Search

Background: Chest wall surgeries are accompanied by severe postoperative pain. Inadequate relief of this pain may lead to both pulmonary complications as lung atelectasis and infection and chronic post thoracotomy pain syndrome. Regional analgesic modalities are important portion of the multimodal therapeutic approach suggested for the management of post thoracotomy pain. Objective: To evaluate serratus anterior plane block as a regional analgesia technique for post thoracotomy and thoracoscopy pain. Recent Findings: Serratus anterior plane block (SAPB), a regional analgesic modality developed by Blanco et al. in 2013, has shown good analgesic effect after thoracotomy and thoracoscopy in many case reports and clinical trials. In such block, a local anesthetic is injected in the fascial plane deep or superficial to the serratus anterior muscle leading to block of lateral cutaneous branches of the intercostal nerves. This provides a sensory block of T2–T9 dermatomes. Conclusion:Serratus anterior plane block as a fascial plane block can be a preferred regional analgesia technique for both post-operative pain management with procedures involving anterolateral chest wall as thoracotomy, thoracoscopy and breast surgery and in cases of multiple rib fractures. This is owing to its easy technique, effective pain relief and potentially better side effects profile compared to other regional modalities and systemic opioids.

Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life? Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block.

The present study was conducted at private Farm at El-Sharqia Governorate, Egypt under supervision of Agronomy Department, Faculty of Agriculture, Suez Canal University, Ismailia, Egypt. Four cultivars of peanut were used in this work namely NC9, Gregory, Bold, and Runner. This work aimed to study the induction of genetic variation in peanut using Sodium azide (NaN3; Mw=65.01) with two doses (1×10-3) and (3×10-3) and three doses of Gamma rays (10, 30 and 50kr) to induce mutagenesis. M1 and M2 seeds per dose for each genotype including the control were sown in a randomized complete block design (RCBD) with three replications in 2017 and 2018 summer seasons. Analysis of variance showed that there were significant differences between genotypes under sodium azide and gamma rays for most studied traits in M1 and M2 generations. Number of primary branches was significantly affected by sodium azide concentrations, however all genotypes gave low number of primary branches under 0.003M than other treatments in both generations. Gregory and NC9 cultivars under Gamma rays had the high number of branches/plant in M1 and M2 generation when treated with 0.001M compared with 0.003M. The average of plant height was affected by radiation mutagen and higher the effect of sodium azide mutagen in both generations. 100-seed weight was affected significantly by sodium azide mutagen more than those by radiation mutagen in both generations. Maximum values of seed yield/plant were recorded for the NC9 followed by Gregory in both generations. NC9 and Gregory had the maximum values of seed yield/plant, when they treated by 0.001m in both generations. Mean values of oil content were increased significantly with increasing concentration of gamma rays doses in M1 and M2 at 10kr, 30kr and 50kr, respectively compared with control. The Bold cultivar had the highest values 51.34% and 50.39% and runner cultivar with values 49.02 and 49.66, when they treated with 50 kr and 30kr in M1 generation. The Runner and NC9 gave the high values for yield and its components and oil content of most genetic parameters under different mutagens in M1 and M2 generations for the most studied traits. The results of heritability, showed moderate to high values for most characters under studied in different mutagens in M1 and M2 generations. Pod yield/plant under the effect of sodium azide appears high positive correlation coefficients with each of seed yield/plant (0.869 and 0.928) during two the generations and 100-seed weight (0.643) in M1 generation

Background Coronavirus disease (COVID-19) pandemic has affected health and lifestyle behaviors of people globally. This project aims to identify the impact of COVID-19 on lifestyle behavior of individuals in the Middle East and North Africa (MENA) region during confinement. Methods We conducted an online survey in 17 countries (Egypt, Jordan, United Arab Emirates, Kuwait, Bahrain, Saudi Arabia, Oman, Qatar, Yemen, Syria, Palestine, Algeria, Morocco, Libya, Tunisia, Iraq, and Sudan) from the MENA region on August and September 2020. The questionnaire included self-reported information on lifestyle behaviors, including physical activity, eating habits, smoking, watching television, social media use and sleep before and during the pandemic. Logistic regression was performed to analyze the impact of COVID-19 on lifestyle behaviors. Results A total of 5896 participants were included in the final analysis and 62.8% were females. The BMI of the participants was 25.4 ± 5.8 kg/m2. Around 38.4% of the participants stopped practicing any physical activities during the confinement (P Conclusions The COVID-19 pandemic was associated with an increase in food consumption and sedentary life. Being exposed to COVID-19 by direct infection or through an infected household is a significant predictor of amplifying these changes. Public health interventions are needed to address healthy lifestyle behaviors during and after the COVID-19 pandemic.

