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Understand the women with cancer about knowledge and practices regarding their nutrition are very important to maintain healthy body weight and eat nutritious foods. Hence, the study was aimed to evaluate the effect of instructional guidelines on women's awareness regarding nutrition after breast cancer surgery. Subjects and method: Design: A quasi-experimental research design was used with a pre-and post-test. Setting: the research was conducted at the inpatient and outpatient clinic of Fayoum Oncology Center. Subjects: A purposive sample of 130 women was included. Three tools were used: Tool (I) women' structured interviewing questionnaire, it included two parts: (a) demographic characteristics; (b) women' medical data, Tool (II) women' knowledge regarding nutrition sheet, and Tool (III) women' practice regarding nutrition sheet (pre/post). Results: More than half of women were having a family history of cancer. The majority of women reported that the main source of information regarding nutritional knowledge after breast cancer surgery was doctors. There was a positive correlation (P=0.005) between women's knowledge scores and their practice post-one-month nutritional instructional guidelines implementation. There were marked improvements in women's knowledge and practices regarding nutrition after breast cancer surgery post instructional guidelines implementation (P=0.005). Conclusion: The instructional guidelines implementation regarding nutrition had a positive effect on improving women's knowledge and practices after breast cancer surgery. Recommendations: The instructional guidelines should be conducted regularly for women after breast cancer surgery to discuss and teach them different aspects about nutrition and replication of the current study with a larger sample

Background: Acridocarpus orientalis (AO) is a medicinal herb indigenous to tropical and subtropical Africa, Arabian Peninsula, and New Caledonia with reported anti-inflammatory and antioxidant properties. Objective: To determine whether AO has any beneficial effects on diabetes-induced metabolic parameters in rats. Materials and Methods: Diabetes mellitus was induced in male Wistar rats by streptozotocin. Diabetic rats were treated with three doses of AO extract (50, 100, and 200 mg/kg BW) for 30 days. Kidney, liver, and pancreatic tissue samples were processed for histopathology to determine the effect of AO on the cells of these organs. The effect of AO on pancreatic islet cells and serum insulin levels was also examined using immunohistochemistry and enzyme-linked immunosorbent assay techniques, respectively. Results: AO (100 mg/kg BW) caused a marked reduction in blood glucose levels in diabetic rats compared to diabetic control on day 10 of the study. Moreover, AO (200 mg/kg BW) increased the number of insulin-positive cells with a concomitant reduction in the number of glucagon-immunoreactive cells in pancreatic islets. AO (100 mg/kg) also increased the serum level of superoxide dismutase significantly. Although the administration of AO was able to significantly decrease the diabetes-associated increases in serum creatinine and bilirubin levels, it had no effect on blood urea nitrogen, serum aspartate, or alanine aminotransferase levels. Histopathological examination showed that AO has no toxic effect on the structure of the pancreas, liver, and kidney. Conclusion: Our findings showed that AO could alleviate some complications of diabetes mellitus.

Background Overdose of paracetamol affects liver cells leading to cell death. This is done through hepatic necrosis, which is characterized by a rupture of the plasma membrane. A variety of investigations has been conducted using herbal extracts to assess liver toxicity induced by paracetamol. Here we examined herbal plant species, Acridocarpus orientalis (A. orientalis), ethanolic extract to study its potential to protect against hepatotoxicity in mice. Serum alanine transaminase (ALT), aspartate transaminase (AST) and reduced glutathione (GSH) enzymes were estimated for all mice groups. A phytochemical screening was also conducted. Results Phytochemical screening showed that A. orientalis contains flavonoids, tannins, carbohydrates and phenolics derivatives. A. orientalis pretreatment showed significant reduction of liver marker enzymes ALT and AST in almost all concentrations. Furthermore, serum GSH levels were significantly increased in A. orientalis pretreated mice groups. In addition, a reduction in liver weights in pretreated mice with A. orientalis showed significant weight loss at dose 250 mg/kg BW (P A. orientalis pretreated mice. Conclusion pretreatment with A. orientalis protects mice against heplatotoxic adverse effects of paracetamol as indicated by reduction of serum ALT and AST enzymes, with elevation of GSH antioxidant protective enzyme, which may have contributed to the main hepatoprotective action of A. orientalis.

