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In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery.The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39 + 0- and 40 + 6-weeks' gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤ 7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated.A total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p 0.001), PPH (p 0.008), NICU admission (p 0.001), low Apgar score at one-minute (p 0.001) and OASI (p = 0.009). The morbidity associated with OVD was significantly higher compared to spontaneous vaginal delivery, including NICU admission (p 0.001), PPH (p = 0.022), birth injury (p 0.001), shoulder dystocia (p = 0.002) and Apgar score of7 at one-minute (p 0.001). The positive likelihood ratios for composite outcomes (where the OVD was excluded) increases with increasing risk score from 1.005 at risk score of 5% to 2.507 for risk score of50%.In women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.

Background: Acute myeloid leukemia (AML) is a complex and heterogeneous hematopoietic tissue neoplasm caused by gene mutations, chromosomal rearrangement and deregulation of gene expression. Inositol polyphosphate 4-phosphatase type II (INPP4B) is a clinically relevant factor in the phosphoinositide 3 kinase (PI3K) pathway- associated cancers, has been found to have a bad prognostic role in AML. However, the exact mechanism is still unclear. Objective: We aimed in this study to investigate the prognostic role of INPP4B overexpression in Egyptian AML patients. Patients and methods: A total of 80 patients with newly diagnosed AML were included in the study. In addition, 40 apparently healthy, age and sex matched subjects served as control group. Immunophenotyping, cytogenetic analysis and quantitative assessment of INPP4B gene transcript were performed using real time PCR. Results: INPP4B overexpression was detected in 27.5 % of newly diagnosed AML patients. There was a statistically significant decrease in the probability of achieving complete remission (CR) with shorter overall survival (OS), event free survival (EFS) and disease-free survival (DFS) in the INPP4B high expression group compared with the low expression group (p=0.003, 0.03, 0.02 and

Background and Aim: Different polymerase chain reaction (PCR) techniques have and are still being used for the direct detection of Brucella DNA in serum samples of different animal species and humans without being validated or properly validated, resulting in discrepancies. Thus, this study aimed to evaluate the diagnostic performance of the TaqMan Real- Time-PCR (RT-PCR) targeting the bcsp31 gene versus conventional PCR for the accurate diagnosis of brucellosis at the genus level in cattle sera. Materials and Methods: One hundred and eighty-four serum samples were collected from bacteriologically positive and negative cows with ages ranging from 1 to 5 years old at some infected private farms in the Nile Delta under quarantine measures as well as brucellosis free farms. These samples were classified into four groups after serological diagnosis and investigated by TaqMan RT-PCR and conventional PCR targeting the IS711 gene for Brucella DNA detection. The diagnostic performance characteristics of both PCR techniques were estimated considering the bacteriological results as a gold standard. Results: TaqMan RT-PCR revealed superiority over conventional PCR; it was able to detect Brucella DNA in 95% (67/70) and 89% (25/28) of the cattle sera samples belonging to Group 1 (serologically and bacteriologically positive) and Group 2 (serologically negative but bacteriologically positive), respectively. On evaluating the diagnostic performance, TaqMan RT-PCR showed superior diagnostic sensitivity (93.9%), diagnostic specificity (88.4%), performance index (182.3), almost perfect kappa agreement (0.825±0.042), strong positive correlation (r=0.826), high accuracy based on the receiver operating characteristic (ROC) curve, and area under the ROC curve (0.911) at p

Background: Total Knee Arthroplasty (TKA) is one of the most advanced surgical solutions for pain relief and mobility improvement in patients with end stage osteoarthritis. TKA patients experience severe postoperative pain. Recently, peripheral nerve blockade and Peri or intra-articular injections have been used successfully with fewer side effects when compared to the conventional analgesic techniques. Measuring quality of recovery (QoR) using QoR-15 scale is considered as an accepted and efficient scale for clarification the success of surgery and anaesthesia. Materials and Methods: One hundred and thirty adult patients scheduled for TKA were randomized into 2 groups: Femoral nerve block (FNB) group and periarticular injections (PAI) group. All patients completed the QoR before or on the day of surgery and at the end of the first post-operative day. Postoperative pain scores, opiod consumption and adverse effects of the drugs and techniques were also measured. Results: Periarticular injections resulted in better analgesia at rest and on movement and less postoperative morphine consumption during the first 24 h postoperatively when compared to femoral nerve block. Global QoR-15 score was significantly higher in PAI when compared to FNB group. Conclusion: Periarticular injection of local anesthetics provides better quality of recovery and sufficient level of analgesia than does single shot femoral nerve block for patients undergoing total knee arthroplasty in early postoperative period. Keywords: Quality of recovery, Peri-articular injections, Total knee arthroplasty, Femoral nerve block.

Brucellosis is a zoonosis that has a devastating impact on the economy and public health, particularly in the Middle East, including Egypt. This study aimed to define risk factors associated with brucellosis in humans and in their cattle in Fayoum governorate - Upper Egypt. Also, molecular genotyping of recovered Brucella isolates from human cases and their cattle to assess the potential cross-species transmission in the study region. Data were obtained via double matched case–control studies for brucellosis in humans (106 cases and 160 controls) and in their cattle (78 cattle cases and 105 cattle controls). The results of multivariate regression analysis revealed that predictors of human brucellosis were animal-related occupations (OR 2.1, P 0.02), previous infection in other household members (OR 3.2, P 0.007), eating home-made soft cheese (OR 2.3, P 0.03), and exposure to cattle abortions (OR 6.9, P, Highlights • The study highlighted brucellosis risk factors in human & cattle in Upper Egypt. • The study recorded widespread risk factors among the cases. • Cattle and human isolates in the same household had matched genotypes. • REP-PCR/virulence genotyping could facilitate traceability in developing countries.

