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Background: Bowl or colorectal cancer (CRC) is the third most common type of cancer with about two million new cases every year. CRC is the second leading cause of cancer related mortalities. Objective: The study aims to evaluate the anticancer activity of ethanolic Ginger Extract (GE) in HCT-116 colon cells and colorectal tumors induced by dimethylhydrazine (DMH). Methods: The antiproliferative activity was measured by MTT assay and the gene expression was assessed by q-RTPCR. For the antitumor study, rats were divided into five groups in random; control, group two was orally treated with 300 mg/kg of GE for 21 weeks, group three was s.c. injected with DMH (20 mg/kg) for 9 weeks, and groups four and five were treated with DMH and then treated with cisplatin (2.5 mg/kg, i.p) or GE, respectively, for 21 weeks. Results: GE had a significant antiproliferative activity with IC50~ 12.5 μg/ml. GE induced both extrinsic and intrinsic apoptotic pathways. GE induced the expression of FasL, TRAIL, p53, and caspase-8 and downregulated Bcl-2 and survivin genes. Treatment of rats with DMH resulted in 100% tumor incidence and 2.3 tumors/rat. DMH significantly elevated the serum ALT, urea, and creatinine and significantly decreased the body weight gain. DMH also caused significant reductions in the hepatic GSH level, and the activities of catalase, SOD, GST, and GR in the liver as well as the renal GSH content and γ-GT activity. The colon from rats insulted with DMH showed adenomatous polyps with polymorphism and mitosis. The mucosa and submucosa were infested with inflammatory cells while serosa and muscularis were devoid from these cells. However, the muscularis was infiltrated with cystic formation, anaplastic changes, and hemorrhage. GE was able to alleviate all the previous deleterious effects of DMH and it was superior to cisplatin in its ameliorative effects. It did so without eliciting hepatotoxicity or nephrotoxicity which were shown in the group treated with DMH and cisplatin. Conclusion: This study proved that the antitumor activity of GE against the DMH induced-CRC is superior to cisplatin. GE was also safer than cisplatin and did not elicit hepatotoxicity or nephrotoxicity. GE induced apoptosis and has carcinostatic activity.

Background: Bleeding from esophageal and gastric varices is a fatal event in patients with liver cirrhosis and portal hypertension. Objective: Evaluation the correlation between Helicobacter Pylori infection and risk of esophagogastric variceal bleeding in liver cirrhosis. Patients and Methods: This study was carried out on one hundred (100) patients, suffering from post hepatitic cirrhosis and portal hypertension: fifty (50) of them presented with esophageogastric varices without bleeding selected from patients coming for screening of esophagogastric varices for anti-hepatitis c virus treatment, and the other fifty (50) presented with acute variceal bleeding. All patients attending to Internal Medicine outpatient’s clinic and Internal Medicine Department of Al-Azhar University Hospital at new Damietta during the period from September 2018, to April 2020. All patients were subjected to complete history, clinical assessment, abdominal ultrasonography, upper GIT endoscope and laboratory investigations. Results: There was a significant relation between H.Pylori infection and the presence of esophagogastric variceal hemorrhage and H. Pylori infection was positive in 92% of the patients in group II, and 24% patients was grade II oseophageal varices, 70% grade III oseophagogastric varices, and 6% grade IV oseophagogastric varices, There was a statistically significant correlation of increased esophageal varices (grade three) in positive H pylori in group II, while in group I detection of H.pylori showed 24% patients were positive, and 76% patients were negative. Endoscopic examination showed 40 patients without esophagogastric varices (80%), 8% patients grade I, 4% patients grade II, 6% patients grade III, 2% patients grade IV, and there was a statistically significant increase on esophageal varices (grade zero) in negative H pylori in group I. Conclusion: Helicobacter Pylori infection helped in the development of portal hypertensive gastropathy as well as its severity, and increased risk of esophagogastric variceal bleeding in patients with liver cirrhosis. So, eradication and treatment of Helicobacter Pylori in all patients with liver cirrhosis helped to decrease risk of esophagogastric variceal bleeding in these patients.

Background: Mitomycin C is an antimetabolite and affects corneal endothelial cells as measured by noncontact specular microscopy after trabeculectomy with mitomycin-C (MMC). Objective: To evaluate the corneal endothelial cells changes after trabeculectomy with MMC. Patients and methods: Patients were categorized into 2 groups, group A(25 eyes) were managed by trabeculectomy with mitomycin-C injection, group B (25 eyes) were managed by trabeculectomy with mitomycin-C sponge-applied technique which was carried out on patients attending at Ophthalmology Department of Al-Azhar University Hospitals from March 2019 to February 2021. Follow-up by specular microscopy preoperatively and 1 month and 6 months postoperatively to evaluate corneal endothelial cells density and morphological changes. Results: There was a significant reduction in the endothelial cell density and percentage of hexagonal cells and increased variation in cell size in the two studied groups after 1 month and 6 months compared with preoperative values. With no differences between the two studied groups. Conclusion: Trabeculectomy with both MMC injection and sponge applied caused a significant loss of the corneal endothelial cells intraoperatively or at the early postoperative period. Progressive cell losses due to MMC were not a major concern.

Tissue factor (TF) activates the coagulation system and has an important role in the pathogenesis of various diseases. Our previous study stated that retinoid receptors (RAR-α and RXR-α) are released as a lipid droplet in monocrotaline/ lipopolysaccharide-induced idiosyncratic liver toxicity in mice. Herein, the interdependence between the release of retinoid receptors RAR-α and RXR-α and TF in Nacetyl-p-aminophenol (APAP)-induced mice liver toxicity, is investigated. Serum alanine transaminase (ALT) level, platelet and white blood cells (WBCs) counts, protein expression of fibrin, TF, cyclin D1 and cleaved caspase-3 in liver tissues are analyzed. In addition, histopathological evaluation and survival study are also performed. The results indicate that using of TF-antisense (TF-AS) deoxyoligonucleotide (ODN) injection (6 mg/kg), to block TF protein synthesis, significantly restores the elevated level of ALT and WBCs and corrects thrombocytopenia in mice injected with APAP. TF-AS prevents the peri-central overexpression of liver TF, fibrin, cyclin D1 and cleaved caspase- 3. The release of RXR-α and RAR-α droplets, in APAP treated sections, is inhibited upon treatment with TF-AS. In conclusion, the above findings designate that the released RXR-α and RAR-α in APAP liver toxicity is TF dependent. Additionally, the enhancement of cyclin D1 to caspase-3-dependent apoptosis can be prevented by blocking of TF protein synthesis.