Background Unsafe injection practices are an occupational hazard among the nursing staff. Awareness of nurses’ staff members about safe injection practices may vary between different hospitals according to the policies adopted for staff training and systematic auditing. Aim To assess awareness and practice of safe injection among nursing staff in a Maternal and Child Hospital, Qassim Region, Saudi Arabia, and Beni-Suef University Hospital, Egypt. Methods A cross-sectional study using a structured questionnaire. Observations included 500 injections (250 from each hospital) from October to December 2017. Results The mean awareness total scores in both hospitals were 9.98 ± 1.76 and 11.12 ± 0.96 respectively with a significant difference among observed nurses (P = 0.001). The mean safe injection practice total score was 27.13 ± 3.11 and 27.39 ± 2.17. Past year safe injection training was received for 95% and 70% for observed Egyptian and Saudi group of nurses. The majority of nurses (98.8%) were aware of the importance of safe injection practices to minimize blood-borne diseases, and 95.2% of them were aware of the placement of sharps disposal box beside the place of injection procedure. Exposure to the past year needlestick injuries (NSIs) was higher among the observed Egyptian nurses (P = 0.001). Using appropriately stored and refilled disinfectants was done by 48.5% and 51.5% of the observed nurses. Needle separation from its syringe inside sharps disposal box and sharps disposal boxes near patient care areas were observed in 95.2% and 95.6% of both hospitals respectively. Conclusions and recommendation Nurses of both hospitals have good awareness and practice of injection safety. This might be attributed to the adoption of appropriate training courses. There is a need for continuous training sessions and auditing for nursing staff to ensure safe injection practices.

Plant secondary metabolites (SMs) common natural occurrences and the significantly lower toxicities of many SM have led to the approaching development and use of these compounds as effective pharmaceutical agents; especially in cancer therapy. A combination of two or three of plant secondary metabolites together or of one SM with specific anticancer drugs, may synergistically decrease the doses needed, widen the chemotherapeutic window, mediate more effective cell growth inhibition, and avoid the side effects of high drug concentrations. In mixtures they can exert additive or even synergistic activities. Many SM can effectively increase the sensitivity of cancer cells to chemotherapy. In phytotherapy, secondary metabolites (SM) of medicinal plants can interact with single or multiple targets. The multi-molecular mechanisms of plant secondary metabolites to overcome multidrug resistance (MDR) are highlighted in this review. These mechanisms include interaction with membrane proteins such as P-glycoprotein (P-gp/MDR1); an ATP-binding cassette (ABC) transporter, nucleic acids (DNA, RNA), and induction of apoptosis. P-gp plays an important role in the development of MDR in cancer cells and is involved in potential chemotherapy failure. Therefore, the ingestion of dietary supplements, food or beverages containing secondary metabolites e.g., polyphenols or terpenoids may alter the bioavailability, therapeutic efficacy and safety of the drugs that are P-gp substrates.

Introduction Primary malignant melanoma of the spinal cord (PSM) is a rare condition with limited evidence regarding its diagnosis (clinical and radiographic), management, and prognosis. Our aim was to report an extremely rare two cases of primary malignant melanoma of the spine one of them is sacral melanoma which represents the second reported case in the literature and to conduct a systematic review of the relevant literature. Methods The diagnosis and management of these cases were retrospectively reviewed. Using the PRISMA guideline, we conducted a systematic review of the literature to analyze different management strategies and the prognosis of such pathology. Results All two patients were operated on, and received gross total removal of their tumors, with extended follow up for tumor recurrences. One of the cases involved a sacral tumor, which was resected without adjuvant therapy. The other one was seen by oncology and received post-operative chemo- and radio- therapy. In addition to the aforementioned cases, we present a comprehensive review of the literature on PSM from 1950 to the present, demonstrating that PSM is a very rare tumor, with a limited counted number of cases reported worldwide. Conclusion In conclusion, we report an exceedingly rare two cases of primary malignant melanoma of the spine. Early surgical intervention is key to the management of these rare and aggressive tumors. GTR should be attempted if possible.

The hypocretin/orexin (Hcrt/orexin) unit affects the functions of the nervous, cardiovascular, gastrointestinal, and reproductive systems. Hcrt/orexin ligands and receptors have been localized to different parts of the central and peripheral nervous systems, cerebrospinal fluid and blood, exocrine (pancreas, salivary, lacrimal) as well as endocrine (pancreatic islets, pituitary, adrenal) glands. Several factors including stress, glucagon-like peptide-1 agonists, glutamate, nicotine, glucose, and hypoglycaemia stimulate the expression of Hcrt/orexin system, but it is inhibited by ageing, bone morphogenetic protein, hypoxia/hypercapnia, melanocortin receptor accessory protein 2, and glucagon. Literature reports show that Hcrt/orexin can significantly increase insulin secretion from normal and diabetic rat pancreata. Hcrt/orexin decreases blood glucose concentration and reduces insulin resistance partly via increased tissue expression of glucose transporter type 4. It reduces obesity by increasing browning of fat cells and energy expenditure. Taken together, Hcrt/orexin modulates obesity and the metabolism of glucose and insulin. The Hcrt/orexin system may thus be a target in the development of new therapies for the treatment of diabetes mellitus.

