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Introduction: Colon and rectal cancers are common malignancies all over the world. The estimated 5-year relative survival is about 65%. Although curative resection of the primary lesion improves survival, still about 40% of patients, mostly patients with distant metastasis, die from colon and rectal cancer.The most common site of distant metastasis is considered the liver. This is true regarding many types of malignancies. Although Metastases of the liver can result from a wide variety of malignancies, with the most widely known being from colorectal origins PET/CT is a very valuable tool in the follow up of colorectal cancer patients, SUVmax is the most commonly used PET parameter and represent the voxel of the highest activity within the ROI. However, other parameters as MTV and TLG gain an interest in recent studies.Aim of the work: The objective of this review is to highlight the value of PET/CT metabolic parameters as SUVmax, MTV and TLG in colorectal patient with liver metastasis.

Background: Urinary biomarkers may help in identification and assessment of the activity of lupus nephritis (LN).Urinary osteoprotegerin may reflect renal disease activity better. Objective: To investigate urinary osteoprotegerin level as a potential marker of lupus nephritis activity. Patients and Methods: The study included 90 individuals classified into three equal groups: Group (I): clinically and laboratory free, Group (II): patients without renal involvement (non active renal group) and Group (III): patients with active lupus nephritis. Measurement of the level of urinary osteoprotegerin has been done by ELISA from January 2018 till June 2019. Results: All patients with systemic lupus erythromatosus SLE in group II and III had significant higher levels in urinary Osteoprotegerin compared to the control group (I). Moreover, SLE patients with lupus nephritis activity (Group III) had marked increase in urinary osteoprotegerin more than SLE patients without renal involvement (Group II). The study showed also that, with advance of renal histopathological class in lupus nephritis patients, the urine OPG level showed more increase. Conclusion: Urinary level of osteoprotegerin may be used as a biomarker for early prediction of lupus nephritis. Also, it may be used for monitoring the progression and follow up of lupus nephritis as well as with shifting from one class to another.

Subtalar distraction arthrodesis is advocated as a salvage procedure for isolated posttraumatic subtalar arthritis. This study aimed at evaluating combined subtalar distraction arthrodesis with peroneus brevis tenotomy for such cases.Twenty patients with isolated posttraumatic subtalar arthritis managed by combined subtalar distraction arthrodesis and peroneus brevis tenotomy were reviewed for a retrospective study. The American orthopaedic foot and ankle society [AOFAS] hindfoot scoring, talocalcaneal height [TCH], talocalcaneal angle [TCA] and heel valgus angle [HVA] were used for both pre and postoperative assessments.The mean postoperative [TCH] [70.3±1.9mm] was statistically better than the preoperative value [64.7±2.2mm] [p0.001]. There was a statistically significant decrease in [HVA] [p0.001]. On the contrary, there was a statistically significant increase in both [AOFAS] hindfoot scoring and the [TCA] [p0.001].Applying this technique for isolated posttraumatic subtalar arthritis with peroneal tendinitis improved both lateral retromalleolar swelling and deformity correction.

Section Title Several major risk factors for hepatocellular carcinoma (HCC) have been identified, including chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Nevertheless, only a fraction of infected patients develops HCC during their lifetime suggesting that genetic factors might modulate HCC development. X-ray repair cross complementing group1 (XRCC1) participates in the repair pathways of DNA. Aim: to investigate the association between XRCC1 gene polymorphism and HCC in Egyptian chronic hepatitis C patients. Methods: This study was assessed on 40 patients with HCC secondary to chronic HCV infection who were compared to 20 cirrhotic HCV patients and 40- age and gender- matched healthy control group. After collection of relevant clinical data and basic laboratory tests, c.1517G>C SNP of XRCC1 gene polymorphism was performed by (PCR-RFLP) technique. Results: A statistically higher frequency of XRCC1 (CC, GC) genotypes and increased (C) allele frequency in patients with HCC was found in comparison to cirrhotic HCV patients as well as control group. In addition, patients with the XRCC1 (CC, GC) genotypes had significantly higher number and larger size of tumor foci and significantly higher Child Pugh grades. Multivariate analysis showed that the presence of c.1517G>C SNP of XRCC1 gene is an independent risk for the development of HCC in chronic HCV patients with 3.7 fold increased risk of HCC development. In conclusion: XRCC1 gene polymorphism could be associated with increased risk of HCC development in chronic HCV Egyptian patients.

