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This study conducted to examine the clinical bovine mastitis to isolate and identify the bacteria causing the disease and to determine the sensitivity pattern of isolates to commonly using antibiotic in Eldamazine locality, Blue Nile State. A total of 45 dairy cows clinically infected by different types of mastitis. Mastitis milk samples were collected from the animals and transported to microbiology laboratory for bacteriological examination. The samples were cultured in blood agar, MacConkey agar and purified in nutrient agar. Gram stain was used for morphological characteristics. Biochemical tests were done to all isolates. Sensitivity test was applied to gentamycin, ampicillin, vancomycin, ciprofloxacin, tetracycline and erythromycin. There were 3 types of mastitis were detected and these were acute mastitis with high prevalence (62.2%) followed by chronic mastitis (35.6%) and gangrenous mastitis (2.2%). The isolates were Staphylococcus spp (73.36%), Streptococcus spp (4.4%), Bacillus spp (8.9%) Pseudomonas spp, and Escherichia spp (8.9%). Also, the results revealed that high prevalence of Staphylococcus epidermidis (8.9%), followed by Staphylococcus hyicus (6.7%), Streptococcus agalactia (4.4%), and Pseudomonas aeruginosa (4.4%). Most effective antibiotics to isolated bacteria were ciprofloxacin, gentamycin, tetracycline, vancomycin and ofloxacin, while resistant to ampicillin and erythromycin. The species Pseudomonas aeruginosa were resistant to all antibiotics used. In conclusion, mastitis is associated with huge economic loss to farmers in the study area, and most effective control is prevention by using good management practices.

Background Coronary tortuosity (CT) is commonly encountered in postmenopausal females and is usually present without obstructive lesions. Circulating sclerostin levels are elevated in postmenopausal females. In view of sclerostin's vasculoprotective effect, we aimed to find possible association between circulating sclerostin and CT. Method We prospectively enrolled 273 consecutive postmenopausal females with non-obstructive coronary artery disease diagnosed by coronary angiography. Presence and severity (by tortuosity score) of CT as well as serum sclerostin levels were assessed for each patient. Results Patients with CT (128, 47% of study group)were significantly older (P650 pg/ml was found to be associated with presence of CT (AUC 0.69, 95% CI: 0.61–0.75, P Conclusion High circulating sclerostin is associated with the presence and severity of CT in postmenopausal females. This may add to the literature on the incompletely understood pathogenesis of CT. Funding Acknowledgement Type of funding sources: None.

Background: Premature birth (PTB) occurs in one in ten pregnancies. There are about 13 million PTBs annually worldwide. Antenatal corticosteroids are administered to enhance fetal lung maturation in cases of threatened preterm delivery between 24- and 34-weeks’ gestational age (GA). Objective: This study aimed to study the cardiotocograp (CTG) before and after antenatal corticosteroids administration in patients at high risk of preterm labor to reduce preterm risks. Patients and Methods: A prospective cohort study included 52 women who were at risk of premature birth. Each woman received the recommended course of corticosteroids consists of 4 doses of dexamethasone 6 mg for 48 hours (Dexamethasone 8 ml intramuscularly, 12 h apart). CTG examination: Fetal heart rate was monitored with fetal monitor cardiotocogram machine. Cardiotocography strips were interpreted visually. Results: In our study we recorded decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant. Decelerations were not present at all before or after the course. The STV showed a significant change before the course, all participants had moderate STV, but after the course, 8 (15.4%) showed marked variability, which was significant. We found that most of participants (90.4%) had decreased fetal kicks after injection relying on maternal perception. Conclusion: There was a decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant.

Lumpy skin disease (LSD) is one of the major viral diseases still causing great economic losses among breeding flocks of Egypt. This study was designed to focus light on non-cutaneous lesions (prevalence, intensity, and impacts) among necropsied LSD infected cattle. We selected some dairy and beef flocks (Frisian breed) located in 3 governorates (Sharkia, Dakahlia, and Kaloubia) in Nile delta, Egypt, in the period from January 2019 to January 2020 for our survey study. The case history of farms declared no previous vaccination of examined farms. The clinical signs, morbidity, and mortality rates were recorded. Average morbidity and mortality percentage were 22.28% and 6.59%, respectively. PCR for specimens from liver, kidneys, heart, lungs, testis, udder, trachea, and lymph node indicates presence of amplicon capripoxvirus gene product at molecular weight size 192 bp. Postmortem lesions of necropsied and emergency slaughtered were recorded. The main detectable histopathology lesions among the infected animals were orchitis (75%), mastitis in immature and lactating udder (66.66%), and necrotic hepatitis (77.77%), disseminated vasculitis (61.11), glomerulonephritis (55.55), myocardial degeneration (50%), and serous atrophy of coronary fats (38.88%), lymphadenitis (88.88%), necrosis and depleted lymphoid tissue of spleen (38.88%), necrotic myositis (77.77%), tracheitis (16.66%), and pneumonia (interstitial bronchopneumonia) (44.44%) besides intra-cytoplasmic inclusions bodies in skin (33.33%). It could be concluded that higher mortalities of LSD may be due to systemic infection of infected animals which had great impact on economic losses among breeding flocks.

Background: Netrin-1 is a laminin-related protein that has anti-inflammatory, tissue-regenerating, and immune-modulating abilities. While inflammation is important in the pathogenesis of insulin resistance and type 2 diabetes, the possible association between netrin-1 and type 2 diabetes remains poorly understood. Objective: This study aimed to evaluate the relationship between netrin-1 and prediabetes or newly diagnosed type 2 diabetes, and the role of netrin-1as a novel biomarker in the pathogenesis of early-stage type 2 diabetes. Subjects and Methods: This cross-sectional study was conducted at Al-Hussein University Hospital of Al-Azhar University. Ninety Egyptian participants were enrolled and equally divided into three groups (prediabetes, recently diagnosed type 2 diabetes, and healthy controls). All participants aged30–65 years.Netrin-1 levels were measured using an available commercially human enzyme-linked immunosorbent assay kit. Results: The type 2 diabetes and prediabetes groups had significantly higher serum netrin-1 levels than the healthy control group (488.6, 408.4, and 228.6 pg/ml, respectively; p < 0.001). Additionally, netrin-1 demonstrated a highly statistically significant positive association with body mass index, fasting blood glucose, 2-hour postprandial blood glucose, hemoglobinA1c, and Homeostatic Model Assessment of Insulin Resistance in all studied groups (p < 0.001). Conclusion: Serum netrin-1 levels were higher in people with prediabetes and recently diagnosed type 2 diabetes and were linked to higher body mass index, insulin resistance, and glucose homeostasis. Future research exploring the exact mechanism may provide new insights into diabetes prevention and treatment.

