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Acute pancreatitis (AP) ranges in severity from mild to severe with high mortality. Severe AP, similar to other critical illnesses, is associated with changes in cortisol level. Early increase of high-sensitivity C-reactive protein (hs-CRP) as an inflammatory marker could be an indicator of AP progression. We aimed to assess the level of cortisol and hs-CRP on initial diagnosis of AP and identify their prognostic value.This case-control study included patients with AP and a control group of healthy subjects. Laboratory tests such as liver profile, kidney functions, blood picture, lactate dehydrogenase, blood glucose, and lipogram were evaluated, the severity of AP was determined, the duration of hospitalization, complications, and outcomes were identified, and the serum levels of cortisol and hs-CRP were assessed.There were 90 patients with AP and 60 controls with a higher percent of females in both groups. Serum cortisol and hs-CRP were significantly higher in AP relative to controls and were higher in severe AP relative to mild AP. Significant positive correlation was present between high cortisol and severity of AP (r = 0.520 and p0.001) and negatively with pancreatic necrosis (r= - 0.303 and p = 0.007) and morality (r= - 0.432, p = 0.005) while hs-CRP did not show significant correlation.Different levels of serum cortisol in early AP should be considered on initial diagnosis. High cortisol level was a good prognostic indicator for AP with low mortality. This could have further implications on the appropriate initiation of steroid therapy to prevent necrotizing pancreatitis and lower the mortality. Meanwhile, hs-CRP has a low prognostic value in early AP.

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

Benign tumors of the eyelids are manifold. They can severely impair the anatomical unit of upper and lower eyelid, which basically serves to protect the eyeball. Furthermore, they can induce reduction of visual acuity or cause a subjectively more or less strong aesthetic disturbance of appearance. Patients may visit the ophthalmologist by themselves or referred by a dermatologist or a general practitioner. Therefore, knowledge of the clinical signs and symptoms of benign tumors are mandatory to discriminate against malign tumors or to identify possible associated disease. In this article, the incidence, clinic, risk factors, symptomatology, histopathologic features, and probabilities of malignant transformation and recurrence of the most common benign eyelid tumors are presented. Objective of this article is to illustrate when to do further work-up to rule out systemic disease and when to do biopsy to rule out malignancy. Finally, the publication is giving an outlook on the use of artificial intelligence to diagnose lid tumors in the future.

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

Background Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. Results The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Background: About eight percent of adults and children who receive a cancer diagnosis today are projected to live at least 5 years thanks to advancements in pediatric cancer therapy over the last several decades. More than half a million people will have survived childhood cancer by 2020, according to current estimates. Objective: To evaluate the association between childhood cancer, antineoplastic treatment and neurocognitive dysfunction. Patients and Methods: In the Pediatrics Department of the Faculty of Medicine at Zagazig University, a case control study was undertaken on 25 cancer patients who had completed their treatment and on 25 healthy children between August 2020 and July 2021. Children of both sexes, aged 5-15, were enrolled in the study. Results: In terms of full and performance intelligence quotient (IQ) scale, there was statistically significant difference between the groups (much higher in the control group), but the verbal scale did not differ statistically between the groups. Regarding verbal IQ, there was no statistically significant difference between the groups examined. However, there were no significant differences in IQ subtests for information, vocabulary, arithmetic, comprehension, picture completion, mazes or block design between groups. Control group was significantly higher as regard similarity and geometric design. Conclusions: Neurocognitive function is affected in cancer survivors of children as there is statistically significant difference between the studied groups regarding full, and performance IQ scale (significantly higher in control group) but verbal scale was not statistically different between the groups.

Background: Sickle Cell Anemia (SCA) is a chronic hematologic disease associated with many physical, psychological, and social problems that can affect on quality of life. Self-learning guidelines has a great effect in improving quality of life and health status of adolescent with Sickle Cell Anemia. Aim of the study was to evaluate the effect of self-learning guidelines on quality of life and self-reported practice of adolescents with sickle cell anemia. Design: A quasi-experimental study. Settings: Inpatient and outpatient of pediatric hematology departments at Benha University and Benha Specialized Pediatric Hospitals. Study subjects: A purposive sample of 50 adolescents diagnosed with sickle cell anemia in the previously mentioned settings was included in the study throughout a period of six months. Data collection tools: A Structured interviewing questionnaire sheet, self-care reported practicesand pediatric quality of life scale. Results: There was a statistical significant difference between total knowledge and total self-reported practices of the studied adolescents regarding to sickle cell anemia post and follow up self-learning guidelines as compared to pre self-learning guidelines implementation. There was a statistical significant difference between the total score of quality of life for the studied adolescents regarding to sickle cell anemia at post and follow up compared to pre self-learning guidelines implementation. Conclusion: Self-learning guidelines implementation was effective in improving the quality of life of adolescents with sickle cell anemia through improving their knowledge and self-care reported practices. Recommendations: In service training program for adolescents with the sickle cell anemia to enhance their quality of life.Conducting premarital screening programs for raising awareness of children and adolescents regarding the nature hereditary of SCA& associated complication.

Background: Multidrug-resistant tuberculosis (MDR-TB) and infections by nontuberculous mycobacteria (NTM) are diseases of major public health concern. Objective: The aim of the present work is to study the prevalence and patterns of MDRTB as well as the characterization of isolated NTM species. Methodology: All samples (1069) were subjected to smear microscopy, culture on Lowenstein-Jensen (LJ) media, and phenotypic drug susceptibility testing (DST) of MTB to isoniazid (INH), rifampin (RF), streptomycin (S), and ethambutol (E). GeneXpert was used for direct detection of MTB and RF resistance. Matrix-assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry (MS) was utilized for characterizing isolated NTM species. Results: M.tuberculosis (MTB) was isolated at a rate of 95.3% (1019/1069). MDR-TB was detected at rate of 7.16% with significant patterns for INH + RF + S + E (46.5%) and INR + RF (24.6%) (P-value

Aim of the studyHealthcare workers (HCWs) are more prone to extraordinary fears of COVID -19 virus infection. This study aimed to explore the frequency and predictors of health anxiety to COVID-19 virus infection among HCWs and identify its relationship to their quality of life (QOL).Subject or material and methodsA cross-sectional study was conducted among a sample of HCWs in hospitals of Sharkia Province, Egypt from June 30 to July 16, 2020. A total of 218 HCWs were interviewed using the short health anxiety inventory (SHAI), Symptom Check List-90-Revised (SCL-90-R), and The World Health Organization Quality of Life – BREF (WHOQOL-BREF).ResultsThe frequency of health anxiety to COVID-19 virus among HCWs was 28%. Symptoms of depression, hostility, phobia and somatization, and history of chronic medical illnesses showed greater odds of health anxiety to COVID-19 virus (OR: 6.7, 9.1, 7.3, 7.7, and 12.6, respectively). Being physicians and the increased number of sleeping hours were less likely associated with health anxiety to COVID-19 virus (OR: 0.1 and 0.5, respectively). Health anxiety to COVID-19 virus was inversely correlated with all domains of QOL among HCWs.DiscussionThe study findings were consistent with other previously conducted similar studies.ConclusionsHealth anxiety to Covid-19 virus infection is common among HCWs, and it negatively affects their QOL.