The discovery of drugs capable of inhibiting SARS-CoV-2 is a priority for human beings due to the severity of the global health pandemic caused by COVID-19. To this end, repurposing of FDA-approved drugs such as NSAIDs against COVID-19 can provide therapeutic alternatives that could be utilized as an effective safe treatment for COVID-19. The anti-inflammatory activity of NSAIDs is also advantageous in the treatment of COVID-19, as it was found that SARS-CoV-2 is responsible for provoking inflammatory cytokine storms resulting in lung damage. In this study, 40 FDA-approved NSAIDs were evaluated through molecular docking against the main protease of SARS-CoV-2. Among the tested compounds, sulfinpyrazone 2, indomethacin 3, and auranofin 4 were proposed as potential antagonists of COVID-19 main protease. Molecular dynamics simulations were also carried out for the most promising members of the screened NSAID candidates (2, 3, and 4) to unravel the dynamic properties of NSAIDs at the target receptor. The conducted quantum mechanical study revealed that the hybrid functional B3PW91 provides a good description of the spatial parameters of auranofin 4. Interestingly, a promising structure–activity relationship (SAR) was concluded from our study that could help in the future design of potential SARS-CoV-2 main protease inhibitors with expected anti-inflammatory effects as well. NSAIDs may be used by medicinal chemists as lead compounds for the development of potent SARS-CoV-2 (Mpro) inhibitors. In addition, some NSAIDs can be selectively designated for treatment of inflammation resulting from COVID-19.

Objectives Chronic hepatitis C infection incidence and prevalence are high in Egypt and represent a major health burden. Hepatitis C virus infection can affect graft outcomes in kidney transplant recipients. Treatment of hepatitis C virus infection among this special group was difficult during the interferon era; however, with advances in direct-acting antivirals, treatment outcomes have become more promising. Materials and methods This is a pilot, observational, single-center, one arm study that included 50 kidney transplant recipients seen at the Mansoura (Egypt) Urology and Nephrology Center. Patients were consented to receive a sofosbuvir-based regimen as all had creatinine clearance of greater than 30 mL/min/1.73 m2. Results All patients achieved rapid virologic responses 4 weeks after starting treatment. Forty-nine of 50 patients achieved 12-week and 24-week sustained viral responses. Six patients had increased serum creatinine levels. Four graft biopsies were performed. Anemia was the most common adverse effect among the patients who were maintained on ribavirin. Conclusions Treatment of chronic hepatitis C infection has become easier and safe with the advance of new direct-acting antivirals.

Summary Background Accurate early risk-prediction for gestational diabetes mellitus (GDM) would target intervention and prevention in women at the highest risk. We evaluated maternal risk-factors and parameters of body-composition to develop a prediction model for GDM in early gestation. Methods A prospective observational study was undertaken. Pregnant women aged between 18 and 50 y of age with gestational age between 10 and 16 weeks were included in the study. Women aged ≤18 y, twin-pregnancies, known foetal anomaly or pre-existing condition affecting oedema status were excluded. 8-point-skinfold thickness (SFT), mid-upper-arm-circumference (MUAC), waist, hip, weight and ultrasound measurements of subcutaneous (SAT) and visceral abdominal-adipose (VAT) were measured. Oral-glucose-tolerance-test (OGTT) for GDM diagnosis was undertaken at 28 weeks gestation. Binomial logistic-regression models were used to predict GDM. ROC-analysis determined discrimination and concordance of model and individual variables. Results 188 women underwent OGTT at ~28 weeks gestation. 20 women developed GDM. BMI (24.7 kg m−2 (±6.1), 29.9 kg m−2 (±7.8), p = 0.022), abdominal SAT(1.32 cm (CI 1.31, 1.53), 1.99 cm (CI 1.64, 2.31), p = 0.027), abdominal VAT(0.78 cm (CI 0.8, 0.96), 1.41 cm (CI 1.11, 1.65), p = 0.002), truncal SFT (84.8 mm (CI 88.2, 101.6), 130.4 mm (CI 105.1, 140.1), p = 0.010), waist (79.8 cm (CI 80.3, 84.1), 90.3 cm (CI 85.9, 96.2), p = 0.006) and gluteal hip (94.3 cm (CI 93.9, 98.0), 108.6 cm (CI 99.9, 111.6), p = 0.023) were higher in GDM vs. non-GDM. After screening variables for inclusion into the multivariate model, family history of diabetes, previous perinatal death, overall insulin resistant condition, abdominal SAT and VAT, 8-point SFT, MUAC and weight were included. The combined multivariate prediction model achieved an excellent level of discrimination, with an AUC of 0.860 (CI 0.774, 0.945) for GDM. Conclusions An early gestation risk prediction model, incorporating known risk-factors, and parameters of body-composition, accurately identify pregnant women in their first-trimester who developed GDM later on in gestation. This methodology could be used clinically to identify at-risk pregnancies, and target specific treatment through referred services to those mothers who would most benefit.

Ibrutinib, a Bruton’s tyrosine kinase that plays an essential role in the B-cell development and cancer cells, has been recently approved to treat chronic, lymphocytic, and other types of leukemia. This study focused on investigating ibrutinib by its electronic transitions, vibrational frequencies, and electrospray mass spectra. The experimental peaks for electronic spectrum were found at 248.0 and 281.0 nm, whereas the νC = 0 stretching frequency was found at 1652.4 and 1639.19 cm−1. These experimental properties were compared with the corresponding theoretical calculations in which density functional theory was applied. The optimized structure was obtained with the calculations using a hybrid function (B3LYP) and high-level basis sets [6-311G++(d,p)]. Most of the calculated vibrational frequencies showed a relatively good agreement with the experimental ones. The electronic transitions of ibrutinib calculated using time-dependent DFT method were performed at two different solvation methods: PCM and SMD. The mass spectrum of ibrutinib, its fragments, and its isotopic pattern agreed well with the expected spectra.

Sphingolipids (SLs), are structural components of the skin that contribute to the regulation of the proliferation and differentiation of keratinocytes as well as regulation of the skin epidermal barrier. A prospective cross sectional comparative controlled study was designed to evaluate the serum level of sphingosine 1 phosphate (S1P) and ceramide (CER) before and after narrow band ultraviolet B (NBUVB) in psoriatic patients. The study included 32 patients presented with psoriasis and 32 healthy age and sex matched control volunteers. (S1P and CER) levels were measured before and after NBUVB sessions for psoriatic patients and their levels were correlated to psoriasis area and severity index (PASI) improvements. PASI scores and serum values of the studied sphingolipids demonstrated a significant difference between the baseline and at the end of the 12 weeks NBUVB treatment. A statistically significant positive correlation was established between psoriasis severity and S1P serum levels before and after treatment while no correlation was observed between psoriasis severity and CER serum levels. Decreased total CER and increased S1P serum levels reflect altered sphingolipid metabolism in psoriasis and can be predictors of disease severity.