Background: Multiple Sclerosis (MS) is an unpredictable autoimmune disease that causes damage to the central nervous system including brain, spinal cord and optic nerve. This damage occurs as the body’s immune system attack the protective coating called myelin around nerve fibers in the central nervous system. It can affect different aspects of a person’s physical and cognitive functioning. Multiple Sclerosis is a complex, chronic disease that necessitates the support of a knowledgeable and concerned team of healthcare providers. This study aimed to assess the relation between upper extremity motor function among patients with MS with fatigue and cognitive impairment. Descriptive correlational research design was conducted on sixty adult patients with the diagnosis of MS who were admitted the MS Outpatient Clinic of El-Hadara Hospital in Alexandria. Four tools were used for collecting data: Tool I: Demographic and clinical data tool, tool II: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, tool III: Multiple sclerosis Neuropsychological screening questionnaire, and Tool IV: Fatigue assessment tool. Results of the present study revealed that moderate disability of the upper extremity was the most disability level encountered representing more than one third among the study sample (36.7%) , furthermore; more than two third (73.3%) the study sample often having cognitive problems, suffering from severe fatigue (36.7%) and fatigue partially interfered with their quality of life(46.7%). Additionally, there was no significant relation between studied patients' motor function of upper extremity and their cognitive function p=0.54. On the other hand, there was a significant relation between studied patients' motor function of upper extremity and fatigue severity level, and effect of fatigue on their quality of life. Accordingly, conducting a comprehensive assessment of patients' upper extremity motor function, cognitive function, and fatigue level among patients with MS is necessary to determine the degree of suffering; this will help the nurses to predict their functional status and the effect of MS on their quality of life.

The present study aimed to clarify the alternations in alpha-fetoprotein (AFP), phosphorus (Ph), calcium (Ca), and metabolic hormones (Growth hormones (GH), insulin, and thyroid gland hormones) in singleton, twin, and triplet pregnancy in goats. Animals were examined for pregnancy ultrasonographically during mid-pregnancy (6-14 weeks of gestation), and were classified conferring to litter size into singleton (n =55), twin (n=25) and triple (n=6) pregnancy, and non-pregnant status (n=64). Blood samples (5 ml) were collected before ultrasound examination and serum was separated for analysis of alpha-fetoprotein, phosphorus, calcium, and GH, insulin, T3, and T4. The current data showed that the fetal numbers markedly influenced AFP, Ph, Ca, GH, insulin, T3 levels, but did not affect T4 and Ph/Ca ratio. AFP levels were higher in twin (P< 0.05) and triple (P< 0.001) bearing does than in non-pregnant does (56.00±5.00 and 87.00±1.90 vs 3.80±.051 ng/ml). Phosphorus and Ca levels declined with pregnancy, with the substantial decreased in multiple feti compared with non-pregnant does. Growth hormone imminently raised in twine and triple fetuses than non-pregnant does. Insulin levels elevated in triple compared to non- pregnant and singleton (P< 0.005). Serum free T3 levels were lower in single and twin bearing does than non-pregnancy. In conclusion, fetal number markedly influenced the dam metabolic profile and mineral homostatis through altering AFP and metabolic hormones levels during pregnancy in goats.

This work aimed to develop a new efficient approach for safe treatment of psoriasis. To achieve that, resveratrol-loaded spanlastics(F1-F12) were prepared and evaluated by complete in vitro characterization. The two optimal formulations (F10 and F11) had their particle size in the nano range with high entrapment efficiency and sustainable drug release. These two formulae were incorporated in carbopol 934 gel formulations (G1-G8) with different concentrations of drug and carbopol 934 polymer. G1 and G5 (1% w/w Carbopol 934 gel and 0.1% resveratrol) showed 40.13% ± 2.017% and 73.76% ± 2.46%,8 hours drug release, respectively. Their pH was accepted and non-irritant. At a shear stress of 500 s−1, G1 and G5 showed a reasonable viscosity of 1048.5 ± 2.12 cps and 954 ± 2.15 cps, respectively. In the in vivo psoriasis study, mice treated by G5 gel showed significant improvement of erythema and scaling compared to positive control group and they maintained healthy skin as shown in histopathological observations. Moreover, this group showed the least changes in mRNA expression of inflammatory cytokines. Concisely, our results suggest that selected carbopol gel of resveratrol-loaded spanlastics could maximize resveratrol topical anti-psoriatic effect.

Background: Neonatal Respiratory Distress Syndrome (RDS) is a dangerous disease in neonates and is accompanied by neonatal complications and death. Objective: The aim of this study was the early determination of neonatal serum vitamin A levels as a possible novel predictor for neonatal RDS. Patients and Methods: A case-control study with the identification number TCTR20210206001, was performed on 100 neonates who were admitted to the Neonatal Intensive Care Unit (NICU) of Tanta University Hospital (TUH) suffering from RDS (patient group) and 100 healthy neonates (control group). Estimation of serum vitamin A (retinol) was made for all neonates of this study within the first four hours after birth before any nutrition or therapies. Results: Showed The results showed no significant difference between serums retinol (RT) levels in grade 1 & 2 RDS neonates (patient group) and the serum RT levels in the control group, while there was a significant difference between serums retinol levels in grade 3 & 4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006 and 0.002 respectively.no significant difference between serums retinol (RT) levels in grade 1&2 RDS neonates (patient group) and the serum RT levels in the control group while there was significant difference between serums retinol levels in grade 3&4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006, 0.002 respectively. Conclusion: Serum vitamin A levels in neonates were found to be decreased in RDS neonates and could be used as a predictor for the development and severity of RDS. Recommendation: It is recommended to carry out routine estimation of serum vitamin A levels in neonates as a novel predictor for neonatal RDS.

This descriptive analytic study is a part of a nation-wide project aiming at assessment the pattern of current clinical practice in Increased incidence of surgical site infections in the inpatient ward at El-Nasr hospital in Port Said Governorate and to compare this pattern with standard international guidelines in Australian Guidelines for the Prevention and Control of Infection in Healthcare (2020) and Core components for infection prevention and control programmers fever, chills , pus from the wound site, Signs of infection at the wound site (pain, redness, delayed healing, redness, or tenderness) etc. The study included 300 clinically of patients with increasing of infection, that lead to your healthcare provider will prescribe antibiotics to fight the infection in Port Said Governorate. Data was collected between September 2020 and December 2020. We concluded that further work is needed to optimize and prevention of infection patients according to evidence-based clinical practice guidelines.

Objective: This study was carried out to evaluate the detoxifying effects of aqueous extract of Moringa Oleifera on sodium fluoride-induced neurotoxicity in male Wister rats. Design: Randomized controlled study. Animals: Forty rats Procedures: Rats were allocated into four equal groups (10 each). Basically, each group received the same basal diet for 30 days. The first group was not received additional treatment (negative control). However, the second group received 20 mg/kg b.wt sodium fluoride daily (positive control), the third group received sodium fluoride at a dose of 20 mg/kg b.wt and Moringa Oleifera at 300 mg/kg daily, and the fourth group received sodium fluoride at a dose of 20 mg/kg b.wt and Moringa Oleifera 500 mg/kg daily using a stomach tube. Results: Dopamine and serotonin were significantly increased in Moringa Oleifera treated rats at 300 and 500 mg/kg in comparison with rats treated with sodium fluoride, but the higher dose of M. Oleifera achieved the best result (1.23±0.13 vs. 0.31±0.013) and (2.95±0.019 vs. 0.91±0.016) respectively. TAC, SOD, catalase were significantly increased in Moringa Oleifera treated rats at 300 and 500 mg/kg in comparison with rats treated with sodium fluoride, versed with MDA significantly decreased in Moringa Oleifera treated rats Also, to improve the anatomical structure of the disease in the brain reduces heavy bleeding and neurodegenerative changes, and maintains normal nerve cells, improves antioxidant ability as a whole. Conclusion and clinical relevance: Collectively, our results indicate that Moringa Oleifera watery extract has a detoxifying effect on NaF induced neurotoxicity via improving neurotransmitters andantioxidant activity.