Objectives: To determine the predictive value of lactate dehydrogenase (LDH) in diagnosis of septic shock and its association with other prognostic scores in critical pediatric patients. Methods: A cross-sectional study was performed at Children’s Hospital of Cairo University between June 2019 and December 2019. A total of 200 pediatric patients were divided into the septic shock group [100 critically ill patients with septic shock from the pediatric intensive care unit (PICU)] and the control group (100 patients with only sepsis). LDH was determined in the first 24 hours of admission. The sensitivity and specificity of LDH in diagnosis of septic shock were assessed; the levels of related indicators of patients with different etiologies were compared; correlations between LDH, Paediatric Index of Mortality Π, and Pediatric Sequential Organ Failure Assessment (PSOFA) were analyzed. Results: LDH was 512 μL (406.50-663.00) in the septic shock group and was significantly higher than that (190 μL, range 160.00-264.50) in the control group (P

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p p p p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

BACKGROUND: Postdural puncture headache (PDPH) is a complication commonly related to neuraxial anesthesia and dural puncture, with an incidence proportional to the diameter of the needle, ranging from 2% with a 29G to 10% with a 27G and 25% with a 25G. The development of ne gauge spinal needles and needle tip modication, has enabled a signicant reduction in the incidence of postdural puncture headache. PDPH presents as a dull throbbing pain with a frontal-occipital distribution. PDPH is thought to be due to a cerebrospinal uid leak that exceeds the production rate, causing downward traction of the meninges and parasympathetic mediated reex vasodilatation of the meningeal vessels. The sphenopalatine ganglion (SPG) is an extracranial neural structure located in the pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. Sphenopalatine ganglion block (SPGB) has been used for the treatment of migraine, cluster headache and trigeminal neuralgia and can be performed through transcutaneous, transoral or transnasal approaches. Obstetric patients are considered at increased risk for this condition because of their sex, young age, and the widespread use of neuraxial blocks. SPGB is minimally invasive, carried out at the bedside without using imaging and has apparently rapid onset than EBP with better safety prole. The most common side effects of SPGB are all temporary, including numbness in the throat, low blood pressure and nausea. OBJECTIVES: We evaluated the efcacy and safety of lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine ganglion block for the treatment of post dural puncture headache on 30 patients. PATIENTS AND METHODS: This prospective, randomized and controlled clinical study was conducted at Sohag University Hospital after its approval by the Ethics and Research Committee of Sohag Faculty of Medicine. Written informed consent was obtained from each patient before participation. RESULTS: Our study showed that there were non signicant differences between the three studied groups regarding age, gender, body mass index, type of operation, onset, site of headache, associated symptoms, relieving factors and exaggerated follow up. There was a nonsignicant difference between the three studied groups regarding changes in visual analogue score for severity of headache. There were nonsignicant differences between the three studied groups regarding presence of bleeding and results of treatment of postdural puncture headache. CONCLUSION: SPGB is an effective initial modality for managing severe headache in patients with PDPH.

Background: Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe and effective in promoting natural processes of wound healing. Objective: Assessment of the efficacy and advantage in using autologous platelet-rich plasma during myringoplasty in closure of tympanic membrane perforation improving overall outcome. Method: Platelet-rich plasma (PRP) is an autologous platelet-rich concentrate prepared from patients’ own blood with growth factors up to 8 times that of normal serum. The efficacy of PRP when used during myringoplasty is studied. 40 patients with chronic otitis media inactive mucosal disease were randomly chosen and 20 of them was the study group and other 20 were the control group. Both group patients underwent myringoplasty and PRP was used in the study group and the results were evaluated. Myringoplasty was done and after placement of the cartilage graft, platelet-rich plasma was placed over the myringoplasty site. Results: In our study among cases that underwent myringoplasty with use of platelet-rich plasma, 90% had complete tympanic membrane closure and only 10% failure has been noticed. In controls 60% out of cases had failure. The graft take up rate in our study is comparable with the reference studies. Use of PRP accelerated graft uptake. Conclusion: Platelet-rich plasma is a cheap and cost effective platelet concentrate with enriched growth factors. It accelerated the tympanic membrane closure following myringoplasty.

Acute exacerbation usually accompanied by increased cough, fever, wheezing, nursing care have been involved in delivering non-pharmacological interventions aimed to reducing symptoms Aim of this study was to evaluate effect of implementing nursing care on respiratory parameters for patients with acute exacerbation of chronic obstructive pulmonary diseases. Design: A quasi experimental research design was used to conduct this research. A convenient sample consisted of 60 patients, they were enrolled into study group (n=30) and control group (n=30) who were admitted to Intensive care unit at Sohag university hospital & chest care unit at Assiut University hospital Tool: this study comprised from Tool I: patient’s demographic and medical data. Tool II: Patient’s clinical assessment sheet consists from: Part 1: Assessment of homodynamic parameters Part II: Respiratory parameters. Part III: laboratory investigation and Receiving medications. The main results: result revealed that there is significant difference regard to temperature in study group compared with control group in 1st & 4 rd days. As regard respiratory parameters the result revealed significant difference regarding heart rate at 4rd &7th day. In addition current study revealed that highly significant difference in both groups regard breath sound (p