Background: Recent studies have reveled the presence of a complex fungal community (mycobiome) in the oral cavity. However, the role of oral mycobiome in dental caries and its interaction with caries-associated bacteria is not yet clear. Methods: Whole-mouth supragingival plaque samples from 30 children (6–10 years old) with no caries, early caries, or advanced caries were sequenced for internal transcribed spacer 2 (ITS-2). The mycobiome profiles were correlated with previously published bacteriome counterparts. Interaction among selected fungal and bacterial species was assessed by co-culture or spent media experiments. Results: Fungal load was extremely low. Candida, Malassezia, Cryptococcus, and Trichoderma spp. were the most prevalent/abundant taxa. Advanced caries was associated with significantly higher fungal load and prevalence/abundance of Candida albicans. Cryptococcus neoformans and Candida sake were significantly over-abundant in early caries, while Malassezia globosa was significantly enriched in caries-free subjects. C. albicans correlated with Streptococcus mutans and Scardovia wiggsiae among other caries-associated bacteria, while M. globosa inversely correlated with caries-associated bacteria. In-vitro, M. globosa demonstrated inhibitory properties against S. mutans. Conclusions: the results substantiate the potential role of the oral mycobiome, primarily Candida species, in dental caries. Inter-kingdom correlations and inhibition of S. mutans by M. globosa are worth further investigation.

Objectives This article prospectively examines the use of ultrasound for antenatal detection of abnormal placental cord insertion (PCI) and compares the antenatal classification with delivered placental classification. Study Design This prospective cohort study examined 277 singleton pregnancies in a tertiary center. Scans were performed between 10 and 14, 18 and 22, and 32 and 34 weeks where PCI site was identified and its shortest distance to margin measured. Standardized images of delivered placentas were taken and digitally measured. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antenatal classification compared with delivered placental classification were calculated. Results Abnormal PCI (distance Conclusion Abnormal PCI can be detected antenatally with optimal agreement with postnatal classification in T2. However, the incidence is overestimated at early scans with low PPVs.

Objective To detect the diagnostic performance of apparent diffusion coefficient (ADC) value and Cho/Cr ratio in distinguishing various pathological subtypes of parotid gland tumors. Patients and Methods This study included 30 patients (14 males and 16 females; age ranged from 25 to 70 years; mean age 50 ± 12.5 years) with 31 parotid gland masses. Diffusion weighted imaging and MR spectroscopy were performed in all patients. ADC values and Cho/Cr ratios were measured for each parotid mass and compared with pathology. The diagnostic performance of ADC value, Cho/Cr ratio, ADC + Cho/Cr ratio and ADC × Cho/Cr ratio for differentiating pathological subtypes were assessed. Results Pleomorphic adenomas had highest ADC values and Warthin tumors had highest Cho/Cr ratios. ADC value had the best diagnostic performance in differentiating pleomorphic adenomas from Warthin tumors by using cutoff value 1.12 × 10−3 mm2/sec with sensitivity, specificity, PPV, NPV and accuracy 100% for each. ADC value × Cho/Cr ratio had the best diagnostic performance in differentiating malignant from benign tumors, malignant tumors from pleomorphic adenoma and malignant from Warthin’s tumors by using cutoff value 2.37 at which sensitivity, specificity, PPV, NPV and accuracy all were 100%. Conclusion: ADC value and Cho/Cr ratio are useful in differentiating different pathological subtypes of parotid tumors.

Chronically Kidney Disease (CKD) is still a health problem with a high incidence, complex aetiology, and often without complaintsor clinical symptoms except in the terminal stadium. To know the distribution of CKD according to age, sex group, aetiology, determiningstage of CKD based on creatinine clearance value, a retrospective study was conducted on 88 patients of CKD at Wahidin SudirohusodoPublic Hospital of Makassar from January to December 2004. The diagnosis of CKD was based on serum ureum value (ModifiedBarthelot), serum creatinine value (Jaffe) and creatinine clearance value (Cockroft Gault). Chronically Kidney Disease was found morefrequent in men 59.09% (52 of 88). The peak age prevalence was between 50 to less than < 60 years 29.55%. The eldest patient was 83years while the youngest was 16 years. The most fragment aetiology of CKD was hypertension 18.18% (16 of 88). Based on creatinineclearance values the medium group, severe group, and renal failure group were the age group respectively 3.41%, 19.32% and 77.27%.The prevalence of CKD is found more frequent in 50 less than 60 years of age. Hypertension seems to be the more predominant aetiology,and staging based on creatinine clearance value showed that most patients were in the renal failure group.

This study aimed to assess the expression of S100A4, Twist and E-cadherin (mRNA and protein) in urothelial bladder cancer, investigate the correlation between them and evaluate their association with the clinicopathological features of the disease. The study included 54 patients diagnosed as urothelial bladder cancer of different stages and grades. The expression levels of S100A4, Twist and E-cadherin (mRNA and protein) in tissue samples were determined by quantitative RT-PCR and immunohistochemistry. The expression of S100A4 and Twist was significantly upregulated while E- cadherin was significantly downregulated in urothelial bladder cancer tissues compared to the adjacent surrounding normal bladder tissues at both mRNA and protein levels (p

Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies. Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software. Results The rates of velamentous (insertion into the membrane) and marginal ( Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight.