Canine parvovirus(CPV2) is considered one of the serious and problematic diseases in young puppies, it remains a common and vital reason for morbidity and mortality in puppies, with very low survival rates in untreated dogs. It causes hemorrhagic enteritis and myocarditis in affected dogs. CPV2 has three antigenic variants CPV-2a, CPV-2b, and CPV-2c—have been described, which are determined by variations at residue 426 of the VP2 capsid protein. The aim of the present study was to detect CPV-2 in feces of clinically diseased diarrheic puppies by rapid Immunochromatographic test (ICT) followed by polymerase chain reaction (PCR). One hundred fecal samples were collected from clinically suspected dogs with CPV-2 in three different provinces and test by ICT then make extraction of DNA and examined by PCR. The clinical diagnosis was confirmed in 45 suspected clinical cases (45 %) by rapid test (ICT) and 86 % by PCR using common and specific primers sets for detection of CPV2.

Objectives Hepatocellular carcinoma is the fourth leading cause of cancer deaths in the world. Conventional methods of cancer therapy are either invasive or have undesirable side effects. Therefore, exploring new therapeutic strategies to control the progression of hepatocellular carcinoma, such as cell-based therapies, is a key issue for prolonging patient survival. In this study, we aimed to evaluate tumor suppressive effects of mesenchymal stem cells on the in vivo progression of hepatocellular carcinoma in murine model. Materials and methods Hepatocellular carcinoma was induced in 40 rats with diethylnitrosamine. Rats were divided into 4 groups: 1 group injected with diethylnitrosamine only, 1 group injected with diethylnitrosamine and 1 dose of rat bone marrowderived mesenchymal stem cells, 1 group injected with diethylnitrosamine and 2 doses of rat bone marrowderived mesenchymal stem cells, and 1 group was injected with diethylnitrosamine and 3 doses of rat bone marrow-derived mesenchymal stem cells. Rats were killed after 1 month of dose 3. Liver specimens were histopathologically examined, and serum samples were examined for liver function and cytokines. Results Histopathological examination revealed that mesenchymal stem cell transplant induced liver regeneration. It also improved liver function as revealed by decreased levels of alanine and aspartate aminotransferase. Mesenchymal stem cells also repaired the immunopathology of the liver environment, as it decreased levels of interleukin 2 and 10, tumor necrosis factor α, and interferon γ. Conclusions Mesenchymal stem cell infusion significantly enhanced hepatic structure and function of livers in a rat hepatocellular carcinoma model.

Background: Obesity-induced inflammation facilitates depression and premenstrual tension syndrome. Hypoxia is a common feature of inflammation. Hypoxia inducible factors adapt cells to low oxygen tension and inflammation. Objectives: We aimed to see how obesity, along with Amiloride, Hydrochlorothiazide, Metformin, calorie restriction, and walking exercise, affected psychosomatic characteristics of premenstrual tension syndrome, during a six-month period.Patients and methods: A prior ethical committee approval and informed patients’ consent were taken. This study was performed in Tanta University, Egypt from May 2019 to December 2019. This study aims at evaluating the effects of obesity-induced inflammatory mediators on psychosomatic effects in women having premenstrual tension syndrome. Effects of combined therapy using (Metformin, Amiloride. Hydrochloride/ Hydrochlorthiazide, caloric restriction, half an hour of walking exercise per day, and Vitazinc capsules) treatment was compared to the same combined therapy including Royal vitamin G treatment (instead of Vitazinc) on alleviating psychosomatic manifestations of premenstrual tension syndrome. Sixty obese women having premenstrual tension syndrome were categorized into younger age group (18-39 years) and older age (40-48 years) versus a non-obese age-matched control group. Body mass index in addition to serum tumour necrosis factor-α (TNF- α), hypoxia-inducible factor-1α (HIF-1α) and receptor activator of nuclear factor- kappa-Β ligand (RANKL) were assessed. Related psychosomatic manifestations of premenstrual tension syndrome (edema, anxiety, and fatigue) were also assessed. Results: Obesity significantly increased serum TNF-α (p < 0.01), HIF-1 α (p < 0.01) and RANKL (p < 0.01). Obesity-induced biochemical effects were higher in older obese women than younger ones. Obesity significantly exaggerated the severity of investigated psychosomatic manifestations (p < 0.001). Both combined therapies (including either Vitazinc or Royal vitamin G) significantly and dramatically decreased the percentage of cases having psychosomatic manifestations (p < 0.001) that was closely related to the decreased serum biochemical parameters. Conclusion: Combined therapy containing Royal vitamin G significantly improved serum biochemical parameters and psychosomatic manifestations better than combined therapy containing Vitazinc.

Background: Imaging plays a very important role in the diagnosis of renal infection. It assists diagnosis and differentiates between different types of renal infection. It also helps to detect and manage the associated complications through image-guided drainage and aspiration. Contrast-enhanced CT is the most useful study. A contrast-enhanced study is essential for a complete evaluation of patients with renal inflammatory disease to demonstrate alterations in the renal parenchymal perfusion and excretion of the contrast material, which occur as a result of the inflammatory process. Objective: To detect the role of multidetector CT in diagnosis of renal infection. Materials and methods: This prospective study was conducted on sixty patients. The study was carried out at Diagnostic Radiology Departments of Menoufia University Hospital. The patients were presenting with fever (< 38°C) mainly and loin pain. Results: From 60 patients with renal infection, 18 cases were diagnosed as pyonephrosis, 16 cases were diagnosed as renal abscess, 12 cases were diagnosed as pyelonephritis, 4 cases were diagnosed as xanthogranulomatous pyelonephritis, 4 cases were diagnosed as perinephric abscess, 2 cases were diagnosed as emphysematous pyelonephritis, 2 cases were diagnosed as fungal ball, 2 cases were diagnosed as urinoma. The mean age was (39.4 ± 15.7). Conclusion: Contrast enhanced computed tomography is a perfect diagnostic modality to assess the severity of inflammatory process and reaching the diagnosis of renal infection. It also helps to reach the cause, predisposing factors, associations, complications and the extent of the disease.

WHAT IS KNOWN AND OBJECTIVE Sofosbuvir has been approved as the first nonstructural protein 5B polymerase inhibitor with pan-genotypic activity against the hepatitis C (HCV) virus. Daclatasvir is a first-in-class hepatitis C virus nonstructural protein 5A replication complex inhibitor. We aimed to evaluate the usefulness of the reference single nucleotide polymorphism (rs12979860) interleukin 28B (CC genotype) for predicting sustained virological response to sofosbuvir plus daclatasvir in Egyptian patients infected with HCV-4. METHODS Samples were collected at week zero. One hundred and thirty-one patients who reached the end of treatment (at week 12) were divided into three groups, according to their interleukin 28B genotype: Group A included 31 patients (CC genotype), group B included 79 patients (CT genotype) and group C had 21 patients (TT genotype). All patients received treatment for 3 months in the form of sofosbuvir plus daclatasvir with ribavirin (in case of cirrhotic patients) or without ribavirin (in case of non-cirrhotic patients). RESULTS AND DISCUSSION Sustained virological response rate was significantly higher in patients with IL28B (CC genotype) vs. (non-CC genotype) (100 vs.88%) (p

Background: Medication errors are errors that doctors, caregivers, pharmacists, and patients make when prescribing, using, or storing drugs. Medication errors may lead to disease in children, disease exacerbation. In the United States, medication errors cost healthcare about $ 177 billion (statistically speaking) annually. (1) The published studies estimated that about 5-10% of hospital admissions were due to the medication errors. It is suspected that approximately 3% of deaths in the Swedish population are because of the medication errors. In Canada, up to 50% of the patient safety indicates in primary care are related to medication errors. (2) Aim of the study: Attempting to prevent medication errors inside health care facilities to raise health care efficiency and maintain patient safety Methodology : Using of quality tools like brain storming, process mapping, and fish bone diagram, and the check list helped us to identify the most common causes of medication errors and finding probable solutions. (3) Conclusion: A standard protocol for the medication management must be performed to reduce medication error

Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.