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Background Vitiligo is a common, asymptomatic, acquired depigmentation disorder, clinically characterized by milky white sharply demarcated, macules and patches that are scattered symmetrically or asymmetrically over the body causing severe cosmetic distress and social stigma. It can be classified as nonsegmental, segmental, mixed, or unclassified. In vitiligo, melanocytes are targeted by multiple aggressions leading to marked reduction and destruction of pigment cells, including autoimmune process, altered cellular environment, defective melanocytes migration, stress, and genetic factors. Objective To evaluate the serum CXCL10 level in patients with more than one year stability, compare them with healthy controls and compare the serum and tissue level before and after treatment with NB-UVB. Patients and Methods The present prospective controlled study included 20 patients with stable vitiligo (according to the VIDA activity score age of patients ranged from 18 to 54 years old were divided into 10 males and 10 females, and were recruited from the outpatient clinic of dermatology of Ain Shams University Hospital in the period from october 2018 to march 2019, twenty healthy persons were used as controls. All the patients were subjected to a full history taking, general and local clinical examination laboratory tests, and graded via VIDA score as below, digital photography were taken before and after NB-UVB. Results A Total of 20 patients were enrolled in the study, completed the study till the end of follow up of 24 visits during 12 weeks, their ages ranged from 18 to 54years old with a mean of 32.88 ± 10.42 years. Patients were divided into 10 males (50%) and 10 females (50%). Only one patient (5%) had a past medical history of diabetes mellitus and five patients (25%) had similar vitiligo affection in their families. As regard the mean difference of serum CXCL10 in comparison to tissue levels after the treatment there was no statistically significant differences indicating that serum is good indicator for measurement of expression of CXCR3 expression with less invasive procedure and tissue CXCL10 is not necessary to be measured Conclusion Cxcl10 is a useful marker for vitiligo and its severity Serum CXCL10 is equally significant to tissue CXCL10, so serum CXCL10 can replase invasive tissue CXCL10 Some drugs can be directed against CXCL10 or its receptor CXCR3 and may be a useful tool to control vitiligo in the future.

Aim The coronavirus disease 2019 (COVID‐19) outbreak began in Wuhan, China, and quickly escalated into a significant pandemic threat. COVID‐19 is associated with variable morbidity and mortality rates, which differ greatly from one country to another. This study aimed to investigate the clinical findings of SARS‐CoV‐2 infection in different ethnic groups, as well as to identify the radiological manifestations and various biomarkers for the assessment of COVID‐19 patients. Materials and Methods The clinical data of 210 COVID‐19 patients with respiratory disorders, who attended the chest clinic at Mouwasat Hospital, Jubail, in the Eastern area of the Kingdom of Saudi Arabia from April to May 2020, were thoroughly reviewed. The patients were divided into seven groups based on their ethnicities (Saudi, Egyptian, Nepali, Filipino, Pakistani, Bangladeshi and Indian). The differences in the clinical findings, laboratory data and radiological manifestations between these groups were statistically analysed. Results The study included 210 COVID‐19 patients from seven ethnic groups (Saudi, Egyptian, Nepali, Filipino, Pakistani, Bangladeshi and Indian). Comorbidities were reported among 60.9% of patients, which were significantly higher among Filipinos at 73.3%. Dyspnoea was prevalent in the Saudi and Pakistani groups, while hypoxaemia was prevalent in the Indian group (40%). In terms of laboratory assessment, Bangladesh patients had the highest median of serum ferritin and lactate dehydrogenase (LDH) levels with a significant P value (

Objective: To measure early changes in anterior chamber morphology after phacoemulsification and IOL implantation using anterior segment optical coherence tomography. Materials and Methods: Prospective consecutive interventional study measuring the anterior chamber configuration changes in twenty(20 eyes) after 1 month of phacoemulsification and posterior chamber IOL implantation. Results: Showing significant difference regarding nasal, superior, temporal and inferior angle measured by anterior segment optical coherence tomography before and after phacoemulsification operation with p.value were (0.027_0.009_0.02_0.012) respectively. Conclusion: Quantitative values showed the anterior chamber angle (ACA),measured using AS-OCT, has increased following uneventful phacoemulsification and IOL implantation.

Schistosomiasis is a common parasitic infestation that affects 200 million people worldwide. There are more than 76 endemic countries that suffer from this infestation, leading to 200,000 deaths annually. Intestinal schistosomiasis is known to cause a variety of serious gastrointestinal complications. Thus, it is important to diagnose it early to prevent such complications and relieve symptoms early. A typical infection with intestinal schistosomiasis tends to present with chronic diarrhea, abdominal pain, dysentery, and in severe cases portal hypertension and hepatosplenomegaly. However, in this study the authors report two cases that came with unusual presentations of intestinal schistosomiasis during their outpatient clinic evaluation. Case Presentation: The first patient is a 33-year-old male Yemeni national who was referred for investigation of a pedunculated rectal polyp. The patient was otherwise asymptomatic with no significant medical history. The second patient is a 39-year-old male Saudi national who presented with constipation, abdominal pain, and bloating. The patient was initially diagnosed as a case of irritable bowel syndrome and was managed conservatively for 2 years with no improvement. Conclusion: Histopathological evidence via biopsies revealed intestinal schistosomiasis in both patients. Therefore, in endemic areas it remains important to keep intestinal schistosomiasis in the differentials when dealing with vague intestinal signs and symptoms. It is also important to not rule out schistosomiasis from a negative stool egg screening alone as this tool tends to yield false negative results during acute infections and low-intensity chronic infections.

The present study was conducted in Khartoum state (Sudan) as a cross-sectional study in 200 participants (100 smokers and 100 non-smokers), to investigate the effects of Cigarettes Smoking on Liver functions of Sudanese smokers. The smokers were categorized into either current smokers (70 participants) or past smokers (30 Participants). Parameters were analyzed by using spectrophotometer. From the results, the levels of liver function tests (TB, Albumin and globulin) were significantly higher in non-smokers (6.0, 3.6 and 2.43 g/dl) as compared to current smokers (4.4, 2.4 and 1.98 g/dl) and past smokers (4.7, 2.7 and 1.93 g/dl). Meanwhile, ALT was significantly increased in current and past smokers as compared to non-smokers, where as AST was significantly higher in current smokers as compared to non-smokers, while there was no significant difference between current and past smokers as well as between past and non-smokers for this parameter. In addition, heavy and long duration of smoking were both associated with low total protein, albumin and AST levels .Also liver function tests were not significantly differing in current smoker's non-diabetics and non-smokers diabetics except total protein. From the results when, liver enzymes raised that may lead to increase proteins metabolism and increase blood glucose. These signs may place cigarettes smoking one of the top causes of hepatitis, pancreatitis, insulin resistance and finally diabetes mellitus type II. On the other hand, smoking cessation in diabetics lead to decrease the risk of hepatitis, Also regular physical activity and using medication regularly in diabetics lead to the same actions above; in addition diabetes complications were decreased.

