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Background Malnutrition has a high incidence among pediatric surgical patients and contributes to increased risks of postoperative complications and extended hospital stays. Purpose The present study aimed to determine the influence of preoperative nutritional status on the postoperative outcomes of pediatric patients who underwent elective gastrointestinal (GI) surgery. Methods This prospective observational study was conducted at Cairo University Specialized Pediatric Hospital. According to the designated inclusion criteria, 75 surgical cases of both sexes were included. A structured questionnaire was developed and administered. This questionnaire included three main sections: demographic data and nutritional status parameters at admission and discharge. Pre- and postoperative nutritional statuses were compared. Results According to both the Subjective Global Nutritional Assessment and STRONGKIDS score Questioner, more than 60% of patients in the upper GI patient group were at risk of malnutrition. Wasting status was most common in the upper GI patient group (67%; versus 39.1% in the lower GI group). Underweight status was more common in the hepatobiliary and upper GI patient groups (nearly 50% for each group) than in the lower GI group (30.4%). On the other hand, stunted patients had a higher incidence of complications and a prolonged hospital stay (P = 0.003 and P = 0.037, respectively), while underweight lower GI patients experienced a prolonged hospital stay (P = 0.02). A higher proportion of patients with preoperative anemia than those without preoperative anemia required a blood transfusion (P = 0.003). Conclusion Nutritional assessment is a crucial component of pediatric surgical patient management. Both underweight and wasting statuses were more common among hepatobiliary and upper GI patients. Postoperative complications and a long hospital stay were more common among stunted patients.

Background: Dysfunction of the coronary microcirculation may be one of the factors responsible for persistent anginal symptoms. Noninvasive as well as invasive modes for assessing microcirculation have yielded inconsistent results. Aim of work: To determine the usefulness of coronary sinus filling time (CSFT) for assessment of microcirculatory transit time in the coronary circulation. Subjects and methods: A case-control study carried out in the Cardiology Department, Zagazig University Hospital on 57 patients divided into three groups: Group A included diabetics with angina, Group B included non-diabetics with angina, and Group C included control group. All patients were subjected to complete history taking, general examination and local cardiac examination. 12 Lead ECG, stress ECG (treadmill test), transthoracic echocardiography and coronary angiography were done. Results: regarding CSFT in group A the mean was 5.247 ± 0.562, in group B the mean was 4.635 ± 0.224 sec and in group C the mean was 3.295 ± 0.525 sec. There were significant difference between group A and control group (P < 0.001), between group B and control group (P < 0.001) and between group A and group B (P < 0.001). There were statistically significant relation between prolongation of coronary sinus filling time and presence of comorbid hypertension (P < 0.001), dyslipidemia (P < 0.05), Family History of CAD (P < 0.001) and obesity (P < 0.05). Conclusion: The coronary sinus filling time is a useful method for assessment of microcirculatory transit time in the coronary circulation. The prolongation of coronary sinus filling time is significantly associated with the presence of diabetes mellitus.

Background: Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Hyperprolactinemia may reflect neuroendocrine stress reaction to acute coronary syndromes, which induces acute endothelial dysfunction, insulin resistance, and induction of vascular immune reactions; thus, prolonged hyperprolactinemia lead to arteriosclerosis, augmentation of arterial stiffness, and hypertension. Objective: To assess role of prolactin as a cardiovascular risk in type 2 diabetes mellitus patients in Zagazig University Hospitals. Patients and Methods: This study was performed in Clinical Pathology, Cardiology and Internal Medicine Departments Zagazig University Hospitals in the period between July and October 2019. Approval for study was obtained from research administration and research ethics committee, Faculty of Medicine Zagazig University. Results: Regarding prolactin level, there was a statistically significant increase on comparing group 1 with group 2, 3 and 4 (P= 0.016, P

BackgroundIntralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited.ObjectiveTo evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts.MethodsSixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions.ResultsThe overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period.ConclusionIntralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.

The objective of the present study was to enhance ocular antifungal activity of fluconazole (FCZ) in treatment of keratomycosis through incorporation into cubosomal nanoparticles. FCZ-loaded cubosomal dispersions were prepared by emulsification method according to 23 full factorial design. Design-Expert® software was used to study the effects of different formulation factors on properties of FCZ-loaded cubosomal dispersions and select the optimal formulation. Eight FCZ-loaded cubosomal dispersions were prepared and were in vitro and in vivo evaluated. In vitro, the results revealed that the optimum formula exhibited a mean particle size of 48.17 ± 0.65 nm and entrapped 85.70 ± 2.56% of FCZ. The ex vivo permeation study confirmed a two-fold enhancement in FCZ permeation through rabbit cornea compared to aqueous FCZ solution. Furthermore, in vivo ocular tolerance and histopathological studies proved the efficacy and safety FCZ-loaded cubosomal dispersion in treatment of induced keratomycosis in rats compared to aqueous FCZ solution after topical ocular application. In conclusion, the obtained results indicated that cubosomes could be promising ocular drug delivery system for enhancing antifungal activity of FCZ in treatment of fungal keratitis in rats. Graphical abstract.

Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospinal fluid to treat hydrocephalus. Advances in laparoscopy tools and techniques made it possible to perform this procedure laparoscopically assisted. Complications of this procedure are also amenable to laparoscopic correction. This study outlines the safety and feasibility of laparoscopy in performing the procedure and management of its complications. A retrospective file review for all cases underwent laparoscopic-assisted VP shunt or laparoscopic management of one of its complications in the period 2015–2019. Laparoscopic-assisted procedure was done either by 3-port technique or a peritoneocentesis needle technique. Management of complications was done according to its nature. Over 4 years, we performed 36 laparoscopic-assisted VP shunt placement and 17 laparoscopic interventions for abdominal complications related to VP shunts. There were no intraoperative or postoperative complications related to the laparoscopic technique. Conversion to conventional laparotomy was done in 3 patients presented with hugely infected CSF pseudocysts with amalgamated intestine with the wall of the cyst. Laparoscopic-assisted VP shunt placement and revisions in children are feasible and safe. No special tools are required for the procedure.

Background: CAD is the largest contributor of cardiovascular diseases (CVDs) and mortality rate is due in prevalence to atherosclerosis. Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has a prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. Objective: To assess the relationship between C reactive protein/albumin ratio (CAR), severity of coronary atherosclerosis assessed by the syntax score (SS) in patients with stable coronary artery disease. Patients and Methods: This study was a prospective cohort study conducted on 100 patients divided into two equal groups according Syntax score. All patients underwent elective percutaneous coronary angiography, and have the following: hemoglobin levels, serum creatinine, serum cholesterol, serum albumin, C- reactive protein, resting 12-lead electrocardiography and Doppler – echocardiography. Results: C-reactive protein/albumin ratio was significantly higher in patients with intermediate-high SS group. In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with serum Cholesterol, HDL and LDL. Conclusion: C-reactive protein/albumin ratio was more tightly associated with the complexity and severity of CAD, and was found to be an independent predictor for intermediate-high SS group.