Background: Neonatal respiratory distress syndrome (RDS) is a common dangerous chest problem that is caused by a lack of surfactant. Aim: The aim of this study was to show the role of zinc as an adjuvant anti-inflammatory therapy in neonatal RDS. Objective: To study the effect of zinc supplementation in cases of neonatal RDS. Methods: A prospective randomized controlled trial (RCT) study was done on 90 neonates suffering from respiratory distress (RD) who had been diagnosed as RDS. The included neonates were classified into two groups: group 1, which received Zinc (Zn) supplementation, and group 2, which received a placebo. Down score, grades of RDS Malondialdehyde (MDA), Superoxide Dismutase (SOD) andInterleukin-8 (IL-8) were estimated on the 1st and 5th day in the presence of incubators. Results: There were statistically significant differences (SSD) in grades of RDS, Down score, MDA, SOD and IL-8 on the 5th day between group 1 and 2(p = 0.001), and between 1st and 5th day in group 1 (p = 0.001) in the presence of an incubator. There was an SSD between groups 1 and 2 in the duration of hospitalization (p = 0.001) and the number of cases that needed mechanical ventilation (MV) (p = 0.049). Conclusion: Zn supplementation is associated with clinical and laboratory improvement in cases of neonatal RDS. Recommendation: Zn supplementation for RDS neonates.

BACKGROUND Type-2 diabetes is the most prevalent metabolic disease, which calls for researchers to find many natural products that are effective in fighting diabetes and its complications. METHODS Stirred yoghurt samples were prepared, enriched with probiotics, and fortified with either 1% or 2% of the fine powder of beetroots. The chemical, physical, sensorial, and microbial properties of the yoghurt samples were studied over a 15-day storage period. The total phenolic compounds, flavonoids, antioxidant activity as well as the reducing power of the dried beetroot and the yoghurt samples were assessed.The prepared yoghurt samples were evaluated in type 2 diabetic rats. RESULTS Fortification with beetroot led to an increase of the total phenolic compounds, antioxidant activity, and the probiotic counts in the prepared yoghurt. The intervention with the prepared yoghurt samples resulted in an increase in the number of beneficial bacteria in diabetic rats’ feces, hypoglycemic effect, and suppression in the elevation of C-reactive protein (CRP) and thyroid stimulating hormone (TSH). CONCLUSIONS This study suggests that stirred yoghurt enriched with probiotics and fortified with beetroot have therapeutic potential for type 2 diabetes.

Background: Mobile-based nursing intervention is a trial to enable children to be safe during the COVID-19 epidemic especially those children with chronic kidney disease and who have no immunity. Now days using mobile becomes a part of universal technology for improving the care of children with such conditions. This study aimed to evaluate the effect of mobile-based nursing intervention on preventive measures of COVID-19 among children suffering from chronic kidney diseases. Design: A quasi-experimental design was adopted. Sample: A purposive sample including 70 children suffering from chronic kidney diseases with predetermined criteria (receive regular kidney dialysis, have no history of previous COVID-19 or previous kidney disease complications and well-being mental health) setting: The study was conducted at the Pediatric Kidney Dialysis Unit at Sohag University Hospital. Tools for data collection: A structured questionnaire was used to collect data concerning characteristics of the studied children (pre/posttest questionnaire) as well as to assess the level of child knowledge regarding mobile intervention, preventive measures of COVID-19 and dialysis therapy, a checklist to assess reported practice as regards preventive measure of COVID-19. And Mobile-based nursing intervention which had been designed by the researchers. Results: There was a statistically significant difference towards using mobile-based nursing intervention in the area of children's knowledge and practice about COVID-19 preventive measures at post-intervention compared to pre-intervention. Conclusion: Mobile-based nursing intervention had a positive effect on improving preventive measures of COVID-19 among children suffering from chronic kidney diseases. Recommendations: apply mobile-based intervention in other pediatric kidney dialysis units and hospitals to achieve a better preventive measure of COVID- 19 among children with chronic disease.

Background: Insecure attachment styles are an area of research that is currently receiving much attention because it has an important role in developing many psychological disorders and might have an effect on an individual's perception of his outer reality. In this respect, assessment of attachment styles among patients with schizophrenia can be informative in indicating how well the patients perceive their reality accurately. Aim: This study aimed to determine the attachment style and reality testing impairment among patients with schizophrenia. As well, investigate the relationship between them among those patients. Setting: This study was conducted at El-Maamoura hospital for Psychiatric Medicine in Alexandria. Subjects: A representative sample of 200 randomly recruited patients with schizophrenia were the subjects of the present study. Tools: A Socio-Demographic and Clinical Data Sheet, Bell Reality Testing Inventory (BRTI), and The Psychosis Attachment Measure (PAM). Results: The study showed that 54.5% of the studied patients exhibited an avoidant attachment style and the patients who exhibited an anxious attachment style constitute 40%. Moreover, 60% of the studied patients had a moderate level of reality-testing impairment and 36.5% had severe impairment. A statistically significant positive correlation between psychotic attachment styles and reality-testing impairment was found (r=0.394, p=0.000). More specifically, there was a statistically significant positive correlation between the avoidant attachment style and the three domains of reality-testing impairment as well as the total scores (r= 0.577, 0.179, 0.278, 0.501 respectively, were p=0.000). Meanwhile, a statistically significant positive correlation between the anxious attachment style was found only with the Hallucinations & Delusions domain of reality-testing impairment (r =0.291, p=0.000). Conclusion: It can be concluded that almost all patients with schizophrenia exhibit insecure attachment styles, with avoidant attachment style being the most prevalent, usually at a severe level in the majority of cases. On the other hand, the great majority of these same patients present with reality-testing impairment reflected in its three domains: reality distortion, the uncertainty of perception, and hallucinations & delusions. Evidence of a correlation between attachment styles and reality testing impairment, (both of the total and sub total domains) in these patients usually and frequently there. Recommendations: Building up a secure, structured, and consistent environment for patients with schizophrenia to modify their insecure attachment styles and hope to become more reality-oriented.