1.1. Diabetes and self-management Diabetes mellitus (DM) is a metabolic disorder disease with multiple long-term complications that affect almost every system in the body, and representing one of the most common causes of hospitalization of diabetic patients. It is estimated that 463 million adults aged 20 to 79 years have DM worldwide, 79.4% of whom are from low- and middle-income countries. Global diabetes prevalence is increasing, and will reach an estimated 578.4 million by 2030, and 700.2 million by 2045 in the 20–79 age group. The Middle East and North Africa region reports surging diabetes prevalence, attributed to changes in lifestyle in the region, rapid economic development, and urbanization (International Diabetes Federation [IDF], 2019). The incidence of diabetes and its complications can be reduced by early detection of high-risk individuals and the management of glycaemia (Miller et al., 2014). Diabetic neuropathy is the most common complication of diabetes. Peripheral neuropathy is the most significant form of diabetes neuropathy, which affects the distal nerves of the limbs, especially the feet. Peripheral neuropathy causes a change in the diabetic patient sensation, which leads to loss of feelings, gradual numbness in the feet, and the formation of ulcers (IDF, 2016). Numbness, tingling, pain, and damage to the skin are the most common symptoms of diabetic neuropathy. Diabetes-related foot problems may occur and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness (O'Gara et al., 2013). The diabetic patient foot has the risk of pathologic sequels, like infection, foot laceration, and destruction of foot deep tissues, associated with neurological abnormalities or various degrees of peripheral vascular disease, and metabolic complications of diabetes in the limb (Ha Van, 2014). Diabetic foot disease is among the most serious and chronic complications of diabetes mellitus, including lesions in deep tissues accompanied by peripheral vascular disease (PVD) in the lower limbs and peripheral neuropathy. PVD is described as a full-thickness wound below the ankle joint in a diabetic patient with adverse outcomes of diabetic foot problems as amputations, and it accounts for more admissions to hospital than any other complications of diabetes, leading to increased morbidity and mortality (Orneholm, 2017). Diabetic foot is a cause of significant suffering and financial costs for the patient and also places a massive load on the patient's family, healthcare providers, and society generally. Patients with diabetic foot ulcers frequently require amputation of the lower limb. It is recommended that prevention strategies can reduce the complications of diabetic foot disease and amputations by up to 85%. These prevention strategies include patient and staff education, multi-disciplinary treatment, and close risk monitoring (Basit and Nawaz, 2013, International Working Group on the Diabetic Foot, 2019). Self-management support is one of the core elements to optimize the care of patients with chronic disease. High-quality hospital care for diabetes requires standards for care delivery implemented using “best practice” protocols, reviews, and guidelines. Additionally, diabetes self-management knowledge and behaviors should be assessed on admission, and diabetes self-management education should be provided whenever possible. Education about diabetic self-management should include appropriate skills needed after discharge, such as medication dosing and administration, glucose monitoring, and recognition and treatment of hypoglycemia (American Diabetes Association [ADA], 2019). Proper care of diabetic foot needs a multi-disciplinary team to achieve the set goal objectives in treating diabetes and its complications (Yewande & Suliat, 2017). Diabetes self-management protocol should be a complementary part of comprehensive diabetic patient care. This study discovers the magnitude of self-care practice of diabetic foot patients regarding their needs, concerns, and medication use. The importance of this research is evident in the value and quality of information it provides to those interested in scientific research, healthcare service provision, and the quality of life of diabetic patients and the community. Moreover, these results can be considered a guide in this field to establish bases and rules based on evidence-based planning to overcome diabetic foot problems and their impacts on patients and other stakeholders.

Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be considered a safe option for treatment of adolescent obesity. This study aimed to assess the outcomes of SG in treatment of severe obesity in adolescents, with emphasis on the impact of baseline body mass index (BMI) and adherence to follow-up. This was a single-center retrospective cohort study on adolescents with severe obesity who underwent SG at a tertiary referral bariatric center. The main outcome measures were weight loss, improvement in comorbidities at 12 months postoperatively, and complications. A total of 72 adolescent patients (47 female) of a mean BMI of 47.9 ± 7.1 kg/푚2 were enrolled in the study. The mean %TWL was 34.94 ± 9.35 and the mean %EWL was 73.47 ± 22.12. Complete remission was recorded in all patients with type 2 diabetes mellitus (DM), pre-DM, and sleep apnea, in 80% of patients with hypertension, and 57% of patients with hypothyroidism. The long-term complication rate after SG was 18%. Patients with higher preoperative BMI had significantly (p = 0.018) lower %EWL at 1 year. SG is an effective and safe surgical procedure for adolescents with severe obesity. It was associated with a significant weight loss, high comorbidity remission rates, and no mortality or serious complications. Lower baseline BMI and better adherence to follow-up were associated with better outcome of SG.

Background Management of intussusception varies according to the case, time of presentation, cause, and symptoms. In this study, we focus on describing the demographic and sonographic characteristics of children with intussusception with failed initial enema reduction who were managed by delayed repeated enema attempts and identify predictors associated with successful repeated reduction. Results This study was conducted in the period from December 2018 to April 2020 at university hospitals (pediatric surgery unit). This study included 40 patients with intussusceptions; 27 are males, and 13 of them are females. Their ages ranged from 5 months to 3 years old. Patients in this study had failed initial enema reduction attempts under sonographic guidance and had subsequent delayed (≥ 2 h from the initial attempt) repeated enemas made up the study population. Of the 40 patients, 34 patients (85%) were successfully reduced, and 6 patients (15%) failed reduction and required surgical intervention. There were no deaths, perforation, or resection of gangrenous bowel. Two cases showed recurrences, but required no surgical intervention. It is also noted that early presentation ( Conclusion Delayed repeated enema in the treatment of intussusception is a viable option in patients with unsuccessful initial enema reduction provided that early presentation, stable vitals, and no signs of perforation or peritonitis are present.