Background and aim Coronary artery anatomy frequently affects location of atherosclerotic plaques and subsequent culprit lesions. We sought to clarify whether presence or absence of Ramus Intermedius coronary artery (RI) would affect location of culprit lesions in acute left circumflex (LCX) coronary artery occlusion. Methods The study included 180 patients, 100 with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) and 80 with ST elevation myocardial infarction (STEMI). All culprit lesions were located in the LCX coronary artery. RI group included 45 patients and the No RI group included 135 patients. Results Culprit LCX lesions were similarly located at a comparable distance from LCX ostium in both groups and the presence of RI was not associated with significantly more proximally located culprit LCX lesions (34.7 ± 15.2 mm compared to 30.8 ± 17.9 mm respectively, p > 0.05). The frequency distribution of culprit lesions' distance from LCX ostium showed no significant difference between both groups in any of the segments studied (10 mm each). There was no significant difference between both groups regarding markers of myocardial necrosis size as cardiac biomarkers (peak cardiac troponin-T 1077.4 ± 361.2 pg/dl vs 926 ± 462.2 pg/dl respectively, p = 0.13), (peak creatine kinase-MB 232.2 ± 81 ng/dl vs 194.7 ± 99.2 ng/dl respectively, p = 0.07) or left ventricular ejection fraction (EF 46.3 ± 6.3% vs 48.3 ± 8.3% respectively, p = 0.76). Conclusion Presence of RI coronary artery, as an additional flow divider, may not be associated with more proximal culprit lesions, compared to its absence, in cases of acute LCX coronary artery occlusion. Possible underlying pathophysiologic mechanisms remain to be clarified.

Morning increase and nighttime decrease in blood pressure (BP) have been associated with cardiovascular (CV) morbidity and mortality in general and diabetic subjects. We aimed to study the association between morning blood pressure surge (MBPS) and left ventricular hypertrophy (LVH) in normotensive type 2 diabetes mellitus (T2DM) patients. This comparative cross-sectional study included 90 normotensive T2DM patients divided according to the presence of diastolic function into two groups. Normotensive T2DM patients were subjected to ambulatory blood pressure monitoring (ABPM) to detect the MBPS and echocardiography to assess left ventricular mass index (LVMI) and diastolic function. Data were analyzed using SPSS and stepwise multiple regression and binary logistic regression analysis was performed to detect the associated independent variables for increase in LVMI. Finally, a receiver operating characteristic (ROC) curve was performed to assess a cut-off value for MBPS. A total of 31% of patients had diastolic dysfunction (DD). There was a strong positive correlation between LVMI and MBPS (r = 0.609, p-value < 0.001). Stepwise multiple regression analysis showed that MBPS was the first independent predictor associated with increased LVMI. Binary logistic regression analysis for the status of diastolic function showed an odds ratio (OR) of 1.26 and 1.11 at 95% confidence interval (CI) for MBPS and age respectively. ROC curve for prediction of DD based on the degree of MBPS showed a fair area under curve and a cut-off value of 25.5 mmHg with 85.7% sensitivity and 61.3% specificity. Higher levels of MBPS are associated with increased LVMI and DD in normotensive T2DM patients. This has potential implication as it might be a significant predictor for discovery of subclinical hypertension in early stages of diabetes mellitus and can help in the prevention of heart failure development.

Background: Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disorder of unknown etiology characterized by symmetrical joint synovitis and pain. RA has a wide clinical spectrum and may vary from mild nonerosive disease to severe inflammation and joint damage with extra articular manifestations. To detect enthesopathy, the European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Objective: To detect subclinical enthesitis in rheumatoid arthritis patients and its relation to disease parameters and disease activity. Patients and Methods: This prospective observational study included 50 adult patients diagnosed as rheumatoid arthritis according to the 2010 ACR-EULAR classification criteria for rheumatoid arthritis. The study was carried out in the Musculoskeletal Ultrasonography Unit of the Rheumatology, Physical Medicine and Rehabilitation Department, Al-Azhar University Hospitals Assiut. Results: We found that the mean age in case group was 46.3 ± 8.4 years. Females accounted for 62% (31 patients) of all patients. The disease duration ranged from one year to 15 years with a mean of 6.2 ± 1.9 years. The BMI was 19.5 ± 42 kg/m2 . Mean of disease activity evaluated by the disease activity score in 28 joints was 4.7 ± 1.5. Our findings demonstrated that prevalence of subclinical enthesitis in patients with rheumatoid arthritis was 32%. There was a statistically significant relation between 28-joint Disease Activity Score (DAS28) score and ultrasound detected enthesitis (p. value < 0.05). Conclusion: BMI, old age and long disease duration were suggested as the risk factors for subclinical enthesitis.

Background: Spondyloarthritis (SpA) and rheumatoid arthritis (RA) are ones of the most rheumatic diseases with chronic inflammatory damaging processes that have a great risk for metabolic syndrome (MS) and cardiovascular diseases. Several studies have indicated higher cardiovascular disease (CVD) risk and mortality rates among these patients compared to the general population. Objective: To identify the prevalence and early detection of metabolic syndrome and cardiovascular disease in seronegative spondyloarthropathy and rheumatoid arthritis patients and their relation to disease activity. Patients and Methods: Our study was carried out on sixty rheumatoid arthritis patients (54 female and 6 males with mean age 46.7 ± 5.5 years) and sixty spondyloarthroapathy patients (27 female and 33 males with mean age 44.9 ± 5.9 years). Results: In RA group, there were 23 patients (38.3%) with metabolic syndrome and 37 patients (61.7%) without metabolic syndrome. In SPA group, there were 21 patients (35%) with metabolic syndrome and 39 patients (65%) without metabolic syndrome. There was no statistical significant difference (p-value > 0.05) between studied groups as regards metabolic syndrome prevalence. There was high statistical significant difference (p-value < 0.001) between patients with MS and patients without MS in RA group regarding age, duration, BMI, FBS, ESR, CRP and DAS28. High statistical significant difference (p-value < 0.001) was detected between patients with MS and patients without MS in SPA group as regards duration, BMI, FBS and BASDI. There was increase in cIMT in RA (0.8 ± 0.2) and SPA groups (0.7 ± 0.1) with high statistical significant difference (p-value < 0.001). Conclusion: MS prevalence increased in patients with RA and SPA, whereas the cardiovascular risks increased in RA patients. The disease activity of both were associated with metabolic syndrome, implicating the role of chronic inflammation in metabolic syndrome development.