Summary The association between endothelial dysfunction and late onset hypogonadism (LOH) in patients with vasculogenic erectile dysfunction (ED) is not yet well settled. Our objective was to assess the association between LOH and endothelial dysfunction in patients with vasculogenic ED. Throughout 2014–2015 a total of 90 men were enrolled in this cross-sectional observational study. Of them 60 patients with a clinical diagnosis of ED were further subdivided into two equal groups: patients with vasculogenic ED and LOH (A); patients with vasculogenic ED and euogonadal (B). Thirty age-matched men with no ED or hypogonadism were enrolled as control group (C). All patients were subjected to detailed medical and sexual history, total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT), flow cytometric evaluation for endothelial progenitor cells (EPCs) (CD45negative/CD34positive/CD144positive) and endothelial microparticles (EMPs) (CD45negative/CD144positive/annexin V positive). The mean age ± SD of the three groups A, B and C were 51.3 ± 11.1, 53.6 ± 10.6 and 48.3 ± 5 years, respectively, with insignificant age differences (p = 0.089). The diagnostic criteria of LOH were adapted according to European male aging study, 2010. The means of TT(ng/mL) were 2.32 ± 0.21, 6.43 ± 0.36 and 5.37 ± 0.30 in groups A, B and C, respectively. There were highly significant differences between group A and groups B and C (p

Despite the improvement in the diagnostic and the therapeutic modalities, colorectal cancer (CRC) morbidity and mortality remain high in both the developed and the developing countries. So, we are in a need to recognize new efficient diagnostic and prognostic biomarkers of CRC. That may help in providing individualized targeted therapy for this lethal malignancy. In this study, we investigated the expression and the prognostic significance of CD133 and ezrin mRNA and protein by quantitative RT-PCR and immunohistochemical analysis in primary CRC cases and the surrounding normal colonic mucosa. The correlations between the expression of both markers and clinicopathological parameters were performed. Compared to control, the expression of CD133 and ezrin mRNA and protein in CRC were significantly up-regulated (P

Aufgrund des zunehmenden demographischen Wandels und der Tatsache, dass kardiovaskulare Erkrankungen weiterhin die Todesursachenstatistik anfuhren, nimmt das kalendarische Durchschnittsalter herzchirurgischer Patienten stetig zu – so waren im Jahr 2015 14,8 % aller herzchirurgischen Patienten 80 Jahre und alter. Mit der durchgefuhrten Metaanalyse wurde untersucht, ob und unter welchen Bedingungen altere Patienten noch von herzchirurgischen Eingriffen profitieren konnen, ohne ein hohes Risiko der Einschrankung der Lebensqualitat, der Morbiditat und Mortalitat eingehen zu mussen. Grundsatzlich zeigte sich, dass das kalendarische Alter kein Risikofaktor fur erhohte peri- und postoperative Morbiditat und Mortalitat ist, sondern das biologische Alter entscheidend ist, insbesondere die Komorbiditaten der Patienten sowie der Zeitpunkt der Operation im Krankheitsverlauf. So waren elektive Operationen bei asymptomatischem Krankheitsverlauf hinsichtlich des Outcomes besser als Operationen in symptomatischen oder gar dekompensierten Krankheitsstadien. Die Durchfuhrung herzchirurgischer Eingriffe bei alteren Patienten fuhrte im Vergleich zur medikamentos-konventionellen Therapie zu einer verbesserten Lebenserwartung. Die Lebensqualitat betreffend wiesen altere Patienten nach herzchirurgischen Eingriffen eine signifikante Zunahme der Lebensqualitat auf, die postoperativ mit denen jungerer Patienten vergleichbar war. Folglich profitieren auch uber 80-Jahrige in jeglicher Hinsicht von herzchirurgischen Eingriffen, sofern diese individuell adaptierte Operationstechniken berucksichtigt.

The newer and potent immunosuppressive agents have successfully reduced the risk of rejection after kidney transplantation, but the development of cardiovascular diseases, infections, and malignancy is major factors limiting their success. Posttransplantation malignancy is the second most common cause of death in renal transplant recipients after cardiovascular disease; it is expected that mortality due to malignancy may become the most common cause of death within the next two decades. This study is designed to evaluate the incidence, risk factors, and types of malignancies occurring after renal transplantation and their impact on patient and graft survival. A total of 2288 patients underwent living donor renal allotransplantation in the Urology and Nephrology Center, Mansoura University, during the period between 1975 and 2011. Among these patients, 100 patients developed posttransplantation malignancy. Patients were categorized into five major groups according to their type of malignancy; Kaposi's sarcoma (KS), non-Kaposi's skin tumors (non-KS), posttransplant lymphoproliferative disorders (PTLD), solid tumors, and genitourinary and reproductive system (GU and RS). Overall, the incidence of cancer in renal transplant recipients was 4%. There were 83 male (83%) and 17 female patients (17%). The most frequent cancer was KS seen in 33 patients (33%). The lowest median time to development of cancer was observed in KS (35 months). The highest median time to development of cancer was observed in PTLD (133 months). The best graft survival was observed in PTLD and the worst in non-KS tumors. The best patient survival was observed in KS and the worst in GU and RS tumors. Azathioprine-based regimen was associated with a higher rate of cancer. The number of patients who died was 65 (65%). Our results indicate that the occurrence of malignancy has an important impact on short- and long-term graft and patient survival.

Background: Obesity has an adverse impact on metabolic parameters including CKD. Bariatric procedures produce significant weight loss compared to non-surgical means and have a positive effect on renal and non-renal parameters. The present study retrospectively evaluated the effect of bariatric procedures and weight loss on renal function, proteinuria, hypertension, lipid profile and diabetic status in chronic kidney disease (CKD) patients in Queensland, Australia. Methods: Of the 880 patients who consented to the CKD Registry, data of patients who underwent bariatric procedures were analysed. Changes in anthropometric measures, renal functions, lipid profile, glycosylated haemoglobin A1c (HbA1c) (%), proteinuria and requirement for blood pressure medications and insulin dose were noted during follow-up. Results: Eight patients (1%) (mean age 48 years: there were 5 men) underwent bariatric procedures (gastric banding - four, gastric sleeve - three and gastric bypass - one). Mean follow-up duration was 10 years. During follow-up a trend towards reduction was noted in weight (kg) (163 - 115 p = 0.01), proteinuria (g/mol) (381 - 65 p = 0.302), HbA1c (%) (8.1 to 6.7 p = 0.03) and total cholesterol (mmol/L) (4.7 to 4.0 p = 0.33). The estimated glomerular filtration rate (eGFR) (mL/min/1.73m2) did not change significantly (58.1 - 54.1 p = 0.426). Reductions of anti-hypertensive medications (1.8 - 0.75, p = 0.08) and insulin dose (IU) (61.3 - 25 p = 0.37) were also noted. One patient developed complications requiring removal of the gastric band. One patient progressed to end-stage renal disease. Conclusions: There was significant weight loss leading to improvement in multiple metabolic parameters. There was a trend towards a slow progression of CKD post-bariatric surgery during the follow-up. Although the numbers are small bariatric procedures appears to have a significant role in the management of obesity associated with CKD and related metabolic conditions.

