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Background: Intrauterine growth restriction (IUGR) is a condition in which the fetus does not reach its growth potential. It is well known that a fetus affected with late IUGR has smaller abdominal size. The aim of the study is to evaluate the fetal liver size, fetal hepatic artery blood flow and other fetal vascular Doppler indices in cases of late IUGR. Methods: This observational analytical, cross-sectional study was carried out on 100 pregnant women at or above 32 weeks. Participants were divided into two groups: Group 1 (study group): 50 pregnant women as study group who were affected with IUGR. Group 2 (control group): 50 normally pregnant women as control group. Results: There was no statistically significant correlation between fetal weight and liver length. There was a positive highly statistically significant correlation between symphysial fundal height and the estimated fetal weight by ultrasound in cases of IUGR. There was a statistically significant decrease in the liver size in IUGR compared to the normal group. There was a statistically significant reduced hepatic arterial Doppler indices. Conclusions: Reduced liver size and hepatic arterial Doppler indices (PI, RI) can be valid diagnostic methods in IUGR. SFH, in fetuses suffering from IUGR when compared to normal cases, was correlated with EFW.

Background: Throughout the fourth week of embryonic development the umbilical cord (UC) is formed, which corresponds to the fifth to the twelfth weeks of gestation. Fetuses with intrauterine growth restriction (IUGR) have leaner UCs than fetuses of appropriate gestational age do, and the caliber of the umbilical vein decreases significantly, resulting in a worsening of the Doppler parameters of the umbilical artery in the mother. The goal of this study was to evaluate the significance of sonographic UC diameter in determining gestational age in third trimester in pregnant women. Methods: We conducted a comparative cross-sectional research on 300 pregnant women aged range between (20-35) years, singleton gestation, gestational age (3rd) trimester estimated from antenatal mothers last menstrual period (LMP), viable fetus, presenting to obstetrics and gynecology department at Tanta university hospital. Results: Highly statistically significant positive correlation between UC diameter and gestational age, BPD, FL, AC, AFI, and estimated fetal weight was found. The increase in UC diameter was positively and significantly correlated with the increase in gestational age and estimated fetal weight, indicating that those who have prolonged gestational age and estimated fetal weight are more likely to have wider UC diameter. Conclusions: The UC diameter (UCD) has the potential to be a valuable indicator of fetal growth, well-being, and perinatal outcome. Sonographic measurement of UC diameter could be an efficient method of measuring fetal growth and predicting gestational age (GA), particularly between 28-40 weeks GA. It is possible that abnormal UC diameter can be a strong indicator to identify antenatal mothers at risk for IUFD and poor fetal outcomes.

BackgroundThere are several surgical strategies involved in the treatment of patients with tentorial meningioma, and choosing the most appropriate one is not straight forward. Our study aims to illustrate our experience in the management of tentorial meningiomata at our center.ResultsThis study included 32 patients with tentorial meningiomas, operated upon, with assessment of the extent of resection and the Glasgow outcome score (GOS). The mean age at the time of surgery for the studied group was 48.4 years ranging from 20 to 70 years. Total removal was considered as Simpson grade I or II and was achieved in 26 cases (81.25%). Subtotal removal was considered as Simpson grade III or IV and was achieved in 6 cases (18.75%). The final Glasgow outcome score (GOS) for all cases was GOS 1 in 4 cases (12.5%), GOS 4 in 9 cases (28.2%), and GOS 5 in 19 cases (59.3%).ConclusionTentorial meningiomas can be very challenging during surgery due to their proximity to vital structures. Subtotal resection should be considered when total removal can be hazardous to the patient or result in severe morbidity.

OBJECTIVE To present long-term outcome of Yang-Monti ileal ureter, with a focus on patients with mild/moderate loss of kidney function and solitary kidney. PATIENTS AND METHODS Between March 2001 and December 2019, Yang-Monti ileal ureter was performed on 36 patients with ureteric defects and median age 46.5 years. Of these, 4, 14, 15 and 3 patients had stage 1, stage 2, stage 3a and stage 4a chronic kidney disease, respectively; 6 had solitary kidney. Patients were regularly followed for complications, morphological, and functional outcome. RESULTS Ureteric stricture etiology was iatrogenic (16), Bilharzial (7), tuberculous (4), retroperitoneal fibrosis (5), malignancy (3), and gunshot injury (1). The median (range) ureteric defect length was 11 (8-16) cm. Four grade 1/2 postoperative Clavien-Dindo complications were noted. Median follow-up was 68 months (range 12-215). Intestinal obstruction developed in 1 patient and urinary tract infection in 10. At last follow-up, serum creatinine, split renographic clearance, and estimated glomerular filtration rate showed significant improvement compared to preoperative values, in the whole series, in cases with chronic kidney disease (stages 2, 3a and 3b) and solitary kidney. Four cases with chronic kidney disease (stage 3) showed deterioration of the kidney function parameters. Magnetic resonance urography showed improvement of hydronephrosis in most patients. No metabolic complications were noted. CONCLUSION Yang-Monti Ileal ureter is durable and effective in improving kidney function with few complications. It can be safely used in cases of mild/moderate kidney function loss and solitary kidney. A threshold eGFR

Background: The aim of this study was to evaluate the prognosis of minimal invasive horizontal alveolar ridge augmentation using small incision and subperiosteal tunneling technique. Methods: This study was conducted on 10 partially edentulous patients with horizontal alveolar bone deficiency in 12 areas that need horizontal alveolar ridge augmentation for future implant placement. Cone beam computer tomography was done for sites that need implant placement preoperatively. Xenogeneic bone was used for grafting deficient horizontal alveolar ridge sites using the flap technique in 6 areas and using the subperiosteal tunneling technique in another 6 areas for future implant placement. Cone beam computer tomography was done for grafted sites immediately postoperative and 6 months postoperative. Results: This study was conducted on 10 patients and included 12 implant sites. No complications related to bone grafting were found and there was an adequate clinical prognosis. Regarding the difference from pre-operatively to 6 months post-operatively, a slightly higher increase in ridge width was recorded in subperiosteal tunnel group (1.48±0.99) in comparison to flap group (0.91±0.94), with no statistically significant difference (p=0.086). Conclusions: The bone graft material retained within a pouch formed using small incision and subperiosteal tunneling technique resulted in additional increase within the width of the alveolar ridge than the flap technique. Keywords: alveolar ridge augmentation, Dental implants, xenogeneic bone graft and subperiosteal tunneling technique.