Background: Weighing in at around 3 pounds, the liver is the body’s second largest organ; only the skin is larger and heavier. The liver performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. These functions make the liver a vital organ without which the tissues of the body would quickly die from lack of energy and nutrients. Fortunately, the liver has an incredible capacity for regeneration of dead or damaged tissues; it can grow as quickly as a cancerous tumor to restore its normal size and function. Objective: to evaluate the levels of fibrosis regression by ARFI in the patients with successful eradication of chronic hepatitis C virus after 12 weeks and 24 weeks after completion of treatment with direct acting antiviral drugs (sustained virological response, SVR 12 and SVR 24). Patients and Methods: This prospective and observational cohort study was conducted during the period between June 2016 and February 2019 in total of 60 individuals at Al-Azhar (Al-Hussein) Hospital and National Search Institute in Cairo divided into three groups. Results: Results show that the median fibrosis degree measured by ARFI in all patients was significantly decreased after HCV eradication with 100 % success in cure rate and 16.5% of patients failed to regress fibrosis. Conclusion: A disappointing percentage (16.5%) failure in fibrosis regression although reaching a sustained virological response.

Fasciolosis is one of the neglected tropical diseases that negatively affect the farming industry and public health. The present study aimed to evaluate a polymerase chain reaction (PCR) assay for detection of infection with Fasciola sp. in field-collected Lymnaea natalensis snails from two rural localities in Egypt; and to compare between it and the ordinary microscopic methods. A total of 1000 lymnaeid snails were collected, and then the samples were examined for the infection by crushing, cercarial shedding and molecular methods. The average sensitivity of microscopic methods compared to PCR was 56.15% and this gives the indication that the molecular techniques were highly sensitive, specific and reliable methods for detecting Fasciola sp. The study detected two genes; nuclear ribosomal central internal transcribed spacer 1 (ITS1856bp) and mitochondrial cytochrome oxidase subunit I (CO1 831bp). Gel electrophoresisshowed strong bands for these single snails' samples and confirmed the presence of infection in both localities. Molecular techniques gave sensitive, accurate identification of infection, established prevalence in endemic areas and planning time for proper control strategy.

Hepatocellular carcinoma (HCC) is a leading cause of cancer related deaths worldwide. It was suggested that albendazole (ABZ) is a powerful inhibitor of several carcinoma types. However, the bioavailability of ABZ is very poor. Additionally, the mechanisms underlying the antitumor effects of ABZ may go beyond its tubulin-inhibiting activity. Therefore, we aimed to examine the effects of ABZ suspension (i.p. and p.o.) and ABZ-loaded cubosomes (LC) on the diethylnitrosamine-induced HCC in mice. ABZ-loaded nanoparticles exhibited a mean particle size of 48.17 ± 0.65 nm and entrapped 93.26 ± 2.48% of ABZ. The in vivo absorption study confirmed a two-fold improvement in the relative bioavailability compared with aqueous ABZ suspension. Furthermore, the oral administration of ABZ cubosomal dispersion demonstrated regression of tumor production rates that was comparable with ABZ (i.p.). ABZ relieved oxidative stress, improved liver function, and decreased necroinflammation score. The antiangiogenic activity was evident as ABZ effectively downregulated tissue expression of CD34, mRNA expression of CD309 and VEGF at the protein expression level. Besides, lower levels of MMP-9 and CXCR4 indicated antimetastatic activity. ABZ showed a considerable level of apoptotic activity as indicated by increased mRNA expression level of p53 and the increased Bax/BCL-2 ratio and active caspase-3. Additionally, Ki-67 expression levels were downregulated showing an antiproliferative potential. These protective effects contributed to increasing survival rate of diethylnitrosamine-treated mice. These effects found to be mediated via interrupting ERK1/2-HIF-1α-p300/CREB interactions. Therefore, our findings revealed that disrupting ERK1/2-HIF-1α-p300/CREB interplay might create a novel therapeutic target for the management of HCC.

Non-alcoholic fatty liver disease (NAFLD) constitutes a major health problem worldwide and intimately links with obesity and diabetes. This study aimed to explore the therapeutic impact of early treatment with metformin (MTF) alone or in combination with Lactobacillus reuteri DSM 17938 ( L. reuteri) + metronidazole (MTZ) in male Sprague Dawley rats with high-fat diet (HFD)-induced NAFLD. Hepatic steatosis was induced by feeding rats HFD for 6 weeks. MTF (150 mg/kg/day) or L. reuteri (2 × 109 colony forming unit/day) were given orally for 4 weeks; meanwhile, MTZ (15 mg/kg/day, p.o.) was administered for 1 week. Administration of L. reuteri + MTZ in combination with MTF produced a superior effect concerning insulin resistance (IR), lipid profile, liver function, oxidative stress, inflammatory and autophagic markers than using each treatment alone. Besides, this combination resulted in disappearance of steatosis, inflammation and vacuolation within hepatic architecture. Moreover, it normalized short chain fatty acids (SCFAs) as well as Firmicutes and Bacteroidetes faecal contents. In conclusion, early treatment with L. reuteri + MTZ in combination with MTF could prevent NAFLD progression and liver injury through targeting gut dysbiosis, inflammation and autophagic pathways.

1- Abstract:Background: Female sexual dysfunction (FSD) is defined as persistent or recurring decrease in sexual desire, sexual arousal, dyspareunia and a difficulty in or inability to achieve an orgasmAim the work: To evaluate the effect of life style and demographic factors on female sexual function in sharkia governorate, Egypt.Subjects and Methods: a cross sectional survey study was carried out on a sample size of 345 married female subjects attended to Dermatology department –Zagazig university hospitals.Results: At baseline, 113 of studied subjects (33.3%) complained of sexual dysfunction, sexual dysfunction was lower in age group (21 to 29) but a higher in age group (30 to 39 years), and was lower in husband age group (21 to 29 years) but higher in husband age group (40 to 49 years), was lower in females with university degree but higher in read and write level, and was higher in employed subjects of physical work condition, and female sexual dysfunction was lower in subjects with high monthly income (>10,000 EGP) but higher in others who had low monthly income.Conclusion: both lifestyle and demographic factors have great effect on normal female sexual function.

Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control. Aim: Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia. Setting: The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Subjects: A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study. Results: Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores. Conclusion: ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one. Recommendations: ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.