Acne vulgaris is one of the most common chronic inflammatory skin disorder affecting millions of people worldwide. Vitamin D deficiency has a role in various inflammatory skin diseases as acne. This study aimed to investigate the serum level of 25 hydroxy vitamin D in acne patients and to assess the efficacy and safety of active vitamin D in management of acne. This study was conducted on 100 patients with acne and 100 healthy controls, then the 100 acne patients were randomized to either the study group that received 0.25ug alfacalcidol daily or the placebo group that received oral placebo during the 3 months study period. Serum levels of 25-hydroxy-vitamin D were significantly lower in acne patients than in healthy control and were inversely correlated to the severity of acne. After alfacalcidol administration, the study group showed significant higher level of 25(OH) D levels (

Background : Evaluation of cervicovaginal fetal fibronectin was considered as one of the most predictive factor for preterm labor when it is 50 ng/ml. Also, Salivary estriol (E3) has the same predictive factor for preterm labor when it is over 2.1ng/ml. The last factor in this study was measurement of cervical length. Objective: Assessing cervicovaginal fetal fibronectin and maternal Salivary estriol (E3) as biochemical markers, as well as transvaginal ultrasound in the prediction of preterm labor. Patients and Methods: The study included 150 pregnant women at gestational ages between 24 weeks and 34 weeks confirmed by sure history of last menstrual period and first trimestric ultrasound examination.The patients in this study were fulfilling the inclusion criteria, and were enlisted in a prospective clinical trial. As regard cervicovaginal fetal fibronectin, measure of it as Dacron swab was rotated in posterior fornix of the vagina or ectocervix and sent for assay of fetal fibronectin. Salivary estriol (E3) was collected from mouth after washing it, and stored till time of assay. Cervical length was evaluated by transvaginal ultrasound. Results: There was a highly significant difference between women with positive and negative fibronectin regarding gestational age at delivery. Salivary estriol (E3) showed a highly significant difference between women with positive and negative E3 regarding gestational age at delivery. Also, cervical length showed a highly significant difference between women with short and normal cervical length regarding gestational age at delivery. There was no significant effect for age, parity, presence of uterine contractions and uterine anomalies on the outcome of pregnancy . Conclusion: Cervicovaginal fetal fibronectin, salivary estriol E3 and measurement of cervical length were more helpful in prediction of preterm labor.

Objective: The present prospective study was carried out in Surgical Department of Tripoli Central Hospital with the aim to evaluate the effect of preoperative single dose of 150 mg pregabalin in reducing postoperative pain and analgesic consumption after laparoscopic cholecystectomy. Patients and Methods: Sixty patients of both sexes in the age of 18–60 years undergoing laparoscopic cholecystectomy were randomly allocated into two equal groups of 30 patients each. The pregabalin group received 150 mg oral pregabalin 1 h before induction of anesthesia and a placebo group received a matching placebo orally. Variables measured included age, sex, body mass index (BMI), duration of surgery, time to first dose and total dose of meperidine after recovery, and the visual analog scale (VAS – static and dynamic). The occurrence of nausea and vomiting during the first 24 h postoperative was also recorded. Results: No significant difference was found between the meperidine and the placebo groups regarding age, sex, BMI, or duration of surgery. The time of first meperidine dose required to alleviate pain after surgery was significantly four times longer in the pregabalin group as compared to the placebo group. The total dose of meperidine required for pregabalin group was significantly lower than that required for placebo group. Moreover, VAS was significantly decreased in the pregabalin group compared to placebo group both at static and dynamic states only 1 h after recovery. Conclusion: This study validates the preoperative use of a single dose of pregabalin in attenuating pain intensity postoperatively and reducing total analgesic consumption.

Background: Ventral hernia is one of the most common abdominal wall hernias. Several procedures have been used for hernia repair. During the last few decades, the open surgical approach has been the standard technique for hernia repair. During the past 1...

Evidence still indicates that traveler’s diarrhea might have unpleasant consequences over the affected patients’ time and health, and can increase the frequency of hospitalization and other health-related parameters. As a result of the newly developing serious issues about the resistance of bacteria to the different antibiotics, the management guidelines of traveler’s diarrhea are frequently changing based on this new data to ensure that proper management is delivered to the affected patients and enhance the healthcare practices. In the present literature review, we have discussed the diagnosis, treatment, and prophylaxis against traveler’s diarrhea based on evidence from the current investigations in the literature. The diagnosis of the condition is mainly based on the presence of symptoms suggestive of gastroenteritis, and having a travel history to an endemic country. Besides, cultures might be needed in certain situations to indicate the diagnosis, especially among resistant cases. The best prophylactic approach is to enhance the eating and drinking practices when travelling to endemic countries, in addition to the frequent washing of ingested food by clean water that is obtained from a safe source. The administration of antibiotics is not always recommended, and only moderate and severe cases should be indicated to receive antibiotics based on their clinical evaluation. The administered antibiotics should be based on the resistance and safety profiles among each country to enhance the efficacy of these antibiotics and obtain favorable outcomes.