Background There is compelling support for implementing prehabilitation to optimize perioperative risk factors and to improve postoperative outcomes. However, there is limited evidence studying the application of multimodal prehabilitation for patients with breast cancer. Objective To determine the feasibility of multimodal prehabilitation as part of the breast cancer treatment pathway. Design This was a prospective, cohort observational study. Breast cancer patients undergoing surgery were recruited. They were assigned to an intervention or control group according to patient preference. Setting UK prehabilitation center. Participants A total of 75 patients were referred during the study period. Forty eight patients (64%) did not participate; 20 of those opted to be in the control group. Twenty four patients engaged with prehabilitation and returned completed questionnaires. In total, 44 patients were included in the analysis. Interventions The program consisted of supervised exercise, nutritional advice, smoking cessation, and psychosocial support. Outcome measures Feasibility was determined by the center's ability to deliver the program. This was measured by the number of patients who wanted to access the service, compared with those able to. Service uptake, patient satisfaction, and project costs were recorded. Patient-reported outcomes (PROs) and the use of healthcare resources were also evaluated. Results A total of 61 patients (81%) wanted to participate; 24 (32%) were able to partake and return questionnaires. Reasons for nonparticipation included surgery within weeks, full-time commitments, and transportation difficulties. A total of 25 (93%) prehabilitation patients recorded high satisfaction with the program. There was a significant reduction in anxiety among prehabilitation patients. There were no significant improvements in the other PROs. There were no changes to hospital length of stay, readmissions, and complications. Conclusions Multimodal prehabilitation is a feasible intervention. Logistical challenges need to be addressed to improve engagement. These results are limited and would require a larger sample to confirm the findings. Work on a thorough cost-benefit analysis is also required.

Background: Hormone resistin is linked to the development of insulin resistance, but direct evidence of resistin levels in humans with nonalcoholic fatty liver disease (NAFLD) is lacking. Objective: To study the role of fibroscan and resistin level in diagnosis of nonalcoholic fatty liver patients. Methods: This study was conducted on60 NAFLD patients, 27 patients with nonalcoholic steatohepatitis (NASH), and 33 patients with simple steatosis, who were admitted to Tropical Medicine Department in Shebin El-Kom Fever Hospital and 30 healthy subjects as control. Patients were subjected to meticulous history taking, clinical examination, routine laboratory investigations, abdominal ultrasound, fibroscan, and measurement of serum resistin level. Results: Serum resistin can be used to discriminate between simple steatosis group and NASH group at a cutoff level of > 10.5, with 53.3% sensitivity, 83.3% specificity, 76.1% PPV and 64.1% NPV (AUC = 0.73 and p-value = 0.002). Also, there was a significant difference in fibroscan score in comparison between groups, NASH group represented the highest score. There was a significant relation between serum resistin level and fibroscan score in both NASH and simple steatosis groups. Conclusion: Fibroscan and serum resistin level can be used for diagnosis of nonalcoholic fatty liver and for discrimination between simple steatosis and NASH patients.

Purpose: To compare success rate as well as difference of marginal bone loss around immediately placed non-functionally loaded implants in osteoporotic patients versus non-osteoporotic patients. Material & Methods: The present study was conducted on 12 patients, six of them were osteoporotic and the other six were normal healthy patients. Both groups underwent immediate post extraction implantation, with a total of 16 implants. Each patient was a candidate for single tooth replacement in the mandibular arch at the premolar area. CBCT was performed at the intervals of immediately after implant installation and 6 months postoperatively. This is to determine radiographic bone loss from initial surgery. Periotest was used to determine the implant mobility at the intervals of immediately after implant installation and 6 months postoperatively. Results: The marginal bone level (flushed implant-bone crest to implant apex) baseline records at time of implant placement was used for all cases as a reference. And then, measurements were taken again after six months to detect the change in the marginal bone level for both groups. After 6 months, the mean marginal bone loss of the osteoporotic group was slightly higher than the normal group but yet not of significant difference. There was no statistically significant bone loss difference between the two groups at the buccal and lingual surfaces either in coronal or sagittal sections. Conclusion: The results of this study suggest that dental implants inserted immediately following extraction in osteoporotic patients do present success rates nearly equivalent to those implants placed in normal patients.

Background: Infertility and its problems are one of the most vital problems that ranges from 10% to 15% among couples. Chronic variable stress (CVS) disrupts normal homeostasis of a variety of body systems and is a major cause of male infertility. Ginger is known to have anti-inflammatory and antioxidant properties via its free radical scavenging activity so it can be used in various experimental models as a protective agent against various toxicants. Objectives: The current work aimed to study the effect of chronic variable stress on the testis and the possible protective and therapeutic roles of the ginger on this effect. Materials and Methods: thirty-five adult male albino rats were divided into five groups. Group I; control, group II received ginger only, group III subjected to CVS, group IV CVS + pretreated with ginger and group V CVS + post-treated with ginger. All rats were weighted, sacrificed, blood samples collected to asses testosterone hormone, the testis was weighted to calculate gonadosomatic index and processed for light microscopic study. Paraffin sections were stained by hematoxylin and eosin stain. Immunohistochemical staining for PCNA, caspase-3 and androgen receptor were also performed. Results: CVS induced decreased gonadosomatic index, testosterone hormone level, destructive effects on the testis as decreased spermatogenic cells and sperm count, detachment of the cells, vacuolations and apoptosis. Ginger produced great improvement of these effects which was pronounced in the protected group (IV) than the treated one (V). Conclusion: CVS caused apoptotic changes in testis and ginger had ameliorating effects on these changes.

This study aimed to determine the predictors of fear-avoidance beliefs, pain, and disability indices in patients with chronic low back pain (LBP). A cross-sectional study was carried out on patients with chronic LBP attending the rheumatology outpatient clinics at Suez Canal University Hospital. Convenience sampling was used, and the main outcome measures were fear-avoidance beliefs, pain, and disability indices, which were measured using structured questionnaires. Mean age was 47 ± 13.4 years; mean body mass index (BMI) was 30.4 ± 5.47. Mean scores of the fear-avoidance belief questionnaire (FABQ)-total, FABQ-physical, FABQ-work, and Oswestry Disability Index (ODI) were 51.6 ± 16.1, 21.2 ± 5.8, 30.5 ± 11.4, and 42.35 ± 14.8, respectively, while median visual analog scale (VAS) score was 70 (50–80). There was a strong correlation among FABQ-total, VAS, and ODI; FABQ-P (r = 0.86, P

The aim of this meta-analysis is to explore the effect of IL-2RA vs rATG on the rate of acute rejection, post-transplant infections, and graft as well as patient's survival in standard- and high-risk renal transplant patients receiving tacrolimus-based maintenance immunotherapy.Random effects model was the method used for identifying risk difference. Confidence interval including the value 1 was used as evidence for statistically significant risk difference. Heterogeneity was assessed using Der Simonian analysis. Heterogeneity was evident at the level of P value 0.1 RESULTS: The random effects model showed no significant differences in both acute rejection rates between IL-2RA and rATG induction therapies with relative risk of 1.24 graft survival with relative risk 0.90. Patient survival also did not demonstrate any significant difference with a relative risk of 1.19. Random effects for CMV infection showed a lesser tendency for CMV infection in IL-2RA group compared to ATG group the with a relative risk of 0.73.In subgroup analysis, the random effects model for acute rejection rates in high-risk transplants showed a higher risk of acute rejection in the IL-2RA group compared to rATG (relative risk equals 1.55) In standard-risk transplants, there were no significant differences between both groups with relative risk equals 1.02 CONCLUSIONS: This meta-analysis revealed no significant difference in patient and graft survival when using IL-2RA vs rATG with the tacrolimus-based maintenance immunosuppression era. However, subgroup analysis showed less incidence of rejection in high-risk renal transplant recipient's population using rATG compared to IL-2RA.