Background: Fibromyalgia (FM) is a syndrome of persistent widespread pain, stiffness, fatigue, disrupted and unrefreshing sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living Objectives: To assess the frequency and pattern of enthesopathy in primary FM using musculoskeletal ultrasound with Glasgow Ultrasound Enthesitis Scoring System (GUESS) and Correlate these findings with clinical and laboratory parameters of FM. Patients and Methods: A cross-sectional study includes 100 persons divided into two groups as follows: Group (1): 50 patients with primary fibromyalgia syndrome (FM) were diagnosed. Group (2): 50 apparently healthy controls with comparable age and sex. Patients were selected from those attending the outpatient clinic of the Rheumatology & Rehabilitation Department of Al-Azhar University Hospital, Assiut. Results: There is no statistically significant difference between cases and control groups regarding age, gender, and BMI (P>0.05 for each), there were no statistically significant correlations between the GUESS scores and any of the clinical characteristics of FM patients. Although non-significant, these correlations were negative between the GUESS score and the tender point number, the Widespread Pain Index as well as the Fibromyalgia Impact Questionnaire. The total GUESS score of the FM group ranged between 0-12 with a mean ±SD of 5.3 ± 2.8. The total GUESS score of control group ranged between 0-6 with a mean ±SD of 0.97± 1.58, with a significant difference between the two groups (P

BACKGROUND (LVDD) either remains latent or manifests as heart failure with preserved ejection fraction (HFpEF). Little is known about echocardiographic parameters associated with symptomatic phenotype. OBJECTIVE To investigate echocardiographic parameters associated with symptomatic state in LVDD. METHODS Three hundred and thirty patients with definite diagnosis of LVDD (according to ASE/EACVI recommendations 2016) were included and divided into asymptomatic LVDD and HFpEF groups according to presence of dyspnea and brain natriuretic peptide levels. We excluded patients with left ventricular ejection fraction

Background Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks. Objective To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital. Methods This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication. Results 15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices Conclusion This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

Imeglimin is a novel tetrahydrotriazine-containing drug suggested as a safe drug for glycemic management in patients with type 2 diabetes mellitus (T2DM). We aimed to 1) evaluate the efficacy of imeglimin on glycemic control and insulin resistance improvement measured by homeostatic model assessment of insulin resistance (HOMA-IR). 2) assess whether the novel drug improves lipid parameters in diabetic patients. 3) compare between different doses regarding safety.We searched PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and Wiley through April 25, 2021, for relevant randomized controlled trials comparing different doses of imeglimin supplied as a monotherapy or as add-on therapy versus placebo for adult patients with type 2 diabetes mellitus. Data on glycemic and lipid parameters and adverse events were extracted and pooled in random-effect models using Review Manager version 5.3.Eight studies comprising 1555 patients with T2DM were included in this study. The overall effect estimate of the meta-analysis showed that the imeglimin group was superior to the control group concerning glycated hemoglobin and fasting plasma glucose (P 0.00001). However, it did not affect HOMA-IR or lipid parameters, including triglyceride, LDL-C, and HDL-C (all p 0.05). Regarding safety profile, imeglimin was safe and tolerable with no treatment-emergent or serious adverse events.Imeglimin safely improved glycemic control by reducing HbA1c and FPG. However, no beneficial effects regarding insulin resistance measured by HOMA-IR or lipid parameters were observed. Further high-quality RCTs with high dose imeglimin are encouraged to ensure HOMA-IR and lipid parameters results.

BACKGROUND Atrial dyssynchrony, but not atrial enlargement/dysfunction, reflects acute atrial histopathological changes. It has been shown to be associated with new-onset atrial fibrillation (NOAF) in various clinical conditions but was not studied in the acute phase of ST-elevation myocardial infarction (STEMI) which is the aim of the current study. METHODS A total of 440 STEMI patients underwent primary percutaneous coronary intervention (PCI) and were monitored for NOAF during hospitalization. Immediately after primary PCI, P-wave dispersion was calculated and conventional/tissue Doppler echocardiography was done. RESULTS During a median hospitalization period of 3 days, 80 (18.2%) patients developed NOAF. The group with NOAF showed significantly higher prevalence of hypertension (P = .049), higher P-wave dispersion (P = .018), higher post-PCI-corrected TIMI frame count (P

Aim of the work: To assess the pattern of joint involvement in systemic lupus erythematosus (SLE) patients by ultrasound (US) and to detect their relation with clinical, laboratory, disease activity and functional status. Patients and methods: Thirty SLE patients and 20 controls were included. SLE disease activity index (SLEDAI-2k) and health assessment questionnaire-disability index (HAQ-DI) were assessed. Anti-cyclic citrullinated peptide (anti-CCP) was measured. Arthritis was evaluated clinically and by musculoskeletal ultrasonography (MSUS) including grey-scale-US (GSUS) and power Doppler-US (PDUS). Results: The mean age of the patients was 28.9 ± 8.7 years (28 females and 2 males) with disease duration of 8.9 ± 1.7 years. Arthritis was detected clinically in 18 patients, MSUS detected synovitis in 20; tenosynovitis was clinically found in 50% and in 56.7% by MSUS. 10 patients with arthritis had PD signals and 7 had erosions. Anti-CCP was positive in 4 patients with arthritis; 3 were erosive. RF was positive in 6; 3 of them erosive. Anti-CCP significantly correlated with PDUS, erosions and tenosynovitis (r = 0.45, p = 0.01; r = 0.37, p = 0.046 and r = 0.48, p = 0.007 respectively). SLEDAI-2k significantly correlated with GSUS, PDUS, erosions, tenosynovitis (r = 0.52, p = 0.003; r = 0.77, p

Background: Diabetic eye disease is an end-organ response to the effects of the condition on the human system. The cornea is a transparent structure protecting the anterior one-sixth of the eye. Chronic hyperglycemia can affect the corneal layers shape and functions that responsible for corneal transparency. Objectives: Comparison of the changes in corneal endothelium namely, cell density (CD), percentage polymegathism, cell volume (CV) and pleomorphism (6A) along with central corneal thickness (CCT) in patients of type 2 diabetes mellitus with normal age and sex- matched subjects. Patients and methods: A case-control study in Sayed Galal University Hospital. 20 eyes of type 2 diabetic patients and 20 eyes of age and sex matched controls were included in the study. Age, gender, other demographic data, and relevant diabetic history were obtained. Full evaluation of both cases and controls including both anterior and posterior segment complete evaluation was done. Non- contact specular microscopy was used to study the corneal endothelial cells. Results: The mean endothelial cell density (ECD) was non-significantly lower in type 2 diabetics compared to controls (p value = 0.751.). There was a highly significant reduction in hexagonally in the cases compared to controls and highly significant increase in coefficient of variation in the cases compared to controls Conclusion: This study acknowledged that type 2 diabetes causes a significant decrease of hexagonality and increase CV (polymegathism). However, non-significant reduction of ECD was documented

[Purpose] Cervicogenic headache is a major problem in patients with upper cervical dysfunction. However, its physical therapy management is a topic of debate. This study aims to determine the effect of C1-C2 Mulligan sustained natural apophyseal glide mobilizations on cervicogenic headache and associated dizziness. [Participants and Methods] This study included 48 patients with cervicogenic headache, who were randomly assigned to three equal groups: Group A (Headache SNAG), group B (C1-C2 SNAG rotation), and group C (combined). Neck Disability Index was used to examine neck pain intensity and cervicogenic headache symptoms. The 6-item Headache Impact Test scale was used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test was used to assess rotation range of motion at the level of C1-C2 and confirmed by a cervical range of motion device. Dizziness Handicap Inventory scale was used to evaluate dizziness. The evaluation was done pre- and post-treatment and compared between the groups. [Results] Group C showed significant improvement in all variables compared with groups A and B. [Conclusion] Sustained natural apophyseal glide mobilizations used in the study were effective in reducing cervicogenic headache and dizziness in all groups with a greater improvement in the combined group. The use of cervical SNAG mobilizations is encouraged as a noninvasive intervention depending on the therapist's assessment, findings, and clinical reasoning.