Background: Breast milk adiponectin could play a role in regulation of infants, growth during lactation. Aim of work: To evaluate adiponectin concentration in human milk and to investigate its relationship with serum adiponectin concentration in lactating mothers and their breastfed infants and with anthropometric parameters of infants and mothers. Materials and methods: 60 healthy term infants and their healthy lactating mothers are included at infant age of one month then repeated again at the age of 4 months. All subjects included in this study were subjected to history, clinical examination, investigations including serum level of adiponectin of infants and their mothers by RIA test, Human milk level of adiponectin by ELIZA test. Results: There was a significant decrease in serum adiponectin of infant and mothers and maternal breast milk at age of 4 months (48 ± 6.5,13 ± 1.7, 5.3 ± 2 respectively) when compared to them at the age of 1 month(62.6 ± 1.5, 21.4 ± 5.6, 13.4 ± 3.8 respectively). There was a significant negative correlation between maternal serum adiponectin and BMI of mothers. There was a significant negative correlation between infant serum adiponectin and their weight and length of infants at age of 1 month and at age of 4 months. Conclusions: There’s a metabolic link between mothers and their infants through breast milk during 1st 6 months of life. A gradual decline in adiponectin level in maternal breast milk is associated with gradual increase in infant growth up to 6 months of age.

Background Renal proximal tubular dysfunction may occur in children with beta-thalassemia major without clinical manifestations of renal dysfunction or a decrease in GFR. Early identification of patients at high risk of developing renal damage is of great importance as it may allow specific measures to be undertaken that will delay the progression of renal injury and thus reduce the incidence of renal impairment. Objective To investigate the presence of glomerular and/or tubular dysfunction in children with beta-thalassemia major using routine and early markers tests such as urinary NAG (N-acetyle-beta- D -glucosaminidase) and To correlate the urinary NAG level with other clinical and laboratory findings. Patients and method The study included 45 patients with beta-thalassemia major attending Fayoum University Hospital. Their ages ranges from 3 to 15 years. The study also enrolled 25 cases were taken as age & sex matched healthy controls. Kidney function tests, blood sugar, Sodium, potassium, calcium and phosphorus and urinary NAG (N-acetyl- B - D -glucosaminidase) levels were checked and statistically compared. Results Our results showed increased urinary excretion of NAG in 55.6% of cases with highly statistically significant differences between cases and controls. Glomerular filtration rate (GFR) levels were lower in patients than controls. Serum levels of creatinine were higher in 40% of patients. We found increased urinary excretion of Ca in 26% of patients and uric acid excretion in 38% of patients. And positive correlation between urinary NAG and serum creatinine, duration of the disease and urinary Ca/Cr ratio. Also urinary NAG levels were higher in patients with splenectomy than in patients with splenomegaly. Conclusion Our data confirm that glomerular and tubular dysfunctions exist in children with beta-thalassemia major. As renal dysfunction may not be detected by routine tests, use of early markers is recommended. Urinary NAG excretion can be considered a reliable index of the tubular toxicity and a possible predictor of proteinuria so it is recommended be evaluated in beta-thalassemia patients.

Purpose To evaluate the CT and clinical findings in patients with H1N1 pneumonia and to discuss any differences between our results and previously reported articles. Patients and methods Screening for cases was started in April 2015. First case was diagnosed in October 2015. The number of cases increased with Peak in December. We reviewed and analyzed the primary CT patterns and the clinical presentation. Results Our patients were more prevalence in the age ranges from 30 to 60 years, equally distributed in both sex. Cough & fever (94%) were the most frequent clinical presentation .The commonest CT finding was the patchy Ground-glass appearance (either alone or associated with other findings) found in 11 cases (69%) followed by Consolidation in 10 patients (63%). The lung affection was bilateral in 14 patients (88%), multifocal in 13 patients (81%), Peripheral location was in 10 patients (62%). Out of the 16 positive cases in CT scan, the X-ray showed positive findings in only 12 cases (75%). Conclusions The most common lung pattern in H1N1 was GGO and consolidation, with bilateral and multifocal involvement in the majority of cases showing peripheral tendency. X-ray missed about 25% of cases.

The WHO project for conforming PHC to requirements of all age groups has resulted in publishing a toolkit for age-friendly PHC in 2008. The toolkit included checklists for physical environment and signage properties. This study matched the current physical environment properties of DHA’s PHC Health Centers against WHO’s recommendations. This is a cross sectional descriptive study that included visits to all 12 Primary Health Care Centers in Dubai city during August-September 2016 with the objective to assess the degree of fulfillment of current properties of Health Centers building to the recommendations of WHO as listed in “Age-friendly Primary Health Care Centres Toolkit” [1]. The study found that 81.86% of physical environment properties are matching the recommendation of WHO, while signage matching was 44.6%. The study concluded that most PHC properties have a physical design that met WHO’s recommendations. The two major deviations were accessibility by public transportations and presence of grab bars. Factors that had a significant impact on design were compliance with multiple international and local standards, the availability of private cars, and the availability of wheel chairs. Signage in DHA’s health centers followed a central plan that differed from WHO’s recommendations.