Kidney allograft failure is a significant complication in kidney transplant recipients, and the surgical decision to perform allograft nephrectomy poses a strong dilemma because it is associated with significant morbidity and mortality. There is a debate over the effect of allograft nephrectomy on the development of allosensitization and the impact on potential retransplantation. Moreover, the use of immunosuppression may contribute to antibody allosensitization as allograft nephrectomy and immunosuppression act jointly and interdependently toward antibody formation. Because more and more patients with kidney allograft failure are entering wait lists for repeat transplant procedures, a review of available evidence on the field is required. Here, we performed a literature search using multiple medical databases to identify relevant studies that assessed the effects of allograft nephrectomy on important retransplant endpoints such as allograft and patient survival; furthermore, secondary outcomes such as alloantibody sensitization were also evaluated. A total of 15 studies were identified; all were retrospective, single-center studies. The rate of allograft nephrectomy in patients with retransplant varied widely (from 20% to 80%). The average allograft nephrectomy rate in included studies was 43% (allograft nephrectomy number/number of repeat transplantations: 2351/5431). Most studies did not observe an allograft survival benefit after retransplant for patients with allograft nephrectomy with the exception of 4 studies that found worse allograft survival after allograft nephrectomy. Interestingly, 1 study found that, in the patient subgroup with early kidney allograft failure (

Background Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in end-stage renal disease patients. The incidence of valvular heart disease is 5 times greater in dialysis patients than in the general population MGP plays a key role in the inhibition of tissue calcification, which was demonstrated in MGP-deficient mice Objective To detect the prevalence of cardiac valvular calcifications among end stage renal disease patients on prevalent haemodialysis and its relation to Matirx Gla protein. Patients and Methods Enrolled patients were recruited from Ain shams hospitals, divided into two groups according to the presence/absence of valvular calcifications on echocardiographic examination as follows: Group A: included patients with valvular calcifications. Group B: included patients without valvular calcifications. Results In current study, 19 (23.8%) patients showed mitral calcification, 30 (37.5%) showed aortic calcification and 44 (55.0%) had calcification in general as 5 patients had both mitral and aortic calcifications. In current study, the patient who had calcification were significantly older, heavier in weight and BMI and were had HD for longer than those who didn’t have calcification. Patient who had calcification had lower levels of both platelets and urea than those who didn’t have calcification. In current study, the mean ucMGP was 549.5 ± 160.1 and the patient who had calcification had higher levels of ucMGP than those who did not have calcification. There was a significant positive correlation between age, weight, BMI, duration of HD and ucMGP. And there was a significant negative correlation between platelet count, serum albumin and ucMGP. Conclusion In current study, MGP was able to significantly differentiate between patients with and without calcification at a cutoff point (>564 pg/mlv) with sensitivity 86.36%, specificity 97.22. Our study confirmed that older age, hypertension, diabetes mellitus low platelet, higher ucMGP and blood urea are the most predictive parameters of valvular calcifications in hemodialysis patients. Other markers were not associated with valvular calcifications. ucMGP serum levels can significantly differentiate between HD cases with valvular calcifications and those not and those who had findings in CXR.

Background Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia. Patients and Methods This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months. Results Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P Conclusion Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.

Clinical practice guidelines of hepatitis E treatment post solid organ transplantation would undoubtedly help improve management of these cases. Whilst hepatitis E viral infection runs a benign course in healthy individuals, it can lead to persistent hepatitis and liver cirrhosis in immunocompromised patients including patients with solid organ transplantation. Available treatment options of these cases lack supporting robust evidence and they are derived from limited number of case series. There are no randomised clinical trials that help inform clinicians' decision making. This results in some gaps in the current guidelines that may require further attention. We hereby present a kidney transplant recipient who developed hepatitis E viral infectio

In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification. A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients’ demographics, routine laboratory and imaging work-up. CT was performed for all, and images were classified based on Huang and Tseng classification. The CT classification was correlated to the laboratory parameters and the final treatment plans. Data were collected and analyzed using SPSS®. Complete data for 34 patients were analyzed. The majority (70%) had positive urine culture, and Carbapenems and Ureidopenicillin were the most commonly used antibiotics. Based on CT classification, 75% (26/34) of the patients were in class I and II, 6 cases with class IIIa, and only two with class IIIb, with no cases of class IV. All patients in class I and II responded well to the medical therapy, and eight required PCN/DJ. Four required nephrectomy in class III, with zero mortality. Patients in class I and II comprise the majority of EP patients, and respond well to medical treatment with excellent outcome. Insertion of PCN and DJ are not required routinely, but with urinary obstruction requiring drainage, and a few cases who required nephrectomy–all with class III. Our data show improvement in the overall survival in patients for EP.

Background: There is substantial evidence that migration to Western countries is associated with an increased risk of metabolic syndrome (MetS)1. However, there is a paucity of data on the incidence of MetS in migrants from different countries coming to Qatar. As a result, an important health problem is overlooked, and prevention measures are absent. This study aimed to investigate the effects of migration on the incidence of MetS following 24 months of residency in the Middle East (ME) among a group of migrants employed at Hamad Medical Corporation (HMC). Methods: This is a prospective longitudinal observational study. Migrants aged 18–65 years who joined HMC from June to December 2017 were invited to consent and participate. Baseline screening for MetS was conducted. Parameters included glycated hemoglobin (HbA1c), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), blood pressure (BP), and waist circumference (WC) measurement. Migrants with normal metabolic parameters at baseline were invited to be rescreened 24 months post-migration. The International Diabetes Federation (IDF) Consensus Worldwide Definition of MetS was employed to diagnose MetS2. Inferential statistics were applied to compare results before and after migration. Throughout the study, migrants with metabolic abnormalities were referred to physicians for further management. Results: Of the 1,379 screened migrants, 472 consented to participate. Of those, only 205 migrants had normal metabolic parameters. The incidence of MetS within the group with normal parameters rose to 17% (n = 27) after 24 months of residing in Qatar. Eighty-one percent (n = 129) developed at least one element of MetS. Migrants receiving medications that potentially induce MetS were more likely to develop MetS (odds ratio OR [(AOR 6.3, p < 0.001); 95% [CI], 0.07-0.59. p = 0.003). Conclusion: The incidence of MetS amongst migrants increases following residency in Qatar however, it is lower than that estimated in many developed countries (3, 4).