Introduction: Fetal macrosomia is encountered in up to 10% of all deliveries. It occurs in 15-45% of diabetic pregnancies. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain and diabetes mellitus. Macrosomia is reportedly associated with neonatal morbidity, neonatal injury, maternal injury, and cesarean delivery. Moreover, shoulder dystocia, brachial plexus injury, skeletal injuries, meconium aspiration, prenatal asphyxia, hypoglycemia, and fetal death. All types of maternal diabetes are risk factors for macrosomia and can affect the foetal cardiac development in the form of Hypertrophic cardiomyopathy and congenital cardiac malformation. Aim of work: To evaluate the cardiac changes and ventricular outflow tracts in macrosomic neonates clinically and by 2D transthoracic echocardiography. Patients and Methods: This prospective study was carried out in NICU of Sayed Galal University Hospital on fifty macrosomic neonates’ thorough detailed history, clinical examination, Chest X-ray, important laboratory investigation, two dimensional M-mode and Doppler echocardiographic examination. Results: The fifty macrosomic neonates consisted of 29 males (58%) and 21 females (42%) with mean age ± SD of 2.16±0.84 days (range, 1-5 days). Statistically, significant relation between inter ventricular septum diastole (IVSD) (mm) according to HbA1c level, increase IVSD with increase HbA1c level, and show statistically significant relation between inter ventricular septum diastole (mm) and LTVOTO. When IVSD increase the incidence of LVOTO increase While TABSE decrease with the increase in IVSD. It also showed significant negative correlation between IVSD and MPI and PAP. Conclusion: Elevated maternal HbA1c level can lead hypertrophic cardiomyopathy mainly septal hypertrophy, which increased incidence of ventricular outflow tract obstruction. These echocardiographic findings (TAPSE and MPI) seem to be a better index of the cardiac outcome of macrosomic neonates than other clinical, laboratory or radiological parameters. Recommendations: Early echocardiographic examination for early detection of myocardial dysfunction or cardiac defect is essential in all macrosomic neonates andIDM even those without audible murmur, especially so if not improving with proper intervention. Echocardiographic indices especially TAPSE and Tei index for all macrosomic neonates to detect early cardiac changes in particular left ventricular dysfunction.

Objectives: To assess predictors of high thrombus burden in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention,We sought to study simple clinical and laboratory values.Methods: This cross-sectional study was conducted in cardiology department, Faculty of medicine, Zagazig university hospitals. We studied patients with acute myocardial infarction underwent primary percutaneous coronary intervention attending our coronary care unit in Zagazig university hospitals. We enrolled 180 patients for the study in the period between January 2019 and January 2020.Results: Patients were classified into two groups: Group 1: Low thrombus burden of culprit vessel, this group included 74 consecutive participants who had thrombus grade less than 4, with age 56.53 ± 5.435 years and were 39 males and 35 females. Group 2: High thrombus burden culprit vessel, which included 106 cases. Patients who had thrombus grade more than or equal 4 with age 57.32 ± 6.6 years and were 57males patients and 49 females. All Patients had PPCI.Conclusion: Initial troponin, pain to balloon time and RDW can be used as predictors of high thrombus burden in acute STEMI patients undergoing primary PCI

BACKGROUND Diastolic function has been reported to be impaired in many patients with coronary slow flow phenomenon (CSFP). CSFP has broad spectrum of clinical presentations, including non-ST elevation myocardial infarction (NSTEMI). We sought to study the short-term evolution of diastolic function in CSFP patients presenting with NSTEMI. METHODS This study included 92 patients with CSFP and acute NSTEMI. Conventional echocardiography Doppler imaging and tissue Doppler echocardiography imaging were used to evaluate diastolic function during index NSTEMI and after 3 months. RESULTS Mean age of study patients was 45.7 ± 6.8 years. The prevalence of diastolic dysfunction (DD) at baseline was 69 patients (75%) and 28 patients (30.4%) at 3 months, p < 0.001. Various diastolic function indices showed significant improvement from baseline to 3 months follow-up. E/Em was 17.32 ± 3.41 at baseline compared to 12.41 ± 5.58 at 3 months, p = 0.039. Septal e' velocity was 5.67 ± 4.56 cm/s at baseline compared to 7.78 ± 3.22 cm/s at 3 months, p = 0.023. Medications used were not significantly different between those with improved versus unimproved DD. CONCLUSIONS Diastolic function seems to improve over short-term follow-up in patients with CSFP presenting with NSTEMI. This could reflect a transient worsening during acute NSTEMI.