Purpose: The purpose of the study is to assess the quality of transurethral resection of bladder tumors (TURBTs) performed by “senior” and “junior” urologists in terms of detrusor muscle (DM) presence at the initial resection and presence of missed and residual tumors at second-look TURBT. Patients and Methods: An analytic prospective cohort study included 171 patients with stage T1 and Ta bladder cancer who had undergone an initial TURBT. Patients were divided into two groups according to surgeon experience. Group 1 (116 patients) operated on by senior surgeons (consultants and trainees in year 5 or 6) and Group 2 (55 patients) operated on by junior surgeons (trainees below year 5). All patients underwent second-look TURBT (by a senior urologist) within 2–6 weeks after the initial resection. The outcome of the initial and re-TURBT represented with regard to the surgeon experience. Results: There is a statistically significant difference between senior and junior surgeons regarding the presence or absence of DM in the initial resection (P = 0.001). A significant relation between the presence of residual tumors in re thermodynamic uncertainty relation (TUR) in relation to the initial operator was found (P = 0.03). Re-TURBT of patients in Group 1 (initially operated on by experienced surgeons) revealed that 57.7% had tumor-free resection while 36.2% had residual tumors, 5.2% had missed lesion and only 0.9% had concurrent residual and missed tumors. In contrast, from Group 2 (55 patients operated by junior surgeons) 47.3% had residual tumor, 21.8% had missed lesions, and 9.1% had concurrent residual and missed tumors in re-TUR. Conclusions: Nonmuscle invasive bladder cancer treated with TURBT should be managed as any other major oncologic procedure. TURBT should be performed by an experienced surgeon or with very close supervision when done by training urologist.

Depigmentation emerges as a feasible solution for vitiligo universalis and refractory cases of vitiligo vulgaris that hinder patients' quality of life. A range of depigmenting modalities has previously been developed. However, each has its own limitations. Based on skin sensitivity, this study sets out to compare the efficacy and tolerability of "trichloroacetic acid (TCA) peels 25% and 50% and Qs Nd:YAG laser (1,064/532 nm)" for facial depigmentation and "cryotherapy, phenol 88% and Qs Nd:YAG (1,064/532 nm)" for extrafacial skin depigmentation. Forty vitiligo patients were examined and equally divided into facial & extrafacial groups. Regular sessions were performed. Patients' responses were assessed after 3 months or when excellent/complete depigmentation was attained through assessing "depigmentation grade", "extent of depigmented skin", "patient satisfaction" and "overall response". Patients were observed for a six-month follow-up period. In facial depigmentation, Qs Nd:YAG showed the highest significant response followed by TCA 50% and 25%. In extrafacial depigmentation cryotherapy, phenol 88% and Qs Nd:YAG laser displayed positive outcomes without significant difference. Among the modalities tested Qs Nd:YAG yielded superior results in facial residual pigmentation in vitiligo when compared to TCA 50% and 25%, whereas in extrafacial sites Qs Nd:YAG, cryotherapy and phenol were equally effective.

peer-reviewed Introduction: Individual placental and umbilical cord morphometry have been previously identified to have an association with fetal growth. This study aims to identify which of the morphometric measurements in combination are associated with pregnancies with small for gestational age (SGA) infants using digital imaging of the delivered placenta. Material and methods: This study examined 1005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken. Placental weight and thickness; umbilical cord length and diameter were measured on gross examination. Distance from the placental cord insertion site to placental margin, length and breadth of the placenta and placental chorionic surface area were measured digitally using ImageJ software. Logistic regression models and area under the curve (AUC) were used to identify the best subset of morphometric measurements to classify infants as SGA (

Background The possible role of phosphodiesterase 5 inhibitors (PDE5Is) in prevention of negative effect of diabetes mellitus (DM) on erectile function is not well settled. Objectives To investigate the effect of early administration of vardenafil on erectile function, cavernosal structure, and genes expression in a rat model of DM. Materials and methods This experimental study was carried out at Suez Canal University's research laboratory. This study was conducted on a total of 60 adult male Albino Wistar rats, aged 60-80 days and weighing an average of 200 g. Rats were equally divided into six groups of 10 rats each: Group I (sham); Group II (DM with no treatment); Groups III, IV, V, and VI received vardenafil started at day 1, week 4, week 8, and week 12 after induction of DM, respectively. Functional study assessment of all groups was performed before euthanization, and then tissues were harvested for histopathological, ultrastructural, and molecular examinations. Results There was a significant difference of intracavernosal pressure between early (94 ± 2.18) and late (40.5 ± 1.94) treatment groups (p = 0.011). Histopathological and ultrastructural changes of DM with no treatment and late treatment groups showed distorted cavernous architecture and extensive fibrosis. There was significant difference of smooth muscle to collagen ratio between early and late treatment groups (p = 0.035). There was significant upregulation of nNOS(p = 0.021) and iNOS (p = 0.047) in early vs. late treatment group. The difference was insignificant in eNOS (p = 0.386) or TGF-β1(p = 0.149). Discussion and conclusion Early treated rats with vardenafil had preserved erection and normal cavernosal structure, ultrastructure and gene expression of iNOS, nNOS, eNOS, and TGF-β1. Quantification of gene expression would improve our knowledge regarding cytokines expression and molecular background of DM-associated ED. Clinical application of this result may encourage early administration of PDE5I to prevent deleterious effects of DM on erectile function in newly diagnosed DM patients with probable uncontrolled blood glucose.