Background: Osteoarthritis (OA) is the most common degenerative joint disease for which there is no permanent treatment. The most affected structures are articular cartilage and subchondral bone. Knees are the most affected by OA, thus leading to severe disability. N-Acetyl phenylalanine glucosamine (NAPA) is a derivative of glucosamine (GlcN), which is one of the components of glycosaminoglycans (GAGs) of cartilage extracellular matrix (ECM).Aim: This work aimed to study the possible curative effect of N-acetyl phenylalanine glucosamine on surgically induced osteoarthritis in the knee joint of the adult male albino rat.Materials and Methods: This study was performed on 30 adult male albino rats. They were divided into three groups: group I included ten animals that were subdivided into two subgroups, IA (control) & IB (underwent Sham operation), group II included ten animals underwent destabilization of medial meniscus (DMM) surgery without receiving any treatment, group III included ten animals underwent DMM surgery then received a single intraarticular injection of NAPA after 4 weeks from the surgery and sacrificed 4 weeks later. At the end of the experiment, knee joints were obtained and processed for histological and immunohistochemical studies.Results: Hematoxylin and Eosin-stained sections showed a moderate degree of OA in group II that was improved in group III. Mallory’s trichrome stained sections revealed decreased collagen content in group II that was also improved in group III. The same results were found as regards the GAGs content of the cartilage matrix that was clearly decreased in group II and restored in group III.Conclusion: From the present study, it could be concluded that the osteoarthritic changes induced by surgical DMM in adult male albino rats can be improved by subsequent intra-articular administration of NAPA.

Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney transplant include posttransplant anemia, leukopenia, neutropenia, and thrombocytopenia. Severely persistent leukopenia and neutropenia events predispose patients to infection, including opportunistic infections. The mainstay tactic for such complications is to reduce the burden of the immunosuppression by the offending agent, but this tactic is associated with increased risk of acute rejection. Given the absence of laboratory investigations to specifically identify the culprit, a complete withdrawal of these agents may be the ultimate diagnostic option. Future therapeutic strategies, however, should focus on reducing the immunosuppressive burden, the introduction of less myelotoxic agents, early recognition, and prompt treatment of infectious episodes. This will help in the optimization of the myelopoietic function and normalization of the hematological profile, resulting in better allograft and patient survival.

Background: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping. Case Description: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site. Conclusion: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.

The increased awareness of systemic sclerosis (SS) and its pathogenetic background made the management of this disease more amenable than previously thought. However, scleroderma renal crisis (SRC) is a rarely seen as an associated disorder that may involve 2%-15% of SS patients. Patients presented with earlier, rapidly progressing, diffuse cutaneous SS disease, mostly in the first 3-5 years after non-Raynaud clinical manifestations, are more vulnerable to develop SRC. SRC comprises a collection of acute, mostly symptomatic rise in blood pressure, elevation in serum creatinine concentrations, oliguria and thrombotic microangiopathy in almost 50% of cases. The advent of the antihypertensive angiotensin converting enzyme inhibitors in 1980 was associated with significant improvement in SRC prognosis. In a scleroderma patient maintained on regular dialysis; every effort should be exerted to declare any possible evidence of renal recovery. A given period of almost two years has been suggested prior to proceeding in a kidney transplant (KTx). Of note, SS patients on dialysis have the highest opportunity of renal recovery and withdrawal from dialysis as compared to other causes of end-stage renal disease (ESRD). KTx that is the best well-known therapeutic option for ESRD patients can also be offered to SS patients. Compared to other primary renal diseases, SS-related ESRD was considered for a long period of poor patient and allograft survivals. Pulmonary involvement in an SS patient is considered a strong post-transplant independent risk factor of death. Recurrence of SRC after transplantation has been observed in some patients. However, an excellent post-transplant patient and graft outcome have been recently reported. Consequently, the absence of extrarenal manifestations in an SS-induced ESRD patient can be accepted as a robust indicator for a successful KTx.

We aimed to report the demographics and management of iatrogenic ureteral injuries (IUIs) with different surgical specialties. Moreover, our goal was to analyze the predictors of late ureteral strictures and secondary intervention after primary surgical management, and the final effect on the kidney. A retrospective study, between 2006 and 2019, enrolled all patients undergoing urological, abdominal, and pelvic surgeries performed through open, laparoscopic, or endoscopic means. If IUIs were discovered intraoperatively, they were managed either by internal stent or surgical intervention following the standard procedure. For IUIs discovered postoperatively, either percutaneous nephrostomy (PCN) or double J (DJ) ureteral stents were inserted for later endoscopic or surgical management. The final outcomes were divided into two groups: patients with successful primary outcomes and those who required secondary intervention later. All predictors were compared between the two groups. Forty-eight patients were reviewed: 23 out of 48 (48%) from obstetrics and gynecology (ob/gyn) involving the lower ureter primarily with overall favorable outcomes (82%), 15 (31%) colorectal, and 10 (21%) urology with serious injuries affecting men in the upper ureter. The primary management included open surgery in 12 patients, and drainage (PCN or DJ) in 36 patients. Restoration of ureteral anatomy and kidney function was achieved in all, but 18 cases required a secondary correction, either endoscopically or surgically. Both early and late discovery resulted in the same outcome. On bivariate analysis, only the side of the injury (left side, p = 0.03), and the specialty (colorectal cancer surgeries, p = 0.01) were predictors for late ureteral strictures, and both sustained their significance in multivariate regression analysis. Iatrogenic ureteral injuries associated with ob/gyn surgeries involve the lower ureter, primarily with overall favorable outcomes (82%). Serious ureteroscopic IUIs affect men in the upper ureter with greater frequency. IUIs on the left side and colorectal cancer surgeries are the predictors for late strictures and secondary interventions.

Background Interleukin-2 (IL-2) antagonist has been used as an induction therapy in many centres in calcineurin inhibitor-sparing regimens. Tacrolimus has overwhelmingly replaced cyclosporine in the maintenance immunosuppressive protocols in many transplant centres. The aim of our study and meta-analysis is to explore the effect of IL-2 induction therapy on the rate of rejection and patient and graft survival in standard-risk renal transplant patients with tacrolimus-based maintenance immunotherapy. Secondary aims included assessment of the effect of IL-2 induction therapy on creatinine change and the risk of cytomegalovirus (CMV) infection. Methods We conducted a systematic review in different databases to identify studies and research work that assessed the effect of IL-2 antibody induction therapy on renal transplant outcomes. Inclusion criteria for our meta-analysis were all studies that compared IL-2 induction therapy with placebo or no induction therapy in standard-risk renal transplant recipients on tacrolimus-based maintenance immunosuppressive therapy. Data collected were the name of the first author, journal title, year of publication, country where the study was conducted, number of patients in the IL-2 induction therapy arm and in the placebo arm, number of patients who had biopsy-proven rejection and graft survival in each arm. A random effects model was used for the meta-analysis. Results Of the 470 articles found in different databases, 7 were included in the meta-analysis. Forest plot analysis for rate of rejection during the follow-up period post-transplant showed no significant difference between the groups. There was no evidence of heterogenicity between included studies (I2 = 21.8%, P = 0.27). The overall risk difference was −0.02 [95% confidence interval (CI) −0.05–0.01]. A random effects meta-analysis for patient and graft survival was performed using forest plot analysis and showed no significant effect of IL-2 receptor (IL-2R) antibody induction on patient or graft survival compared with placebo. The overall risk difference was −0.01 (95% CI −0.04–0.01) and 0.00 (95% CI −0.00–0.01), respectively. Three of the included studies showed no effect of basiliximab on creatinine change, two showed no effect on risk of CMV infection and two showed less risk of post-transplant diabetes in the basiliximab group. Conclusion IL-2R antibody induction therapy has no significant effect on the rate of rejection or patient or graft survival in standard-risk renal transplant recipients on tacrolimus-based maintenance immunotherapy. More randomized controlled studies are needed.