Background: Patient involvement in health care is a basic patient's right. Effective communication between the health care professional and the patient is associated with improved psychological functioning of the patient, adherence to treatment, and higher quality of life. Objective(s): This study aims to explore qualitatively breast cancer patients’ experience and satisfaction with their involvement in cancer care. Methods: This study was carried out among 30 women in different breast cancer care stages through in depth-interviews. The patients were purposively selected from surgery and oncology outpatient clinics and surgery inpatient wards in Medical Research Institute Hospital- Alexandria University, and in Ayadi El-Mostakbal Cancer Care Center - Ayadi El-Mostakbal Charity Foundation, Alexandria, Egypt. Results: Some patients mentioned that they did not know their diagnosis until late, others complained of the harsh non-empathetic way of breaking the news of their disease. Patients, generally, reported a little understanding of their treatment plan, they just followed physician’s instructions without receiving enough explanation. Patients on chemotherapy and radiotherapy expressed their unsatisfied need for information. Patients’ source of information was mainly other patients who suffered from the same disease. Patients, in general, were not familiar with the concept of giving feedback, it was perceived by the majority of them as equivalent to complaining. Some patients believed that complaining could put them in trouble such as receiving harsh blame or even delaying their medication. Conclusion: Patients’ narratives revealed poor involvement in health care and showed dissatisfaction of the majority of patients with their level of involvement.

ObjectiveThis study describes the influence of sex and disease phenotype on the occurrence of cardiac events in Fabry disease (FD).MethodsCardiac events from birth to last visit (median age 50 years) were recorded for 213 patients with FD. Patients were categorised as follows : men with classical FD (n=57), men with non-classical FD (n=26), women with classical FD (n=98) and women with non-classical FD (n=32), based on the presence of classical FD symptoms, family history (men and women), biomarkers and residual enzyme activity (men). Event rates per 1000 patient-years after the age of 15 years and median event-free survival (EVS) age were presented. Influence of disease phenotype, sex and their interaction was studied using Firth’s penalised Cox regression.ResultsThe event rates of major cardiovascular events (combined endpoint cardiovascular death (CVD), heart failure (HF) hospitalisation, sustained ventricular arrhythmias (SVAs) and myocardial infarction) were 11.0 (95% CI 6.6 to 17.3) in men with classical FD (EVS 55 years), 4.4 (95% CI 2.5 to 7.1) in women with classical FD (EVS 70 years) and 5.9 (95% CI 2.6 to 11.6) in men with non-classical FD (EVS 70 years). None of these events occurred in women with non-classical FD. Sex and phenotype significantly influenced the risk of major adverse cardiovascular event. CVD was the leading cause of death (75%) to which HF contributed most (42%). The overall rate of SVA was low (14 events in nine patients (4%)).ConclusionsSex and phenotype greatly influence the risk and age of onset of cardiac events in FD. This indicates the need for patient group-specific follow-up and treatment.

Background: Rheumatoid Arthritis (RA) is a systemic, autoimmune and inflammatory disease that is associated with progressive joint degeneration, limitation of physical activity and disability. Aim: the study aimed to assess factors affecting self-management of patients with rheumatoid arthritis. Design: A descriptive exploratory research design was utilized. Setting: This study was carried out at the National Medical Institute of Damanhur –affiliated to the General Organization for teaching hospitals and Institutes at the Medical clinics in the out- patient department. Study subjects: A purposive sample of 100 adult patients of both genders with rheumatoid arthritis. Tools: Patient interviewing questionnaire, Rheumatoid Arthritis Disease Activity Scale, Rheumatoid Arthritis Self-Efficacy and Rheumatoid Arthritis Self-Management practices Questionnaire. Results: About 58% of the studied patients had unsatisfactory level of knowledge about the self-management of RA. Also, 32% of them had low disease activity. Moreover, 52% of them had moderate level of self-efficacy and 50% of them had moderate level of total self-management. Conclusion: More than half of the studied patients had unsatisfactory level of knowledge about rheumatoid arthritis. Also, one third of them had low level of disease activity. Moreover, more than half of the studied patients had moderate level of self-efficacy and half of them had moderate level of total self-management. There was highly significant positive correlation between total knowledge of the studied patients and self-efficacy with self- management. While, there was highly significant negative correlation between total disease activity of the studied patients and self- management. Recommendation: Self-management educational program should become an integrated part of the total management of patients with rheumatoid arthritis.

The transplantable tumor model of Ehrlich ascites tumor (EAC), which is a cancer simulation, is frequently used to study the antineoplastic effects of amygdalin (VB17). This study aims to find out how cardiac toxicity and oxidative stress triggered by EAC could be countered with VB17 in female mice. Twenty-five female mice were included and divided into 5 groups namely, the control group (Gp1), EAC (Gp2), VB17 control group (Gp3), EAC+VB17 (Gp4), EAC+VB17+SOR IP (Gp5). All groups underwent cardiac marker assessment in addition to oxidative stress marker MDA determination and the evaluation of the anti-oxidative stress marker of SOD. By comparison with the naive control group, the EAC positive control group had a significantly higher level of Troponin, serum lactate dehydrogenase (LDH), CK-MB, CPK, and MDA content. On the other hand, the EAC group had significantly lower levels of cardiac SOD than the control group. Furthermore, better improvement in cardiac toxicity and oxidative stress was displayed by the cotreated (VB17+SOR) group 5 than by the (EAC + VB17) group 4. This led to the conclusion that VB17 conferred cardiac protective and antioxidant effects against EAC. This finding necessitates further research into the benefits of VB17 as adjuvant agents in the prevention and treatment of cardiac toxicity.

Background: There is no doubt that the mothers' adaptation helps improve the quality of life, not only for any child with special needs but for the whole family, which greatly helps in improving the child's condition and improving the care provided to him by a conscious parent who can meet the child's needs properly. The present study aimed to evaluate the effect of parent training regarding coping strategies on reducing stress among mothers of children with autism spectrum disorder (ASD). Research design: A quasi-experimental design was used in carrying out this study. Setting at This study was conducted at the Child Psychiatry out-patient clinic at Sohag University Hospital. Sample: A purposive sample of a total of forty mothers and their children with ASD aged 4-12 years participated in this study. Tools: Four tools were utilized for data collection. I- A structured interviewing questionnaire sheet, which included two parts, part 1: Demographic characteristic of the mothers, Part 2: Demographic characteristic of their children, II-Parenting Stress Index: Short Form Abidin (1992), III- Coping Strategies Inventory (CSI), IV- Child Behavior Checklist. The data were collected before, immediately after and 3 months after the implementation of the parent training program. Results: The current study revealed a statistically significant improvement was found between the Parenting Stress Index and the Coping Strategies Inventory of the studied mothers as pre/ immediate post and after three months after the training program implementation (p < 0.05). Conclusion: implementation of parent training regarding coping strategies reduced stress among mothers of children with ASD, so the study mainly recommended that parent training regarding coping strategies for mothers of children with ASD should be conducted to reduce stress among mothers of children with ASD.