Introduction: Vitiligo is a common disorder characterized by progressive depigmentation of the skin due to selective destruction of melanocytes. Although its cause is still to be exactly defined, the hypothesis of an autoimmune etiology is supported by increasing evidence.Objective: To assess the efficacy of TCA 70% after skin microneedling using dermapen in the treatment of non segmental vitiligo.Patients and Methods: This current study was conducted on 34 patients of both sexes at outpatient clinic of Dermatology, Venereology and Andrology Department at Zagazig University during the period from January 2018 to November 2018. A written informed consent was taken from each patient after explaining to them the details about the nature of study and after obtaining approval from Institutional Review Board (IRB).IRB approval number is (4587).The patients received 4 sessions of microneedling followed by TCA 70% at 2 weeks interval, followed up monthly for 3 monthsResults:Evaluation of repigmentation by the qualitative method showed that the improvement was good to excellent (repigmentation >50%) in 53% of patients, the improvement was moderate (26-50%) in 14.8% of patients, there was no effect in 8.2% of patients. Conclusion: Microneedling plus TCA 70% is considered a simple modality to treat vitiligo of all age groups with cosmetically acceptable repigmentation and a relatively safe alternative or additive method that can be used prior to (or in conjunction with) any of the well-known and widely approved treatment modalities of stable, non-segmental vitiligo.

Background: Hepatitis B is a serious chronic infection of the liver and caused by hepatitis B virus. It is an endemic disease in Sudan. Healthcare workers are occupationally more prone to acquire the disease. Evaluation of their knowledge, attitude and practice, and their vaccination status, are very important in the control of the disease. The aim of this study is to assess the knowledge, attitude, and practice of healthcare workers towards hepatitis B and their vaccination status. Materials and Methods: In total, 372 healthcare workers were enrolled in the study, which was conducted at 10 public hospitals in Khartoum state during July-August 2015. After taking written informed consent from the Khartoum state research department, self-administrated questionnaires were distributed to the healthcare workers. The KAP score was the sum of the three categories, which is 32 points, and the mean was then obtained. Results: The study revealed that the respondents’ mean scores of knowledge, attitude, and practice (KAP) were 18.4, 2.14 and 2.49, respectively. The study also showed that doctors have the highest KAP score in comparison with other occupations. Doctors are the least occupational category that uses gloves when dealing with patient’s blood. The KAP score was found higher among vaccinated healthcare workers in comparison to unvaccinated ones, which indicates the association between KAP score and vac-cination status (p-value 0.007).Is better to add the proportion of vaccinated workers. Conclusions: This study concluded that, there is positive association between the level of vaccination among Health care workers and their Knowledge, attitude and practice of hepatitis B virus. Further studies would be recommended on larger population. Keywords: KAP study, hepatitis B, health care workers, vaccination, Kartoum, Sudan, general hospitals

Highlights • Intrauterine devices (IUD) are effective, safe, and widely used contraceptive devices. Their use is about 14.7% in the developing countries and 8.9% in developed ones. • The perforation of the uterus by the IUD is a relatively rare complication whose incidence is estimated between 1.3 and 1.6 per 1000 insertions, but the consequences can be very serious. • Ectopic migration of IUD with involvement of adjacent organs can cause catastrophic complications such as gastrointestinal perforation. • Ideal treatment of IUD migration remains controversial., Introduction Intrauterine devices (IUDs) are commonly used as a contraceptive method. However, they may cause rare but potentially serious complications such as migration through the uterine wall and gastrointestinal perforation. Presentation of case We report a case of a 26-year woman, carrying an IUD for 2 years, who presented to the emergency with pelvic pain with breakthrough bleeding. Abdominal imaging revealed the presence of two devices the first of which was located in the uterine cavity and the other in the wall of the sigmoid colon associated with a 5-centimeter pelvic collection. Intraoperatively, the IUD was found to be embedded in the wall of the sigmoid colon which was removed by wedge resection of the involved segment followed by a closure of the puncture with drainage. Discussion The Intrauterine Device (IUD) is an effective method of contraception, relatively well tolerated, reversible, inexpensive and widely used. However, it is not without risk. Indeed, serious complications can occur such as uterine perforation and migration to adjacent abdomino-pelvic structures. Our observation illustrates its rarity given the fact that this complication has been observed the first time in our department over the last ten years. Conclusion The migration of IUD must be treated even in asymptomatic patients due to the risk of severe complications.

Aim of the work: positron emission tomography (PET) response assessment of residual nodal masses in patients with lymphoma after completion of therapy is performed visually using Douveille as the reference. The primary objective of this study was to define the role of PET in response assessment of Non Hodgkin Lymphoma patients and define various response criteria. Patients and methods: our prospective study included 40 patients with Non Hodgkin’s lymphoma diffuse large B cell type assessed for response assessment after completion of therapy, two readers independently assessed response by IHP and Deauville criteria. The addition of morphological parameters on CT was assessed in relation to therapy response. Results: Non Hodgkin lymphoma is one of chemosensitive tumors with high ability of nodal and extranodal spread and PET /CT is more sensitive than CT in monitoring response to treatment in non Hodgkin lymphoma diffuse large B cell type patients. Conclusions: PET/CT is the best tool for evaluation of the response to treatment in patients with Non Hodgkin lymphoma diffuse large B cell type, as well as Douveille criteria represent the accurate indicator of response categories determination.PET/CT has an obvious impact on clinical practice according to the response results and activity of residual lesion.

Vitiligo is a skin disorder commonly acquired. Although different therapies are used, they are refractory to therapy in many cases. Trauma has been reported to cause hyperpigmentation by the pigment incontinence, which results in the build-up of melanophages in the upper dermis after basal cell layer destruction. To detect the effectiveness of trichloroacetic acid (TCA) 70% in the treatment of nonsegmental vitiligo after skin microneedling by dermapen or intradermal injection of 5-fluorouracil. PATIENTS AND METHODS A prospective comparative study was enrolled with 32 patients with vitiligo who were assigned to two equal groups. Each containing 16 patients; group 1 was treated by microneedling followed by TCA 70%, group 2 was treated by intradermal 5-FU injection. This was done every 2 weeks for 2 months. RESULTS According to the Physician's Global Assessment, there was no significant (P

Background: The immune system plays an important part in the clearance of molluscum contagiosum (MC) and, therefore, there has lately been a trend in using immunotherapy in MC therapy. Tuberculin-purified protein derivatives (PPDs) and topical cantharidin have not earlier been compared with their effectiveness in therapyAim: The aim of this research was to determine the effectiveness and security of intralesional immunotherapy in the therapy of MC with tuberculin PPD versus topical cantharidinPatients and methods: Twenty patients with various MC lesions received topical cantharidin as control (group A) and 20 MC patients received intralesional tuberculin PPD following prior intradermal immunity tests (group B‏).Results: Complete clearance of lesions was detected in 90.0% of patients in the cantharidin group; the partial response was detected in10.0% of the patients. However, in the PPD group, 85% of the patients showed a complete response and 15% showed a partial response, with no significant difference in the clinical response between the two groups. Mild side effects were detected‏.Conclusion: The results suggest that intralesional PPD and topical cantharidin 0.7% are effective and safe treatment modalities, but benefits of intralesional PPD is being a simple, effective and safe treatment with tolerable pain and can be an alternative treatment for multiple resistant types‏.