For decades, kidney diseases related to inappropriate complement activity, such as atypical hemolytic uremic syndrome and C3 glomerulopathy (a subtype of membranoproliferative glomerulonephritis), have mostly been complicated by worsened prognoses and rapid progression to end-stage renal failure. Alternative complement pathway dysregulation, whether congenital or acquired, is well-recognized as the main driver of the disease process in these patients. The list of triggers include: surgery, infection, immunologic factors, pregnancy and medications. The advent of complement activation blockade, however, revolutionized the clinical course and outcome of these diseases, rendering transplantation a viable option for patients who were previously considered as non-transplantable cases. Several less-costly therapeutic lines and likely better efficacy and safety profiles are currently underway. In view of the challenging nature of diagnosing these diseases and the long-term cost implications, a multidisciplinary approach including the nephrologist, renal pathologist and the genetic laboratory is required to help improve overall care of these patients and draw the optimum therapeutic plan.

Thrombotic microangiopathy (TMA) is one of the most devastating sequalae of kidney transplantation. A number of published articles have covered either de novo or recurrent TMA in an isolated manner. We have, hereby, in this article endeavored to address both types of TMA in a comparative mode. We appreciate that de novo TMA is more common and its prognosis is poorer than recurrent TMA; the latter has a genetic background, with mutations that impact disease behavior and, consequently, allograft and patient survival. Post-transplant TMA can occur as a recurrence of the disease involving the native kidney or as de novo disease with no evidence of previous involvement before transplant. While atypical hemolytic uremic syndrome is a rare disease that results from complement dysregulation with alternative pathway overactivity, de novo TMA is a heterogenous set of various etiologies and constitutes the vast majority of post-transplant TMA cases. Management of both diseases varies from simple maneuvers, e.g., plasmapheresis, drug withdrawal or dose modification, to lifelong complement blockade, which is rather costly. Careful donor selection and proper recipient preparation, including complete genetic screening, would be a pragmatic approach. Novel therapies, e.g., purified products of the deficient genes, though promising in theory, are not yet of proven value.

The glomerular diseases after renal transplantation can occur de novo, i.e., with no relation to the native kidney disease, or more frequently occur as a recurrence of the original disease in the native kidney. There may not be any difference in clinical features and histological pattern between de novo glomerular disease and recurrence of original glomerular disease. However, structural alterations in transplanted kidney add to dilemma in diagnosis. These changes in architecture of histopathology can happen due to: (1) exposure to the immunosuppression specifically the calcineurin inhibitors (CNI); (2) in vascular and tubulointerstitial alterations as a result of antibody mediated or cell-mediated immunological onslaught; (3) post-transplant viral infections; (4) ischemia-reperfusion injury; and (5) hyperfiltration injury. The pathogenesis of the de novo glomerular diseases differs with each type. Stimulation of B-cell clones with subsequent production of the monoclonal IgG, particularly IgG3 subtype that has higher affinity to the negatively charged glomerular tissue, is suggested to be included in PGNMID pathogenesis. De novo membranous nephropathy can be seen after exposure to the cryptogenic podocyte antigens. The role of the toxic effects of CNI including tissue fibrosis and the hemodynamic alterations may be involved in the de novo FSGS pathophysiology. The well-known deleterious effects of HCV infection and its relation to MPGN disease are frequently reported. The new concepts have emerged that demonstrate the role of dysregulation of alternative complement pathway in evolution of MPGN that led to classifying into two subgroups, immune complex mediated MPGN and complement-mediated MPGN. The latter comprises of the dense deposit disease and the C3 GN disease. De novo C3 disease is rather rare. Prognosis of de novo diseases varies with each type and their management continues to be empirical to a large extent.

Renal transplantation remains the best option for patients suffering from end stage renal disease (ESRD). Given the worldwide shortage of organs and growing population of patients with ESRD, those waitlisted for a transplant is ever expanding. Contemporary crossmatch methods and human leukocyte antigen (HLA) typing play a pivotal role in improving organ allocation and afford better matches to recipients. Understanding crossmatch as well as HLA typing for renal transplantation and applying it in clinical practice is the key step to achieve a successful outcome. Interpretation of crossmatch results can be quite challenging where clinicians have not had formal training in applied transplant immunology. This review aims to provide a worked example using a clinical vignette. Furthermore, each technique is discussed in detail with its pros and cons. The index case is that of a young male with ESRD secondary to Lupus nephritis. He is offered a deceased donor kidney with a 1-0-0 mismatch. His complement dependent cytotoxicity (CDC) crossmatch reported positive for B lymphocyte, but flow cytometry crossmatch (FCXM) was reported negative for both B and T lymphocytes. Luminex-SAB (single antigen bead) did not identify any donor specific antibodies (DSA). He never had a blood transfusion. The positive CDC-crossmatch result is not concordant with DSA status. These implausible results are due to underlying lupus erythematosus, leading to false-positive B-lymphocyte crossmatch as a result of binding immune complexes to Fc-receptors. False positive report of CDC crossmatch can be caused by the underlying autoimmune diseases such as lupus erythematosus, that may lead to inadvertent refusal of adequate kidney grafts. Detailed study of DSA by molecular technique would prevent wrong exclusion of such donors. Based on these investigations this patient is deemed to have "standard immunological risk" for renal transplantation.