Background Laparoscopic radical prostatectomy is minimally invasive technique used to treat cancer prostate. Controlling post-operative pain is one of the main concerns for better post-operative recovery. This study compared the efficacy of ultrasound guided transversus abdominis plane (TAP) block with intraperitoneal instillation of local anesthetics for reduction of postoperative pain after laparoscopic radical prostatectomy. Methods Forty adult patients scheduled for laparoscopic radical prostatectomy were randomized to receive TAP block (group I) or simple instillation of local anesthetics in the peritoneal cavity (group II). The primary outcome was assessing Visual Analogue scale (VAS) during rest and during mobilization. Secondary outcome was measuring total amounts of supplementary morphine consumption. Results There were significant lower pain scores in group II when compared to group I at rest and on movement till the end of the first 24 hours post-operatively. patients undergoing peritoneal block had reduced total amount of 24 h morphine consumption (8±1.9) in comparison to TAB block group (5.8±1). Conclusion Peritoneal block with local anesthetics provides better post-operative analgesia and reduced morphine consumption up to 24 hours after laparoscopic surgery when compared to TAP block.

BACKGROUND The treatment strategies of astrocytoma have not changed considerably due to the restricted appreciation of its biology. OBJECTIVES This study aimed to evaluate the expression of the stem cell-related proteins (CD133 and Sox2) and their prognostic value in astrocytic glioma. METHODS The immunohistochemical expression of CD133 and Sox2 in 40 patients with an astrocytic glioma of different grades was studied. The recorded data on the overall survival (OS), progression-free survival (PFS) and the response to the therapeutic protocol were collected and lastly analyzed. RESULTS CD133 expression was observed in 87.5% of the cases, while positive Sox2 expression was found in all the studied cases. There was a significant association of CD133 expression with the histological grade and the tumor size (p< 0.001). A significant association of Sox2 with the histological grade and the tumor size was noted (p= 0.004, p= 0.006 respectively). Up-regulation of both CD133 and Sox2 had a significant association with poor clinical response to the therapy (p< 0.001 for each). Shorter OS and PFS were related to CD133 and Sox2 overexpression. CONCLUSIONS Astrocytoma with CD133 and Sox2 overexpression had an unfavorable prognosis and poor clinical response to the current therapeutic protocol.

Background: Food allergy is a major problem in both developed and developing countries and seems to increase over the past 10–15 years. Due to the incomplete understanding of the effects of food allergy on health-related quality of life (HRQL) among adolescents. This study aimed to identify the impact of food allergy on adolescent’s quality of life. Method: In this cross-sectional study, 144 adolescents aged 12–18 years who objectively-diagnosed having food allergy were included. Adolescents were interviewed and completed questionnaire sheet consisted of two parts, the first part for personal data and the second part included questions about types of allergic foods, signs and symptoms and complications of allergy, also they completed specific food allergy quality of life questionnaire-teenager form. Results: Shows that, the average score of the food allergies scale is (167.93), which is in the high range. The average quality of life measure for adolescents is 105.42 degrees, which is considereda low level of quality of life as a whole. There is a negative correlation between food allergies in adolescents and the quality of life dimensions at the level of significance p= 0.05, which highlights the importance of the current study. Conclusions: The present study concluded that food allergy has a high impact on the quality of life of adolescents and there are negative correlations between adolescent food allergies and the quality of life from all dimensions.

Background Abnormal placental cord insertion (PCI) includes marginal cord insertion (MCI) and velamentous cord insertion (VCI). VCI has been shown to be associated with adverse pregnancy outcomes. This systematic review and meta-analysis aims to determine the association of abnormal PCI and adverse pregnancy outcomes. Methods Embase, Medline, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Databases were searched in December 2016 (from inception to December 2016). The reference lists of eligible studies were scrutinized to identify further studies. Potentially eligible studies were reviewed by two authors independently using the following inclusion criteria: singleton pregnancies, velamentous cord insertion, marginal cord insertion, and pregnancy outcomes. Case reports and series were excluded. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Outcomes for meta-analysis were dichotomous and results are presented as summary risk ratios with 95% confidence intervals. Results Seventeen studies were included in the systematic review, all of which were assessed as good quality. Normal PCI and MCI were grouped together as non-VCI and compared with VCI in seven studies. Four studies compared MCI, VCI, and normal PCI separately. Two other studies compared MCI with normal PCI, and VCI was excluded from their analysis. Studies in this systematic review reported an association between abnormal PCI, defined differently across studies, with preterm birth, small for gestational age (SGA), low birthweight (

Objectives To examine the prevalence of dental anxiety and its associations with pain and other psychological variables among patients seeking dental treatment and develop a directed acyclical graph of these relationships. Methods One hundred and twenty patients who sought regular or emergency dental care completed a semi-structured interview assessing DSM-IV specific phobia of dental procedures and questionnaires assessing dental anxiety, pain at last dental visit, blood-injection-injury (BII) phobia, social appearance anxiety, and other psychological constructs. Differences between regular and emergency patients were explored using t-tests. Potential excess risk of dental anxiety due to interactions between pain and psychological processes was explored. Finally, multivariate linear regression was conducted. Results Thirty-five percent of participants came for emergency care. Almost half (49.2%) reported moderate or high anxiety, and 20% met criteria for specific phobia. The relationship between pain at the last dental visit and dental anxiety scores was confounded by social appearance anxiety and BII phobia. Conclusion The dental anxiety–pain response may be affected by psychological processes such as social appearance anxiety and BII phobia. Targeting these related psychological constructs may improve the management of anxiety treatment among adult patients seeking dental care.

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment.