Vitamin D is a regulatory factor for immunity and skin barrier functions. It is hypothesized to be linked to atopic dermatitis (AD) which is characterized by interaction between epidermal barrier dysfunction and dysregulation of skin immune functions. One hundred AD patients and one hundred and one normal controls were collected from outpatient clinic based on their clinical condition, both had measurement of 25-hydroxyvitamin D [25(OH)D]. We assessed the relationship between 25(OH)D deficiency and AD prevalence using adjusted Poisson regression model. Serum 25(OH)D levels were significantly lower in cases than controls (mean 35.1 versus 22.6 ng/mL, p p-interaction In this case-control study in children, we found a statistically significant dose–response association between vitamin D deficiency and AD. We also observed a statistically significant effect modification of this association by gender. Further research is recommended to study this association longitudinally, and to examine whether treating vitamin D deficiency may potentially improve AD.Key pointsQuestion: Can atopic dermatitis be associated with vitamin D deficiency?Finding: Serum 25(OH)D levels were significantly lower in cases with AD than in controls. Prevalence ratios for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction Meaning: vitamin D deficiency is associated with AD in children, effect modification of this association by gender was also observed. Question: Can atopic dermatitis be associated with vitamin D deficiency? Finding: Serum 25(OH)D levels were significantly lower in cases with AD than in controls. Prevalence ratios for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction Meaning: vitamin D deficiency is associated with AD in children, effect modification of this association by gender was also observed.

Mustardé technique of otoplasty is probably the most famous and practical among all otoplasty procedures especially in our centers. Yet it possesses the risk of suture extrusion, stitch granulomas and recurrence. Such complications have been reported, albeit few, yet they are bothersome to patients and their families. Placing tissues between the suture lines and the postauricular incision whether grafts or fascial flaps have been reported to reduce these complications.This study was set to evaluate the effectiveness of elevating a post-auricular fascial flap to cover the sutures in Mustardé and Furnas techniques for reducing the risk of suture extrusion and granulomas and possibly recurrence.Eleven patients with prominent ears (21 ears) fit our inclusion criteria. Nine of them were males and two females. They underwent suture otoplasty with post-auricular fascial flap in Burn and Plastic Surgery Hospital in Sulaimania from December 2011 to July 2015. Their mean age was 15.5 years, with a mean follow-up period of 242 days (ranged from 66 days to 431 days. Polydioxanone suture was used in (6 ears), and polypropylene suture was used in (15 ears).We achieved 91% satisfaction rates among patients and their families (only one patient was unsatisfied). One patient developed partial recurrence of the middle half of antihelix in one side (4.7%). Another one developed bleeding that only needed pressure and change dressing in the left ear (4.7%). Adding fascial flap to cover the sutures appears to be beneficial in preventing suture extrusions and granulomas and possibly recurrence by acting as another supporting layer.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Objective To study the prevalence of anxiety and its correlation with the academic performance among medical students.. Methods The analytical cross-sectional study was conducted over six months from March 2018 to August 2018, at the male and female campuses of the College of Medicine, Majmaah University, Majmaah, Saudi Arabia, and comprised medical students of either gender. Data on anxiety was collected using a selfreporting questionnaire that included the Beck Anxiety Inventory. Academic performance was taken as a measurable record from the cumulative grade point average. Data was analysed using SPSS 24. Results Of the 247 subjects, 170(68.8%) were males. Anxiety was found in 97(39.3%) of the students. The level of anxiety was significantly higher among females compared to males (p=0.001), among those in the final year (p=0.002), and in those with low academic grades (p=0.016). Conclusions Anxiety was found to be common among medical students and it was associated with female gender, low grades and advanced year of studies.

A male infant presented to the neonatal team on day 1 of life with concerns over cysts on his penis. He had been born at term in good condition following an emergency caesarean section for face presentation and suboptimal cardiotocograph. There was no relevant antenatal history of note and no significant family history. He had a normal examination other than his genitalia. He had a coronal hypospadias with two symmetrical cystic lesions measuring 2–3 mm each on the glans penis, just distal and lateral to the opening of the urethral meatus on the ventral surface (figure 1). There was no obvious discharge or surrounding erythema. By day 2, there was some mild superficial ulceration of the cyst surfaces. Both testes were palpable in his scrotum. He was discharged home after confirmation …

The antibacterial activity of crude extracts of leaves coated with wax and other de-waxed leaves ofTamarix nilotica, against nine human pathogenic bacteria were evaluated using the agar plate well-diffusion method with plant extract concentration of 100 mg/ml. The minimum inhibitory concentration (MIC) was determined. The antibacterial activity was found in the least MIC, as 7.5 mg/ml, belonged toStaphylococcus aureusandPseudomonas aeruginosa. Most susceptible gram-negative bacteria wereP. aeruginosaand least susceptible gram-negative bacteria wereE. coliandS. typha. In gram-positive bacteria, most and least susceptible wereS. aureusandB. cereus, respectively. These findings should stimulate the research for novel, natural product such as many anti-bacterial agents. The percentage yield of epicuticle wax fromTamarix niloticaleaves, extracted with n-hexane was 0.7%. The results of the preliminary phytochemical analyses of the ethanol extract of the leaves coated with wax and de-waxed leaves ofTamarix niloticawere performed. Steroids, phenolic compounds, saponins, tannins, flavonoids and sugars are present in all of the two samples analyzed except sugars in de-waxed leaves.