OBJECTIVE To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term. METHODS We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth. Secondary outcome was maternal morbidity, defined as: transfusion of 4 or more units of red blood cells, any transfusion of other products, postpartum infection, intensive care unit admission, hysterectomy, venous thromboembolism, or maternal death. Multivariable modified Poisson regression was used to evaluate associations between race and ethnicity, cesarean birth, and maternal morbidity. Indication for cesarean birth was assessed using multivariable multinomial logistic regression. A mediation model was used to estimate the portion of maternal morbidity attributable to cesarean birth by race and ethnicity. RESULTS Of 5,759 included participants, 1,158 (20.1%) underwent cesarean birth; 1,404 (24.3%) identified as non-Hispanic Black, 1,670 (29.0%) as Hispanic, and 2,685 (46.6%) as non-Hispanic White. Adjusted models showed increased relative risk of cesarean birth among non-Hispanic Black (adjusted relative risk [aRR] 1.21, 95% CI 1.03-1.42) and Hispanic (aRR 1.26, 95% CI 1.08-1.46) people compared with non-Hispanic White people. Maternal morbidity affected 132 (2.3%) individuals, and was increased among non-Hispanic Black (aRR 2.05, 95% CI 1.21-3.47) and Hispanic (aRR 1.92, 95% CI 1.17-3.14) people compared with non-Hispanic White people. Cesarean birth accounted for an estimated 15.8% (95% CI 2.1-48.7%) and 16.5% (95% CI 4.0-44.0%) of excess maternal morbidity among non-Hispanic Black and Hispanic people, respectively. CONCLUSION Non-Hispanic Black and Hispanic nulliparous people who are low-risk at term undergo cesarean birth more frequently than low-risk non-Hispanic White nulliparous people. This difference accounts for a modest portion of excess maternal morbidity.

Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease prevention strategies, but the serotype distribution varies among patient groups. The objectives of this study were to establish the group B Streptococcus (GBS) serotype distribution in patients from Egypt and to assess antibiotic sensitivity of invasive GBS isolates. A total of 490 patients participated in this multicenter study; 160 had urinary tract infection, 115 complained of diabetic foot ulcers, 125 men had genital tract infections, and 30 women females had genital tract infections. Others had bronchopneumonia, otitis media, synovitis, or meningitis. Serotyping of the isolated GBS was performed at the CDC in the United States. Antibiotic sensitivity patterns were determined using the disk diffusion method. In men, the most common serotypes were II, III, and V, whereas types Ia, II, III, and V were isolated from women. Macrolides (erythromycin) resistance occurred in 4.1% of the isolates; 10.2% were resistant to both clindamycin and inducible resistance of macrolides, lincomycin, and streptogramin; 17.3% were resistant to quinolones; and 95.9% were resistant to tetracyclines. GBS primarily infected the urinary tract, skin, soft tissue, and genital tract in both genders. Isolates were sensitive to beta-lactam drugs, vancomycin, and linezolid; 14.0% were resistant to macrolides with or without clindamycin. Only 6.0% of the strains were sensitive to tetracyclines. Although GBS causes invasive infections in Egyptian adults, it rarely causes neonatal meningitis or sepsis. Future studies should determine whether GBS isolates are transmitted sexually, by performing a follow-up study of the partner of the infected patient.

Inflammation and oxidative stress are the major pathways involved in ischemia–reperfusion (I/R)-induced renal injury. This study was designed to evaluate the potential effect of pomegranate against I/R-induced renal injury. I/R injury was induced in nephrectomized rats by unilateral occlusion of the left renal pedicle for 45 min followed by 24 h of perfusion. Pomegranate succeeded to decrease serum levels of creatinine, potassium, and urea nitrogen, along with increasing creatinine clearance. Pomegranate also decreased I/R-induced changes in histopathological examination. Pomegranate attenuated the renal inflammatory response reflected by the suppression of nuclear factor κB p65 DNA binding activity, the upregulation of inhibitory protein kappa B-alpha mRNA expression, the downregulation of mRNA and protein expression of tumor necrosis factor α, in addition to the reduced myeloperoxidase activity and mRNA expression. Additionally, pomegranate attenuated oxidative stress likely through the modulation of lipid peroxidation and antioxidant levels reflected by the decreased MDA content and the increased glutathione level and superoxide dismutase activity. Results confirm the potential protective effect of pomegranate against I/R-induced renal injury through its anti-inflammatory and anti-oxidant effects mediated through the upregulation of inhibitory protein kappa B-alpha, the inhibition of NF-κB activity, and the associated TNF-α release, neutrophil infiltration, and oxidative stress.

Introduction: Early detection of colorectal cancer (CRC) is the key to reduce its related morbidity and mortality. Methods: One hundred CRC patients were included in this study, they were admitted at Mansoura Gastroenterology Center, Mansoura University and diagnosis was confirmed by pathology.100 apparently healthy individuals were served as the control group.CD24 (P170 C/T) and CD24 (P-534 A/C) single nucleotide polymorphisms (SNPs) were analyzed using polymerase chain reaction–restriction fragment length polymorphism (PCR/RFLP). Results: Regarding CD24 P170 C/T SNP, no statistically significant association was found between genotypes, alleles and risk of CRC. While, P-534 A/C; AC, CC, AC+CC genotypes and C allele showed significantly higher frequency in cases when compared to controls. CC and TC haplotypes were significantly associated with risk of CRC when compared to control group. Multivariate logistic regression analysis revealed that higher CEA and P-534 A/C (AC+CC) were considered as independent predictors of higher CRC stages. Conclusion: The current study observed an association between CD24 P-543 A/C SNP and the risk of developing CRC in Egyptian subjects.

BACKGROUND Although dysbiosis and the role of the microbiome in the pathogenesis of inflammatory skin diseases have been intensively investigated, fungal colonization or infection has received minimal attention. AIMS To isolate and identify different fungal species namely Candida, Dermatophytes, Malassezia, and Aspergillus from plaque psoriasis patients, evaluate the association of IL-17A gene single nucleotide polymorphisms (SNPs) with psoriasis, and to reveal the relation between IL-17A gene SNPs and the fungal presence within the psoriatic plaques. PATIENTS/METHODS Fifty plaque psoriasis patients and fifty healthy age and sex volunteers as controls were enrolled in this study. From psoriatic plaques, mycological isolation was done by direct microscopic examination (10% KOH mount), culture onto the three sets of media then species identification by phenotypic procedures. Genomic DNA extraction and genotyping for IL-17A (rs10484879) SNPs using polymerase chain reaction and restriction fragment length polymorphism were also done. RESULTS Psoriasis cases showed higher frequency of fungal growth 86% vs. 14% in controls; (p

Background and Aim: Digital dermatitis (DD) is one of the most common causes of lameness in dairy cattle. It is seen in nearly all dairy herds across the world and has substantial welfare and economic implications. In this study, we aimed to investigate the efficacy of phenytoin sodium topical treatment on painful ulcerative stage of bovine digital dermatitis (BDD). Materials and Methods: In total, 45 Holstein-Friesian dairy cows with DD were randomly assigned to one of the three topical treatment trials (15 each): Saline solution (first treatment, negative control), chlortetracycline spray (second treatment, positive control), or phenytoin sodium powder (third treatment, positive control) (third treatment). On day 0 (pre-treatment) and on days 7, 14, 21, and 28 post-treatment, the response of DD-affected cows to the medications used was evaluated by measuring lesion depth and size, as well as the total clinical score (lameness, pain, and discomfort). Results: The cure rate in cows treated with phenytoin (86.66%) on day 28 was significantly improved compared to cows treated with either chlortetracycline (60%) or normal saline (6.66 %). Conclusion: Our findings highlight the superiority of phenytoin over the commonly used antibacterial agent, chlortetracycline, in the topical treatment of BDD, and subsequently suggest that phenytoin should be considered a suitable alternative treatment option for the treatment of BDD.