Objective: Good oocyte quality and maturity are important prerequisites for high fertilization and implantation rates in IVF/ ICSI treatment cycles. Reactive oxygen species (ROS) are produced within ovarian follicles, especially during the ovulation process, and increased ROS activity may be a cause of impaired oocyte maturation and higher rate of failure of IVF/ ICSI cycles. Study design: RCT evaluating the effect of antioxidant supplementation on ICSI/IVF outcomes. Two hundred and eighteen women with unexplained subfertility undergoing IVF/ICSI were randomized into two groups. The study group ( n 112) received daily oral antioxidants in the form of multivitamins and minerals (amino acid chelated) while the control group ( n 106) did not. Main outcomes were number of mature metaphase II (MII) oocytes and clinical pregnancy rate. Results: There were no signifi cant changes between the groups as regards age, BMI, basal FSH, number of mature (MII) oocytes (12.7 9.4 vs. 13.2 8.6, P 0.7) and clinical pregnancy rate per woman randomized (38% vs. 34%; [OR 1.2; 95% CI, 0.70 – 2.11]. Conclusion: Oral antioxidants in the form of a combination of multivitamins and minerals (amino acid chelated) did not improve oocyte quality and pregnancy rates in women with unexplained infertility undergoing IVF/ICSI treatment.

Increasing body mass index (BMI) has reached epidemic proportions globally and recently emerged as strong, independent risk factors for chronic kidney disease (CKD). We conducted this study to verify the prevalence of obesity and the associated risk of developing CKD among 3000 Egyptian students. The World Health Organization classification of BMI categorized study population into 1-5 groups, 1146 subjects with normal BMI (20-25), 951 subjects with BMI 25-29.9, 540 subjects with BMI 30-34.9, 225 with BMI 35-39.9, and 138 with BMI above 40. The participants were subjected to clinical examination, anthropometric measurements, laboratory investigation, including urinary albumin/creatinine ratio (ACR) and estimation of glomerular filtration rate (eGFR). The prevalence of overweight, obesity, and metabolic syndrome (MS) was 31.7%, 30.1%, and 16%, respectively. The prevalence of CKD among subjects with BMI >25 was 6.5%, almost all of them had BMI >35. ACR and eGFR rose progressively with increasing BMI. Elevated mean arterial pressure (MAP), high sensitivity C-reactive protein, and MS increased the risk of development of CKD. Moreover, MAP, waist to height ratio, and triglycerides to high-density lipoprotein ratios at levels of >95 mm Hg, >0.6, and >3 had sensitivity 91.7%, 88.4%, and 86.7%; and specificity 92.3%, 96.4%, and 96.5%, respectively to predict CKD. The prevalence of obesity among Egyptian young adults was high (30.1%) and was associated with increased the risk of CKD (6.5%).

Background The Wilms’ tumor 1 (WT1) gene is overexpressed in patients with acute leukemias. Many studies have reported the importance of quantitative assessment of WT1 expression as a molecular marker of minimal residual disease monitoring. However, biological significance and the prognostic effect of WT1 overexpression in acute myeloid leukemia (AML) remain elusive. Subjects and methods A total of 42 patients with newly diagnosed AML were included in the study. Also, 42 individuals matched for age and sex were enrolled as controls. Immunophenotyping, cytogenetic analysis, and quantitative assessment of WT1 gene transcripts were performed using real-time PCR. Results WT1 overexpression was detected in 73.8% of our patient group. There was a statistically significant decrease in the probability of achieving complete remission with shorter overall survival and event-free survival in the WT1 overexpression group compared with the downexpression group (P=0.035, 0.045, 0.011, respectively). Application of multivariate analysis showed that WT1 overexpression by itself is an independent and negative indicator for predicting overall survival and disease-free survival of AML patients. Conclusion WT1 overexpression is an independent negative prognostic marker that could be used to evaluate response to induction chemotherapy and prognosis of AML patients.

Background: Contrast-induced acute kidney injury (CI-AKI) continues to have an increasing incidence, representing the third most common cause of hospital acquired acute kidney injury. It is a syndrome in which an acute renal dysfunction is diagnosed after the intravascular injection of contrast media. Acute renal injury is typically diagnosed by measuring serum creatinine that is an unreliable indicator during acute changes in kidney function; thus, the need for early sensitive biomarkers to detect acute kidney injury before the rise of creatinine has emerged. Urinary Liver type fatty acid binding protein is a newly emerging biomarker that might represent an early, sensitive and non-invasive biomarker for acute renal injury. Cystatin C is a cysteine protease inhibitor that demonstrated a high diagnostic value to detect AKI on the two days before creatinine elevation. Objective: The aim of our study was to elucidate if urinary L-FABP and plasma Cystatin C can be early predictors of AKI after contrast adminstration. Subject and methods: thirty three patients were included in this study, they were divided into two main groups; Group (I): 16 patients underwent coronary angiography for dioagnostic and therapeutic purposes, Group (II): 17 patients underwent computerized tomography using IV (high-osmolar) contrast media; then classified after the procedure to AKI group and Non AKI group according to the change in serum creatinine after 24 hours. Results: the basal value of both plasma cystatin c and urinary L-FABP is significantly higher in AKI vs non AKI groups indicating predictive value of both biomarkers before contrast exposure (AUC of urinary L-FABP = 0.837 (95%CI; 0.673 – 1.001); AUC of plasma Cystatin C = 0.742 (95%CI; 0.600 – 0.925)). After contrast exposure, both both plasma cystatin c and urinary L-FABP showed a highly statistically significiant elevation at 6 hours in the AKI group compared to the non AKI group, while there was no statistically significiant difference in serum creatinine (mg/dl) that showed significant elevation only after 24 hours; thus, both plasma cystatin c and urinary L-FABP may serve as early predictors of AKI after contrast adminstration before any significant change in serum creatinine (AUC of urinary L-FABP =1 (95%CI; 1 – 1); AUC of plasma Cystatin C =1 (95%CI; 1 – 1)). Conclusion: urinary L-FABP and plasma Cystatin C can be considered as predictive biomarkers of contrast induced nephropathy before contrast exposure and as early biomarkers after contrast exposure instead of serum creatinine, as their levels start to rise about 24 hours before any significant change in serum creatinine. Further studies are recommended using large number of patient. Keywords: L-FABP, cystatin c, contrast-induced nephropathy, high osmolar contrast.