Appendiceal anomalies are extremely rare malformations that are usually found incidentally. Agenesis and duplication of the appendix has been well documented, however the reported cases of appendiceal hypoplasia are very limited, as only few cases have been reported so far. Here, we report a 31-year-old male who underwent appendicectomy after clinical presentation and diagnosis of appendicitis. The appendicular specimen showed all histomorphological features of appendiceal hypoplasia. Appendiceal hypoplasia is often missed and usually difficult to be diagnosed in the preoperative workup. The chief concern in this case is to focus on the classical histo-morphological features of appendiceal hypoplasia, especially in view of its clinical course.

A 51-year-old man presented with chest pain, high troponin level, inflammatory syndrome and ST-segment elevation in the anterior leads. While the transthoracic echocardiogram (TTE) showed anteroseptal hypokinesis and apical akinesis, the coronary angiogram was normal. Cardiac MR demonstrated a typical aspect of myocarditis (multiple areas of mid-myocardial late gadolinium enhancement, sparing the subendocardial layer, along with oedema). The initial diagnosis was clinically suspected myocarditis with pseudoinfarct presentation. However, the short-term evolution was not typical of this syndrome, since an apical transmural scar with aneurysm developed within 2 weeks. Seven years later, the patient remained asymptomatic, while Q waves persisted in anterior leads along with an apical aneurysm on TTE. A transmural myocardial necrosis with aneurysm is an unusual complication of acute myocarditis. The potential mechanisms accounting for the development of these lesions are reviewed, and the clinical implications for the diagnosis and monitoring of acute myocarditis are discussed.

This study sought to investigate the association of baseline serum cystatin C levels with myocardial perfusion and cardiac functional recovery in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). 108 patients with a first anterior STEMI who underwent PPCI were enrolled. Serum cystatin C was measured by immunoturbidimetric method. Patients were divided into two groups according to the median cystatin C levels on admission: group 1 (≥median, n = 54) and group 2 (

Objectives To investigate polymorphism in exon 8 of the SLC 3 A 1 gene in children with urinary cystine calculi in Khartoum. Methods A semi-quantitative chemical method was used to analyse 175 urinary calculi removed surgically from paediatric patients at Soba Teaching Hospital in Khartoum between October 2005 and May 2009. DNA was extracted with phenol chloroform isoamyl alcohol, and exon 8 of the SLC 3 A 1 gene was amplified in a thermocycler and sequenced with an AB3130 genetic autoanalyser. Results Of the 175 stones, 10 were cystine calculi (5.7%). The sex ratio of the patients was 2.3:1 (boys to girls), and the mean age at cystine stone onset was 31.1 ± 28.2 months (range, 3–125 months). Of the 10 patients, 8 had a positive family history of calculi formation, 4 had bilateral calculi, 3 had both renal and urinary bladder calculi, and 2 had obstructive acute renal failure. All patients required more than one surgical operation. One patient had a missense mutation M467K in exon 8 of the SLC 3 A 1 gene. Conclusion The prevalence of cystine calculi among urinary calculi in Sudanese children was 5.7%. A family history was found in 80% of children. A mutation ( M467T ) was identified at exon 8 of the SLC 3 A 1 gene in one child.

Background: Loco-regional surgery remains the mainstay therapy of extremity soft tissue sarcoma (ESTS) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience, radiotherapy, adjuvant and neoadjuvant chemotherapy increased the survival. Aim of study: to evaluate the effect of the type of surgical intervention on the survival and quality of life of ESTS Patients. Methods: This is a prospective study to evaluate the impact of loco-regional surgical control on the survival among ESTS patients attended the National Cancer Center, Hadhramout -Yemen, between April 2010 and October 2018. Extremity soft tissue sarcoma patients were operated either by wide-local excision with safety margin or amputation or disarticulation. The study population consisted of 52 patients in which males and females represented (53.85%) and (46.15%) respectively. The three variable methods were compared using Chi-square test. Survival rate was analyzed by Kaplan-Meier test. Results: Fifty two patients, 12 patients in Group I (23, 1%), 10 patients in Group II (19.2%) and 30 patient’s in Group III (57.7%). The mean survival in patients underwent disarticulation was (77.5) months, while patients who had an amputation, the survival was (45.5) months, and in wide local resection patients was (59.9) months. The mean overall survival was (65.9) months, P value > (0.026) which was significant. Among the 3 different types of management, high overall survival rate was found in patients underwent disarticulation, while overall survival rate was also high in patient underwent wide local excision or compartmental resection in spite of functional limb preservation and good quality of life. The mean overall survival rate was low in patients who had limb amputation with loss of limb function. Conclusion: The wide local excision or compartmental resection mandates margin-negative, accepted post-operative local wound complication, associated with prolonged disease-free-survival and overall survival than other methods. Must be deal with improve patient overall survival, decrease local recurrence and obtained best Oncological outcome by preserve function with good quality of life for ESTS patients who underwent wide or compartmental resection or radical limb sparing surgery.