Background:Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis.Methods:An observational retrospective cross-sectional study including neonates, small infants, and children who underwent balloon pulmonary valvuloplasty in the period from 2007 to 2016 in the cardiac catheterisation unit of the paediatric cardiology department in Cairo University. Multivariable models were built to report the predictors of the outcome of balloon pulmonary valvuloplasty and its complications.Results:A total of 1200 patients were included in the study and divided according to age into 3 groups: neonates and early infants (n = 282), infants (n = 362), and children (n = 556). Procedural success, defined as a drop pressure gradient across the pulmonary valve to less than or equal to 50% of the baseline measurements, was achieved in 82.7% of the patients. Multivariate analysis revealed that only infundibular pulmonary stenosis (p value 0.032), supravalvular in association with valvular pulmonary stenosis (p value Conclusion:The absence of infundibular and supravalvular stenosis and a large pulmonary valve diameter were the most significant predictors of success.

Background: Head injury remains one of the most common causes of death worldwide. Approximately 10 to 50% of patients with head injury developed disability at some point in their illness, and represent one of the most common brain casualty encountered by neurosurgeons. Objective: This study was aimed to assess and evaluate a group of patients with open head injury including depressed skull fracture and skull fractures associated with epidural hematoma, subdural hematoma, intracerebral hematoma or foreign body penetration regarding surgical management and post-operative results. Patients and methods: The study was done prospectively in the Neurosurgery Department, Al-Azhar University Hospitals and Matareya Teaching Hospital; the study included 30 patients with acute open traumatic head injury requiring surgical intervention in the form of Decompressive. Craniotomy with evacuation of hematomas if existed or elevation of depressed skull fractured bones. Results: In this study, depressed fracture was present in 17 cases, fissure fracture in 7 cases, skull base fracture in 2 cases, diastatic fracture in 1 case and beveling (bullet inlet and exit) in 1case. Also, in this study, 9 cases (30%) had Glasgow Outcome Score I (GOS I), 3 cases (10%) had GOS III, 3 cases (10%) had GOS IV and 15 cases (50%) had GOS V. Regarding the overall complications, chest infections were detected in 4 cases, frontal manifestations in 1 case, grade 4 Lt. sided weakness in 1 case, stable GCS at 14 in 2 cases, reoperation in 1 case and right hemiparesis in 1 case. Conclusion: It could be concluded that surgical intervention is the ideal solution for the management of acute traumatic brain injury (TBI) with persistent increased ICP when the other medical management fail under the good circumstances of early intervention and the other factors.

Background HCC is one of the most common malignancies worldwide and is a major cause of death, because of its high frequency and poor prognosis. It is especially common in Egypt, where it develops on top of cirrhosis secondary to viral hepatitis C and B. Since HCV infection is highly prevalent in Egypt, it accounts to most of the cases of HCC in Egypt. HCV infection is found in a variable proportion in HCC cases in different populations, accounting for 75-90% of cases in Japan, 31-47% in the U.S, 44-76% in Italy, and 60%-75% of HCC cases in Spain. Objective To compare between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection. Patients and Methods Our study was a comparative study including 60 patients divided into 2 groups as follow patients successfully treated with Ledipasvir based regimen (Group A) and patients successfully treated with Daclatasvir based regimen (Group B) from January 2016 to June 2017. Results There were no statistically significant difference between the two groups as regard demographic and laboratory data. In comparison between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection in the first group there were 3/30 cases of percentage of 10% has developed HCC and in the second group there were 2/30 cases of percentage 6.6% has developed HCC after successful therapy for each group, there were no statistically significant difference between the two groups as regard the incidence of HCC after successful treatment, but generally DAA as Ledipasvir based regimen and daclatasvir based regimen both have low incidence of HCC after successful therapy of HCV infection. Conclusion There were several researches to study relation between DAA as treatment for HCV infection and HCC incidence after successful therapy. Our study was done to compare between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection.

Background and study aim: PCR is currently the non-debatable proof for diagnosis of HCV infection as well as conclusion of treatment outcomes. HCV core antigen (HCVcAg) testing is a neglected, less expensive and less time-consuming test that’s presumed to achieve the same aims. The aim of this study is to find the cost-effectiveness of HCV core antigen testing in the monitoring of treatment response as an alternative to the gold-standard PCR test. Patients and Methods: 48 patients indicated for DAAs-therapy in the period from January- to July 2018. Pre- and post-treatment routine investigations including HCV-RNA levels as well as HCVcAg were done. Results: There was a high statistically-significant difference (p

Objectives. To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. Background. Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. Methods and Results. Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months–54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. Conclusions. The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.