Background: Poor clinical outcomes in cystic fibrosis are often associated with undernutrition. Nutritional status is an important prognostic marker, regardless of the level of respiratory function in the patient. Careful and repeated nutritional assessments allow for early detection of nutritional deterioration. Objectives: To assess the growth of cystic fibrosis children using different parameters as body mass index percentiles (BMIP) and standard anthropometric indexes, including height-for-age percentile (HAP), weight-for-age percentile (WAP) and compare between them as measures for nutritional failure in children with cystic fibrosis (CF). Methodology: This was a cross sectional study including fifty children of both sexes with CF below 12 years of age, recruited from the cystic fibrosis clinic, Specialized Children’s Hospital, Cairo University. Patients were subjected to full history taking including age at diagnosis, frequency of hospital admissions (per year), current medications and presence of complications. Thorough clinical examination was performed with special emphasis on anthropometric measurements including body weight, length/height, BMI calculation. Results: This study included 30 boys and 20 girls between 2 and 11 years old with a mean of 4.25 ± 2.30 yrs. Pancreatic insufficiency was found in 36% of patients, 28% had failure to thrive as the main complaint while 72% had recurrent chest infection as the main complaint. Growth assessment revealed that 21 patients (42%) were below −2 SDS for weight. As for BMI, 14 patients (28%) were below the 10th percentile. A highly significant negative correlation was reported between the weight SDS and the frequency of hospital admission (r = −0.412, p = 0.003). Furthermore, there was a highly statistical significant difference between the malnourished patients and the patients with average weight regarding the frequency of hospital admission (p

Transplant recipients are vulnerable to a higher risk of malignancy after solid organ transplantation and allogeneic hematopoietic stem-cell transplant. Post-transplant lymphoproliferative disorders (PTLD) include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissues to frank malignancy with aggressive behavior. Two main risk factors of PTLD are: Firstly, the cumulative immunosuppressive burden, and secondly, the oncogenic impact of the Epstein-Barr virus. The latter is a key pathognomonic driver of PTLD evolution. Over the last two decades, a considerable progress has been made in diagnosis and therapy of PTLD. The treatment of PTLD includes reduction of immunosuppression, rituximab therapy, either isolated or in combination with other chemotherapeutic agents, adoptive therapy, surgical intervention, antiviral therapy and radiotherapy. In this review we shall discuss the prevalence, clinical clues, prophylactic measures as well as the current and future therapeutic strategies of this devastating disorder.

Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Patients and Methods: This study is an interventional prospective cohort study; 48 prevalent HD patients were enrolled. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group two: 17 patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level 200 ng/mL and transferrin saturation (TSAT) >20 % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after 3 months. Results: On comparing the two groups, oral vitamin C in group 1 resulted in a statistically significant reduction in hepcidin levels [mean 2506.456 ± 1320.53 pg/mL to 1748.396 ± 1432.28 pg/mL (P = 0.03)], and a significant reduction in hs-CRP level [mean 8603.236 ± 2547.77 ng/mL to 5611.296 ± 2829.27 ng/mL] (P = 0.001) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.

Introduction Wire guided localisation (WGL) is the standard localisation technique for impalpable breast lesions. Radio-guided occult lesion localisation (ROLL) has been proposed as an alternative. We have been performing ROLL for therapeutic wide local excisions (WLE) and diagnostic excision biopsies (DEB) for the last 15 years. We present the largest reported consecutive series of ROLL excisions to date. Patients and methods One thousand thirty nine consecutive patients who underwent ROLL for impalpable breast lesions were identified from a prospectively collected database. 673 patients underwent WLE and 366 patients underwent DEB. Data were analysed from proformas completed at the time of the procedure by the radiologist and operating surgeon. These data were supplemented with an analysis of patient electronic records including specimen radiograph and histopathology reports. Results 99.1% of ROLL WLE revealed histological diagnoses of invasive cancer or DCIS. 98.7% of radiological abnormalities were identified on WLE post-excision radiographs (97.5% following DEB). Complete excision was recorded in 79.0% of the WLE patients following histological evaluation. 31.7% of DEB cases were pathologically upgraded to a malignant diagnosis. The presence of microcalcification, preoperative underestimation of the lesion size and symptomatic referral predisposed to incomplete excision status. Discussion ROLL is a safe and effective technique to localise impalpable breast lesions. In addition ROLL has potential technical and logistic advantages over WGL.

Background Flexible airway bronchoscopy is an accepted and frequently performed procedure in the evaluation of children with known or suspected airway and lung parenchymal disorders. Methods Between 2012 and 2015, retrospective analysis of 134 flexible bronchoscopies was done in Children’s Hospital, Cairo University, as regards demographic profile, clinical and radiological presentation and diagnostic indication. The results were analyzed on the basis of bronchoscopy inspection, conclusion and future recommendations. Results Patients indicated for flexible bronchoscopy presented clinically with unilateral diminished breath sounds in 24.6%, unilateral bronchial breathing in 17.9%, recurrent lower respiratory tract infection in 11.2%, persistent cough in 4.5% and stridor in 9.7%, others showed radiological findings in the form of unilateral hyperinflation in 9%, bronchiectasis in 3.7% and unilateral wheezes in 1.5%. Out of 134 patients undergoing bronchoscopy, 38% had foreign body (FB) in the airways although only 7.5% of patients had recalled a previous history of FB aspiration (15.6% in the trachea, 52% in the right side and 31.3% in the left side, among those patients 60.8% were males while 39.2% were females), 14.1% had tracheal abnormality, 26.8% had post inflammatory changes, 56.7% had right bronchus abnormality, 55.2% had left bronchus abnormality, bronchoalveolar lavage (BAL) was done in 30.6% of patients, FB was successfully removed in 15.6% of patients and further cardiothoracic intervention was needed in 29.8% of patients. Conclusion The combination of history, physical examination, and chest X-ray findings are crucial when investigating a child with suspected foreign body aspiration. Flexible bronchoscopy is effective for diagnostic and sometimes therapeutic purpose of problems in the upper and lower respiratory airways in children, with a high success rate as it significantly reduces the rate of negative rigid bronchoscopies and ultimately saves the child from undergoing an unnecessary procedure.

Rotaviruses are the most common infectious agents causing severe diarrheal diseases in young children globally. Three rare human rotavirus strains, two G3P[9] and one G3P[6], were detected in stool samples of children under 5 years of age hospitalized for gastroenteritis in Lebanon during the course of a surveillance study. Complete genomes of these strains were sequenced using VirCapSeq-VERT, a capture based high-throughput sequencing method. Genomic sequences were further characterized by using phylogenetic analyses with global RVA G3P[6]/P[9] strains, other vaccine and reference strains. Genetic analysis revealed that the G3P[6] strain emerged as a DS-1/Wa-like mono-reassortant strain with a potential Ethiopian origin. The two G3P[9] strains possessed a mixed DS-1/Wa/AU-1-like origin indicating that these may have evolved via multiple reassortment events involving feline, human and bovine rotaviruses. Furthermore, analysis of these strains revealed high antigenic variability compared to the vaccine strains. Additional studies are essential to fully understand the evolutionary dynamics of G3P[6]/P[9] strains spreading worldwide and their implications on vaccine effectiveness.