Background: Thyroid nodular (TN) lesions are a common clinical problem in the world. These are more common in women and in areas of iodine deficiency. Exposure to ionizing radiation in childhood and adolescence increases the risk of solitary thyroid nodule and thyroid carcinoma. Objective: Determination of the optimal surgical approach for individuals undergoing thyroidectomy for solitary thyroid nodule identified as indeterminate follicular lesion on preoperative fine needle aspiration cytology (FNAC) diagnosis and to estimate the long term outcome of patients treated by lobectomy for solitary follicular thyroid nodule. Patients and methods: From June 2017 to June 2019, 50 patients having a solitary thyroid nodule with a cytological diagnosis of “indeterminate follicular lesion” were selected prospectively. Results: There were 26 women and 24 men with a mean age of 56 years (range: 28-83). Hemithyroidectomy (HT) was performed in 25 patients (50%) and a total thyroidectomy (TT) in 25 (50%). Postoperative morbidity was 3.50% in patients who underwent HT and 9.75% in those who underwent TT. At the histological analysis 3 (12%) patients of hemithyroidectomy group had a malignant lesion. Conclusions: Considering the high rate in which HT represents the adequate treatment, and the low rate of reoperation morbidity, HT seems to be the preferable initial surgical approach for indeterminate follicular lesions. Long-term ultrasonographic follow-up seems advisable.

Background/aim Conjunctival malignant melanoma (CMM) is a rare, but very aggressive tumor with a high metastasis rate. Not much is known about the CMM metastasis mechanisms. So far, epidermal growth factor (EGF) and its receptor (EGF-R) as well as macrophages and matrix metalloproteinase 9 (MMP-9) have been reported to lead to metastasis by epithelial-mesenchymal-transition and tumor migration in different solid tumors. Therefore, we evaluated whether EGF and EGF-R, CD68 and MMP-9 are altered in CMM samples in comparison to conjunctival nevi and healthy conjunctiva. Patients and methods EGF, EGF-R, the macrophage marker CD68 and MMP-9 expression were analyzed in human conjunctival melanoma (CMM, n=16), human conjunctival nevi (n=13) and disease-free human conjunctiva (controls, n=14) by immunohistology. Staining of each sample was evaluated using a standardized score ranging from negative (0) to triple positive (3). The groups were then compared by ANOVA, followed by Tukey's post-hoc test. Results A statistically significant increase of EGF was seen in CMM samples in comparison to conjunctival nevi (p=0.03). In contrast, no statistically significant differences in EGF-R expression were noted between the three groups. A statistically significant increase of CD68 was only seen in conjunctival nevi compared to controls (p=0.04). MMP-9 expression was similar in all groups. Conclusion In CMM, the study data demonstrated an up-regulation of EGF in comparison to conjunctival nevi. Hence, EGF might promote proliferation of CMM cells and induce the epithelial-mesenchymal transition. Therefore, our data suggest that an interplay between EGF and CMM might have a critical role in the developing CMM tumors and metastasis.

Background: Persistent Depressive Disorder (PDD) has higher comorbidity rates and negative impact on different aspects of patient’s life than episodic, non-chronic, Major Depressive Disorder. To our knowledge, no recent studies about PDD held in Egypt. Objective: To estimate the prevalence and comorbidities of PDD and its subtypes among a sample of psychiatric outpatients. Patients and methods: This was an observational, cross-sectional, non-randomized study. It was conducted in Al-Azhar University hospitals over the period from October 2109 till July 2020. Sample of 111 adult patients, aging (18 - 65) years old from both genders, who are visiting the psychiatric outpatient for whatever complaint are collected consecutively. Prior to applying the tests, patients with the diagnosis of bipolar I and II disorders, psychotic disorders, acute suicidality, intellectual disabilities, organic mental disorders, or history of brain surgery were excluded from the study. Those patients underwent detailed clinical examination, patient health questionnaire and persistent depression screener. Results: Prevalence of PDD among our sample was 36.9% (n=41) with late onset in 55% (n=22). The subtype “intermittent major depressive episodes with current episode” was the most prevalent subtype in 61% (n=25). post-traumatic stress disorder and specific phobia were significantly more common in PDD cases (P= 0.001, P=0.41 respectively), while panic disorder was significantly less common (P=0.013). All other comorbidities were equally distributed among PDD and non-PDD cases. Conclusion: PDD was a highly prevalent psychiatric disorder and may be masked by comorbid psychiatric disorders even MDD. These findings might promote psychiatrists to give more attention to PDD because of its impact on prognosis of other disorders and patient’s quality of life.

The purpose was to determine impact of nutritional treatments containing energy and protein on ewes body condition score (BCS), body weight (BW), milk production, newborn of lambs behavior and blood parameters of twin-bearing ewes. At trimester of pregnancy, one hundred-fifty shearing Rahmani ewes had been scanned to choose twin-bearing ewes. Then, twenty-four ewes had been diagnosed twin-bearing actually. They age from 3 to 4 years, BW 51.30±0.39 kg and BCS 2.54±0.16 (on a scale of 1 to 5). They were allocated to 3rd nutritional treatments (n=8/ treatment). Ewes in T1 were received rations consisted of concentrate fed mixture (CFM) + roughage included berseem hay (BH) + rice straw (RS). However ewes in T2 and T3 were fed the previous ration addition with protected fat (PF) and corn steep liquor (CSL), respictevely. Then, T1, T2 and T3 were offered from 100 day until weaning according to NRC (2007) . Resulting indicated that either T2 or T3 to twin-bearing ewe from trimester of pregnancy to weaning could be achieved the greatest (P

Autism Spectrum Disorder (ASD) is a developmental disorder with the age of onset under 3 years old. It is characterized by definite impairments in social interactions, speech abnormalities, and stereotyped patterns of behaviors. Although the exact pathology and etiology of ASD are not fully elucidated, exposure to environmental toxins, micronutrients deficiency, dysbiosis and mutation in genes of mammalian target of rapamycin (mTOR) signaling pathway are emerging as risk factors for ASD. Maternal exposure to heavy metals, air pollutants, and pesticides markedly increases the risk of ASD. Many clinical and experimental trials documented that gastrointestinal symptoms and disturbances of the gut microbiota usually accompanied cerebral disorders in autistic patients. Furthermore, studies showed that gene mutations causing hyperactivation of mTOR significantly lead to autistic symptoms. Pharmacological and nutritional interventions revealed a significant improvement in autistic individuals. The use of dietary supplements and the elimination diets exhibit minor or no adverse effects as compared to conventional drugs. In this review article, we tried to summarize some of the etiological factors that predispose to autism. We discussed the possible mechanisms that potentiate autistic symptoms by such factors. Also, we focused on the role of interventions either by various dietary supplements or by elimination diets in the management of autism.