Patient: Male, 43 Final Diagnosis: ST-elevation myocardial infarction Symptoms: Dyspnea • ear pain Medication: — Clinical Procedure: Percutaneous coronary intervention Specialty: Cardiology Objective: Unknown ethiology Background: Myocardial infarction (MI) is one of the most serious conditions presenting to the Emergency Department. Typical/classical symptoms of MI include chest pain and tightness that is referred to the left arm. Case Report: We present a case of ST-elevation myocardial infarction (STEMI) with a primary atypical presentation of right ear pain. The patient was diagnosed with STEMI based on electrocardiogram (ECG) and cardiac markers. As a result, the patient underwent percutaneous intervention (PCI), which showed an occluded left anterior descending artery (LAD) compared to the previous reported studies with similar presentation in which the right coronary artery (RCA) was affected. Conclusions: While MI is known for its typical presentation, being vigilant to patients who present atypically especially when they possess risk factors is extremely important and doing so can be critical to the outcome because MI treatment is dependent on fast and prompt management.

Background Pediatric-onset SLE (pSLE) is a multisystem autoimmune disease. Recently, the ficolin-2 (FCN2) gene has emerged as a potential candidate gene for susceptibility to SLE. Objectives The objective of this study was to evaluate the association of the FCN2 gene polymorphisms at positions −986 (G/A), −602 (G/A), −4 (A/G) and SNP C/T (rs3124954) located in intron 1, with susceptibility to pSLE in Egyptian children and adolescents. Methods This was a multicenter study of 280 patients diagnosed with pSLE, and 280 well-matched healthy controls. The FCN2 promoter polymorphisms at –986 G/A (rs3124952), −602 G/A (rs3124953), −4 A/G (rs17514136) and SNP C/T (rs3124954) located in intron 1 were genotyped by polymerase chain reaction, while serum ficolin-2 levels were assessed using enzyme-linked immunosorbent assay. Results The frequencies of the FCN2 GG genotype and G allele at −986 and −602 positions were significantly more represented in patients with pSLE than in controls ( p Conclusion The FCN2 promoter polymorphisms may contribute to susceptibility to pSLE in Egyptian children and adolescents. Moreover, the FCN2 GG genotype at position −986 and AA genotype at position −4 were associated with low serum ficolin-2 levels and may constitute risk factors for lupus nephritis in pSLE.

Introduction: Gallbladder disease is common and results in high health care costs. Indeed, estimates of the lifetime risk of gallstone formation are as high as 10% to 20% of the general population. The natural history of symptomatic gallstone disease is such that approximately 70% of patients will continue to have episodic symptoms or experience a complication of gallstones within 2 years of initial diagnosis. Adding to this potential confusion is the occurrence of abdominal pain thought to resemble gallbladder pain but without gallstones present. Laparoscopic cholecystectomy remains the gold standard for treatment of symptomatic cholelithiasis. However, persistent symptoms after cholecystectomy occur in 10 to 33% of patients. Although a variety of clinical characteristics have been evaluated as preoperative factors associated with outcome after cholecystectomy, preoperative symptoms are generally used as a reference point for diagnosis and determination of need of cholecystectomy. Characterizing and identifying symptoms that predict relief from upper abdominal pain after cholecystectomy could better guide physicians to recommend cholecystectomy so as to reduce morbidity, mortality and cost and minimize unnecessary surgery. Aim: The objective of this study is to identify symptoms predicting complete relief of upper abdominal pain (UAP) after cholecystectomy to help better selection of patients who might benefit from surgery. Subjects and methods: This study is a prospective analysis involving 950 adult patients undergoing cholecystectomy for symptomatic cholelithiasis. The study included 721 females (75.89%) and 229 males (24.11%). The patients were asked to complete a previously-validated biliary symptoms questionnaire (BSQ) before operation and 3 months postoperatively as well. At the end of the last questionnaire, each patient was required to define whether (as overall) his symptoms were relieved or not. Our patients were divided into two groups according to pain relief after surgery; Group (I) included patients who had pain relief after surgery (713 patients-75.05%) and group (2) included patients who did not have pain relief after surgery (237 patients-24.95%). Results: Our study shows that the likelihood of having pain relief is greater in patients who have UAP onset one year or less preoperatively, UAP of short duration, UAP occurring most frequently in the evening or at night time and whose pain awakens them by night, patients who do not have lower abdominal pain, patients who have normal bowel habit pattern, patients who have infrequent nausea attacks, patients who do not often have excessive gas bloat or burps and patients who do not suffer concomitant GERD or IBS. Conclusion: Laparoscopic cholecystectomy is an effective management option for symptomatic cholelithiasis, with a cure rate of 75.05% in our study. Better rates of pain relief can be achieved by better selection of patients, as sub analysis of symptoms showed better cure rates in the subgroups. The followings were found as good predictors of outcome: older age, female patients, short onset of the disease (≤ 1 year), infrequent attacks of pain once or less per week, short duration of attacks less than 30 minutes, attacks occurring by night or awakening the patient by night, attacks of moderate to severe intensity, patient with normal bowel habits, absence of lower abdominal symptoms, absence of gas bloating, and absence of GERD or IBS. Our study shows that pain relief progressively increases with increasing the number of positive predictive symptoms, being the best at the level of 4 positive predictive symptoms. Further larger studies are still needed to further define reliable prognostic symptoms to assure better selection of patients.