Introduction Despite widespread adoption for the localization of impalpable breast lesions the wire guided localization (WGL) technique has a range of disadvantages including high re-operation rates. Radio-guided occult lesion localization (ROLL) has been proposed as an alternative technique, which may have superior clinical outcomes and be more flexible in its clinical application. A retrospective study of outcomes following ROLL therapeutic wide local excisions (WLE) and diagnostic excision biopsies (DEB) was performed. This documented 12 years experience of the ROLL technique at a single institution to provide a comprehensive analysis of the largest UK based series of ROLL excisions and sentinel node occult lesion localisations (SNOLL). Methods 942 patients were identified who had been referred with non-palpable breast lesions from 2000-2012. 576 patients underwent WLE following a biopsy proven diagnosis of breast cancer. 366 patients underwent DEB. Prospective data collection was performed using bespoke proformas by the operating clinician. These data were supplemented with a retrospective analysis of prospectively collected data held on patient electronic records including evidence of radiological excision on specimen radiographs and histopathological characteristics including excision margin status. Sub-group analysis was performed to examine the outcomes from "same day" and "next day" protocols for ROLL/SNOLL procedures and to examine the effect of residual radioactivity levels in the excision bed on margin status. Results 99.0% of ROLL WLE returned histological diagnoses of invasive cancer or DCIS and 98.4% of radiological abnormalities were identified on post-excision specimen radiographs. 97.5% of radiological abnormalities were identified on post-excision radiographs following DEB. Surgical localisation was rated as easy in 92.3% of excisions and 29 adverse events were recorded as a result of the localisation procedure (3.1%). Complete histological excision was recorded in 77.8% of the WLE sub-group based on defined margin criteria with a median specimen weight of 50g. 31.7% of DEB were pathologically upgraded to a diagnosis of breast cancer. No significant difference was seen in complete excisions rates between "next day" (76.4%, n=250) and "same day" (78.8%, n=326) ROLL protocols (p= NS). No significant difference was seen when levels of residual excision bed radioactivity and complete excision rates were compared (p=NS). Sentinel Lymph Node (SLN) localisation was successful in 97.6% of cases (n=205) with an SLN positivity rate of 12.7%. No significant difference was identified between SLN localisation rates for "next day" vs. "same day" SNOLL protocols (p=NS). The presence of microcalcification as the radiological abnormality (p=0.0005), underestimation of lesion size on pre-operative imaging (p=0.0005) and symptomatic referral (p=0.001) were factors that predisposed to incomplete excision margin status. Conclusions ROLL/SNOLL can be safely and effectively used to accurately localize impalpable breast lesions in agreement with current evidence. In addition to highly accurate localization, ROLL also has technical and logistical advantages that may make it more acceptable than WGL for clinicians and patients. Citation Format: Simon C Hawkins, Iain M Brown, Kirsten Stepp, Sue Widdison, Donna Christensen, Mohsen El-Gammal, Alistair Paterson, Philip Drew. Radioguided occult lesion localization (ROLL). A 12-year single institution experience of 942 ROLL excisions [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-05.

Endocrine derangement and oxidative stress are two distinguishing features of obesity that have limited the success rate of various management strategies, especially physical activities. The objective of the current study was to examine the effect of 8 weeks of moderate-intensity regular exercise training on oxidative stress, appetite and weight loss in obese women compared with normal-weight women. Sixteen normal-weight (body mass index (BMI) 30 kg/m2) exercised on the bicycle ergometer at moderate intensity for 30 min, 3 times per week for 8 weeks. Blood samples were collected at the first day of training and 72 h after the completion of the training program which were then used for the measurement of F2-Isoprostanes, glutathione (GSH), oxidized glutathione (GSSG), leptin, adiponectin and nesfatin-1. Eight (8) weeks of training resulted in lower BMI, insulin, GSSG (P < 0.05), leptin (P < 0.01), and F2-Isoprostanes (P < 0.001) and higher nesfatin-1 levels (P < 0.01) relative to the levels at the pre-test stage in obese women. Also ∆leptin levels after exercise were positively correlated with ∆F2-Isoprostanes and ∆BMI. Eight weeks of moderate-intensity regular exercise program did not only induce weight loss and improve oxidative stress, but also modified insulin, leptin and nesfatin-1 concentrations, particularly in obese women. Key words: Endocrine derangement, oxidative stress, obesity, exercise, weight loss, leptin, nesfatin-1.

Background: Diabetic osteoporosis is caused by reduced bone mineral content due to the abnormal levels of sugar, protein, fat, and macroelements, such as calcium and phosphorus. Beside metabolic bone diseases, these changes at times lead to pathological fractures. Still, the effect of type 2diabetes (T2DM) on bone mineral density remains controversial. There are potential mechanisms behind the increased fracture risk that occurs in patients with diabetes, even those with increased bone mineral density. One potential link between diabetes and bone is the osteoblast-produced factor, osteocalcin. Objective: The aim of this study was to determine the level of osteocalcin in type 2 diabetic patients as a marker for early detection of osteoporosis. This may help early prediction and treatment of osteoporosis before bone mass density (BMD) affected. Subjects and Methods: Sixty diabetic patients (30 males and 30 females) aged33 –61years were recruited and classified by DEXA into three equal groups: patients with type 2 diabetes mellitus with osteoporosis, patients with osteopenia, and patients with normal bone, as well as twenty apparently healthy controls. The inclusion and exclusion criteria were applied for both patients and controls. All subjects included in this study were subjected to the following : Full history taking and clinical examination , laboratory investigations including complete blood picture (CBC) , fasting and post prandial serum glucose levels, serum creatinine, lipid profile (LDL, HDL, total cholesterol and triglycerides) and complete urine analysis. Serological test for osteocalcin by ELISA technique was used. Results: The results of the present study showed that serum osteocalcin level significantly decreased in diabetic patients with osteoporosis, osteopenia and normal bone as compared to healthy control subjects. Also, there was significant decrease in serum osteocalcin level in type 2 diabetic patients with osteoporosis as compared to those with osteopenia and normal bone density groups. Significant negative correlation was found between osteocalcin and HbA1c, LDL, duration of diabetes and TG in all diabetic patients groups, and positive correlation between osteocalcin, HDL, and BMD in all diabetic groups. Conclusion: Osteocalcin may have a role on prediction of osteoporosis in diabetic patients even before bone mineral density affected.

In view of the availability of new immunosuppression strategies, the recurrence of allograft glomerulonephritis (GN) are reported to be increasing with time post transplantation. Recent advances in understanding the pathogenesis of the GN recurrent disease provided a better chance to develop new strategies to deal with the GN recurrence. Recurrent GN diseases manifest with a variable course, stubborn behavior, and poor response to therapy. Some types of GN lead to rapid decline of kidney function resulting in a frustrating return to maintenance dialysis. This subgroup of aggressive diseases actually requires intensive efforts to ascertain their pathogenesis so that strategy could be implemented for better allograft survival. Epidemiology of native glomerulonephritis as the cause of end-stage renal failure and subsequent recurrence of individual glomerulonephritis after renal transplantation was evaluated using data from various registries, and pathogenesis of individual glomerulonephritis is discussed. The following review is aimed to define current protocols of the recurrent primary glomerulonephritis therapy.