Background: the polycystic ovary syndrome (PCOS) is important cause of an ovulatory infertility and a notable proportion of women of reproductive age are affected. Different factors could result in different manifestations and many of these are related to predispositions. Objectives: The study was carried out to study the improvement of ovulation induction in obese patients with Polycyctic ovarian syndrome (PCOS). Subjects and methods: This is prospective clinical trial that was conducted in the infertility unit of Zagazig university Hospital on 120 patient suffering from PCOS were included in this study during the period from Actober 2018 to May 2019. This trial was designed to compare the improving induction of ovulation in obese females with Polycystic ovarian syndrome undergoing induction of ovulation by Clomid and Metformin (n=60) or Letrozole (n=60).Results: There was no significant statistical difference between Clomid and Metformin group and letrozole group in term of pregnancy rate, There was a significant statistical difference between Clomid and Metformin group and letrozole group in term of Size of dominant Graafian follicle (on day 11) (p=0.03) and the Size of dominant Graafian follicle (on day 13-14) (p=0.01).Conclusion Letrozole improves endometrial thickness and cervical mucosa and causes monofollicular ovulation but action of clomiphene citrate combined with metformin improved the ovulation and increased total number of follicles. Therefore, Letrozole can be used for the ovulation induction improvement in obese women having PCO

Acne vulgaris in adult women is a chronic inflammatory disorder of pilosebaceous unit with many relapse cases. It commonly has psychological and social impact that interfere with the quality of life of many patients. Androgenic hormones have a very important role in the pathogenesis of acne. Androgens affect many functions in our body therefore, any alternation in androgen receptors may have an important implication in the development of the signs of hyperandrogenic states in women. The early diagnosis of these hyperandrogenic states is a very important point for the proper evaluation of the patient of acne and for the better choice of therapeutic management. Defining a pattern for laboratory profile analysis is very useful in the control of relapse cases of acne vulgaris in adult women. Which lately has been the aim of many of published studied.Aim to establish the relation between 3 alpha-diol G levels and acne in female patients with normal androgenic status without menstrual dysfunctions in comparison with controls, in an attempt to elucidate its role in the pathogenesis of acne vulgaris which might help in treatment.

Background: The aim of this study was to assess the efficacy of combination between microneedling with dermapen and topical bleomycin in the treatment of plantar warts in comparison with in...

Objectives: To compare use of ultra-fast high-pitch dual-source free-breathing computed tomography pulmonary angiogram ( CTPA) with conventional standard-pitch single-source breath-hold CTPA. Methods: This retrospective comparative study was conducted in Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia from July 2016 to December 2017. Patients (N=130) were divided into 2 groups, each having 65 consecutive patients; Group-1 (single-source CT) and Group-2 (dual-source CT). Previously treated pulmonary embolism cases, pregnant patients and those with incomplete data were excluded. Image quality was subjectively assessed by 2 readers for adequacy of contrast opacification and pulmonary vessel outline, and presence of artifacts (breathing motion, cardiac pulsation, and contrast related). Scan acquisition times and radiation doses were also compared. Chi-square and t-test were used to determine association. Results: Improved image quality (optimal studies without artifacts 91%) was seen in Group-2 compared to Group-1 (optimal studies without artifacts 75.4%). Also, reduced scan time (1-2 sec.) and radiation dose (mean dose length product (DLP)-248 mGy-cm) were observed in Group-2 compared to Group-1 (scan time- 6.5 sec, mean DLP-375). Results were found significant ( p less than 0.05). Conclusion: High-pitch dual-source CT with free-breathing yields better image quality, reduces image acquisition time and radiation doses. Saudi Med J 2019; Vol. 40 (3): 230-237 doi: 10.15537/smj.2019.3.23940 How to cite this article: Al Hassan DA, Waheed KB, El Sirafy MN, Khattab MA, Al-Hammadi HI, Ibrahim MF, et al. Computed tomography pulmonary angiography using high-pitch dual-source scanner technology. Saudi Med J . 2019 Mar;40(3):230-237. doi: 10.15537/smj.2019.3.23940.

Introduction: Inflammatory pseudotumor (IPT) is a rare benign disease which presents as tumor like mass mimicking malignancy. The most common sites are lungs, liver, orbits and gastrointestinal tract. Splenic IPT is very rare. Presentation of Case: A 41-year-old woman presented with the complaints of left upper quadrant pain radiating to the back for a year. Abdominal ultrasound and computed tomography (CT) revealed a hypodense lesion of approximately 5 cm located in the splenic parenchyma near the hilum. Hydatid serology was negative. The patient was treated with splenectomy due to diagnostic dilemma and final diagnosis of IPT was made on histopathological examination of the resected spleen. Discussion: Splenic IPT usually affects middle aged women presenting as incidental finding on abdominal imaging. It is most often isolated but at times may be associated with IPT at other sites probably suggesting a systemic etiology. Radiological findings are non-specific leading to diagnostic dilemma. Splenectomy is useful for treating symptomatic cases and helps in making the accurate diagnosis in cases of diagnostic dilemma. Conclusion: Splenic IPT is a rare, benign condition which should be included in the differential diagnosis while evaluating a splenic mass.

Epidemiological, clinical and microbiological studies on environmental mastitis were carried out on 100,3-7 years old cows, 50(peracute, acute, chronic) of them suffering from different forms of clinicalmastitis which divided into two equal groups; applying teat dipping (1st group) and non-applying teatdipping (2nd group). Other 50 cows were apparently healthy with apparently normal milk and also theydivided into two equal groups; apply teat dipping (3rd group) and non-apply teat dipping (4th group). Ourresults showed that peracute, acute and chronic mastitis in 1st group were 8%, 48% and 44%respectively, while in 2nd group were 16%, 56% and 28% respectively. Percentage of subclinical mastitisin 3rd and 4th groups were 28.5% and 71.4%. 41 isolates from teat dipping groups (1st and 3rd) and 76isolates from non-teat dipping group (2nd and 4th) were isolated. Environmental pathogen were E. coli 7,20 isolates, Enterobacter 4, 8 isolates, Klebsiella 2,3 isolates Str. uberis 10,17 isolates, Str. dysgalactiae1, 2 isolates respectively. Contagious pathogens were Staph. aureus 10, 16 isolates and Str. agalactiae 6,5 isolates respectively. Minor micro-organism; C. bovis (1 isolate) from non-teat dipping groups, CNstaph (1 isolate) from teat dipping group and Str. bovis (2 isolates) and Serratia (2 isolates) from non-teatdipping groups. Staph. aureus, Str. agalactia, C. bovis, Str. Dysagalactia, Str. ubris, Str. epidermids, Str.bovis and CN staph are more sensitive to danofloxacin, penicillin,andenrofloxacin, while E.coli,Enterobacter, Klebsiella and Serratia are more sensitive to danofloxacin, gentamycin, kanamycin. Weconcluded that, teat dipping is important in controlling environmental mastitis in cows, the environmentalmicro-organisms are coliform group (E. coli, Klebsiella and enterobacter), Str. uberis, Str. dysgalactiae,while contagious micro-organisms are S. aureus and Strept.agalactiae. Penicillin is the most effectivedrug in treatment of mastitis in cows.

