfaces and keratoconus summary parameters; surface asymmetry index of front and back (SIf, SIb respectively), elevation at keratoconus vertex front and back (KVf, KVb respectively), Baiocchi Calossi Versaci front and back index (BCVf, BCVb) and its vector summation (BCV) and convergence radius and cutoff value for each was calculated Results: All studied indices were significantly different between the two groups. The highest predictive accuracy “Area under receiver operating characteristic curve (AUROC)” of 0.999 was observed for BCVf, KVb, RMS and RMS/A at 6 mm aspherotoric reference posterior surface. Keratoconus summary indices had high AUROC (0.986, 0.984, 0.948, 0.999, 0.999, 0.998 respectively). Curvature indices had lower AUROC than elevation indices, except for curvature of corneal apex at anterior (0.98) and posterior surface (0.99). Higher AUROC was noted with elevation at thinnest point especially at aspherotoric reference surface. Conclusion: Sirius topography showed high predictive accuracy in detection of keratoconus. Elevation indices and keratoconus summary parameters have the highest diagnostic ability.

Background Conventional MR imaging is not enough for evaluation of symptomatic foraminal stenosis, because there is high incidence of false-positive results in asymptomatic elderly patients. Conventional MR cannot quantitatively assess the severity of the nerve lesion. DTI is a non-invasive way to effectively trace the nerve fiber bundle and quantitatively evaluate the nerve injury. DTI with fiber tracking may describe abnormalities beyond the resolution of conventional MR techniques. The aim of this work was to compare between the mean values of diffusion parameters such as fractional anisotropy and apparent diffusion coefficient of the compressed lumbar spinal nerve roots and of the contralateral normal nerve roots. Correlate these parameters with the severity of neurological symptoms. This is a prospective study that was conducted on 50 patients with symptomatic unilateral posterolateral lumbar disc prolapse at a university hospital. They were investigated with diffusion tensor imaging with tractography on a 1.5-T MR. The changes in the mean fractional anisotropy and apparent diffusion coefficient values of the compressed nerves and the relationship between these changes and the severity of the neurological side effects using Japanese Orthopedic Association score and visual analogue scale were investigated. Results The mean fractional anisotropy values were significantly lower (p ≤ 0.001), and mean apparent diffusion coefficient values were significantly higher (p ≤ 0.001) in compressed nerves than in contralateral intact nerves. There were strong correlations between the DTI parameters and the severity of the neurological symptoms as assessed using the Japanese Orthopedic Association score and the visual analogue scale. Conclusion In patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots and this affection is correlated with the degree of prolapse and with the severity of neurological symptoms. DTI with fiber tracking provide clinically relevant information and describe abnormalities beyond the resolution of conventional MR techniques.

Exosomes isolated from plasma of lung transplant recipients with allograft injury contain donor‐derived lung self‐antigens (collagen V and Kα1 tubulin) and human leukocyte antigen (HLA) molecules. We present a case of a 76‐year‐old, female lung transplant recipient treated for acute cellular rejection with methylprednisolone and anti‐thymocyte globulin, who subsequently contracted SARS‐CoV‐2 and developed a sharp increase in the mean fluorescent intensity of anti‐HLA antibodies. Analysis of circulating exosomes during rejection, but before SARS‐CoV‐2 infection, revealed the presence of lung self‐antigens and HLA class II molecules. After the patient contracted SARS‐CoV‐2, exosomes with the SARS‐CoV‐2 spike protein were also found. After resolution of infectious symptoms, exosomes with SARS‐CoV‐2 spike protein were no longer detected; however, exosomes with lung self‐antigens and HLA class II molecules persisted, which coincided with a progressive decline in spirometric flows, suggesting chronic lung allograft dysfunction. We propose that the analysis of circulating exosomes may be used to detect allograft injury mediated by both rejection and infection. Furthermore, the detection of exosomes containing viral proteins may be helpful in identifying allograft injury driven by viral pathogens.