Background/aim Successful coronary chronic total occlusion (CTO) revascularization was found by many studies to be associated with improved left ventricular (LV) systolic function and survival if evidence of viability is present. Little is known about the association of CTO revascularization in patients with electrocardiographic Q waves and improvement in angina burden as a measurement of health-related quality of life (HRQOL) afterwards. Methods In this study, 100 patients with single vessel CTO were included. Myocardial viability was tested by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and 50 patients showed evidence of viability. Seattle Angina Questionnaire (SAQ) scores were used as a measure of HRQOL. Results Pathological Q waves were present in 48 patients (including 19 patients with viable CTO territory) out of 100 patients. Patients with Q waves tended to have worse Seattle Angina Questionnaire (SAQ) scores compared to those with no Q waves (31.2 ± 11.7 vs 45.3 ± 13.9 respectively, p = 0.002), worse LV systolic function and wall motion score index (WMSI) on CMR. They also had significantly less prevalence of viability (p < 0.001). Patients with Q waves and positive viability had lower SAQ scores (37.2 ± 10.1 vs 52.7 ± 13.2 respectively, p = 0.02), higher LVEF and lower WMSI. They also had well developed collateral grade (2.1 ± 1.03 vs 0.7 ± 0.82 respectively, p < 0.001). After successful percutaneous coronary intervention (PCI), in the viable LV group, presence of Q waves was not associated with better LV functional recovery, while those with higher collateral grades were more likely to have better LV functional recovery post CTO-PCI. Patients with Q waves and viable CTO territory showed significantly better SAQ scores compared to pre-PCI (87.3 ± 12.2 vs 37.2 ± 10.1 respectively, p < 0.001). For angina frequency, post-PCI score was 80.2 ± 7.9 compared to 39.2 ± 7.1 before PCI, p < 0.001). Multivariate regression analysis showed that pathological Q waves, Rentrop's collateral grade and the Canadian Cardiovascular Society (CCS) angina class before PCI were the most significant independent predictors of improved HRQOL as reflected by SAQ (OR for Q waves 7.83, 95% CI 1.62-18.91,p 0.003), (OR for Rentrop's collateral grade 8.31,95% CI 2.21-26.33, p < 0.001), (OR for CCS class 8.39, 95% CI 1.21-20.8, p 0.01). Conclusion Well-developed collateral circulation could independently predict LV functional recovery after CTO-PCI. Patients with Q waves and viable CTO territory tend to have higher CCS class before revascularization and get significant improvement of HRQOL after PCI. Other predictors of improved HRQOL are Rentrop's collateral grade and worse CCS class before PCI.

Revascularization of chronic total occlusion (CTO) is still debated regarding its indications and therapeutic benefits. Guidelines recommend patient selection based on ischemia detection and viability assessment. We aimed to investigate the relationship between the quality of coronary collaterals (CC), graded by Rentrop classification, and myocardial viability assessed by cardiovascular magnetic resonance (CMR). Unselected 100 consecutive patients with a single CTO were prospectively enrolled. CC of Rentrop grade two or three were considered as well-developed. Analyzing late gadolinium enhancement (LGE) images, CTO territories with mean segmental transmural scar extent

Background : the link between allergic rhinitis(AR) and asthma has been confirmed. AR is a risk factor for the onset of asthma . Spirometry is a noninvasive method to evaluate lower respiratory system function in AR patients. The aim of the study: to evaluate spirometric lung function and response to post- bronchodilatation test in patient with AR. Methods: This prospective cross sectional study carried out on 100 patients with persistent AR. Spirometry ,post- bronchdilatation test, serum total IgE and eosinophils in blood and sputum were performed for all patients. Results: Our results reconfirming the concept of "a single air way with a single disease". In our study the patients with persistent AR were have impaired spirometric parameters. Conclusion: Our study confirming the predictive value of forced expiratory flow at 25% and 75% (FEF 25-75) as a marker of early bronchial involvement of small air way disease (SAD) in AR and also confirm the link between upper and lower respiratory system.

Background: the third stage of labor is defined as the period of time between delivery of the fetus and delivery of the placenta. The most common complication accompanying this stage is postpartum hemorrhage (PPH) and prolonged third stage of labor owing to placenta retention and uterine atony are among the underlying cause of most cases of PPH. The duration of the third stage of labor is 5-15 min. Aim: to assess the efficacy of intraumbilical vein oxytocin in reducing duration of third stage of labour and the amount of blood loss. Patients and Methods: this study included 150 women attending the delivery room of Department of Obstetrics and Gynecology which was divided according to the inclusion and exclusion criteria into two groups: Group A (study group): include 75 cases which received 10 IU (1ml) of oxytocin in umbilical vein. Group B (control group): include 75 cases which received 1ml of saline in umbilical vein. Results: the time of third stage took seconds in each group with no statistically significant difference detected (p>0.05). Conclusion: intra-umbilical oxytocin is a useful alternative in patients where methylergometrine is contraindicated or in cases where intravenous fluids need to be restricted. For optimum effect, rapid injection immediately after clamping of the cord is essential.

Background:Systemic lupus erythematosus (SLE) is a multi-factorial, chronic autoimmune disorder, characterized by dysfunction of T and B lymphocytes. It affects various vital organ systems, and 70% to 90% of SLE patients are females. Lupus nephritis (LN) is one of the common complications in patients with SLE and influences overall outcome of these patients. About two-thirds of patients with SLE have renal disease at some stage which is a leading cause of mortality in these patient.Iron is critical in nearly all cell functions and the ability of a cell, tissue and organism to procure this metal is obligatory for survival. Iron is necessary for normal immune function, and relative iron deficiency is associated with mild immunosuppression. Concentrations of this metal in excess of those required for function can present both an oxidative stress and elevate risks for infection. As a result, the human has evolved to have a complex mechanism of regulating iron and limiting its availability.Ferritin levels correlate with disease activity in patients with SLE and developing of lupus nephritis. Objective: To correlate between Iron profile and SLE activity and developing lupus nephritis. Materials and Methods: A prospective study was conducted on 75 adult persons: 25 Patients with SLE with proteinuria, patients with SLE without proteinuria, 25person have no SLE (control group).These person were Admitted at internal medicine department and outpatient clinic of Al-Hussein university hospital, Cairo, Egypt. SLE patients were diagnosed according to the American College of Rheumatology (ACR) criteria, Lupus Activity assessment by C3&C4, Lupus nephritis assessment using Albumin /creatinine ratio. Iron profile was measured and included: serum iron, serum TIBC, transferrin saturation and Serum ferritin levels were tested by ELISA. Results: There were no significant statistical difference between groups as regard age or sex however, There were significant difference between groups as regard S.iron, S. ferritin, TIBC and TSAT, Between group analysis results showed significantly lower s.iron and TSAT level of SLE patients with and without proteinuria in comparison with control group. While S. ferritin is significantly high in SLE patients with proteinuria in comparison with SLE patients without proteinuria and control group. And this data go with activity markers of SLE. Conclusions: 1) Hyperferritinemia is a useful marker in assessment of disease activity and severity of Albuminuria in SLE patients complicated by lupus nephritis, treatment of hyperferritinemia can result in decreased Albuminuria and delayed renal damage. 2) Iron homoeostasis is important in normal immune function and Iron disturbance can result in mild immunosuppression.