About 10% of cases of pneumoperitoneum are not associated with a hollow viscus breach. Here we present a rare cause due to a gas-forming organism in a 45 day-old male patient. He presented with severe abdominal distension and poor general condition that started at day 10 of life. Erect abdominal x-rays revealed pneumoperitoneum. A chronic abscess cavity was found on exploration and the underlying gut was healthy. The cavity was evacuated and a drain left in-situ. Culture and sensitivity reported Escherichia coli and Pseudomonas aeruginosa . The baby tolerated full oral feeds 48 h after the procedure. His general condition improved with the appropriate antibiotics.

Abstrct Gut microbiota is a crucial factor in pathogenesis of non-alcoholic steatohepatitis (NASH). Therefore, targeting the gut–liver axis might be a novel therapeutic approach to treat NASH. This study aimed to investigate the therapeutic effects of a probiotic (Lactobacillus reuteri) and metronidazole (MTZ) (an antibiotic against Bacteroidetes) either alone or in combination with metformin (MTF) in experimentally-induced NASH. NASH was induced by feeding rats high fat diet (HFD) for 12 weeks. MTF (150 mg/kg/day) or L. reuteri (2x109 colony forming unit/day) were given orally for 8 weeks; meanwhile, MTZ (15 mg/kg/day, p.o.) was administered for 1 week. Treatment with L. reuteri and MTZ in combination with MTF showed additional benefit compared to MTF alone concerning lipid profile, liver function, oxidative stress, inflammatory and autophagic markers. Furthermore, combined regimen succeeded to modulate acetate: propionate: butyrate ratios as well as Firmicutes and Bacteroidetes fecal contents with improvement of insulin resistance (IR). Yet, the administration of MTF alone failed to normalize Bacteriodetes and acetate contents which could be the reason for its moderate effect. In conclusion, gut microbiota modulation may be an attractive therapeutic avenue against NASH. More attention should be paid to deciphering the crosstalk mechanisms linking gut microbiota to non-alcoholic fatty liver disease (NAFLD) to identify new therapeutic targets for this disease.

e19523 Background: Graft-versus-host disease (GVHD) is a life-threatening complication of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT). Calcineurin inhibitor (CNI) and methotrexate (MTX) have been used as the standard GVHD prophylaxis in HLA-matched HSCT. Promising clinical trial data using high dose post-transplant Cyclophosphamide (PT-Cy) with or without additional immunosuppressive agents (IS) have shown that it’s an effective, well tolerated alternative. However, experiences are limited with controversial results. Methods: We analyzed 62 patients with Acute Leukemia (39 males, 23 females) with age ranges from 18 to 60 years underwent allogeneic HSCT from matched sibling donors (MSD) using reduced intensity chemotherapy at Maadi Armed Forces Medical Hospital after informed consent. They were randomized into 2 groups according to GVHD prophylaxis regimen. The 1st group (40 patients) received MTX in the following doses; day+2 (15mg), day +4 (10 mg), day +6 (10 mg) with Cyclosporine (5mg/kg) from day -3 till day +90 and Mycophenolate (MMF) (2 -3gm/day) from day +1 till day +30. The 2nd group(22 patients) received PT-Cy (45 mg/kg/day) on days +3 and +4 with Cyclosporine (5mg/kg) from day +5 till day +30 & MMF:(2-3gm /day) from day +5 till +30. Results: At median 1 year Post Allo, PT-Cy was associated with statistically significant lowering of chronic GVHD (cGVHD) incidence compared to MTX group (22.7%, 56.4%) respectively (P = 0.011). Incidence of acute GVHD (aGVHD) at day +100 was (40%, 22.7%) in group 1, 2 respectively (P = 0.169). 92% of patients in group 1 and 86.4 % of patients in group 2 were engrafted with full donor chimerism on day +30 (P = 0.659). The cumulative incidence of relapse at 4 years after transplantation was 17.9 % for group 1 and 36.4 % for group 2 (P > 0.05). Relapse related mortality were 16.2% among MTX group while 27.3% in PT-Cy group (P = 0.10). Transplant related mortality (TRM) in MTX group were; Severe aGVHD (8%), cGVHD (10%), Hepatic Toxicity (8%), Nephrotoxicity (2.7%) & ARDS (5.4%). In PT-Cy group TRM were; septicemia (18%), severe aGVHD (4.5%) & ARDS (4.5%). Cumulative 4 years Disease Free Survival (DFS) & Overall survival (OS) in PT-Cy group were (51.8 %, 46.4%) respectively while (69.3%, 39%) in MTX group which is statistically non-significant (P > 0.05). Conclusions: For GVHD prophylaxis in MSD, PT-Cy is a safe alternative that reduces the risk of cGVHD in comparison with MTx based regimen without affecting Relapse rate, DFS or OS.

Purpose Central pancreatectomy (CP) has been used sparingly because the spectrum of indications is quite narrow. The author has modified the procedure of CP in such a way to avoid distal pancreatic segment drainage, in addition to reserving the patient euo-insulinemic. Materials and methods Between March 2010 and January 2015, 41 cases have been recruited. Cases presented with blunt abdominal trauma showing central pancreatic transection with or without duodenal transection have been recruited. Technique of CP has been modified to enable sparing distal pancreatic drainage procedure. The study describes a case series where the modified technique in the field of pancreatic surgery is applied on trauma patients through both laparoscopic and open approaches according to patients' hemodynamic stability. Results There was no pancreatic fistula, deficiency nor any of the major complications related to the traditional CP technique. Conclusions None of the cases developed pancreatic necrosis or fistula, steatorrhea or showed picture of diabetes mellitus. The new technique has used the available anatomic and functional pancreatic facts to revolute sparing the distal pancreatic drainage procedure.