Background: Methylenetetrahydrofolate reductase (MTHFR) is involved in DNA synthesis and repair. We here aimed to investigate two common polymorphisms, C677T and A1298C, with genotype and haplotype frequencies in colorectal cancer (CRC) cases among Jordanian. Materials and Methods: 131 CRC cases were studied for MTHFR C677T and A1298C polymorphisms, compared to 117 controls taken from the general population, employing the PCR-RFLP technique. Results: We found the frequency of the three different genotypes of MTHFR C677T among Jordanians to be CC: 61.7%, CT: 35.2%, and TT 3.1% among CRC cases and 50.9%, 38.8% and 10.3% among controls. Carriers of the TT genotype were less likely to have CRC (OR=0.25; 95%CI: 0.076-0.811; p=0.021) as compared to those with the CC genotype. Genotype analysis of MTHFR A12987C revealed AA: 38.9%, AC: 45%, and CC 16% among CRC cases and 37.4%, 50.4% and 12.2% among controls. There was no significant association between genetic polymorphism at this site and CRC. Haplotype analysis of MTHFR polymorphism at the two loci showed differential distribution of the TA haplotype (677T-1298A) between cases and controls. The TA haplotype was associated with a decreased risk for colorectal cancer (OR=0.6; 95% CI: 0.4-0.9, p=0.03). Conclusions: The genetic polymorphism of MTHFR at 677 and the TA haplotype may modulate the risk for CRC development among the Jordanian population. Our findings may reflect an importance of genes involved in folate metabolism in cancer risk.

Background: Cancer is a major health problem facing the entire world, and Jordan is no exception. However, patterns of cancer incidence and cancer burden in Jordan have never been explored thoroughly, and the aim of this study was to close this knowldege gap. Materials and Methods: The study was based on data obtained from the Jordan cancer registry from 1996 to 2009. All cancer cases that were diagnosed during the study period were registered and included in this study. Results: A total of 51,626 cases were registered in Jordan during the 14- year period. The incidence rate showed no significant increase in males (percent change PC 6.8%), while in females a marked increase was observed (PC 14.8%). The major cancer sites for males were bronchus and lung, colorectal, bladder, leukemia and prostate. In females, the leading cancer sites were breast, colorectal, leukemia, thyroid and NHL. Conclusions: Compared to other countries in the region, Jordan has comparable rates. On the other hand the rates of cancer are markedly lower in Jordan compared to more industrialized countries such as the US and Europe. There was an overall increase in the incidence of cancer in Jordan, especially among females, which stresses the need for programs to raise awareness on the importance of early diagnosis and preventive life style measures.

Background and Aims Thiopurine S-methyltransferase (TPMT) is responsible for inactivation of thiopurine drugs which are commonly used in leukemia, organ transplantation and autoimmune diseases. The gene encoding TPMT is polymorphic, and both phenotyping and genotyping studies have shown ethnic variations in gene sequence and enzyme activity worldwide. The aim of this study is to identify the most common genetic polymorphisms of TPMT in healthy Jordanian volunteers and patients with rheumatoid arthritis (RA). Methods A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used to identify the frequency of TPMT ( *2, *3A, *3B, and *3C ) polymorphisms in 250 healthy Jordanian volunteers and 110 RA patients. Results Only four healthy subjects (1.6%) and one RA patient (0.9%) with variant alleles were identified in this study. Two healthy subjects had the TPMT*3A allele and the other two had the TPMT*3B allele, whereas the one RA patient had the TPMT*3A allele. No homozygous polymorphisms were detected and all genotypes detected were heterozygous ( *1/*3A ) ( *1/*3B ). None of the subjects had TPMT*2 or TPMT*3C variant alleles. Conclusions Mutant alleles identified in this study have a low frequency. TPMT ( *3A and *3B ) were the only detected heterozygous alleles. No homozygous variant allele was detected. Further studies are necessary to identify other variant alleles that might uniquely occur in Jordanians.

To evaluate the clinicopathological correlation of renal pathology and outline the frequencies of different renal diseases, beside assessment of lupus nephritis (LN), we studied 150 patients [72 (48%) males and mean age of 33.82 ± 15.4 years] who were subjected to native renal biopsy; 112 (72.8%) biopsied patients were diagnosed to have glomerulonephritis (GN). The most frequent clinical renal syndrome was nephrotic syndrome found in 55 (36.6%) patients, followed by nephritic syndrome in 38 (25.3%) patients, chronic kidney disease in 28 (18.6%) patients, acute kidney injury (AKI) in 17 (11.3 %) patients, and subnephrotic proteinuria (SNP) in 12 (8%) patients. Focal segmental glomerulosclerosis (FSGS) was the most common patterns in primary GN (16.6%), LN was the most common pathology in secondary GN (33.3%). LN represented 18.1% of nephrotic syndrome, 68.3% of nephritic syndrome, 35.2% of AKI, and 58% of SNP. FSGS was the most common pattern in obese patients (58%), membranoproliferative GN (MPGN) was the most common pattern in hepatitis-C virus +ve patients (66.6%) and mem- branous GN was the most common pattern in hepatitis-B virus +ve patients (66.6%). In conclusion, GN was the most common pathology in this study, FSGS and MPGN were the most common patterns in primary GN.

Endothelial dysfunction plays an important role in the pathogenesis of diabetic vascular disease, including diabetic nephropathy (DN). Endothelial nitric oxide synthase (eNOS) gene polymorphisms that affect eNOS activity are associated with endothelial dysfunction. The aim of this study was to evaluate the association of three polymorphisms of the eNOS gene (894GT, -786TC, and 27-bp-VNTR) with the risk of DN among type 2 diabetic patients. A total of 400 type 2 diabetic patients were enrolled in this study. The DN group comprised 200 patients; the group of diabetics without nephropathy comprised another 200 patients. Genetic analysis for eNOS gene polymorphisms was done in all subjects. Measurement of nitric oxide levels was estimated. The C allele for -786TC and the T allele for 894GT were significantly more frequent in diabetics with nephropathy than in diabetics without nephropathy (p0.001; odds ratio [OR] and 95% confidence interval [CI] for the C allele=1.64 [1.24-2.17] and p0.001; OR and 95% CI=1.7 [1.27-2.26] for the T allele). The haplotypes CTa (with all the mutant alleles) and CTb were significantly more common in patients with DN (p=0.01 and 0.003, respectively). These results suggested that the eNOS polymorphisms might represent genetic determinants for developing DN in type 2 diabetic Egyptians.