BACKGROUND: Depression and anxiety are common prevalent in patients with chronic disease, and Chronic illness are long-lasting conditions with persistent effects and complications. Depression and anxiety disorders are well known to have a negative but significant impact on the course, outcomes, long-term survival, and treatment efficacy of patients suffering from physical disease. Given the high prevalence and potential negative consequences of this type of comorbidity in elderly patients, there is an urgent need for this study to be conducted due to the scarcity of statistics on the topic among middle and older adults in the Al-Qassim region. On the other hand, early identification of people who are more likely to experience psychological distress is critical in prevention and management strategies. OBJECTIVES: To assess the severity of depression and anxiety, using validated self-report measures of middle-aged and older adults; and to determine the association between anxiety and depression levels and socio-demographic characteristics. METHODS: In February 2021 and for two months, a cross-sectional study of middle- aged and older adults from Al-Shifa hospital at Al-Qassim region was conducted with questionnaires on socio-demographic and clinical characteristics, and validated Generalized Anxiety Disorders (GAD-7), and Patient Health Questionnaire (PHQ-9) anxiety and depression questionnaires. Two hundreds middle- aged and older adults participants of Al-Shifa Hospital participated in this study and agreed to complete the questionnaire. RESULTS: 79% (n=158) of participants had minimal to mild depression and 21% (n=42) had moderate-to-severe depression; the average PHQ-9 score was 7.05 (M =7.05; SD=4.4), while 81.5% (n=163) of participants had minimal to mild anxiety and 18.5% (n=37) had moderate-to-severe anxiety; the average GAD score was 6.6 (M =6.6; SD =4.3). The significant predictors of moderate-to-severe depression in the logistic regression analysis were: male sex (odds ratio (OR):0.0.272; confidence interval (CI):0.101-0.730) and psychiatric disorders (odds ratio (OR):13.131; confidence interval (CI):2.975-57.949). The significant predictors of moderate-to-severe anxiety in the logistic regression analysis were psychiatric disorders (odds ratio (OR):13.080; confidence interval (CI):3.261-52.464). There was a strong significant positive correlation between PHQ-9 score and GAD score. CONCLUSION: The study group had higher prevalence of moderate and severe depression, which was significantly associated with female sex and psychiatric disorders; while the prevalence of moderate and severe anxiety was significantly associated with the presence of psychiatric disorders. Our findings reaffirm the importance of providing appropriate specialized interventions to promote the mental health of chronically ill elderly, with a focus on high-risk groups.

Background : Hydrosalpinx is a common gynecological dis­ease. 30% of infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET) have hydrosalpin­x. Leukemia inhibitory factor (LIF) mRNA expression level is lower in the endometrium during the implantation window in the presence of bilateral hydrosalpinges. If the hydrosalpinx is removed, LIF mRNA expression returns to normal values. Objectives: This study was designed to evaluate laparoscopic intervention of bilateral hydrosalpinges versus transvaginal ultrasound guided aspiration on LIF mRNA expression level during implantation window and pregnancy outcome after IVF-ET cycle. Methodology : Sixty patients who had bilateral hydrosalpinges were classified into two groups; 30 women underwent laparoscopic salpingectomy or proximal tubal occlusion and 30 women underwent transvaginal ultrasound guided aspiration. Determination of LIF mRNA expression level in endometrial samples was performed preoperatively and in the 3 rd postoperative cycle. In addition, pregnancy outcome was evaluated in the first IVF-ET cycle. Results: Endometrial LIF mRNA expression level in laparoscopic group significantly increased postoperatively than transvaginal ultrasound guided aspiration group with a significant difference (P=0.03). In addition, there is increased levels in patients undergoing laparoscopic and ultrasound guided aspiration groups after treatment than before with a significant difference (P=0.005) and (P =0.04); respectively. As regards pregnancy outcome, it is more favorable in laparoscopic group than ultrasound guided aspiration with statistically significant difference (P=0.013). Conclusion: Our findings showed that endometrial LIF mRNA expression level was increased and pregnancy outcome was more favorable after laparoscopic inter­vention versus transvaginal ultrasound guided aspiration for treatment of bilateral hydrosalpinges patients. , Egypt

Background Alpha-fetoprotein (AFP) is currently used for serologic screening in hepatocellular carcinoma (HCC) but with low sensitivity ranging 41–65% with a high rate of false-negative and false-positive results. For the hypermethylation of the p16 inhibitor of cyclin-dependent kinase 4 (p16INK4A), a tumor suppressor gene results in the uncontrolled division of cells. This suggests that the loss of p16INK4A function due to promoter methylation may be an early event in HCC pathogenesis so the study aimed to assess aberrant p16INK4A gene methylation as an early diagnostic marker in HCC patients. Results Our study revealed a highly significant increase of p16INK4A methylation in patients versus controls (Fisher, 36.11; p < 0.01). P16INK4A methylation was detected in 86.6% (26/30) and none of the controls were methylated (100% specificity) compared to the low sensitivity of AFP 65.38% at a cutoff value of 28 ng/mL. Data revealed non-significant difference of p16INK4A methylation status between different HCC Barcelona stages (Fisher, 0.055; p > 0.05). While, AFP levels were statistically significantly higher in stages B and C (median = 243,400 ng/mL, respectively, when compared to stage A (median = 10 ng/mL) (H:16.667, p < 0.01)). Conclusion Early diagnosis of HCC can be achieved through the detection of p16INK4A gene methylation in chronic liver disease (CLD) patients with normal serum AFP especially in known cirrhotic patients that deteriorate clinically without apparent etiology.