Overflow retentive stool incontinence (ORSI) is secondary to constipation and fecal loading. In our study, the dose and duration of senna-based laxatives (SBL) treatment to achieve full defecatory control will be examined for possible correlation with new parameters measured from the initial contrast enema.Initially, an observational study was conducted prospectively on a group of patient with ORSI to define the optimum dose of SBL to achieve full defecatory control with measurement of six parameters in the initial contrast enema (level of colonic dilatation, recto-anal angle, ratio of maximal diameter of dilated colon to last lumbar spine, ratio of maximum diameter of dilated colon to normal descending colon, immediate and after 24-h post-evacuation residual contrast). The result was analyzed statistically to reach a correlation between the radiological data and prescribed dose.Over 2 and half years, 72 patients were included in the study; their mean age was 6.3 ± 3.33 years. The mean effective starting dose of SBL was 57 ± 18.13 mg/day and the mean effective ending dose was 75 ± 31.68 mg/day. Time lapsed till full defecatory control ranged from 1 to 16 weeks. Statistical correlation revealed that mean effective ending dose of SBL treatment significantly increased with higher levels of colonic dilatation. A weak positive correlation was found for both the mean effective starting and ending doses with the ratio of maximum colonic diameter to last lumbar spine and descending colonic diameters ratio.Senna-based laxatives are effective treatment for overflow retentive stool incontinence and their doses can be adjusted initially depending on the analysis of the radiological data.

To launch a process ensuring review of all deaths on an acute medical unit using a standardised format and to generate learning points to share within the multidisciplinary team. The process of formal mortality review on the acute medical ward at Homerton University Hospital started in 2015. Every death was reviewed using a structured assessment form, completed by a junior doctor who was involved in the care, followed by the responsible consultant. This was then evaluated by an …

Both myocardial necrosis and ischemia can decrease the left ventricular ejection fraction (LVEF). An accurate estimate of the relative contributions of these irreversible and potentially reversible factors could lead to better decisions regarding the risk and benefit of coronary artery bypass grafting (CABG). The value of an Ischemia Index calculated by subtracting the ECG estimated infarction dependent LVEF from the measured LVEF to predict post-operative improvement of LVEF was studied in 55 patients with LVEF40% before CABG. Patients were grouped according to absence or presence of other coexisting ECG confounders.No significant (p=0.083) relationship was found between the Ischemia Index and the improvement in LVEF after CABG in the overall population, but a strong trend was present in the patients with ECGs without confounding QRS changes (p=0.056).These results suggest a positive relationship between the Ischemia Index and improvement of LVEF after CABG in patients without electrocardiographic confounders, but a prospective study using a larger sample is needed.