Objectives: To outline two surgical strategies for managing traumatic incudostapedial joint disarticulation (ISJD) with intact tympanic membrane (TM), aiming for improving the stability and the functional outcomes of the procedure.Patients and Methods: This randomized controlled clinical trial was performed on 27 ears of 27 patients with isolated traumatic ISJD with intact tympanic membrane. The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: anatomical reconstruction group (n=14), and stapes bypass group (using a Teflon piston) (n=13). Air and bone conduction thresholds at frequencies 500–4000 Hz, were determined pre- and postoperatively.Results: The postoperative pure-tone average and mean air-bone gap (ABG) were statistically significantly different (p < 0.001). The mean postoperative gain of air conduction (AC) threshold and consequently the mean postoperative ABG closure were significantly better with the stapes bypass group compared to the bone cement one. ABG closure to within 10 dB in the stapes bypass group was found in 11ears (84.6%), while in bone cement group, closure to within 10 dB was found in 10 (71.4%) and to within 20 dB in 14.2%. The cochlear function remained stable postoperatively in both groups (p=0.422). No complications were reported, and no patient had a postoperative ABG greater than 30 dB.Conclusion: When the ISJ is dislocated, two options exist for ossicular reconstruction: bypassing the stapes using Teflon piston (stapedotomy) and anatomical reconstruction using ionomeric bone cement. Both techniques are successful with no statistically significant difference regarding hearing outcomes.

Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic., Highlights • Simulation was used to prepare surgeons for challenges of the COVID-19 pandemic • Level of confidence improved significantly as a result of the simulation training • It was a key strategy to test and improve the Standard Operating Procedures

Purpose To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up. Methods A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity. Results Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively. Conclusions Alcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.

Objectives: In oropharyngeal squamous cell carcinoma (OPSCC), toll-like receptors (TLR) 5 and 7 associate with the tumor's human papilloma virus (HPV) status (Jouhi et al., 2017). TLR 2, on the other hand, has been linked to head and neck squamous cell carcinoma (HNSCC), and to oral carcinogenesis (Farnebo et al., 2015; Binder Gallimidi et al., 2015). Here we investigated the presence of TLR 2 and 4 in HPV-positive and HPV-negative OPSCC, and their relationship to opportunistic oral pathogen Treponema denticola chymotrypsin-like protease (Td-CTLP) immunoexpression, clinical parameters, and patient outcome. Materials and methods: Clinicopathological data of 198 unselected consecutive OPSCC patients came from hospital registries. Immunoexpression of TLRs 2 and 4 we evaluated by immunohistochemistry, and earlier in this patient series we studied immunoexpression of Td-CTLP and HPV DNA, HPV mRNA, and p16 status. Results: Immunoexpression of both TLRs 2 and 4 showed a significant association with HPV-status. Strong expression was associated with HPV-positivity and mild expression with HPV-negativity. Patients with strong TLR 2 immunoexpression in the HPV negative subgroup had significantly poorer 5-year DSS (58%) than did patients with mild TLR 2 expression (77%), and strong TLR 2 immunoexpression remained as an independent factor linked to increased disease mortality in the multivariable setting (P = 0.019). No association existed between TLR 2 or 4 and Td-CTLP expression. Conclusion: Our results support the role of TLR 2 receptor as a possible target for development of therapeutics as earlier proposed (Farnebo et al., 2015). The involvement of Td and other oral pathogens in carcinogenesis of OPSCC, remains open and calls for further study.