BACKGROUND: Diabetes and ear disease are some of the most widespread health concerns. The focus here is on the impact of using the term “Diabetic Ear” for patients with skull base osteomyelitis (SBM) in the context of malignant otitis externa (MOE). The aim of this study was to discover the awareness of general practitioners (GPs), residents, specialists, and consultants at Primary Health Care Centers about necrotizing otitis externa (NOE), also known previously as malignant external otitis (MOE), assess their deficiencies and provide solutions; also assist them for the early detection and possible prevention of diabetes- related ear diseases and their complications. MATERIALS AND METHODS: A cross-sectional study was conducted among a random sample of physicians (residents, specialists, and consultants) working at the Primary Health Care Centers in Al-Khobar and Dammam cities of the Eastern Province, Saudi Arabia. Data was collected using a standardized questionnaire. SPSS was used for data entry and analysis. RESULTS: The total number of medical practitioners was 84. Their mean age was 33.97 (±9.55). The proportion of females was higher than males, only 28.3% of the participants responded correctly when asked about MOE. Similarly, very few were aware of the risks of MOE (2.5%), complications associated with it (17.3%) and the necessary procedures for managing patients (24.2%). The awareness of doctors in the primary health clinics about MOE was significantly better than those in hospitals (P = 0.002). CONCLUSION: There was a significant deficiency in the knowledge of GPs on MOE. Therefore, health education and awareness programs on MOE are recommended. Furthermore, we recommend that it is necessary to encourage the use of the term “Diabetic EAR “to increase the level of awareness of physicians about MOE.

The current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with risky varices who will benefit from primary prophylaxis. This leads to a heavy burden on endoscopy units and affects patient compliance. Noninvasive identification of risky patients would limit performing endoscopy to those most likely to benefit. Upper GIT endoscopy is the gold standard against which other tests are compared, but is not without its limitations. Some tests are clearly preferable to patients but are not as accurate as upper GIT endoscopy in the diagnosis of esophageal varices. The aim of this work is to study the relation of serum NT pro-CNP to severity of cirrhosis and the presence of esophageal varices and the risk of their bleeding. The study was carried-out on 80 subjects divided into 4 groups: 20 cirrhotic patients with esophageal varices which have previously bled, 20 cirrhotic patients with esophageal varices which have not yet bled, 20 cirrhotic patients without esophageal varices and 20 normal healthy control subjects. Serum NT pro-CNP level was significantly elevated in cirrhotic patients with esophageal varices compared to cirrhotic patients without esophageal varices, but not significantly elevated in bleeders than in nonbleeders. Also spleen and portal vein diameters, Child’s score, Fib-4 score, serum bilirubin and AST levels and prothrombin activity were significantly elevated in the same group. Therefore, serum NT pro-CNP is a promising noninvasive marker for predicting severity of cirrhosis and presence of esophageal varices and not the risk of variceal bleeding in HCV-related liver cirrhosis patients.

PURPOSE: The objective of this study was to evaluate the operative management of pes planovalgus deformity in ambulatory cerebral palsy (CP) children by calcaneal lengthening osteotomy described by Evans. METHOD: Fifteen children (10 girls and 5 boys) with average age 11 years 6 months (range, 8 years 4 months–14 years 6 months) with 22 feet with pes planovalgus (PPV) deformity were included in this study. Clinical evaluation was made according to Dogan's scale and graded as perfect, good, fair and poor. Preoperative and postoperative radiological assessment of anteroposterior talo-first metatarsal angle (AP-T1MT), anteroposterior talo-calcaneal angle (AP-TC), laterl Talo-first metatarsal angle (Lat. T1MT), lateral Talo-calcaneal angle (Lat. TC), and lateral Calcaneal pitch angle (Lat. CP) had been done for all feet. All feet were corrected with the modification of the calcaneal lengthening osteotomy described by Mosca. RESULT: Clinical results were perfect in 18 feet (82%), good in 2 feet (9%) and fair in 2 feet (9%). Radiological results showed improvement in 20 feet, while 2 feet showed no improvement. The improvement was significant in Lat. T1MT (P ‹ 0.001), AP-T1MT (P 0.05). CONCLUSION: The results of the present study showed that the procedure reliably relieves pain in PPV foot in CP children and proved effective in addressing all components of the deformity in both hindfoot and forefoot clinically and Radiologically.