Objectives To compare the effect of Iberet Folic® and Zincofer® on haemoglobin (Hb) and serum ferritin level; and its adverse effect. Methods This randomised controlled trial conducted from January 2018 until December 2018. Pregnant women below 34 weeks of gestation, with Hb concentration less than 11 g/dL and serum ferritin level less than 12 ug/L were randomised to receive either one tablet Zincofer® or one tablet Iberet Folate® daily for four weeks. Both groups were compared in terms of effect on Hb level, serum ferritin level, and other haematological indices adverse effect related to treatment, and treatment cost. Results Hundred and thirty patients were recruited in this study with 68 patients in Iberet Folic group and 62 patients in Zincofer group. The change in the Hb and serum ferritin level from baseline to day 30 did not differ significantly between treatment groups. The mean (±SD) change from baseline to day 30 was 2.15 (±0.59) g/dL in the Iberet Folic group, and 1.98 (±0.49) in the Zincofer (p value = 0.08). Mean serum ferritin at day 30 was 17.2 (±3.68) ug/L and 16.7 (±4.28) ug/L with 8.44 (±3.41) and 8.55 (±3.50) difference, respectively (p = 0.86). Adverse events were comparable in between groups, with p value >0.05. GI intolerance and constipation were among the common side effects, occurred in 34.6 and 29.2% cases, respectively. Conclusions Zincofer® offers equivalent efficacy and side effect profile in comparison with Iberet Folic® for the treatment of iron deficiency anaemia (IDA) during pregnancy, but with lower cost.

In our promising project toward discovery of secondary metabolites with potential anticancer activity against human cervical cancer, seven marine organisms were screened for their cytotoxic activit...

There is a need to develop animal models of schizophrenia-like behaviors that have both construct and predictive validity. Recently, a neonatal phencyclidine (PCP) and post-weaning social isolation dual-hit model was developed; however, its face and predictive validities need to be further investigated. The aims of this study were to extend the characterization of the behavioral changes occurring in the neonatal PCP and post-weaning social isolation dual-hit rat model and to evaluate the effects of chronic treatment with clozapine on signs related to schizophrenia. Male Wistar rat pups were treated with PCP (10 mg/kg s.c.) on postnatal days (PND) 7, 9, and 11. Starting from weaning, neonatal PCP-treated rat pups were socially isolated, while control saline-treated rats were group housed. At adulthood, rats were assessed using behavioral tasks evaluating locomotor activity, social recognition, prepulse inhibition, and reversal learning. Clozapine (3 mg/kg i.p.) was administered daily starting from a week before behavioral tests and until the end of the study. Neonatal PCP-treated and post-weaning social isolated (PCP-SI) rats displayed persistent and robust locomotor hyperactivity as well as social recognition impairment. The latter could not be explained by variations in the motivation to interact with a juvenile rat. Weak-to-moderate deficits in prepulse inhibition and reversal learning were also observed. Chronic treatment with clozapine attenuated the observed locomotor hyperactivity and social recognition deficits. The PCP-SI model presents enduring and robust deficits (hyperactivity and social recognition impairment) associated with positive symptoms and cognitive/social deficits of schizophrenia, respectively. These deficits are normalized by chronic treatment with clozapine, thereby confirming the predictive validity of this animal model.

BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year. RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p < 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p < 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p < 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p < 0.05). CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.

Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is primarily detected during pregnancy. Objective: To determine the relationship between glycemic control and glycated albumin in women with GDM. Patients and Methods: This prospective study was carried out in the Department of Obstetrics and Gynecology, Zagazig University Hospitals, Zagazig, Sharkia, Egypt from December 2018 to October 2019. The study included 30 patients suffering from GDM (study group) as well as another matching 30 women (control group). Maternal screening for all cases at 24-28 wks using a 75-gm oral glucose tolerance test (OGTT) which is a fasting blood glucose sample was done. Results: GA levels were significantly higher after 24 weeks of gestation in the GDM group compared with controls. Elevated GA levels had a positive correlation with birth weight. In the present study, fetal weight was significantly higher among the study group (3850.0±513.7) than controls (3396.6±334) (p < 0.001). Glycated albumin, HbA1c only showed association with large‐ for‐ date status. Also, GA24_28, more than 13.4 had a sensitivity of 82% and specificity of 72% for GDM. ROC curve, as the cut‐ off point for identifying poor glycemic control in GDM women, and provided the optimal sensitivity (75.93%) and specificity (86.36%). Conclusion: GDM women, the risk of macrosomia significantly increases when the GA levels are ≥14.45% in the third trimester. The results provide strong support for the use of GA measurements, as a complement to finger stick glucose, for assessing short‐ term glycemic control and predicting large birth weight in the GDM women.

Background: Renal pruritus is a distressing disease, often overlooked condition in patients with chronic kidney disease and end-stage renal disease that adversely affect the quality of life (QOL) and medical outcomes of patients and therapy with antihistamines has been unsuccessful. Objective: The purpose of the study was to evaluate the efficacy of low-level laser on renal pruritus in hemodialysis patients. Patients and methods: Thirty patients who established diagnosis of chronic renal failure with age ranged 35-60 years were selected randomly from Hemodialysis Unit of Al-Galaa military Hospital. Patients were randomized into two groups of equal number, 15 each. Group (A) received low level laser therapy 3times/week for 8 consecutive weeks and antihistamine and their conventional medical care. Group (B) who only received antihistamine and their conventional medical care. Parameters: Itching visual analogue scale (VAS) and 5-D Pruritus scale. Results: Compared to the results before and after low level laser (LLLT) treatment. Our study showed that there was a statistically significant decrease in the results of VAS and 5-D pruritus; but the results of group (A) were superior to that of group (B) when comparing the group results together. Conclusion: It can be concluded that low level laser therapy (LLLT) relieves itching pain and lowers progression of renal pruritus in patients undergoing hemodialysis.

Hepatocellular carcinoma "HCC" is a leading cause of cancer mortality worldwide. High-mobility group box 1 "HMGB1" is a nuclear DNA-binding protein which involved in DNA stability, programmed cell death, immune response and inflammatory responses in HCV and HCC. Its over expression was revealed in HCC and different types of human cancers.

Background: Obesity is considered a health hazard for metabolic disorders including diabetes mellitus (DM), dyslipidemia, hypertension and other related comorbidities. Laparascopic sleeve gastrectomy is considered more efficient bariatric procedure for weight loss compared with nonsurgical interventions. Single anastomosis sleeve ileal (SASI) bypass has been established as a new bariatric and metabolic procedure. Objective: To show metabolic disorders (DM, hyperlipidemia and hypertension) after SASI operation, and to detect short outcomes as regard weight loss and to assess complications as malnutrition. Patients and Methods: An interventional prospective study was carried at Bab Alshaariya university hospital, Cairo from May 2019 till November 2019.This study was conducted on 20 patients with body mass index (BMI) ≥ 48 kg/m2 underwent SASI bypass surgery and were followed for 6 months postoperatively. Changes in BMI, excess weight loss (EWL), routine lab investigations (FPG, HbAIC, triglyceride, cholesterol, HDL), and comorbidities improvement were recorded on six months follow-up post operation. Results: The main results of the study revealed that mean±SD age of the patients at the time of operation were 38.3 ± 3.61, mean BMI was 48.7 ± 7.6, 25% of cases were males and 75% were females. 65% of cases were diabetic, 40% hyperlipidmic, and 30% were hypertensive patients. There was a high significant difference between pre and post-surgery as regard FPG, HbAIC, triglyceride, cholesterol, HDL and LDL. There was a high significant difference between before and after surgery as regard BMI. Mean amount of blood loss was 76.1 ± 15.2 with a range of 50-150ml. During surgery, leak during methylene blue test was in 5% of cases, and no post-operative stenosis in cases. Conclusion: SASI bypass is an effective bariatric and metabolic surgery for achieving satisfactory weight loss in patients suffering other metabolic disorders with minimal surgical complications.