Highlights • Amyand’s hernia is a rare finding during inguinal hernia surgery, and even rarer on the left side. • It is rarely diagnosed pre-operatively, so surgeons’ awareness of this condition is important for preoperative suspicion and appropriate management. • The inflammatory status of the appendix determines the type of hernia repair. • Prophylactic appendectomy is not recommended except in young patients., Introduction Amyand’s hernia is a rare finding of the appendix inside an inguinal hernia sac with classically estimated incidence of 1%. Most cases are found intra-operatively during right-sided inguinal hernia repair. Presentation of case We are reporting a very rare case of left-sided Amyand’s hernia. An 81 year-old man with long standing left inguinal hernia was referred to our surgical assessment unit with tender irreducible left inguinal hernia. He was vitally stable with no clinical signs of intestinal obstruction. A diagnosis of irreducible left inguinal hernia without obstruction was made. Exploration of the hernia sac revealed the presence of non-inflamed appendix, caecum and terminal ileum. The contents were reduced and a mesh repair was performed with satisfactorily outcome. Discussion The surgical management of Amyand’s hernia involves appendectomy of inflamed appendix through the inguinal incision together with hernia repair. Prophylactic appendectomy is not recommended by most authors except in young patients. Conclusion There are less than 20 cases reported in the literature describing left-sided Amyand’s hernia. Awareness of such very unusual condition may help surgeons to be prepared for appropriate management of a very usual procedure as inguinal hernia repair.

Objectives To look for correlations among clinical, radiographic, and sonographic scores for enthesitis in patients with ankylosing spondylitis (AS). Methods Prospective study of 60 patients meeting modified New York criteria for AS. The clinical evaluation relied on the BASDAI, BASFI, and ASQoL and on a visual analog scale (VAS) for entheseal pain, as well as on two specific enthesitis indices, the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Radiographs and ultrasound scans were taken of five entheses on both sides (patellar insertion of the quadriceps tendon, proximal and distal insertions of the patellar tendon, and calcaneal insertions of the Achilles tendon and superficial plantar fascia). Ultrasound scans were obtained using a Philips HD 11™ machine with a high-frequency linear probe. Results We studied 48 men and 12 women with a mean age of 36 ± 11 years. The radiographic score correlated with the VAS pain score, BASDAI, and BASFI. The sonographic score for acute enthesitis correlated only with the MASES, and the sonographic score for chronic enthesitis correlated with none of the clinical scores. The Doppler score correlated with the VAS pain score, BASDAI, BASFI, and ASQoL. The overall sonographic score correlated with the MASES and SPARCC. Conclusion Good correlations were found between the clinical and sonographic scores for enthesitis. The radiographic score seemed correlated with the general AS parameters rather than with the clinical scores. Larger studies are needed to better define the role for radiographs and sonography of the entheses in the diagnosis of AS and follow-up of treated AS patients.

Resume Objectifs Rechercher les correlations entre les scores cliniques, radiographiques et echographiques d’enthesite au cours de la spondylarthrite ankylosante (SA). Methodes Etude prospective portant sur 60 patients, atteints de SA, repondant aux criteres de New York modifies. Nous avons utilise le BASDAI, le BASFI, l’ASQoL et l’echelle visuelle analogique (Eva) au niveau des entheses pour l’evaluation clinique de la SA, ainsi que les indices specifiques d’enthesite : le Maastrich Ankylosing spondylitis Enthesitis Score (MASES) et le Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Cinq sites enthesiques ont ete explores de facon bilaterale par des radiographies et par des echographies-Doppler (insertion rotulienne du quadriceps, insertions proximale et distale du tendon rotulien, insertion du tendon d’Achille et de l’aponevrose plantaire superficielle), a l’aide d’un echographe Philips HD 11TM utilisant une sonde a balayage lineaire de haute frequence. Resultats Cette etude a porte sur 48 hommes et 12 femmes, leur âge moyen etait de 36 ± 11ans. L’etude des correlations entre les scores cliniques, radiographique et echographiques a montre que le score radiographique etait correle avec l’Eva douleur des entheses, le BASDAI et le BASFI. Le score echographique d’enthesite aigue etait correle uniquement avec le MASES. Le score echographique d’enthesite chronique n’etait correle avec aucun score clinique. Le score Doppler etait correle avec l’Eva douleur, le BASDAI, le BASFI et l’ASQoL. Enfin, le score echographique global etait correle avec le MASES et le SPARCC. Conclusion Une bonne concordance a ete notee entre les scores cliniques et echographiques d’enthesite alors que le score radiographique semble plus lie aux parametres generaux de la SA. Des etudes de plus grande envergure sont necessaires pour mieux apprecier la place des radiographies et de l’echographie des entheses dans la demarche diagnostique et le suivi des malades sous traitement.

Objective The aim was to study the relation between plasma lipid severity of cognitive impairment in elderly patients with depression and dementia. Background Cognitive functions are related to changes in lipid profile. Materials and methods Two groups of participants were studied: group A (patient group) included 60 patients subdivided into two subgroups: 30 patients who currently have dementia as a whole without taking into consideration the different kinds of dementia, but after exclusion of vascular dementia, and 30 patients with depressive disorders. Group B (control group) included 30 normal participants selected from among volunteers matched to the patient group for age, sex, education, sociodemographic, and economic status. They were subjected to the following: a psychological assessment that included the geriatric depression scale, the Wechsler memory scale − revised short form, and plasma lipid concentration assessment (overnight fasting blood was collected from each participant by standard venipuncture). Results The results of the study clarified that dementia patients showed more statistically significant impairment in cognitive functions than depressed patients in terms of the Wechsler memory scale − revised. The mean values of the blood cholesterol level, low-density lipoprotein, and high-density lipoprotein in the depressed group were significantly higher than those of the dementia and control groups. Conclusion There is a relation between cognitive impairment in depressed and dementia patients and plasma lipid concentration.