Aim: Studying the value of the surgical loupe in the enhancement of performing safe thyroidectomy via dissection of the major structures which are vulnerable to injury during the operation. Subjects and methods: 150 patients with benign and malignant thyroid masses underwent near total or total thyroidectomy at Zagazig university hospitals. History taking and all necessary investigations were done. Thyroidectomy was done under the magnification of the surgical loupe and we dissected the recurrent laryngeal nerve, the external branch of superior laryngeal nerve, branches of superior thyroid artery and selectively ligating them and trace the parathyroid glands by following their minute blood vessels originating from the inferior thyroid artery. Results: Mean age of the patients was 42.5 years (range: 23-69). Female: male ratio was 19:11 (95/55). 65 patients (43.3%) had a discrete thyroid nodule and 85 patients (56.7%) had multinodular goiter. Patients were sent home in a mean of 1.6 days (1–4 days). No operative related mortality was encountered. Only three cases of transient hypocalcaemia which were resolved within three days by oral calcium supplementation and symptoms did not recur during the follow-up of these three patients. All patients were extubated without any complications. There was no any case recorded for hoarseness of voice or low pitched voice. There was only one case of secondary hemorrhage and was re-explored for control of the source (injured anterior jugular vein on the right side). Three cases developed hypertrophic scars during the follow up. Conclusion: total or near total thyroidectomy can be done with a minimal number of complications by using the surgical loupe during the dissection of the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands and their minute blood vessels.

Background: If the patient of penetrating abdominal stab wound is hemodynamically stable and has equivocal abdominal examination findings, surgeons pose a significant challenge to take decision in favor of surgery or nonoperative conservative treatment. This decision requires a precise diagnosis that is not always possible with imaging techniques. In consequence of this circumstance; laparoscopy can be a diagnostic or therapeutic tool in these cases. It also leads to avoid negative exploratory laparotomies. Methods: This is a randomized study including 51 patients with penetrating abdominal stab wounds. The patients were selected according to the following criteria; hemodynamically stable, no signs of peritonitis and fully conscious without evidence of raised intracranial pressure and absence of contraindication for pneumoperitoneum. So we were able to evaluate the diagnostic and therapeutic role oflaparoscopy. Results: Patients were divided into two groups. Group I underwent exploratory laparotomy (26 patients). Group II underwent laparoscopic laparotomy (25 patients). The mean operating time in both groups was (89±23.5 vs. 55±19 minutes, (P O.05) respectively. There was no mortality in both groups. Accurate diagnosis was done to all patients in Group II except one patient (96.15%) with missed intestinal injury (this happened in the first cases of the study). Treatment was done for four patients from eight patients with discovered organ injuries (50%). Other four patients were converted to exploratory laparotomy (50%) due to severe injuries. Conclusion: The use oflaparoscopy as a diagnostic or therapeutic method in patients with penetrating abdominal stab wounds is an efficient, safe and effective method. The most important advantages are reduction of morbidity, shortening of hospitalization and cost-effectiveness.

Diabetes mellitus (DM) is a major metabolic disorder currently affecting over 200 million people worldwide. Approximately 90% of all diabetic patients suffer from Type 2 diabetes mellitus (T2DM). The world's economy coughs out billions of dollars annually to diagnose, treat and manage patients with diabetes. It has been shown that the naturally occurring gut hormones incretins, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) can preserve the morphology and function of pancreatic beta cell. In addition, GIP and GLP-1 act on insulin receptors to facilitate insulin-receptor binding, resulting in optimal glucose metabolism. This review examines the medicinal chemistry and roles of incretins, specifically, GLP-1 and drugs which can mimic its actions and prevent its enzymatic degradation. The review discussed GLP-1 agonists such as exenatide, liraglutide, taspoglutide and albiglutide. The paper also identified and reviewed a number of inhibitors, which can block dipeptidyl peptidase 4 (DPP-4), the enzyme responsible for the rapid degradation of GLP-1. These DPP-4 inhibitors include sitagliptin, saxagliptin, vildagliptin and many others which are still in the experimental phase.

The aim of this study is to examine the effect of intragastric administration of chlorella (1 g/kg body weight) for a period of 30 days to treat normal and diabetic male Wistar rats. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ) (60 mg/kg - 1 body weight). A significant (p < 0.05) reduction of blood glucose level in diabetic chlorella-treated rats was observed compared to diabetic untreated. Chlorella increased the number of glutathione-positive cell in diabetic rats compared to untreated diabetics. Chlorella administration increased the percentage of insulin secreting pancreatic beta cells both in normal and diabetic treated rats. Percentage of glucagon producing alpha cells of the pancreas were reduced both in normal and diabetic chlorella-treated rats. Chlorella-induced regenerative ability on pancreas was mediated by up-regulation of Ki67 and down-regulation of P53 and by its potent anti-oxidant ability. The present results suggest that chlorella may play an important role in improving the overall condition of diabetic patients and delay its complication by restoring the function of pancreatic insulin-secreting cells.