BACKGROUND/PURPOSE This work aimed to assess the impact of different etiologies of acute pancreatitis (AP) and vitamin D receptor (VDR) TaqI rs731236 gene polymorphism on the severity of AP. METHODS This case-control study included 70 patients with AP and 40 healthy controls. Etiologies of AP were identified by imaging, ANA, cytomegalovirus (CMV) IgM, coxsackie B virus IgM, and IgG4. Genotyping of VDR TaqI rs731236 polymorphism, Laboratory tests and severity scores using Ranson, BISAP, Atlanta and APACHE II scores were determined. RESULTS The age in AP patients was 36.03 ± 10.76, and females were 85.7%. The etiologies of AP were as follows: biliary (51.4%), coxsackievirus (22.9%), autoimmune (14.3%), post-ERCP (8.6%) and 2.9% were idiopathic. The TT genotype of VDR polymorphism was significantly more common in AP than control (P = .001) and allele T dominated in AP group (OR = 2; 95% CI: 0.665-5.64). Most cases showed low severity scores with significant differences among etiologies and VDR genotypes. Biliary pancreatitis showed highest percentages of severe AP. However, etiologies and VDR polymorphism were not predictors of severity. CONCLUSION Etiology of AP could have impact on the disease severity. VDR gene polymorphism increases the risk of AP. Neither the etiology nor VDR gene polymorphism could predict AP severity.

In this study, samples of farmed thin-lipped mullets, Mugil capito from Lake Manzala and wild-caught grey mullet Mugil cephalus from Alexandria were found to be infected with heterophyid encysted metacercariae (EMC), and the overall prevalence rates were 80 and 100%, respectively. The number of metacercarial infection in tail tissue was significantly higher than that recovered from trunk and head among M. capito and M. cephalus. M. capito were simultaneously infected with two morphologically different EMC that ascribed to Heterophyes and Pygidiopsis species, while M. cephalus were infected with EMC of Heterophyes species. The experimental infection of domestic pigeons (Columba livia domestica) with the recovered encysted metacercariae confirmed the successful development of two types of Heterophyid flukes: identified as Heterophyes heterophyes and Pygidiopsis genata in the small intestine of pigeons. The histopathological examination revealed that Heterophyes cyst was small, elliptical with thick wall and predominating between cardiac muscle fibres and in the lumen of atrioventricular region of the heart. Pygidiopsis species cyst appeared larger in size, rounded with thin cyst wall and prominent internal structure. Pygidiopsis species were few in the abdominal fat and prominently encysted in the internal visceral organs including wall of the stomach, kidneys and muscular tissue away. They were also deeply encysted in testes and ovaries. Interestingly, the adult flukes were demonstrated in the intestinal lumen of the experimentally infected pigeons but with minor histopathological alterations. Our findings suggest that the heterophyids EMCs in mullets have genera-specific morphological characters and may induce histopathological changes in surrounding host-associated tissues.

Summary Cystic echinococcosis is an important cosmopolitan parasitic zoonosis that causes public health and economic problems in Egypt. The present study was undertaken to identify genotypes of hydatid cyst (HC) DNA isolated from different animal isolates and to identify the genotype of secondary hydatid cysts (HCs) developed in rabbits experimentally infected with camel HC for detection of any genetic mutation. In the present study, we extracted DNA from the germinal layers of 8 HCs collected from 3 camels, 1 cattle, 1 sheep and 3 donkeys in addition to 3 secondary HCs collected from rabbits experimentally infected with camel HC. PCR amplification of the ITS1 gene of all examined samples showed an amplified DNA band at 1115 bp. The partial nucleotide sequences of the ITS1 gene of all isolates were aligned and compared with the reference sequences of the genotypes G1–G8 in GenBank. The camel and rabbit samples were identified as Echinococcus canadensis genotype 6 (G6), while the cattle and sheep samples belonged to E. granulosus sensu stricto (G1). The donkey isolates belonged to E. equines (G4). Alignment of the ITS1 partial nucleotide sequences of the camel HCs and rabbit secondary HCs isolates with the G6 partial nucleotide sequence in GenBank was performed. Both camel HCs and rabbit secondary HCs isolates exhibited the same sequence identity matrix, which indicated the absence of mutation in the rabbit secondary HCs. It can be concluded that camel and rabbit samples were identified as E. canadensis (G6), the cattle and sheep samples belonged to E. granulosus sensu stricto (G1) and donkey isolates belonged to E. equines (G4). No mutation occurred during HCs transmission from camel to rabbit.

Background This study investigates the health-related quality of life (HRQOL) of female patients with congenital adrenal hyperplasia (CAH) in Malaysia. The objectives were to attain socio-demographic and medical data on these Malaysian females with CAH and establish their health-related quality of life (HRQOL) in comparison to age matched diabetic controls. Methods A cross-sectional study was conducted over 6 months in the two main tertiary centres for CAH patients in Malaysia. Participants including 59 female-raised CAH patients (mean age ± SD = 16.3 ± 4.2 years, range 10–28 years) compared to 57 age-matched female diabetic patients (mean age ± SD = 16.5 ± 3.4 years, range 10–26 years). Socio-demographic and medical profiles was obtained through semi-structured interviews. HRQOL of participants were evaluated utilising validated, Malay translated questionnaires which were age appropriate: Pediatric Quality of Life Inventory (PedsQL v4.0) scales for Child (8–12) and Adolescent (13–18) and Medical Outcome Survey 36-item Short Form version. These were then compared to the diabetic controls. Results The CAH participants consisted of children (ages 10–12 years, n = 12), adolescents (ages 13–17 years, n = 29) and adults (≥ 18 years, n = 18). The majority were Malays (64.4%) and had salt-wasting CAH (67.8%). There were no significant differences between the total mean score of the HRQOL of the combined children and adolescents CAH group (total mean score ± SD = 81.6 ± 17.9, 95% CI = 75.6–87.6) when compared to age-matched diabetic patients (total mean score ± SD = 80.8 ± 11.0, 95% CI = 77.0–84.5, P = 0.81, effect size = 0.05); no significant difference between the adult CAH and diabetic controls in the physical [median score (IQR) CAH vs diabetics; 49.3 (11.4) vs. 50.2 (6.1), P = 0.60, effect size = 0.09] and the mental composite scores [median score (IQR) CAH vs. diabetics; 47.8 (14.1) vs. 50.0 (10.8), P = 0.93, effect size = 0.01]. Conclusions The HRQOL of the Malaysian CAH cohort were comparable to the diabetic controls.