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.

Embaràs i malaltia cardíaca; Resultats de l’embaràs; Transposició de les grans artèries Embarazo y enfermedad cardíaca; Resultados del embarazo; Transposición de las grandes arterias Pregnancy and cardiac disease; Pregnancy outcomes, Transposition of the great arteries Background In the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk. Methods and Results The ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed. Conclusions Women after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate. Funding from “Zabawas Foundation” and “De Hoop Foundation” in addition to the support from EURObservational Research Programme (EORP) is greatly acknowledged. Since the start of EORP, the following companies have supported the program: Abbott Vascular Int (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc (2014–2016), Menarini Int Op (2009–2012), MSD‐Merck & Co (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), and Vifor (2019–2022).

Background: Ovulatory dysfunction is a common cause of infertility and polycystic ovary syndrome (PCOS) is the main reason of this dysfunction. PCOS is the most common endocrinopathy in women of childbearing age. A combination of ovarian stimulation or superovulation with intrauterine insemination (IUI) remains an important option available to an infertility specialist and is a widely used treatment modality for a broad range of indications. Objective: To compare between Letrozole-Gonadotrophins combination in and Clomiphene Citrate – Gonadotrophins combination in ovarian induction for PCOS Patient undergoing Intrauterine Insemination. Patients and methods: prospective chohort study was conducted in International Islamic Center for Population Study and Research, Al-Azhar University including 300 infertile women who already diagnosed as PCOS by Rotterdam 2003 Criteria. Women had been divided randomly into three equal groups: Group (A) were given clomiphene citrate 100 mg daily starting on day 3 till 7 day of cycle plus gonadotrophins (75 IU) once daily starting from 6th day of the cycle till growing follicle reach 18 mm, Group (B) were given letrozole (5mg/ day) starting on day 3 till 7 day of cycle plus gonadotrophins 75 IU once daily starting from 6th day of the cycle till growing follicle reach 18 mm and Group (C) were given letrozole (5mg/ day) starting on day 3 till 7 day of cycle. Results: Women’s ovulation rate in Group (A) was 78% had ovulation while in Group (B) 80% had ovulation and 68% in group (C). There were statistically significant differences between groups. Women’s pregnancy rate in Group (A) was 8% in Group (B) was 7% in group (C) was 4%. There were no statistically significant differences between groups. Group A showed more multiple follicles, more OHSS and then group B and C. more cancellation rate than group B. Group B showed less in multiple follicles and less OHSS than group A and less in cancellation rate than group A and C better in endometrial thickness. Group C Letrozole alone more monofollicular growth, less multiple follicles, less multiple pregnancy, less OHSS and less coast. Than group A and B but had less ovulation rate and more in cancellation rate than group A and B. Conclusion: We can offer ovulation induction and intrauterine insemination (IUI) for PCOS if first lines (lifestyle changes, pharmacotherapy (metformin, clomiphene citrate, letrozole, gonadotrophins) failed.

Background: Intrauterine Growth Restriction (IUGR) is defined as decreased fetal birth weight less than 10th percentile as regard to gestational age also diagnosed when there is a delay more than 2 weeks in a serial ultrasound monitoring of fetal gestational age. Objective: The aim of the work was to evaluate accuracy of transcerebellar diameter (TCD) in detection of gestational age in pregnancies with intrauterine growth restriction IUGR. Patients and Methods: Case-Control study was carried out on 52 women with normally progressing pregnancies during the third trimesters, with gestational ages between 27 and 37 weeks of gestation came to outpatient clinic of department of Obstetrics and Gynecology, Zagazig General Hospital and Zagazig University Hospital from June 2019 to March 2020, of them, 26 subjects were normal pregnancies and 26 subjects diagnosed as IUGR in 3rd trimester at gestational age (27week to 37 week). Trans-abdominal ultrasound was performed on all subjects; Fetal TCD was measured using the widest diameter of the cerebellum, measurement of fetal Bi-Parietal Diameter (BPD), Abdominal Circumference (AC), and Femur Length (FL). Results: There was statistically significant difference between gestational age (GA) by Last Menstrual Period (LMP) and sonar parameters at normal group but highest was TCD with P value 0.000 but in IUGR group only TCD, AC and FL were significantly positive correlated with GA; and TCD were highly significant. Conclusions: It could be concluded that the TCD measurement appears to be an accurate predictor of gestational age, even in the third trimester of pregnancy.

OBJECTIVE To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy. METHODS We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days' postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models. RESULTS Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61-3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65-4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy-most notably those related to hemorrhage and transfusion. CONCLUSION Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this.

Background Enthesopathy is a common feature of Spondyloarthritis (SpA) but can also be found in rheumatoid Arthritis (RA). Recognizing enthesopathy could be challenging because of low sensitivity and specific clinical testing. To detect enthesopathy, The European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Aim of the work To investigate the frequency and distribution of entheseal involvement in RA patients and its relation to disease activity. Patients and methods 100 RA patients with any symptom in foot and ankle were enrolled. Disease activity score (DAS28), Visual analogue scale (VAS), Health assessment questionnaire-Disability index (HAQ-DI) and Glasgow Ultrasound Enthesitis Scoring System (GUESS) were assessed. Results The mean age of patients was 44.1 ± 12.2 years, disease duration was 7 ± 5.8 years and 86% were females. The mean DAS28 score was 4.3 ± 1.2 and GUESS score was 7.2 ± 4.2; all patients had variable degrees of enthesitis: 30% of patients had mild enthesitis, 42% had moderate enthesitis and 28% had marked enthesitis. GUESS was significantly higher in patients with moderate (7.8 ± 4.9) and high (7.2 ± 3.2) disease activity than in patients with low disease activity (5.2 ± 3.9) and those in remission (6.5 ± 1.9) (p = 0.015). HAQ, Age and ESR significantly correlated with GUESS score (r = 0.19, p = 0.049; r = 0.23, p = 0.023; r = 0.33, p = 0.001 respectively). Conclusion Subclinical enthesitis is remarkable in RA patients. Quadriceps tendon enthesis was mostly affected. Enthesitis is significantly related to age, ESR and HAQ. The presence of enthesitis in RA may represent a potential marker for disease activity.

Background: Any protrusion through the anterior abdominal wall with the exception of hernia through the inguino-femoral region is defined as ventral hernia. Incisional hernia and primary defects in the abdominal fascia, which can cause umbilical hernia, epigastric hernia, para-umbilical hernia and spigelian hernia are grouped under the definition of ventral hernia. Objective: To evaluate the recurrence rate of laparoscopic ventral hernia repair with closure and non-closure of the hernia defect in non-complicated ventral hernia cases. Patients and Methods: This prospective randomized study was conducted from March, 2015 till December, 2019 in General Surgery Department, Mansoura University Hospital. It involved 50 patients with ventral hernia, who were classified randomly into 2 groups by computer generated sampling technique after retrieval of the calculated sample size according to inclusion and exclusion criteria. Results: The mean age of the non-closure group and of the closure group was 39.96 ± 6.52 and 39.84 ± 7.48 years respectively. The males were 36.0% and females were 64.0% in non-closure group, while in the closure group males were 24.0%, and the females were 76.0%. The mean BMI in the non-closure group was 31.44 ± 3.76 kg/m2, while in the closure group was 30.88 ± 3.70 kg/m2. In the non-closure group, the most common hernia sites were epigastric (60.0%), followed by umbilical (40.0%) while in the closure group, the most common hernia sites were umbilical (96.0%). Conclusion: Laparoscopic ventral hernia repair is a safe and feasible technique. The great advance in abdominal laparoscopic surgery and advance in the equipments and instruments as well as individual skills make closure of the hernia defect represents a good alternative to conventional laparoscopic ventral hernia repair (LVHR) with mesh only.