Context Surgical treatment of breast cancer was challenged over years. Breast conservation is as oncologically safe as mastectomy and gives better cosmetic and psychological outcomes. Aim The aim of our study was to evaluate the oncological and esthetic outcomes of the lazy lateral technique as a new approach for tumor located at the upper outer quadrant near anterior axillary fold. Patients and methods Between October 2012 and September 2014, 18 patients with early breast cancer at the upper outer quadrant and near the anterior axillary fold were surgically treated with the lazy lateral technique. Results The age of our patients ranged from 36 to 58 years (median: 47 years). Most of the patients in this study were diagnosed as having infiltrating ductal carcinoma (14 patients, 77.7%). The size of the tumor ranged from 0.9 to 3.8 cm. No involved margin on frozen section. Seroma was the most common postoperative complication and developed in two (11.1%) patients. The cosmetic outcome was excellent in 12 (66.6%) patients, good in five (27.7%) patients, and satisfactory in one (5.5%) patient. No local recurrence or systemic metastasis was noticed in our patients during a median follow-up period of 38 months (range: 27–49 months). Conclusion The lazy lateral technique is a novel approach for surgical treatment of upper outer quadrant breast cancer near the anterior axillary fold. It is an oncologically safe procedure and promotes satisfactory esthetic outcomes.

The prevalence of diabetes mellitus (DM) is about 6 % across the globe. This prevalence has been reported to increase in the near future. This means that the number of women with DM who would like to get pregnant and have children will also increase. The present study is aimed at investigating the morphological changes observed in the uterus after the onset of DM. The study also examined the pattern of distribution of nociceptin (NC), a neuropeptide involved in the regulation of pain, a major physiological factor during parturition. The study shows a severe atrophy of uteri as early as 15 days post DM and continued until the termination of the eight-week study. This atrophy was confirmed by light microscopy. Electron microscopy study showed atrophy of the columnar cells of the endometrium, reduced myofibril number and destruction of smooth muscle cells in the myometrium of diabetic rats compared to control. Immunofluorescence and immunoelectron microscopy studies clearly demonstrated the presence of NC in the endometrium, myometrium and on the myofibrils of the smooth muscles of both control and diabetic rat uteri. In addition, NC-positive neurons and varicose fibres were observed in the myometrium of both normal and diabetic rats. However, the expression of NC decreased after the onset of DM. Morphometric analysis showed that the number of NC-labeled cells was significantly (p

To evaluate the qualitative and quantitative changes in N-linked glycosylation, which occurred in association with diethyl nitrosamine-induced hepatocellular carcinoma (HCC) in rodents.Liver tissues of (1) normal (non-tumor-bearing) rats; and (2) tumor-bearing rats; were collected and were used for histological and GlycanMap analyses. Briefly, GlycanMap analysis is a high-throughput assay that provides a structural and quantitative readout of protein-associated glycans using a unique, automated 96-well assay technology coupled to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and custom bioinformatics. Histopathological studies were carried out to ensure the development of HCC in the tested animals.The N-glycomic analysis revealed 5 glycans; Glc₁Man₉GlcNAc₂, Gal₂Man₃GlcNac₄Fuc₁Neu₁, Man₄GlcNac₂, Gal₂Man₃GlcNac₄Neu₃OAc₃, and Man₃GlcNac₅ Fuc₁, which showed significant changes in rat HCC tissues when compared with normal liver tissues. Four glycans were increased (P0.05) and Glc₁Man₉GlcNAc₂ was decreased (5.89 ± 0.45 vs 3.54 ± 0.21, P0.01) in HCC tissues compared to normal liver tissues. An increase (66.5 ± 1.05 vs 62.7 ± 1.1, P0.05) in high-mannose structures in HCC rats was observed compared to normal rats. Importantly, HCC rats showed an increase (P0.05) in both tumor-associated carbohydrates and in branched glycans. The changes in glycans correlated well with glycan flow changes reported in the glycan biosynthetic pathway, which indicates the importance of enzyme activities involved in glycan synthesis at different subcellular localizations.The reported HCC-associated changes in glycan flow and subcellular localization explain the increase in high mannose glycans and siayl Lewis glycans common in HCC liver tissues.