Opuntia ficus-indica (L.) Mill. (OFI), also known as Indian fig Opuntia or prickly pear, is a member of the family Cactaceae that produces edible, nutritionally rich sweet fruits. It has been traditionally used to treat several health disorders and is considered to possess various therapeutic properties. In this work, we have characterized 37 secondary metabolites using HPLC-MS/MS, identified the polysaccharide from the fruits and cladodes pulp, and estimated the neuroprotective activity. All tested extracts exhibited substantial antioxidant activities in-vitro and neuroprotective potential in AlCl3 induced Alzheimer’s condition. Administration of OFI extracts attenuated AlCl3 induced learning and memory impairment as confirmed from passive avoidance test and counteracted the oxidative stress as manifested from decreasein the elevated MDA level, increased TAC, GSH, SOD and CAT levels. OFI extracts significantly decreased the elevated brain levels of proinflammatory cytokines (NF-κβ and TNF-α), increased anti-inflammatory cytokine (IL-10), and monoamine neurotransmitters (NE, DA, 5-HT) as compared to positive control group. The extracts showed a significant decrease in acetylcholinesterase level (AChE) as compared with AlCl3. Furthermore, molecular docking was performed to investigate the ability of the major constituents of OFI extracts to interact with acetylcholinesterase (AChE) and serotonin transporter (SERT). Among the tested extracts, cladodes contain highest phenolic content and exhibited the highest antioxidant, anti-inflammatory and neuroprotective activities, which could be attributed to presence of several polyphenols, which could function as AChE and SERT inhibitors. Opuntia ficus-indica might be promising candidate for treating Alzheimer disease, which makes it a subject for more detailed studies.

Background:Handle and administer of antineoplastic chemotherapy can cause negative health effect among nurses prepare, and administer antineoplastic chemotherapy. Aims of the study:explore the nurse'sperformance and adverse health effects on nurses dealing with chemotherapeutic Agents. Design:A correlation descriptive research design. Setting: This study was conducted at three chemotherapeutic units in oncology Institution in Damietta, Port Said general hospital and EL Tadamon hospital. Sample: A Purposive sample of 48 nurses, oncology Institution in Damietta (N=41), Port-said hospitals (N=7) in period of 6 months. Data collection: Two tools were used for data collection: A Structured self-administered questionnaire and Nurses' performanceobservational checklist. Results:Only 57.9% of the studied nurses had unsatisfactory level of general knowledge, while 52.3% of them had satisfactory level of practice, with regards to the adverse health effect the results shown that 54.8%, 51.6%, 41.9%, 38.7% and 35.5% s inflammation of the skin, fatigue, loss of weight, ulcers in the mouth and hair loss, headache, loss of appetite, change in nail color and changes in menstrual cycle respectively. Conclusion: There are statically significant relation between nurses' level of performance and the occupational health hazards. Recommendations:periodiceducational and training programs to improve nurses'performance regarding use of chemotherapy and protection from its health hazardsare needed.

Background: Alpha-smooth muscle actin (α-SMA) is used as a marker for a subset of activated fibrogenic cells, myofibroblasts, which are regarded as important effector cells of tissue fibrogenesis. Purpose: We addressed whether ASMA gene (actin alpha 2 gene or ACTA2) expression is up regulated in cases with BM fibrosis compared to those with no bone marrow (BM) fibrosis in order to evaluate its role in the pathogenesis of BM fibrosis. Subjects and methods: ASMA expression was detected by quantitative RT-PCR in formalin fixed paraffin embedded (FFPE) bone marrow trephine biopsy samples of cases with neoplastic bone marrow diseases as well as reactive bone marrow disorders cases. Both groups included cases with and without bone marrow fibrosis. Results: Results indicated that there was no statistically significant difference in ASMA (ACTA2) gene expression between neoplastic fibrotic and non-fibrotic cases as well as between reactive fibrotic and non-fibrotic cases. Also the level of α-SMA expression does not correlate positively with the grade of bone marrow fibrosis. Conclusion: We conclude that α-SMA is not a functional marker of fibrogenic cells in bone marrow fibrosis. Exploration of other related genetic pathway is recommended.

Background Clinical presentation and outcomes of COVID-19 infection during pregnancy remain limited and fragmented. Objectives To summarize the existing literature on COVID-19 infection during pregnancy and childbirth, particularly concerning clinical presentation and outcomes. Search strategy A systematic search of LitCovid, EBSCO MEDLINE, CENTRAL, CINAHL, Web of Science, and Scopus electronic databases. The references of relevant studies were also searched. Selection criteria Identified titles and abstracts were screened to select original reports and cross-checked for overlap of cases. Data collection and analysis A descriptive summary organized by aspects of clinical presentations (symptoms, imaging, and laboratory) and outcomes (maternal and perinatal). Main results We identified 33 studies reporting 385 pregnant women with COVID-19 infection: 368 (95.6%) mild; 14 (3.6%) severe; and 3 (0.8%) critical. Seventeen women were admitted to intensive care, including six who were mechanically ventilated and one maternal mortality. A total of 252 women gave birth, comprising 175 (69.4%) cesarean and 77 (30.6%) vaginal births. Outcomes for 256 newborns included four RT-PCR positive neonates, two stillbirths, and one neonatal death. Conclusion COVID-19 infection during pregnancy probably has a clinical presentation and severity resembling that in non-pregnant adults. It is probably not associated with poor maternal or perinatal outcomes.

Background Myocardial recovery following primary percutaneous coronary intervention is often suboptimal despite of restoration of thrombolysis in myocardial infarction (TIMI) 3 flow, in part due to thrombus embolization which results in impairing microvascular reperfusion besides increasing infarct size. The purpose of the present study was to estimate the effect of aspiration thrombectomy followed by intracoronary delivery of tirofiban on decreasing the infarct size utilizing cardiac MRI (cMR) in large anterior ST-segment elevation myocardial infarction (STEMI) patients. Patients A prospective randomized controlled study of 100 patients with large anterior STEMI were randomized to (Study group) using intracoronary tirofiban (intracoronary) and (control group) without intocoronary tirofiban. A 6 F thrombus aspiration catheter was used in all patients. Tirofiban was injected locally at the place of the highly thrombus burden through the aspiration device after flushing the aspiration device well. Results Patients of intracoronary tirofiban group compared with control group had a significant difference in decreasing the infarct size at 30 days [median, 15.451 g - interquartile range (IQR), 17.404 gm - n = 50] vs (median, 43.828 g - IQR, 49.599 g - n = 50) P value = 0.002. Conclusion In patients early presented with large anterior STEMI, infarct size at 30 days was significantly decreased by intracoronary tirofiban delivered to the infarct lesion site followed aspiration thrombectomy.