Background Development of esophageal varices (EVs) is the main complication of portal hypertension. Early detection prevents variceal bleeding. Baveno VI consensus recommended endoscopy if transient elastography (TE) > 20 kPa and platelets below 150,000/mm3. Aim Assessment of the reliability of the albumin-bilirubin (ALBI), platelets-albumin-bilirubin (PALBI), albumin-bilirubin-platelets (ALBI-PLT) score, and gamma-glutamyl transferase-platelets (GAR) ratio as non-invasive models for prediction of EVs presence and the need for endoscopy in patients with HCV-related cirrhosis. Methods HCV-related F4 fibrosis by TE or cirrhosis patients were included (n = 661). Full metabolic profile, CBC, ultrasonography, and endoscopy were done. Results The average age was 42.89 years mainly males. Patients with EVs had statistically significant (p < 0.05) higher TE values, ALBI, ALBI-PLT, and PALBI than those without EVs. Both groups were comparable for GAR. Large varices were statistically (p < 0.05) associated with higher ALBI, ALBI-PLT, and PALBI. Both small and large varices had comparable TE and GAR. EVs detection cutoffs (sensitivity, specificity): TE > 20 kPa (83.64%, 91.62%), ALBI >− 2.43 (81.28%, 74.89%), ALBI-PLT > 3 (77.34%, 72.93%), and PALBI >− 2.28 (62.1%, 76.4%). On comparison of the ROCs, TE was better than ALBI (p < 0.05), ALBI-PLT, and PALBI. ALBI was better than ALBI-PLT and PALBI. Both ALBI-PLT and PALBI are comparable (p > 0.05). Positive indirect hemagglutination of schistosomiasis, portal vein diameter, splenic vein diameter, TE, ALBI, ALBI-PLT, and PALBI were independent predictors of EVs existence. On multivariate analysis, portal vein diameter, TE, and ALBI score were significant. Conclusion The ALBI, ALBI-PLT, and PALBI are useful predictors of EVs presence and the need of diagnostic endoscopy especially in centers that lack FibroScan.

Objectives: The study aims to assess the real-world incidence of hypoglycemia in patients with Type 1 Diabetes Mellitus (T1DM) or Type 2 Diabetes Mellitus (T2DM) in Egypt cohort of the International Operations Hypoglycemia Assessment Tool (IO HAT) study. Methods: This is a non-interventional study to estimate hypoglycemia in eligible patients with T1DM or T2DM, aged ≥18 years and treated with insulin for >12 months, who have completed self-assessment questionnaires to record demography, treatment information, and hypoglycemia during the 6-month/4-week retrospective and 4-week prospective periods. Data on hypoglycemia for this sub-analysis were collected from DM patients of Egyptian cohort who were recruited in IO HAT study across 36 sites in Egypt between 22 Nov 2014 and 15 Apr 2015. Results: Percentage of patients who reported at least one hypoglycemic event in the prospective period was any: T1DM: 96.3% (95% confidence interval [CI]: 89.6%, 99.2%) and T2DM: 93.1% (95% CI: 89.8%, 95.6%) and severe: T1DM: 67.5% (95% CI: 56.1%, 77.6%) and T2DM: 64.2% (95% CI: 58.7%, 69.4%). An estimated rate of any and severe hypoglycemia in the prospective period was 63.3 (95% CI: 57.2, 69.9) events per patient year (PPY) and 28.9 (95% CI: 24.8, 33.4) events PPY, respectively, for patients with T1DM and 32.0 (95% CI: 29.8, 34.3) events PPY and 15.5 (95% CI: 14.0, 17.1) events PPY, respectively, for patients with T2DM. Hypoglycemic rate was independent of glycated hemoglobin levels. Conclusion: The self-reported hypoglycemia data from Egypt confirms that hypoglycemia is under-reported. The high impact of hypoglycemia on the Egyptian DM patients and healthcare system warrants patient education to prevent hypoglycemia.

Objective of the study: Evaluate some of the non atretic indications for endoscopic infantile nasal surgery regarding surgical technique, safety, and success.Patients and Methods: Retrospective analysis of 14 infants required endoscopic nasal surgery for severe non atretic nasal blockage in ORL department mansoura university hospital between 2010 and 2017, their age ranged between 1 month and 19 months, 8 female and 6 males. The indications were nasal obstruction due to craniofacial anomaly (Cruozon syndrome) 3 cases, post traumatic nasal adhesions 10 cases, and congenital pyriform aperture stenosis in 1 case. Endoscopic nasal surgery was conducted to perform widening of the nasal airway through bilateral partial inferior turbinectomy in Cruozon syndrome, nasal adhesolysis with or without stenting in post traumatic nasal adhesions, or trans nasal correction of pyriform aperture stenosis.Results: All patients showed postoperative improvement without restenosis or complications during follow up period in all study groups, only one patient of nasal adhesions group showed restenosis and didn’t complete the follow up.Conclusion: TVarious non atretic indications for infantile endoscopic surgery as nasal adhesions, nasal obstruction in crouzon syndrome and CPAS could properly managed with endoscopic surgery. Careful management of nasal obstruction during neonatal care with delicate handling is very important to avoid unnecessary complications as nasal adhesions. Proper knowledge and experience with endoscopic surgery in this age is mandatory regarding the preoperative preparation and planning, operative technique, and post operative follow up. The technique is challenging and required good experience yet it is rewarding and mostly successful.