Introduction: Diabetes mellitus (DM) is a major metabolic disorder currently affecting over 350 million people worldwide. Also, another one billion people in the world are pre-diabetic, who may eventually end up with full- blown diabetes. It costs around 1,200 billion USD to diagnose, treat and care for both type 1 DM (T1DM) and type 2 DM (T2DM) patients globally. The disorder is rapidly increasing out of proportion in both developed and developing countries, especially T2DM, which is associated with modern lifestyle habits such as reduced physical activity, diet, obesity and genetic factors. If left untreated, DM can lead to a number of diseases and long-term complications leading subsequently to death. Areas Covered: In this mini review, we aim to highlight a number of complications, cascades or pathways (polyol, hexosamine, protein kinase C, advanced glycation-end product) of events and cellular, sub-cellular and molecular mechanisms associated with DM-induced hyperglycaemia (HG). Conclusion: Chronic complications of DM are caused largely by HG-induced cellular and molecular impairment of neural and vascular structure and function. HG-induced oxidative stress is a major contributor in the development of long-term complications of DM. DM-induced neuropathy and angiopathy, in turn, may lead to the dysfunction of cells, tissues and organ systems.

Tribulus terrestris L (TT) is used in the Arabic folk medicine to treat various diseases. The aim of this article was to investigate the protective effects of TT in diabetes mellitus (DM). Diabetes is known to increase reactive oxygen species (ROS) level that subsequently contributes to the pathogenesis of diabetes. Rats were divided into six groups and treated with either saline, glibenclamide (Glib), or TT for 30 days. Rats in group 1 were given saline after the onset of streptozotocin (STZ)-induced diabetes; the second diabetic group was administered Glib (10 mg/kg body weight). The third diabetic group was treated with the TT extract (2 g/kg body weight), while the first, second, and third nondiabetic groups were treated with saline solution, Glib, and TT extract, respectively. At the end of the experiment, serum and liver samples were collected for biochemical and morphological analysis. Levels of serum alanine aminotransferase (ALT) and creatinine were estimated. In addition, levels of malondialdehyde (MDA) and reduced glutathione (GSH) were assayed in the liver. The tested TT extract significantly decreased the levels of ALT and creatinine in the serum (P < 0.05) in diabetic groups and lowered the MDA level in liver (P < 0.05) in diabetic and (P < 0.01) nondiabetic groups. On the other hand, levels of reduced GSH in liver were significantly increased (P < 0.01) in diabetic rats treated with TT. Histopathological examination revealed significant recovery of liver in herb-treated rats. This investigation suggests that the protective effect of TT for STZ-induced diabetic rats may be mediated by inhibiting oxidative stress.

Context The surgical treatment of breast cancer has changed significantly over time, but modified radical mastectomy (MRM) is still performed in about 20–30% of patients undergoing surgeries. Many articles that have studied the breast lymphatic system claim that the deep fascia is very poor in lymphatic vessels. Aim The aim of our study was to detect the benefits and oncological safety of pectoral fascia preservation in patients undergoing MRM. Materials and methods Totally, 73 patients with early breast cancer underwent MRM. The patients were randomized between removal (n=37) and preservation (n=36) of pectoral fascia. Results The amount of blood loss, operative time and drain output was significantly reduced in a case of pectoral fascia preservation (P>0.00001); in addition, seroma was significantly reduced (P=0.025). No chest wall recurrence had occurred in both groups. Conclusion Pectoral fascia preservation is safe and has many advantages as regards operative time, blood loss, seroma formation and cosmetic appearance of the flaps. It is oncologically safe compared with pectoral fascia resection, provided that good selection of the patient was done.

Incretins, such as glucagon-like peptide-1 (GLP)-1, have been shown to elevate plasma insulin concentration. The purpose of this study is to investigate the cellular and molecular basis of the beneficial effects of GLP-1. Normal and diabetic male Wistar rats were treated with GLP-1 (50 ng/kg body weight) for 10 weeks. At the end of the experiment, pancreatic tissues were taken for immunohistochemistry, immunoelectron microscopy and real-time polymerase chain reaction studies. Samples of blood were retrieved from the animals for the measurement of enzymes and insulin. The results show that treatment of diabetic rats with GLP-1 caused significant (P

Glucagon-like peptide 1 (GLP1) agonists are promising therapeutic agents in the treatment of diabetes mellitus. This study examines the mechanism of the protective effects of exenatide in experimental diabetes, employing four groups of ten rats each, in which two groups were streptozotocin-induced diabetic and two were control groups. One control and one diabetic group were treated with exenatide (1 μg/kg body weight (BW)) for 10 weeks. Blood plasma was taken for biochemical analyses while pancreatic tissue was taken for immunofluorescence and immunoelectron microscopy studies and real-time PCR to examine the expression of genes. The results show that exenatide improved BW gain and reduced blood glucose in diabetic rats compared with controls. Similarly, exenatide enhanced insulin release from the pancreatic fragments and improved liver and kidney functions and lipid profile in diabetic rats compared with controls. Exenatide not only induced significant increases in serum insulin level but also elevated the number of insulin-, GLP1- and exenatide-positive cells compared with untreated controls. Exenatide also elevated the number of catalase- and glutathione reductase-positive cells in diabetic rat pancreas compared with controls. Exenatide caused significant elevation in the expressions of pancreatic duodenal homeobox-1, heat shock protein-70, glutathione peroxidase, insulin receptor and GLP1 receptor genes in the pancreas of both control and diabetic rats compared with untreated animals. The results have demonstrated that exenatide can exert its beneficial and protective effects by elevating the levels of endogenous antioxidants and genes responsible for the survival, regeneration and proliferation of pancreatic β-cell.