Background: Current laboratory criteria for antiphospholipid syndrome (APS) classification recommend testing positive for antiphospholipid (aPL) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative. Aim of the work: To analyze the potential clinical usefulness of testing for anti-annexin A5 antibodies in patients with APS and to study the effectiveness of testing for non-criteria aPLs in an attempt to increase the diagnostic yield, particularly in seronegative APS. Patients and methods: 60 APS patients were divided into two groups; 30 seropositive (SP-APS) (group I) and 30 age and sex matched seronegative (sN-APS) testing negative for aPL antibodies. Serum assay for detection of isotypes of anti-annexin A5 antibodies (IgG and IgM) were conducted. Results: The mean age of the patients was 32.9 ± 5.8 years, female:male 57:3 and disease duration in SP-APS versus sN-APS (10.17 ± 4.9 years versus 9.6 ± 5.5 years) respectively. Secondary APS was present in 16(53.3%) patients in group I compared to 3(10%) in group II (p

To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition. A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24–36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy. A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4–11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P

Objective The aim of the study was to assess the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (CTS) and to determine the relationships of ultrasonographic measurements with the clinical severity and the electrophysiological grading scale. Patients and methods One hundred CTS diseased hands and 100 nondiseased hands were assessed clinically and by nerve conduction studies. We measured ultrasonographic cross-sectional area (CSA) of the median nerve at various levels of the carpal canal (inlet and outlet), flattening ratio (FR), palmar bowing of the flexor retinaculum, wrist/forearm ratio, as well as median nerve mobility and power doppler signals. Data from patients and controls were compared to determine the diagnostic relations and the grade of severity. Results Measures of CSA of the median nerve at the inlet and at the outlet, palmer bowing and inlet/forearm ratio in the CTS group were significantly higher than the control group (P

im of the work: To evaluate the results of radio-active I-131treatment and the prognostic variables of papillary thyroid carcinoma with desmoplastic reaction after long-term follow-up. Material andMethods: This retrospective study includes analysis of 272 patients, post-surgery and radio-active I-131treatment of papillary thyroid carcinoma with desmoplastic reaction. Follow up period of twelve years with calculation of ten-year recurrence free and the overall survival together with the analysis of the risk factors. RESULTS: 238 Out of 272 (87.5%), showed complete response to the treatment (CR), while 34 patients (12.5%) did not have complete response. Out of these 34 patient 20 (7.4%) showed partial response (PR), 6 patients (2.2%) showed stationary disease (SD), while 8 patients (2.9%) showed progressive disease (PD). Six patients (2.2%) died during the long follow up period. The overall and the ten-year recurrence free survival was 97.5% and 89.9% respectively, in those patients with CR. Recurrence occurred within 5 years in 83.3% of patients who developed local recurrence. Conclusion: Although desmoplasia is a feature of tumor invasiveness, the prognosis of papillary cancer thyroid with desmoplastic reaction in the present study was excellent with high ten years recurrence free and overall survival. Bad prognostic factors include large tumor size, lymph node involvement, old age, vascular and capsular invasion, extra-thyroidal extension, distant metastasis and high thyroglobulin level.

Coronary tortuosity (CT) is commonly encountered in postmenopausal females and is negatively associated with coronary atherosclerosis. Circulating sclerostin levels are elevated in postmenopausal females. In view of sclerostin's anti-atherogenic effect, we aimed to find an association between CT and

Colorectal carcinoma (CRC) is one of the most lethal malignancies, it ranks third in cancer-related morbidity and mortality. Although great progress has been made in early diagnosis and combined treatment of CRC, the prognosis of patients remains poor owing to the high rate of recurrence and distant metastasis. CXCR7 belongs to chemokine receptor family and has been identified as a novel receptor for CXCL12. It plays an important role in development and in progression of cancer to metastatic stage.To evaluate the immunohistochemical expression of CXCR7 in colorectal adenoma and carcinoma and to analyze its correlation with clinicopathological factors. This is retrospective study including 58 colonic adenocarcinoma specimens and 18 cases of colonic adenoma.CXCR7 showed positive cytoplasmic expression in two out 18 cases of colorectal adenoma (11%) and 42 out of 58 cases of CRC (72.4%) with a significant difference between both (p 0.001). We found a significant correlation between upregulation of CXCR7 and presence of lymphovascular tumor emboli, presence of lymph node metastasis and advanced TNM stage of the CRC. The association of the CXCR7 with patient age, sex, tumor size, depth of invasion and tumor cell differentiation was found to be non-significant. Regarding colonic adenoma, we found no significant association between CXCR7 expression on one hand and patient age, sex, tumor size, histologic type and degree of dysplasia on the other hand.CXCR7 in CRC may act as a novel predictive indicator for prognosis and even be a potential molecular target for anticancer therapies.

Background The aim of this study is to determine the frequency of inflammatory back pain and associated ankylosing spondylitis in rheumatoid arthritis patients. Results Sacroiliitis was found in 22% of rheumatoid arthritis patients. The frequency of rheumatoid arthritis patients who fulfilled classification criteria for spondyloarthritis or ankylosing spondylitis was 58%, in whom HLA-B27 was positive in 21 patients (35.2%) and was correlated with MRI sacroiliitis. Twenty pecent of rheumatoid arthritis patients had ankylosing spondylitis (56%) and 27% had axial spondyloarthritis. Conclusion Frequencies of inflammatory back pain and sacroiliitis in Egyptian rheumatoid arthritis patients were high.

Background Calcium pyrophosphate dihydrate deposition disease (CPPD) has been reported to involve the spine, but few systematic studies have been published. Objective To further characterize the spinal involvement with CPPD by a review of CPPD patients hospitalized in a rheumatology department. Methods We retrospectively reviewed data for patients consecutively admitted with a diagnosis of CPPD in the rheumatology department of Lariboisiere hospital in Paris, France over 5 years by using a standardized protocol and electronic case report forms. Imaging studies were also reviewed. Results Spinal CPPD was diagnosed in 37/152 (24.3%) CPPD patients. Patient with spinal involvement had more widespread peripheral CC. The cervical (n = 21) and lumbar (n = 19) segments were most involved. CT-scan was more sensitive than plain radiographs for detecting spinal calcifications. Crown dens syndrome was a prominent feature of cervical involvement. Inflammatory sterile spondylo-discitis was observed in 6 patients. Lesions were frequently multiple and were classified into 4 types. Ruling out septic discitis required image-guided biopsies in 3 patients. Sacroiliac involvement included calcification in 5 patients and severe sterile destructive arthropathy and joint fusion in one patient each. Degenerative changes were common, and CPPD could not be implicated because of the patients ‘age and lack of a control population. In 12 patients, severe clinical features requiring hospitalization were related to such degenerative changes. Conclusion Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. Specific entities were the cause of hospitalisation in 25 of the 37 patients with spinal calcification and included inflammatory pain related to crystal deposits and destructive arthropathy of the spine and sacroiliac joints. Discitis exhibited a wide range of MRI features and biopsies were needed to rule out infection in 3 of the 6 discitis.

Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Median nerve mobilization is a manual therapy intervention used for treating CTS. Aim The aim of the present study was to investigate the effectiveness of median nerve mobilization in relieving manifestations of CTS when compared with conventional medical treatment. Patients and methods A total of 28 CTS patients were divided into two groups: patients in group I (n = 18) underwent median nerve mobilization, and those in group II (n = 10) underwent conventional medical treatment. Median nerve mobilization consisted of 18 treatments (three/week for 6 weeks). Patients were assessed for hand sensitivity, paresthesia, strength, pain, night awakening, thenar eminence atrophy, and were subjected to Phalen′s test, Tinel′s sign, Boston Carpal Tunnel Questionnaire′s Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and sensory and motor conduction studies for median nerve at baseline and at 6 weeks after treatment. Results At baseline versus at 6 weeks, pain, sensation, paresthesia, tingling, Tinel′s signs, and Phalen′s test outcomes were significantly improved in both groups; wrist flexion and extension improved only in group I. The difference between group I and group II after 6 weeks was significant as regards tingling, pain, wrist flexion, and extension. BCTQ-SSS and BCTQ-FSS scores improved after 6 weeks compared with baseline in patients in group I, whereas in group II the improvement was observed in BCTQ-FSS; the difference between the groups was significant. Sensory nerve conduction velocity, sensory distal latency, sensory amplitude, distal motor latency, and motor amplitude were significantly improved after 6 weeks in group I. In addition, there was a change in the grade of CTS, whereas in group II there was improvement only in sensory nerve conduction velocity; the difference between the groups was not significant. Conclusion CTS improves after median nerve mobilization, which is better than conventional medical treatment. It provides support for the use of manual therapy in conservative management of CTS with satisfactory Results .

Background: Osteoarthritis is a painful chronic joint disease characterized by structural changes to the whole joint, including loss of articular cartilage, development of osteophytes, synovial inflammation, subchondral bone changes, meniscal damage, muscle weakness, and ligamentous laxity. Aim of the Work: To detect osteopontine (OPN) in knee osteoarthritis. Method: 60 patients diagnosed as primary knee OA fulfilling Arthritis Rheum 1986 OA classification criteria, And 60 healthy control were included. All patients subjected to through history taking and full examination, body mass index, plain x ray knees PA view to assess severity according to Kellgren and Laurence grading, plasma and synovial fluid OPN levels, and plasma OPN for control. Assessment of pain for OA patients by patient pain visual analogue scale (VAS) and for functional status by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), ESR,CRP were done. Results: There was significant difference between both groups regarding plasma osteopontine (p

During the Ramadan month, Muslims abstain from eating any food, drinking any liquid, smoking and sexual intercourse in this holy month as testimony of faith, charity, pilgrimage, and daily prayer during daylight hours. Food and drinks are allowed before dawn and after sunset these meals are called suhoor and iftar, respectively. the aim of this article is to review the health benefits of Ramadan fasting by addressing peer reviewed human and animal studies published in international academic journals. this article is reviewed 40+ published papers from the period of 1970 up to 2019. The papers were searched from different databases, including PubMed/Medline, science direct, plose one, scopus, directory of open access journals and the Cochrane library by using the following key words: - “intermittent fasting”, ” Ramadan fasting”, “Ramadan month”, “fasting”, “and/or”, “cardiovascular diseases”, “coronary heart diseases”, “diabetics”, “dyslipidemia”, “HDL”, “LDL”, “cholesterol”, “overweight”, “obesity”, “metabolic diseases”, “metabolism”, “cancer”, “immunity”,: immune system”. This review article concluded that, Ramadan fasting significantly reduces the risk for cardio-vascular diseases and diabetics by decreasing body weight, total cholesterol, ldl cholesterol and increasing HDL cholesterol. other hand, Ramadan fasting have beneficial effects of metabolic markers. It also improves the effectiveness of immune system by decreasing pro-inflammatory cytokines, increasing level of complement proteins and phagocytic activity of polymorphs. It lowers the incidence of diabetes by decreasing insulin resistance, increasing insulin sensitivity, glucose uptake, decreasing lipolysis, and assisting in weight loss. According to the results of the current review, the health benefits of Ramadan fasting could be sustained by leading a healthy lifestyle and practicing optional fasting regularly after the holy month of Ramadan twice a week on mondays and thursdays.

Background The aim was to study urinary angiostatin, CXC chemokine ligand 4 (CXCL4) and vascular cell adhesion molecule-1 (VCAM-1) as biomarkers of renal disease in systemic lupus erythematosus (SLE). Method Patients who fulfilled ≥ 4 American College of Rheumatology (ACR) criteria for SLE with active renal, active non-renal or inactive disease, and a group of healthy controls were studied. Urine samples were assayed for angiostatin, CXCL4 and VCAM-1 by ELISA, and normalized by creatinine. Receiver operating characteristic analysis was performed to obtain the best cutoff values to calculate the performance of these markers in differentiating the different groups of patients as compared to anti-double-stranded DNA (anti-dsDNA) and complement C3. Correlation between these urinary biomarkers and various renal parameters was also tested. Results Patients with SLE (n = 227; 80 with inactive SLE, 67 with active non-renal disease and 80 with active renal disease; 94% women; age 39.2 ± 13.8 years) and 53 controls (96% women) were studied. All were ethnic Chinese. Urinary angiostatin, CXCL4 and VCAM-1 (normalized for creatinine) were significantly higher in patients with active renal disease than in patients with active non-renal disease, patients with inactive SLE and controls. These markers correlated significantly with total SLE disease activity index (SLEDAI) and renal SLEDAI scores, and with the urinary protein-to-creatinine ratio. Urine angiostatin exhibited higher specificity and sensitivity in differentiating active renal from active non-renal SLE (area under the curve (AUC) 0.87) than serum anti-dsDNA/C3. Urine CXCL4 (AUC 0.64) and VCAM-1 (AUC 0.73), on the other hand, performed similarly to anti-dsDNA/C3. All three markers performed comparably to anti-dsDNA/C3 in distinguishing active from inactive SLE. In a subgroup of 68 patients with paired renal biopsy, the urinary levels of these proteins did not differ significantly between the proliferative and non-proliferative types of lupus nephritis. Urinary CXCL4 and VCAM-1 correlated significantly with the histologic activity score, and urinary angiostatin correlated significantly with proteinuria in this subgroup. Conclusions Urinary angiostatin, CXCL4 and VCAM-1 are potential biomarkers for SLE, in particular lupus nephritis. Further longitudinal studies are necessary to delineate the performance of these markers in predicting renal flares and prognosis in SLE patients.