Background: The impact of hepatitis virus infection on arterial calcification (AC) was not studied. Objective: To study the prevalence, severity and distribution of AC in incident hemodialysis patients with hepatitis B and C viral infection. Cases and methods: 172 stage 5 CKD adults (98 male and 74 female) were included; 58 of them were seronegative for both hepatitis B and C (SN group), 48 were positive for hepatitis B virus infection (HBV group) and 66 were hepatitis C virus positive (HCV group). Beside histopathology of the obtained arterial samples, all these cases were examined for body mass index (BMI), serum calcium (Ca), phosphorus (P), alkaline phosphatase (AP), serum albumin, uric acid (UA), alanine transaminase (ALT), parathormone (PTH), fibroblast growth factor 23(FGF23), interleukin 6 (IL6), and 25 hydroxy vitamin D (25 (OH) vit D), hemoglobin concentration, and serum ferritin. Results: 86 (50%) of the cases had AC; 11 of them were in SN group (19%), 9 in HBV group (18.8%) and all the 66 HCV group (100%). In SN group, 4 had intimal calcification, 5 had medial calcification, and 2 had both intimal and medial calcification. In HBV group, 9 had intimal calcification, while no cases were encountered with either medial or both site calcifications. In HCV group, 16 had intimal calcification, 31 had medial calcification, and 19 had both intimal and medial calcification. Calcification was in the form of spots in one case in SN group, and 6 cases in HBV group, a single plaque of calcification in 5 cases of SN group, 3 cases of HBV group, and 16 cases of HCV group, multiple plaques were detected in 4 cases in SN group, and 31 cases in HCV group, and diffuse calcification in one case in SN group, and 19 cases in HCV group.In HBV group, calcification was only detected in patients with high viremia, while all patients with low or moderate viremia were devoid of calcification. In HCV group, all patients with low viremia had intimal solitary plaque of calcification, all patients with moderate viremia had multiple plaques of medial calcification, while all patients with high viremia had diffuse intimal and medial calcification. Both groups of viral hepatitis were significantly different in comparison to SN group in either distribution or calcification score (P

Background Childhood psychosocial dysfunction (CPD) is an important cause of morbidity among children, and its frequency in primary care is growing. The information about its prevalence and risk factors is weak in many developing countries. The study aims to determine the prevalence of psychosocial problems among primary school children and identify the risk factors associated with childhood psychosocial dysfunction. Results A cross-sectional study was conducted on 368 primary school children aged 6–12 years. About (19.0%) of the studied sample had probable CPD according to Strengths and Difficulties Questionnaire (SDQ). CPD was statistically associated with older age group, male sex, and low social class. The association between biological and medical risk factors of the studied group and CPD showed statistical significant relations between CPD and low body weight (n = 35, 50.7%), maternal history of problems with pregnancy (n = 26, 66.47%), history of receiving medications during pregnancy (n = 13, 86.7%), abnormal general condition of baby at birth (n = 57, 16.2%), family history of mental disorders (n = 2, 100%), medical history of congenital diseases (n = 9, 90%), acute medical disorders (n = 29, 90.6%), chronic diseases, receiving medications (n = 22, 91.7%), and exposure to trauma (n = 27, 84.4%). Also, The association between psychosocial risk factors and CPD revealed high statistical significant relation between CPD among the studied children and presence of family problems (n = 33, 62.3%), living with single parent (n = 15, 71.4%), parent(s) death (n = 12, 63.2%), major changes in the family (n = 39, 79.6%), parent(s) smoking status (n = 22, 51.2%), and parent(s) addiction (n = 4, 100%). Moreover, there was statistical significant relation between CPD among the studied children and poor academic achievement (n = 19, 27.5%), problems with teachers (n = 25, 33.3%), problems with peers (n = 22, 51.2%), and exposure to violence (n = 56, 22.4%). Conclusions Psychosocial dysfunction is common among Egyptian school children. It is associated with many risk factors. Hence, mental health services should be incorporated into primary health care facilities and school health program. Also, training of family physicians and primary health care providers is crucial.

Background: The traditional inhibition of contralesional primary motor area (cM1) with low frequency repetitive transcranial magnetic stimulation (rTMS) fails to improve post-stroke severe motor impairment. The role of contralesional motor areas in post-stroke motor recovery is still questionable. While the previous data suggested that cM1 exerts transcallosal inhibitory effect on ipsilesional M1 (iM1) following stroke, there isan evidence that contralesional motor areas, particularly the contralesional dorsal premotor area (cPMd), have compensatory roles in severely impaired patients who have extensive ipsilesional damage. Objectives: To study whether facilitating cPMd with high frequency rTMS as a novel approach, instead of conventionally suppressing cM1, has beneficial effect on motor recovery of post-stroke severely impaired upper extremity (UE) or not. Patients and Methods: Forty right handed, first ever stroke patients (3 months post event) with severe stroke symptoms, severe motor deficit, and radio logically evident massive right cerebral infarctions at baseline were randomly assigned to two equal groups, to receive, as adjunct to ordinary rehabilitation techniques, ten consecutive sessions of either: (1) High frequency rTMS at 5 Hz on cPMd; or (2) Sham rTMS. The Medical Research Council (MRC) for muscle strength and UE- Fugl Meyer Assessment (UE-FMA) were assessed before and after the intervention. Results: By using the one way analysis of covariance (ANCOVA), we found significant improvements in grand means of MRC in the active rTMS group in relation to the sham group. The improvements included in particular the mean proximal MRC, whereas no significant improvement in the mean distal MRC. Similarly, we found that the UE-FMA totals were markedly improved in the active group in relation to the sham group, mainly in the proximal UE-FMA. Stepwise regression showed that lower baseline MRC of the affected UE muscles is an independent predictor of better response to the novel rTMS approach. Conclusion: Applying high frequency rTMS to cPMd can improve motor functions of the disabled UE, mainly proximal functions, in more severely impaired stroke patients.

Background: Ambulatory BP monitoring (ABPM) might be more accurate than clinical BP measurement. It allows detection of nocturnal BP and dipping patterns, and can reduce false-positive results by detecting white-coat hypertension and false-negative results by detecting masked hypertension. Objective: Assessing the use of ambulatory BP monitoring (ABPM) in individuals with diabetes mellitus to identify the presence of hypertension and its association with arterial stiffness. Patients and Methods: The study included 100 diabetic patients in addition to 20 apparently healthy individuals. Results: In comparison with healthy subjects, patients with diabetes were found to have hypertension using ABPM. ABPM appeared to be useful in the detection of hypertension in patients with diabetes. Comparison between patients and control showed statistically significant difference according to average day, average night and allover average readings. Arterial stiffness also found to be increased in patients with hypertension with statistically significant difference between studied groups according to stiffness index. Conclusion: ABPM analysis revealed that about one-third of the participants with diabetes had masked hypertension. Those individuals cannot be detected by office BP alone. Moreover, arterial stiffness increased in individuals with masked hypertension. These findings supported the use of ABPM to identify individuals at risk of cardiovascular disease.