Even after development of molecular targeting therapies, platinum-based chemotherapy is still a standard care for treatment of locally advanced non-small cell lung cancer (NSCLC). So far, critical molecular markers capable to predict the therapeutic response in NSCLC patients remain undetermined. We here attempted to identify novel biomarker genes for cisplatin (CDDP) for a tailored therapy. Initial screening to explorer association of IC(50) values of CDDP obtained by MTT assay and gene expression levels measured with oligonucleotide microarray and real-time RT-PCR provided 6 candidate genes, namely, NUBPL, C9orf30, ZNF12, TMEM158, GSK3B, and FBLP1 using 9 lung cancer cells consisting of 3 small and 6 NSCLC cells. These 6 genes together with 5 reported biomarkers, i.e., GSTP1, ERCC1, BRCA1, FRAP1, and RRM1, were subjected to a linear regression analysis using 12 NSCLC cell lines including 6 additional NSCLC cells: only FBLP1 and TMEM158 genes showed positive associations with statistical significances (P = .016 and .026, respectively). The biological significance of these genes was explored by in vitro experiments: Knockdown experiments in PC-9/CDDP cells revealed that the reduced expression of TMEM158 significantly decreased the chemo-resistance against CDDP (P

Background Medial displacement calcaneal osteotomy is indicated in individuals with stage 2 posterior tibial tendon deficiency (PTTD) with a supple hindfoot and the absence of clinical or radiographic arthritis. Patients and methods This prospective study evaluated the effects of medial displacement calcaneal osteotomy and flexor digitorum longus transfer to navicular bone on pedal realignment and function in 14 patients (15 feet) with a stage 2 PTTD. Results American College of Foot and Ankle Surgeons scoring scale module number 3 was measured before the reconstruction and at latest follow-up, and also patients’ satisfaction were reported, demonstrating a good realignment in short-term follow-up (15–18 months). The American College of Foot and Ankle Surgeons score improved postoperatively from average of 53.5 to 87.4 without progression of arthritis at adjacent joints. Conclusion This simple surgical procedure has an excellent effect on realignment and function of PTTD stage 2 without marked forefoot abduction.

The current investigation was carried out to evaluate oxidative stress serum biomarkers , antioxidant concentrations and isolation the most common etiology of bacterial pneumonia. Thirty goats of different age and sex belonging to private farms in Giza governorate were used in this study .All goats were exposed to complete and comprehensive clinical examination. The animals were divided into two equal groups apparently healthy (15), diseased (15). Blood samples were collected from both groups to determine enzymatic activates of superoxidase dismutase (SOD), glutathione peroxidase (GPX) in erythrocyte haemolysate, catalase (CAT), vitamin C, vitamin E and Albumin, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), urea and creatinine, as well as nasal swabs were collected for isolation of possible bacteria. The levels of CAT, SOD and GPX were significant higher (p≤0.05), vitamins C, E were significant decrease (p≤0.05), Significant decrease (p≤0.05) in Albumin in pneumonic goats. Of 30 goats’ nasal swabs, 73.3% (22/30) yielded different bacterial isolates. Mannheimia (Pasteurella) haemolytica was the predominant isolates (81.8%; 18/22) and other isolates . It can concluded that pneumonia served to produce oxidative stress in the goat with increased activities of antioxidant enzymes to facing excessive production of free radicals. For healthier status in small ruminant antioxidant supplementation is very important as supportive treatment in diseased cases and preventive aid in healthy cases. Keywords: Oxidative stress, Antioxidant, Vit. C, Bacteria, Pneumonia, goat

Objective The aim of this study was to determine the histological, histochemical, and immunohistochemical effects of monosodium glutamate (MSG) on the ovaries of adult female albino rats and the possible protective role of green tea. Background MSG is a commonly used food additive. It plays an important role in the pathogenesis of anovulatory infertility. Materials and methods A total of 35 female adult albino rats were used in this study. The rats were divided into four groups: groups I-IV. Group I was the control group. In group II (MSG treated) 10 rats were treated with MSG at a dose of 4 mg/g body weight by subcutaneous injection daily for 14 days. The rats were killed 24 h after MSG treatment. In group III [combined green tea extract (GTE) and MSG treated] 10 rats were treated with GTE and MSG for 14 days. MSG was given at the same dose as that in group II and GTE was given at 300 mg/kg body weight orally daily. The rats were killed 24 h after MSG and GTE treatment. In group IV (GTE treated) five adult rats were treated with GTE only for 14 days and then killed. Results MSG-treated rats showed degenerative changes of the ovary with many atretic follicles. The stroma appeared vacuolated. The medulla showed multiple vacuoles with congested blood vessels. However, combined treatment of GTE and MSG in group III showed amelioration of the histological changes in the ovary. Conclusion It has been concluded that GTE improves the histological changes caused by MSG in the ovary.