Background: Juvenile idiopathic arthritis (JIA) is generally considered a clinical syndrome involving several disease subsets, with a number of inflammatory flows, leading to an eventual common pathway in which persistent synovial inflammation and associated damage to articular cartilage and underlying bone are present. Neoptrin is a reliable marker in the assessment of the rate of IFN-γ production. Levels of neoptrin increase in direct proportion with the level of interferon. Measurement of neopterin level is useful because of its relative stability also it is a prognostic indicator for cell-mediated immunity. Aims: This study aims to assess serum level of neopterin in patients with Juvenile Idiopathic Arthritis (JIA) in relation to the disease activity, severity and response to conventional and biological therapy. Methodology: The study was conducted on 30 patients (Group A) previously diagnosed as SoJIA, they were divided into two subgroups according to their therapy into Group AI on biological therapy (15 patients) and Group AII on conventional therapy (15 patients). These in addition to 20 healthy controls (Group B). Results: Basic clinical evaluation and laboratory investigations were done. We found that JIA patients had significantly higher levels of serum neopterin than healthy controls. We also found a highly significant difference between neopterin levels in the activity and remission states among all patients (Group AI and Group AII). Conclusion: We concluded that serum neopterin is a useful marker for cellular immune activation and also indicative of the activity of JIA. Our findings are supported by positive correlations between serum neopterin levels and other markers of activity as TLC, PLT counts, ESR, and CRP. We also concluded that serum neopterin is a sensitive and accurate predictor of disease activity where sensitivity of that test was 93.3% and accuracy was 72.5%. Recommendations: Investigating the serum neopterin measurement in other autoimmune collagen diseases. Assessment the influence of biological therapy on neopterin levels in relation to disease progression.

Chronic, low-grade adverse events are common in patients with chronic myeloid leukemia who are treated with imatinib. These events may decrease patient quality of life and adherence, and may ultimately contribute to a suboptimal response. Alternative, second-generation tyrosine kinase inhibitors, such as dasatinib, are available with the potential to reduce adverse events, improve tolerability, and support long-term treatment goals. We present the final, primary analysis of DASPERSE/CA180-400 (NCT01660906), an open-label, multicenter, phase IV study designed to determine whether chronic, low-grade nonhematologic adverse events in imatinib-treated patients improve after switching to dasatinib, without affecting efficacy. Of the 121 chronic, grade 1/2, imatinib-related adverse events identified at baseline in 39 patients, 77% resolved or improved within 3 months after switching to dasatinib. Dasatinib maintained a consistent safety profile; headache (33%), pleural effusion (26%), fatigue (23%), and rash (23%) were the most common treatment-related adverse events after the switch. Patients either maintained (56%) or improved (44%) their molecular response on dasatinib. Patients who switched to dasatinib also experienced improved patient-reported symptom burden from baseline as assessed by the MD Anderson Symptom Inventory for chronic myeloid leukemia (on a 1–10 scale, mean change in disease-specific score was − 2.24 and core symptom severity score was − 1.06). Overall, the efficacy and quality of life/symptom burden improved in many patients, despite the onset of dasatinib-related adverse events in most patients. This suggests that imatinib-treated patients with chronic, low-grade adverse events could benefit from switching to treatment with dasatinib. Electronic supplementary material The online version of this article (10.1007/s00277-018-3295-8) contains supplementary material, which is available to authorized users.