This study aimed to assess the effects of Ginkgo Biloba Extract and Troxerutin on the hippocampus of induced diabetes mellitus in adult albino rats using histological methods.50 adult male albino rats were divided into three groups; Group I (Control); Group II (diabetic): subdivided into Subgroup IIa (T1DM)), Subgroup IIb (T1DM+GBE), Subgroup IIc (T1DM+ troxerutin); Group III: subdivided into Subgroup IIIa (GBE) and Subgroup IIIb (troxerutin). The brain was removed and the cerebral hemisphere was coronally cut at the hippocampal level and used for light microscopic study (H&E staining and PCNA immunostaining). There was a statistically insignificant improvement in animal weights in subgroup IIb and subgroup IIc. Subgroup IIb showed a statistically significant reduction of blood glucose levels while the subgroup IIc showed insignificant reduction of blood glucose levels. Diabetes disturbed the light microscopic structure of the hippocampus. In subgroup IIb and subgroup IIc the hippocampus retained an apparently normal appearance and the stratum pyramidale exhibited the pyramidal cells with rounded vesicular nuclei and acidophilic cytoplasm. Diabetic hippocampal sections revealed negative PCNA immunoreactivity in all layers of DG. In subgroup IIb and subgroup IIc, hippocampal sections showed positive immunoreactivity.

Background: Gall stone-related disease is one of the most common ailments that general surgeons treat. Between 10% and 15% of the population have gallstones, and of these, between 1% and 4% will be become symptomatic each year. Aim of Study: The aim of this prospective study is to compare between early and interval laparoscopic cholecystec-tomy for treatment of acute cholecystitis in grade I and grade II according to Tokyo guide lines in post-operative complica-tions hospital stay quality of life and cost. Patients and Methods: This study was analytical prospec-tive study; it was carried out on 20 patients presented with acute calcular cholecystitis admitted in the General Surgery Department at Al-Zahraa University Hospital in the period from April 2018 to November 2019. Results: According to Tokyo guidelines 2013, 12 patients undergone and completed early laparoscopic cholecystectomy (6 patients from mild group and 6 patient from moderate group) while 4 patients treated by delayed laparoscopic cholecystectomy. Only 3 patients (2 in mild group and 2 in moderate group) needed intraoperative conversion. Operative time was longer in open surgery and statistically significant in early lap and conversed cases. Post-operative pain was severe in majorty of patients with open surgery and mild in laparoscopic group. The mean time of starting oral feeding and hospital stay was longer in open surgery than lap chole-cystectomy. Conclusion: These results clarify that application of Tokyo guidelines 2013 was successful in guiding us in determining the proper time of laparoscopic cholecystectomy according to severity.

Takayasu's arteritis should be kept under the differential diagnosis of stroke in all young patients. Early, proper diagnosis and treatment are necessary to reduce any further progression, morbidity, and mortality rates of the disease.

Summary Background Cystic fibrosis (CF) is an inherited disorder that causes severe damage to multiple organs in the body. Nutritional management has a dramatic effect on growth and survival in CF patients. This study aimed to assess the nutritional status of Egyptian pediatric patients with CF before and after proper nutritional counseling and supplementation. Methods This is an interventional observational study conducted on fifty children with CF recruited from CF clinic, Children's Hospital, Cairo University. The patients were subjected to history taking, clinical examination, full nutritional assessment, including signs of vitamins deficiencies, Subjective global assessment (SGA), anthropometric measurements, laboratory assessment (complete blood count, kidney, liver function tests and Prealbumin as a nutritional marker). After the initial assessment all the patients were subjected to a proper nutritional plan plus vitamin and mineral supplementations then reassessed them after 3 months. Results SGA showed that 60% of the patients had severe malnutrition, 62%, 78%, and 48% of the patients were below −2 Z score for height, weight, and BMI respectively which decreased to 45%, 40%, and 32% after nutritional supplementation. 43% of the patients were anemic, 29% were hypoalbuminemic, and 80% had low serum Prealbumin levels. After 3 months of follow up, only 17% had anemia, 11% had hypoalbuminemia, and 41% had low serum Prealbumin. Compliance was detected in 76% of caregivers during the follow up. Conclusion CF patients had considerable impairment in their nutritional status. Proper caloric intake and vitamin supplementation had a valuable impact on their growth and prognosis.

(1) Background: Altered levels of autoantibodies (aab) and their networks have been identified as biomarkers for various diseases. Neovascular age-related macular degeneration (nAMD) is a leading cause for central vision loss worldwide with highly variable inter- and intraindividual disease courses. Certain aab networks could help in daily routine to identify patients with a high disease activity who need to be visited and treated more regularly. (2) Methods: We analyzed levels of aab against Angiotensin II receptor type 1 (AT1-receptor), Protease-activated receptors (PAR1), vascular endothelial growth factor (VEGF) -A, VEGF-B, and VEGF-receptor 2 in sera of 164 nAMD patients. In a follow-up period of five years, we evaluated changes in functional and morphological characteristics. Using correlation analyses, multiple regression models, and receiver operator characteristics, we assessed whether the five aab have a clinical significance as biomarkers that correspond to the clinical properties. (3) Results: Neither the analyzed aab individually nor taken together as a network showed statistically significant results that would allow us to draw conclusions on the clinical five-year course in nAMD patients. (4) Conclusions: The five aab that we analyzed do not correspond to the clinical five-year course of nAMD patients. However, larger, prospective studies should reevaluate different and more aab to gain deeper insights.

Purpose: The demonstration of a rare case of bilateral diffuse uveal melanocytic proliferation (BDUMP) due to a lung carcinoma with unusual dermal lesions. Case description: A 76-year-old man with painless bilateral vision loss revealed leopard or giraffe spot chorioretinopathy and bilateral serous retinal detachment. Ultrasound biomicroscopy revealed uveal swelling expanding into the anterior chamber angle. Dermal and mucosal lesions were present on the lip, breast, groin, scrotum, and penis. Screening analyses revealed a non-small cell lung carcinoma. Conclusions: The diagnosis of BDUMP, a rare paraneoplastic syndrome, was made. The ophthalmological diagnosis led to screening investigations and revealed the underlying malignant disease. Uncommonly, multiple dermal and mucosal lesions could be detected and were analyzed histopathologically.