In this study, the proposed technique is combining the invented method of extraperitoneal dissection utilizing gas insufflation through Veress needle introduced from the groin with the transabdominal approach. Such a combination minimizes operative demands, achieves major goals, and reduce operative time in an attempt to improve laparoscopic hernioplasty techniques. The study recruited 211 patients having primary reducible inguinal hernia upon first diagnosis. Abdominal ultrasound examination achieved to exclude any additional pathology and confirming clinical diagnosis. The new technique is applied on all patients without any modification through the whole series. Patients’ epidemiology, operative characteristics, and follow-up are all tabulated. Results showed no complications nor conversion to open procedure. The proposed procedure showed preliminary encouraging results regarding technique, clinical outcome, time-saving, and patients’ safety. Combination of extraperitoneal gas-derived dissection, transabdominal field review, and preperitoneal mesh application offers an innovative and promising laparoscopic hernioplasty technique. The study is introducing the technique and as well invites further trials on wider scale to verify the technique.

Objectives: Radiofrequency of mobile phones may affect biological systems by increasing free radicals and by changing the antioxidant defense systems of tissues, thus leading to oxidative stress. L-cysteine, as a glutathione precursor, has an antioxidant property that may prevent oxidative damage to normal cellular processes. Methods: The effect of different concentrations of parentral L-CyS-HCl against harmful effects of EMR on rats' blood was studied namely: hematological parameters (osmotic fragility and blood picture), and biochemical parameters (reduced glutathione and malondialdehyde levels). Results: The results revealed that 20 mg parenteral L-CyS-HCl showed high protection for EMR radiated rats against hemolysis. In addition, EMR radiated rats received 20 mg parenteral L-CyS-HCl showed normal blood picture, GSH and Malondialdehyde levels, compared to radiated untreated rats. Conclusion:Parenteral L-CyS-HCl can be used for protection against mobile phone hazards

Introduction: Gynaecomastia is a benign enlargement of male breast; many techniques have been described for management but none have gained universal acceptance. We discuss the outcomes of the surgical management of gynaecomastia and assess the morbidity and complication rates associated with the procedure to determine whether certain surgical techniques produce better outcomes. Materials and Methods: 75 patients with gynaecomastia were operated in our hospital during the period from Jan. 2009 to Jan. 2015. Results: A total of 140 breasts were operated on during the study period. Patients underwent either liposuction alone (20 breasts), excision alone (70 breasts), both excision and liposuction (36 breast) or skin reduction procedure (14 breasts). 19 operated breasts (13.4%) experienced some form of complications. Minor complications included seroma (4 patients), superficial wound dehiscence (3 patients) and two patients developed haematomas requiring evacuation in theatre. Unsatisfactory cosmotic result was present in 10 breasts and surgical revision was done in 5 breasts. Simon grade 111 breasts experienced the highest complication rate. Conclusion: The study has found that moderate sized gynaecomastia whether true or pseudo gynaecomastia with mild to moderate breast redundancy can be managed easily and effectively by liposuction alone or combined with glandular resection while the conventional infraareolar subcutaneous mastectomy still gives satisfactory results and with no need to remove extra skin. On the other hand, large gynaecomastia with severe breast redundancy can be treated effectively by the inferior pedicle technique without vertical scar.

The objective of this study was to prepare cubosomal nanoparticles containing a hydrophilic anticancer drug 5-fluorouracil (5-FU) for liver targeting. Cubosomal dispersions were prepared by disrupting a cubic gel phase of monoolein and water in the presence of Poloxamer 407 as a stabilizer. Cubosomes loaded with 5-FU were characterized in vitro and in vivo. In vitro, 5-FU-loaded cubosomes entrapped 31.21% drug and revealed nanometer-sized particles with a narrow particle size distribution. In vitro 5-FU release from cubosomes exhibited a phase of rapid release of about half of the entrapped drug during the first hour, followed by a relatively slower drug release as compared to 5-FU solution. In vivo biodistribution experiments indicated that the cubosomal formulation significantly (P, Graphical abstract 5-Fluorouracil (5-FU) was successfully incorporated into cubosomal nanoparticles. Cubosomes loaded with 5-FU exhibited reasonable in vitro characteristics. Moreover, in vivo biodistribution of 5-FU in rat׳s liver indicated that the cubosomal formulation increased 5-FU liver concentration (nearly 5-fold) compared to 5-FU solution. In conclusion, cubosomes containing 5-FU has significant liver targeting properties.

Objectives: The aim of this study was to investigate the ability of siRNA-loaded nanoparticles to control the capability of cisplatin-resistant cell lines to decrease cancer metastasis and cell proliferation rate. Methods: The effect of siRNA-loaded NPs on the migratory (metastasis) and proliferation (cell growth rate) activity of cisplatin-resistant cell lines compared to untreated cells was investigated using the wound healing assay and cell growth rate assay, respectively. Results: The results showed that cells were treated with siRNA-loaded nanoparticles after 24 h from starting the scratch, succeeded to cover of 59 ± 12.9, and 30 ± 6.1% only from the wound for cell line Cis 1R and Cis 12R, respectively. On the other hand of the untreated cells that were treated with positive control nanoparticles showed complete healing for the wound within the same period of time. Results of cell proliferation of both cell lines exhibited significantly (P≤ 0.001) lower growth rate after treatment with loaded nanoparticles compared to positive control nanoparticles and untreated cells. Conclusion: The obtained results indicated that siRNA-loaded nanoparticles succeeded to not only reduce metastasis but also decrease cell proliferation rate of cisplatin-resistant cell lines.

Highlights • Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components. • To the best of our knowledge only eight cases have been reported in the English literature till date. • Surgical excision remains the mainstay of treatment., Introduction Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components. To the best of our knowledge only eight cases have been reported in the English literature till date. Presentation of case We report a case of a 29-year-old female, hospitalized for epigastric pain with poor general condition. An upper gastrointestinal endoscopy showed a polypoid mass in the stomach near the gastric cardia suspicious of gastrointestinal stromal tumor. The patient underwent atypical proximal gastrectomy with splenectomy. Detailed histopathological examination of the resected specimen revealed the diagnosis of gastroblastoma. After six months, the patient developed loco-regional recurrence for which surgical debulking was performed. Discussion Gastroblastoma is predominantly seen in young adults with non-specific complaints. They appear as submucosal lesion in the stomach mimicking gastrointestinal stromal tumor. Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment. On histology, they consist of mesenchymal component which stain positively for vimentin and CD10 and epithelial component which is positive for cytokeratin on immunohistochemistry. Conclusion Gastroblastoma is a malignant tumor with risk of local recurrence after curative resection.