Objectives: To determine the utility of pre-implantation renal biopsy (PIB) to predict renal allograft outcomes. Methods: This is a retrospective review of all patients that underwent PIB from January 2003 to December 2011 at the Great Ormond Street Hospital for Children in London, United Kingdom. Thirty-two male patients (56%) aged 1.5-16 years (median: 10.2) at the time of transplantation were included in the study and followed-up for 33 (6-78) months. The results were compared with 33 controls. Results: The PIB showed normal histopathological findings in 13 patients (41%), mild chronic vascular changes in 8 (25%), focal tubular atrophy in one, moderate to severe chronic vascular change in 3, mild to moderate acute tubular damage in 6, and tissue was inadequate in one subject. Delayed graft function (DGF) was observed in 3 patients; 2 with vascular changes in PIB, and one with normal histopathological findings. Two subjects with PIB changes lost their grafts. The estimated glomerular filtration rate at 3-, and 6-months post-transplantation was lower in children with abnormal PIB changes compared with those with normal PIB. There was one case of DGF in the control group, and 4 children lost their grafts including the one with DGF. Conclusion: Pre-implantation renal biopsy can provide important baseline information of the graft with implications on subsequent medical treatment for pediatric renal transplant recipients. Saudi Med J 2015; Vol. 36 (11): 1299-1304 doi: 10.15537/smj.2015.11.12976

Background Our preliminary proteomic analysis revealed elevated levels of urinary angiostatin, CXCL4 and VCAM-1 in patients with active lupus nephritis Objectives To study the performance of urinary angiostatin, CXCL4 and VCAM-1 in differentiating between active renal and non-renal SLE. Methods Patients who fulfilled the ACR classification for SLE with active renal disease, active non-renal disease and inactive disease were randomly recruited, together with a group of healthy controls. Stored urine samples of the participants were assayed for angiostatin, CXCL4 and VCAM-1 and compared among the different groups. ROC analysis was performed to obtain the best cut-off values to calculate the performance of these markers in differentiating among the different groups of patients. SLE disease activity was assessed by the SELENA-SLEDAI and physician9s global assessment (PGA). Specificity and sensitivity of these markers in differentiating between active renal and non-renal SLE was determined by 2x2 contingency tables. In patients with active renal disease, correlation between these urinary biomarkers with clinical renal parameters was also performed. Results 227 SLE patients (80 inactive SLE; 67 active non-renal disease; 80 active renal disease; 94% women, age 39.2±13.8 years) and 53 controls were studied. Urinary angiostatin, CXCL4 and VCAM-1 levels normalized for creatinine were significantly higher in patients with active renal than non-renal disease (angiostatin 18.4±27.1 vs 1.6±2.91 pg/ng; p 3 vs 0.72±1.10x10 3 pg/ng; p Conclusions Urinary angiostatin, CXCL4 and VCAM-1 are potentially useful biomarkers for SLE, in particular lupus nephritis. Further longitudinal studies are necessary to delineate the sensitivity and specificity of these two urinary protein markers in predicting renal flares and prognosis in SLE patients. Disclosure of Interest None declared

In 2008, the Ministry of Health introduced prenatal screening followed by genetic counseling to at-risk couples attending public health clinics. Perinatal diagnosis and termination of pregnancy was...

Background: Primary immunodeficiency diseases (PID) comprise a group of more than 300 diseases that affect development and /or function of the immune system. Objectives: The aim of this study was diagnosis of PID among a suspected group of neonates and infants within the first six months of life as well as identifying the warning signs of PID characteristic to this period. Method: Fifty neonates presenting with warning signs of PID were enrolled in the study. Results: The study revealed that twenty six patients (52%) were diagnosed with Primary Immunodeficiency, T cell/combined immunodeficiency were noted as the most common PID class (88.5%) with fourteen T-B-SCID patients (70%) and six T-B+ SCID patients (30%), phagocytic disorders were estimated to be 7.7% while 3.8% were unclassified immunodeficiency. The mean age of presentation for PID group was 1.42±1.38 months with a diagnostic lag of 3.08±1.78 months. Consanguinity was positive in 76.9% of the PID group. Lower respiratory tract infections ,persistent fungal infections and lymphopenia were the most significant warning signs for diagnosing PID with a p value of (0.01). Combined, lower respiratory tract infections, fungal infections and lymphopenia were 12.3 times more likely to be associated with PID. Conclusion: Focused screening in high risk neonates proved to be a valuable tool for diagnosis of PID disorders. Keywords: Primary immunodeficiency disorders, neonatal period, early infancy.

Neonatal Sepsis is a major problem in newborn nurseries because of the difficulty of early diagnosis and because of high morbidity and mortality. The objective of this study was to investigate whether urinary nitric oxide (NO) level could be useful for the diagnosis and follow-up of infected newborns. Urinary NO was measured for 30 newborns with sepsis on the first and on the fourth day (group I) and compared with 10 age-matched healthy control (group II). Ninety percent of the septic group showed increase in the urinary NO level during sepsis, while there was decrease in the NO level in the control group. The levels of NO did not differ significantly between cases and control on the first day (p = 0.24), but the difference was significant between the two groups on day 4 (p = 0.02). On comparing the change in NO level from first to fourth day between the two groups, a statistically significant difference was found (p = 0.000). Although urinary NO levels were higher in the infected newborns as compared to the controls on the fourth day, its failure to rise to statistically significant levels on day 1 makes it a nonsuitable marker for early diagnosis of neonatal sepsis, it can however be used for monitoring infection due to its rising level and ease of sample collection.

Tourism industry development becomes one of the key strategies for economic development of many countries during the few decades. This study intends to predict monthly tourist arrivals in Sri Lanka for the period of six years from 2015 January to 2020 December using Time series forecasting simulation method. For the development of the model 516 monthly observations are made after adjusted for seasonality using X-13ARIMA-SEATS monthly seasonal adjustment Method. The study uses 36 alternative ARIMA models as simulation to find the best model to predict monthly tourist arrivals in Sri Lanka. The Akaike Information Criterion (AIC) is used as selection criteria for the models which find that the ARIMA (5, 1, 3) as the best model among the alternative models. According to the model, the expected tourist arrivals in the month of December 2020 will be 178, 705 tourists in Sri Lanka.

Background: Headache is that the most prevailing pain disorder, affecting sixty six percent of the worldwide population. Cervicogenic headache may be a common condition inflicting significant

Unexplained weight loss is common in patients with chronic obstructivepulmonary disease (COPD). Leptin not only is a critical regulator of body weight andappetite, but also serves as an immune-modulator. Nitric oxide (NO) is a potentrelaxant of bronchial and pulmonary artery and leptin has a regulatory role in itssynthesis. In the present study, the association of serum leptin levels with nitric oxidemetabolites (NO) in COPD was investigated. Methods: Serum leptin and NO levelswere measured in COPD patients [males (n=18) and females (n=15)] above fortyyears old compared with control group (n=30) in the same age matched group.Serum leptin levels were measured by enzyme linked immune sorbant assay (ELISA)technique. NO level was measured by spectrophotometric method. Results: Serummean leptin level was significantly lower in COPD male group (9.7 ± 4.1 pg/ml) andfemale group (11.1 ± 3.7pg/ml) than corresponding control group (male: 12.7 ±1.4pg/ml and female: 15.1 ± 1.5pg/ml) ( p