The effect of rate control and rhythm control on left ventricular (LV) function in patients (pts) with atrial fibrillation (AF) and ischemic (LV) failure need to be delineated.MethodsThe study was conducted on 48 pts with persistent AF of more than one week and less than one year duration and ischemic LV failure (EF60mm, intractable heart failure. Myocardial performance index (Tei index) was determined. Rate control: was achieved using digoxin, carvedilol, bisoprolol. Precardioversion TEE was done within 24h of cardioversion. All pts received warfarin.ResultsHeart rate on admission and after one month follow up (mean): G1: 96 then 78. G2: 95 then 74. All improvement of LV function was statistically insignificant. NIHA class II, III and IV: G1: 100% then 66%, G2: 91% then 58%. The EF increased from 41% to 46% and 42% to 47%. Fractional shortening: G1 20 to 23; G2 20 to 23. Tei index improved in both groups: 1.4 and 0.96 to 1.27 and 0.74. LA diameter G1 50mm to 52; G2 48 to 46.ConclusionsBoth rate and rhythm control strategies are effective in controlling HR equally. There is no difference between both strategies in improvement in LV function after one month of therapy.

Esophageal varices (OV) are a serious and common complication of portal hypertension associatedwith liver cirrhosis. Hemorrhage from OV rupture is a life-threatening complication withhigh mortality. The model for end stage liver disease (MELD), MELD-Na+ scores are predictorsof non-transplant surgical mortality among patients with cirrhosis and has been a usefultool predicting the mortality in patients awaiting liver transplantation. As well, they have beensuggested in many studies as useful predictors of OV presence and severity.This study evaluated accurate cut-off values of MELD-Na and aspartate aminotransferase toplatelet count ratio index (APRI), AST/ALT (AAR), creatinine (ASR/Cr) as well as AST/ Bilirubin(AST/Bil.) ratios as new non-invasive predictors for liver cirrhosis patients.

Sphenoid wing dysplasia occurs in 3-7% of patients with neurofibromatosis type 1 (NF1). The typical radiological features are partial or complete absence of the greater wing of the sphenoid. This condition is slowly progressive and may result in temporal lobe herniation into the orbital cavity, producing pulsating exophthalmos and gross facial deformity. Thus, reconstruction of the orbit is important for both cosmetic and functional reasons. Traditional surgical treatment of sphenoid dysplasia involves split bone grafting and repair of the anterior skull base defect. However, several reports have demonstrated complications of graft resorption and recurrence of proptosis and pulsating exopthalmos. In this case series, we present two patients suffering from pulsating exophthalmos due to sphenoid dysplasia. Radiological and MRI studies demonstrated orbital enlargement and complete absence of the greater wing of the sphenoid. Surgical management of these patients involved dural defect repair, and the use of titanium mesh in conjunction with bone graft to act as a barrier between the orbit and the middle cranial fossa. The mesh was fixed by fine screws. Proptosis improved markedly post-operatively and resolved within a few weeks. Ocular pulsation subsided and remained quiescent with at least 1-year follow-up.

OBJECTIVE: Craniopagus parasiticus is an extremely rare condition. The first attempt to separate such twins was performed in the Dominican Republic in 2004. The infant died 7 hours after surgery. The aim of this report is to present a case in which surgical separation was successfully performed on February 18, 2005. In February 2006, the child was still alive and in relatively good health. METHODS: The authors operated on a patient with craniopagus parasiticus at Benha Pediatric Hospital in Egypt, 45 km north of Cairo. The child was 10 months old when the surgery was performed. By minimizing the time of surgery and adequate control of intraoperative bleeding, a successful surgical separation was achieved. Computed tomography, magnetic resonance imaging, magnetic resonance angiography, and computed tomographic angiography provided the information necessary to perform surgery. RESULTS: The child underwent operation at the age of 10 months; the duration of surgery was 9 hours. Bleeding was the most serious problem, with the child receiving four liters of blood. The main arterial supply to the parasite was via the middle cerebral artery and was ligated in the Sylvian fissure. Bleeding, however, was mostly venous and was mainly controlled by diathermy and thrombin soaked packs of Surgicel, as well as clipping. After separation of the parasitic head, the dura was repaired using artificial dural grafts. Free bone flaps from the parasite were used to cover the osseous defect in the autosite. Skin flaps from the parasite were also used to cover the cranium. CONCLUSION: This is the second case of craniopagus parasiticus in which separation was attempted. The first patient, operated on in the Dominican Republic, died 7 hours after surgery. In the present case, the child is still alive and without neurological deficit.