One of the presumed pathological mechanisms of multiple sclerosis (MS) is the failure of apoptosis of autoreactive T lymphocytes. This study aimed to determine the relationship of the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) mRNA gene expression ratio and serum TRAIL levels with MS and brain atrophy. This study was conducted on 53 relapsing-remitting Egyptian MS patients and 25 matched healthy volunteers. The expression of TRAIL in peripheral blood lymphocytes was analyzed by reverse transcription polymerase chain reaction, serum levels of soluble TRAIL (sTRAIL) were determined by enzyme-linked immunosorbent assay and brain MRI measured "black holes" and the bicaudate ratio as a measure of brain atrophy in all patients. The serum TRAIL level was lower in MS patients compared to controls but no difference was seen in the TRAIL mRNA gene expression ratio. No significant correlation was detected between the serum TRAIL level and the TRAIL mRNA expression ratio in either group. No statistically significant correlation was found between serum TRAIL levels or the TRAIL mRNA expression ratio with the number of black holes or the bicaudate ratio on MRI. Apoptosis of T lymphocytes is decreased in MS patients, which could be useful when designing treatments. There was no difference in the TRAIL mRNA gene expression ratio between MS patients and controls.

Background: Chronic obstructive pulmonary disease (COPD) causes a major burden in terms of deaths and hospitalizations worldwide; it is associated with progressive lung function loss, and frequent exacerbations. Administration of macrolides has been considered beneficial in reducing the frequency of COPD exacerbations. The aim of this study is to assess the safety and efficacy of long-term administration of Azithromycin for patients with chronic obstructive pulmonary disease. Methods: An extensive search was conducted on SCOPUS, and PubMed databases, CENTRAL, and ClinicalTrials.gov clinical trial registers for randomized clinical trials conducted on COPD patients and administered Azithromycin for more than two weeks. The selected studies underwent assessment for the risk of bias. We conducted random-effect model meta-analysis for the frequency of acute exacerbations during follow-up as a primary outcome. Results: Out of 1021 screened records, 3 RCTs (Randomized controlled trials) involving 1264 patients were included in the final analysis. The pooled data of all 3 trials showed that administration of Azithromycin reduced the frequency of acute exacerbation of COPD [risk ratio (RR) = 0.69; 95% CI 0.53, 0.91, p = 0.01]. Subgroup analysis indicated that 500 mg Azithromycin [risk ratio (RR) =0.65; 95% CI 0.53-0.79, p=0.01] was found to be more beneficial than 250 mg Azithromycin [risk ratio (RR) = 0.60; 95% CI 0.27-1.33, p=0.21] in reducing acute exacerbation rate, however due to many limitations the analysis of the dosage was not conclusive. Conclusion: Long-term Azithromycin administration for COPD patients is statistically not associated with increased risk of developing adverse events; in addition, it might be effective in reducing the frequency of acute exacerbations of COPD. However, dosage and duration of Azithromycin administration analysis was not conclusive and thus more RCTs are needed in these areas.

Background: Burst abdomenis a continuing problem for thegeneral surgeon as theincidence of such complication may reach 3% with a mortality rate exceeding 25%. Methods: Component separation of all layers of anterior abdominal wall would give an extra length on each side towards medial advancement. 20 patients, 12 men and 8 women aged 35-65 {mean, 48.6) years, with burst abdomen after major gastrointestinal and hepatobiliary surgery whose abdomen could not be closed primarily were managed using this technique. Long term follow up of patients was done for development of complications. Results: One patient died on the fourth postoperative day from pulmonary embolism {mortality 5%), and 2 patients developed subincisional abscesses (10.5%). Skin necrosis occurred in 1 patient (5%). No single case of reburst occurred Only one patient showed few symptoms of abdominal compartment syndrome. The mean hospital stay was 18.5 days. Long term follow up showed only one case ofincisional hernia (5.5%) in a patient with biliary fistula. Conclusion: The component separation technique is a suitable, straightforward and tension free method with a comparable mortality and morbidity to other conventional methods for closure of burst abdomen.

A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy in these cases included complete penile degloving, excising the scarring due to circumcission, fixing the penile skin at the penopubic and penoscrotal angles and reconstructing the penile skin with full thickness skin graft. Results: Improvement was noted in all cases. Conclusion: Surgery for hidden penis using full thickness skin graft achieves very satisfactory aesthetic and functional improvement.

Le kyste hydatique de la surrénale reste une affection exceptionnelle et une localisation inhabituelle du kyste hydatique, même dans les pays où l'hydatidose sévit à l'état endémique. Nous rapportons un cas de kyste hydatique surrénalien révélé par des douleurs de l'hypochondre droit. Le diagnostic a été évoqué en préopératoire sur les données de la tomodensitométrie abdominale qui avait objectivé une masse kystique surrénalienne droite. La sérologie hydatique était positive. Le traitement chirurgical avait consisté en une résection du dôme saillant et avait permis de conserver la glande. Le kyste était univésiculaire contenant un liquide eau de roche avec une membrane proligère. Les suites opératoires étaient simples. La surveillance à distance, échographique et immunologique, n'avait pas décelé de récidive avec un recul de deux ansKey words: kyste hydatique, surrénale, tomodensitométrie, chirurgie

Objective: The objective of this research was to formulate and evaluate iron oxide nanoparticles for treatment of iron deficiency anemia (IDA). Methods: Iron oxide nanoparticles were prepared by co-precipitation method and stabilized by coating with folic acid or chitosan. The prepared nanoparticles were characterized in vitro for morphology, particle size, zeta potential, crystallinity and ultraviolet-visible (UV-Vis) absorption. In vivo studies were performed to evaluate the efficacy of the prepared nanoparticles in treating iron-deficient anemic rats compared to the commercial iron product. Results: In vitro results revealed that particle sizes were 65.95±5 nm, 220.2±12 nm and 295.3±19 nm for uncoated iron oxide nanoparticles, folic acid-coated iron oxide nanoparticles and chitosan coated iron oxide nanoparticles, respectively. UV-Vis absorption spectrum and x-ray diffraction (XRD) patterns confirmed that the prepared nanoparticles were iron oxide nanoparticles. In vivo results indicated that folic acid-coated iron oxide nanoparticles showed effective restorative action, returning haemoglobin (Hb) concentration to normal levels, where not only complete recovery of Hb within short time from the anemic state to the high normal level, but also improved Hb concentrations compared to the commercial iron product. Conclusion: The results obtained in this research work clearly indicated a promising potential of folic acid-coated iron oxide nanoparticles for the effective treatment of IDA.