Generally speaking, the laparoscopic cholecystectomy is performed by using three or four ports. Two ports laparoscopic cholecystectomy is a rarely performed procedure as it demands greater expertise and skills. Benefits of this technique are related to the cost this being cost effective with less scar forming as compared to the conventional approach of laparoscopic cholecystectomy. A group of twenty cases of laparoscopic cholecystectomy was performed by using only two ports. All procedures were completed successfully and no extra port or conversion to open procedure was indicated. Mean operation time was 60 minutes. No intra and postoperative complication occurred. Hospital stay was one day.

Sclerosing peritonitis, more commonly called abdominal cocoon, is a rare intra-peritoneal disease that is characterized by complete or partial encapsulation of the small intestine by a thick collagenous membrane. This disease mostly presents in the form of small bowel obstruction, however in our case the patient presented with intra-cocoon bleeding following a motor vehicle accident.

The present experiment is aimed to evaluate the hepatoprotective effects of purslane (PuE) and fig leaves (FlE) extracts on diclofenac-sodium (DS) induced hepatotoxicity in rats. Adult male rats were pretreated orally with PuE and FlE extracts at a dose of 10ml/kg and 200mg/kg body weight, respectively for 14 days. Co-treatment of DS 16mg/kg body weight was given orally for 7days. The present results demonstrated that the treatment with PuE and FlE combination with DS induced a marked improvement in the studied parameters. Data indicated that there were no significant differences in relative liver weight (RLW) and relative kidney weight (RKW) in group treated with PuE and FlE and /or their combination as compared to control. Plasma liver enzyme activities as well as bilirubin levels were increased in the groups receiving diclofenac only or in combination as compared with control group. However, the administration of PuE and FlE ameliorated DS induced hepatotoxicity by improving antioxidant status, decreasing inflammation, lowering TBARS and weakening the adverse effect of diclofenac on hepatic tissues. Liver injury was confirmed by the histological changes. Taken together, the present study concluded that enhancement of antioxidants and promising activity against diclofenac-induced hepatotoxicity may a result for the effect of PuE and FlE.

The real effect of parasitic infection on transplant recipients is not known. Interestingly, only 5% of human parasitic infections can affect functioning of transplanted organs. Parasitic infections manifest in two different ways: first, systemic illness, including anemia and constitutional symptoms, and second, local syndromes, which are usually confined to the lower gastrointestinal tract. Examples for pathogens causing systemic disease are Plasmodium malaria, Leishmania, Trypanosoma, and Toxoplasma. On the contrary, protozoal infection with Cryptosporidium and microsporidia, or the nematodes such as Strongyloides, may manifest with the local syndromes. Management of these infections in transplant recipients entails the following: prevention, timely diagnosis, cultures, specific serological tests, and PCR testing. Once the diagnosis is established, prompt medical/surgical interventions should be instituted to save these patients from developing hyperinfection or disseminated parasitic syndromes, involving, for example, the lungs or the central nervous system.

Objective: To assess the incidence, imaging, surgical approach and prognosis of adrenal tumors associated with venous thrombosis. Material and Methods: Charts of 206 patients who underwent adrenal surgery were reviewed. Data of patients with pathologically confirmed venous thrombosis, utilized diagnostic modalities, operative treatment and prognosis were reviewed and analyzed. Results: Venous thrombosis was confirmed pathologically in 6 patients (2.9%). All were of male gender with age ranging between 2 and 54 years. The mean size of the masses was 11.5 ± 5.2 cm. Venous thrombosis was diagnosed preoperatively in 2 patients, adrenal vein thrombosis in 1 patient, and renal vein thrombosis in the others. Masses were successfully excised via an open approach in association with nephrectomy in 3 cases. There was no operative mortality or gross morbidity. Pathologically, thrombosis was limited to the adrenal vein in 4 patients and extended to the renal vein in 2. Pathology of the masses revealed neuroblastoma in 2, pheochromocytoma in 2, adrenocortical carcinoma in 1, and pleomorphic sarcoma in 1 case. Metastasis developed within 6 months in 3 of these patients. Conclusion: Venous thrombosis with adrenal tumors is a rare pathological condition in which open surgery is the standard of care. Primary malignant adrenal masses with venous thrombosis have a poor prognostic outcome.

Purpose: To critically analyze the role, accuracy and safety of percutaneous adrenal biopsy for indeterminate adrenal lesions. Materials and Methods: Adrenal biopsies were performed in 15 among 214 patients (7%) diagnosed with adrenal masses being indeterminate on preoperative imaging. Definitive histopathology was obtained in all and overall sensitivity and negative predictive value were calculated. Safety of the procedure was reported. Results: The study included 8 male and 7 female patients with a mean age of 33.3 ± 20.3 years (range 7–65). Biopsy was carried out under computed tomography and ultrasound guidance in 12 and 3 patients, respectively. There were 2 nonrepresentative biopsies that were proved to be adrenocortical carcinoma and myelolipoma after adrenalectomy. Results of biopsy in the remaining 13 patients provided accurate diagnosis as proved by definitive histopathology in all but 2 in whom the final diagnosis was established as adrenocortical carcinoma while biopsy was paraganglioma in one and cortical adenoma in the other. Overall sensitivity and negative predictive value of adrenal biopsy was 73.3 and 60%, respectively. Apart from two mild hypertensive episodes following silent pheochromocytoma biopsy, no complications were reported. Conclusions: Percutaneous biopsy is a safe procedure for the diagnosis of pathologic conditions of the adrenal gland with a reasonable diagnostic aid.

To compare the functional results from a prospective randomized trial of two different reflux-prevention techniques for ileal bladder substitution.In all, 60 patients with invasive bladder cancer were randomized to receive either a serous-lined extramural tunnel (group 1) or T-limb ileal procedure (group 2) as an antireflux technique for the ileal substitute. The preoperative evaluation included intravenous urography, radioisotope renography to evaluate glomerular filtration rates (GFRs) and renal cortical imaging with 99mTc- dimercaptosuccinic acid to assess parenchymal scarring. Evaluable patients were re-assessed by the same imaging, and by ascending studies.The follow-up included 27 patients (49 units) in group 1 and 23 (45 units) in group 2, with a mean (sd) follow-up of 6.3 (0.5) and 7.4 (1.9), respectively. Uretero-ileal strictures were diagnosed in one renal unit in each group (P = 0.5). Ascending studies showed no reflux in any patients in group 1, while 13 renal units (29%) in group 2 were refluxing (P0.01). There was progressive cortical scarring with or with no significant reduction in GFR (25%) in three and four renal units in groups 1 and 2, respectively. Among the 13 refluxing units in group 2, three showed a significant deterioration in GFR and one renal unit was diagnosed with progressive cortical scarring.Both procedures provided a low rate of anastomotic stricture, with acceptable preservation of renal function. The serous-lined extramural tunnel provided a more effective antireflux mechanism.