Background: Breast cancer is the second most common cancer among women, with an estimated 3.5 million survivors as of 2015. There is continuous annual improvement of the overall survival of breast cancer patients, with 5-year overall survival estimates increasing from 84.6% to 90.9% over the previous two decades. Objective: The aim of the current work was to improve aesthetic satisfaction and oncological outcome of patients with breast outer quadrant tumors. Patients and Methods: This interventional study included a total of 18 cases with early breast cancer at upper and lower-outer quadrants of breast, attending at Onco-Surgery Unit, General Surgery Department, Faculty of Medicine, Zagazig University. This study was conducted between December 2020 to May 2021. All patients were subjected to demographic data taking, complete clinical examination, and investigations including imaging, biopsies, and histopathology. Results: The Histopathological type of tumor, all of them had Invasive ductal carcinoma. Most of the tumors were (ER) and (PR) Positive with HER2/neo Negative. The mean duration of operation was 86.94±10.45 (range 70–105) minute and the mean blood loss was 286±12.34 (range 250-315) milliliter and all patients had no intraoperative complication. Conclusions: It could be concluded that the vertical axillary incision is a safe and effective approach for the management of tumors of the outer quadrant of the breast; and cosmetically appropriate maneuver for these tumors.

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

Purpose We aimed to compare our parent-based exercise programem's efficacy with the foot abduction brace (FAB) Ponseti manipulation as a retention programme. Methods We conducted this prospective multicentre cohort study between August 2009 and November 2019. The included children were allocated into one of two groups according to the retention protocol. The Pirani and Laaveg-Ponseti scores were used to assess the feet clinically and functionally. Radiological assessment was performed using standing anteroposterior and lateral radiographs of the feet. We assessed the parents’ satisfaction and adherence to the retention method. SPSS version 25 was used for the statistical analysis. Results A total of 1265 feet in 973 children were included. Group A included 637 feet managed with FAB, while group B included 628 feet managed with our retention programme. All patients were followed up to the age of four years. At the final follow-up, Pirani scores in group A participants were excellent, good and poor in 515, 90, and 32 feet, respectivel, while in group B the scores were excellent, good and poor in 471, 110 and 44 feet, respectively. The mean total score of Laaveg-Ponseti was 87.81 (sd 19.82) in group A and 90.55 (sd 20.71) in group B (p = 0.02). Group B participants showed higher satisfaction with the treatment method (p = 0.011) and more adherence to the treatment (p = 0.013). Conclusion The deformity's recurrence related to the brace's non-compliance in the Ponseti method might be reduced by substituting the brace with our home-based daily stretching exercises. Level of Evidence II

Background: Peripheral nerve lesions are common and severe injuries that impact about 2.8% of traumatic patients annually, and result in lifetime disability if untreated. Objective: This study aimed to investigate the effect of corticosteroids vs hyaluronic acid in peripheral nerve healing in rats. Patients and methods: This was experimental and histopathological study that had included (18) Sprague-Dawley rats with an average weight of 300–350 gm. All rats were divided into three groups (n=6 per group). Group 1; Corticosteroids was injected under epineurium after primary repair. Group 2; Hyaluronic acid group: the site of anastomosis was coated by hyaluronic acid after primary repair. Group 3; Primary repair only was done. Results: 100% of cases in group 1 and group 2 showed satisfactory wound healing and 83.3% in group3 showed satisfactory wound healing with no significant difference between them. Conclusion: There was an increase in the number of regenerated nerve fibers in the corticosteroids and hyaluronic acid especially on the distal end in comparison to the control group.

Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and

Background: Digital breast tomosynthesis (quasi three-dimensional [3D] mammography) is a relatively novel technique. It creates thin-slice reconstructions of the breast from low-dose digital mammographic images acquired at multiple angles. This evolution of mammography improves lesion visibility by reducing overlapping tissue. Hence, it has the potential to increase BC detection and to reduce false-positive (FP) findings. Objective: To review the role of 3D Digital Mammography in Studying of dense breast Lesions in adult female. Patients and methods: This was a retrospective study conducted on 40 patients who were eligible for examination by 3D Digital Mammography referred to WAFI center (women and fetal imaging center). The study was conducted during 12 months from January 2019 till January 2020 and was carried at Al-Azhar University Hospitals and WAFI Center (Woman and fetal imaging center). Results: There was no statistically significant difference between ultrasound (US) and tomosynthesis (TOMO) as regarding mass detection. There was a statistically significant increase as regarding calcification detection in TOMO than US. There was a statistically significant increase as regarding asymmetry detection in TOMO than US. There was no statistically significant difference between US & TOMO as regards Arch. Distortion detection. There was no statistically significant difference between US & TOMO as regards inflammatory reactions detection. There was statistically significant increase as regarding cyst detection in US than TOMO. There was a statistically significant increase as regarding dilated ducts detection in US than TOMO. There was a statistically significant increase as regarding added value detection in US than TOMO. There was no statistically significant difference between US & TOMO as regarding Breast Imaging-Reporting and Data System (BI-RADS). Conclusion: Both modalities were not similar in the ability to identify malignant lesions. Wide-angle digital breast tomosynthesis (DBT) was able to initially identify two more lesions

Introduction Early recognition of an anaphylaxis event is crucial for instituting lifesaving management. We sought to explore knowledge and practice towards anaphylaxis in a sample of physicians from ten Egyptian governorates. Methods An eighteen question-based questionnaire was developed by expert allergists to evaluate the knowledge and practice towards anaphylaxis, based on the World Allergy Organization guidelines for the assessment and management of anaphylaxis. The questionnaires were distributed, and the answered forms collected via emails, and data were tabulated, and analysed. Results In this cross-sectional study, a total of 242 physicians completed the survey (183 (75.6%) paediatricians, 32 (13.2%) internists, 22 (9.1%) intensivists and five (2.1%) anaesthetists). Only 91 participants (37.6%) identified all the four proposed anaphylaxis clinical scenarios while 70, 45 and 36 identified three, two and one scenario, respectively. Loss of consciousness and abdominal symptoms were not recognised as possible presentations of anaphylaxis by 64.5% and 80.2% of the participants, respectively. Epinephrine was considered the first line treatment by 98 (40.5%), corticosteroids by 77 (31.8%) and antihistamines by 25 (10.3%). 75 (31%) responders identified the right dose of epinephrine while 119 (49.2%) identified the proper route. Concerning practice, 83 physicians (39.2%) used epinephrine for all cases of anaphylaxis, 88 (41.5%) used it for refractory cases only whereas 41 (19.3%) did not use epinephrine at all. Discussion Our survey shows that the knowledge of Egyptian physicians and their practice towards anaphylaxis are still inadequate. The current situation reinforces the need to disseminate and encourage the adoption of the international guidelines for anaphylaxis diagnosis and treatment.