Background The practice of tube thoracostomy entails high risk as it is a closed technique. Open thoracostomy and closed minithoracostomy techniques have been approved worldwide as safe modalities. Applying the concept of a new closed thoracostomy technique with high safety and simplicity is a major advancement in this regard. Materials and methods This was a case series pilot study introducing a new technique for closed-tube thoracostomy. Thirty-one patients with primary unilateral pneumothorax were selected for the study. All patients coming to the Emergency Department at Security Forces Hospital, Dammam City, Kingdom of Saudi Arabia, between January and August 2012, matching the study criteria were recruited to undergo the new technique. The surgical set required for the technique was defined and prepared sterile. Preinsertion and postinsertion chest x-ray and chest computed tomography scans were obtained for the entire study sample. Results We recruited the first 31 patients requiring tube thoracostomy who visited the Emergency Department. All procedures were performed by the author, assisted by on-call registrars. No complications were observed with the new technique. Moreover, advantages of the technique were demonstrated and documented. Conclusions The new technique provides safe tube introduction and precise tube positioning, saves time, and involves no technical precautions. The technique has been applied on selected simple cases as the first trial and requires further testing in cases of hemothorax, empyema thoracis, traumatic chest injuries, and complicated pulmonary diseases that require drainage. Further evaluation of the technique by randomized studies is required.

BackgroundThe epidemiology of viral hepatitis during pregnancy is essential for health planners and programme managers. While much data exist concerning viral hepatitis during pregnancy in many African countries, no proper published data are available in Sudan.AimThe study aimed to investigate the sero-prevalance and the possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among antenatal care attendants in central Sudan.MethodsDuring 3 months from March–June 2006, sera were collected from pregnant women at Umdurman Maternity Hospital in Sudan, and they were tested for markers of hepatitis B virus (HBVsAg) and HCV.ResultsHBVsAg was detected in 41 (5.6%) out 728 women, Anti-HCV was detected in 3 (0.6%) out of 423 women, all of them were not aware of their condition. Age, parity, gestational age, residence, history of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HBVsAg sero-positivity.ConclusionThus 5.6% of pregnant women were positive for HBVsAg irrespective of their age, parity and socio-demographic characteristics. There was low prevalence of Anti-HCV.

Human immunodeficiency virus (HIV) infection and the development of the acquired immunodeficiency syndrome (AIDS) are increasing at an alarming rate especially in the sub-Saharan region. Pregnant women susceptible to HIV and its transmission to the fetus provide a unique opportunity for implementing preventive strategy against HIV infection of newborn babies. During the period of August-December 2005 a cross-sectional study was conducted at the Fath-Elrahman Elbashir antenatal clinic, Khartoum Teaching Hospital, to investigate pregnant women's basic knowledge and attitude toward HIV and mother to child transmission as well as voluntary counseling and testing. Pre-tested structured questionnaires were given to antenatal attendants by professional counselors. Their basic socio-demographic and obstetric characteristics were obtained. Respondents' knowledge about HIV and mother to child transmission were tested. In addition, their willingness toward HIV testing was also reported. Out of the 1,005 women investigated, 79% had basic knowledge about HIV. Those who were resident in Khartoum and whose age was > or =26.1 years and their education level was secondary and above were found to be more knowledgeable about HIV. More than half of respondents were aware of mother to child transmission. Older (> or =26.1 years), educated, and working mothers were found to be more knowledgeable about mother to child transmission. Willingness to undergo the test was demonstrated in 72.8% of respondents. However, only 30.3% had the test done. Older women, primigravidae, and Muslims have higher acceptance of voluntary counseling and testing. There is a need to extend the voluntary counseling and testing program in all antenatal clinics. In addition, there is a need to increase the level of education and raise health awareness about HIV and mother to child transmission.

Therapies for microsporidiosis in humans are limited, and fumagillin, which appears to be the most broadly effective antimicrosporidial drug, is considered to be moderately toxic. The purpose of this study was to apply an in vitro drug screening assay for Encephalitozoon intestinalis and Vittaforma corneae and an in vivo athymic mouse model of V. corneae infection to assess the efficacy of TNP-470 (a semisynthetic analogue of fumagillin), ovalicin, and eight ovalicin derivatives. TNP-470, ovalicin, and three of the ovalicin derivatives inhibited both E. intestinalis and V. corneae replication by more than 70% in vitro. Another three of the ovalicin derivatives inhibited one of the two microsporidian species by more than 70%. None of the treated athymic mice survived the V. corneae infection, but they did survive statistically significantly longer than the untreated controls after daily treatment with fumagillin administered at 5, 10, and 20 mg/kg of body weight subcutaneously (s.c.), TNP-470 administered at 20 mg/kg intraperitoneally (i.p.), or ovalicin administered at 5 mg/kg s.c. Of two ovalicin derivatives that were assessed in vivo, NSC 9665 given at 10 mg/kg i.p. daily also statistically significantly prolonged survival of the mice. No lesions associated with drug toxicity were observed in the kidneys or livers of uninfected mice treated with these drugs at the highest dose of 20 mg/kg daily. These results thus support continued studies to identify more effective fumagillin-related drugs for treating microsporidiosis.

Evaluation of the MLS index as a measurement for Mitral stenosis. 2D Echocardiography was done in 50 patients with MS in this study: Group1 consisted of 25 patients in sinus rhythm with mean age was 28.6 ± 5.6 years. Four of the patients were male (16%), and 21 were female (84%). Six patients had

Two 3-alkyl-substituted 2-hydroxy-1,4-naphthoquinones, NSC 113452 (NSC52) and NSC 113455 (NSC55), were evaluated for activity against Toxoplasma gondii in vitro and in murine models of acute toxoplasmosis. In vitro, both NSC52 and NSC55 significantly inhibited intracellular replication of T. gondii . In vivo, each compound was examined alone and in combination with other drugs currently used for treatment of human toxoplasmosis. Although none of the compounds protected mice against death when administered orally, both were significantly protective when administered intraperitoneally. In addition, a significant increase in survival was observed when suboptimal doses of each compound were used in combination with suboptimal doses of pyrimethamine or sulfadiazine. These results indicate that combinations of NSC52 or NSC55 with pyrimethamine or sulfadiazine have promising activity against T. gondii .

Lipomas are the most common mesenchymal benign tumor of the colon. They are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. A lead-point for adult intussusception exists in 90% of cases and is frequently malignant. The diagnosis can be made by colonoscopy, barium enema examination, and by computed tomography. We have reported two cases of submucosal lipoma of the ascending colon with intestinal obstruction. At laparotomy there was an intussusception of ascending colon, and right colectomy was performed.

The National Cancer Institute (NCI), in a continuing effort to discover novel anticancer leads, has screened more than 350,000 compounds. Thus, extensive chemical and biological database files have become available. The recent establishment of the chemistry-biology computer interlink offers the opportunity to undertake carefully planned structure-activity studies. Although a selective acquisition approach in the screening program is now adopted by the NCI [1] promising antitumor leads still have to be developed from the screening of large numbers of compounds in various tumor systems. These novel leads can then be optimized through both structure-activity analysis of the total NCI file and analog synthesis.