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Background: Febrile Seizures (FS) are the most common seizures in children younger than 5 years. In the last decade, various coding and noncoding sequence variations of voltage-gated sodium channels SCN2A have been identified in patients with seizures, implying their genetic base. We aimed to evaluate the association between SCN2A c. G/A genetic polymorphism among Egyptian children with febrile seizure plus. Methods: The present cross-sectional study was carried out on 100 epileptic infants and children, attendants of the Neurology Unit, pediatric department, Menoufia University Hospitals (Group Ι). The patients were sub-classified into two groups, according to response to anti-epileptic treatment; Group Ι a (drug responder) and Group Ι b (drug-resistant). Evenly divided number of apparently healthy, age and gender-matched children were selected as controls (Group II). A complete history, throughout the systemic examination and radiological & metabolic assessment, whenever needed was provided, all participants were genotyped for SCN2A rs17183814 polymorphism by Restriction Fragment Length Polymorphism (PCR-RFLP). Results: Both of A allele and AA, GA genotypes of SCN2A c. 56 G/A were detected more in patients with febrile seizure plus comparison to the control group with a statistically significant difference at frequencies of 17% and 11% and 12% respectively; OR (CI95%): 10.04 (3.49-28.87) and p Conclusion: SCN2A rs17183814 (A) allele was specifically associated with developing febrile seizure plus and could modulate the patient's response to anti-epileptic medications.

In reaction to skin injury in genetically predisposed persons, the keloid is formed and marked by benignant overgrowth of dermic collagen. Intralesional triamcinolone was used in the treatment of keloids with varying results.Intralesional triamcinolone is a gold standard in treating the keloids in comparison with its effectiveness versus intralesional 5-fluorouracil intralesional verapamil and intralesional platelet-rich plasma.Several 160 cases were categorized into four groups of each group-containing 40 cases. Group-A (control) treated with intralesional triamcinolone and Group-B intralesional verapamil, Group-C intralesional 5-fluorouracil, and Group-D intralesional platelet-rich plasma. Patients were assessed for clinical response based on a decrease in the patient and observer scar assessment scale (POSAS) at baseline and the end of treatment.The mean base-line POSAS score was 91 ± 10.98 SD check-in Group-A, 90 ± 10.85 in Group-B, 89 ± 10.06 in Group-C, and 92 ± 10.84 in Group-D. POSAS score after 24 weeks 36 ± 12.74 in Group-A, 29 ± 10.91 in Group-B, 39 ± 13.74 in Group-C, 36 ± 12.74 in Group-D. Statistically, a significant difference was observed between groups.Intralesional verapamil reported to be the most effective therapy and platelet-rich plasma was effective as intralesional triamcinolone acetonide with no serious side effects and 5-fluorouracil was less effective in treating the keloids.

Background: Neonatal Respiratory Distress Syndrome (RDS) is a dangerous disease in neonates and is accompanied by neonatal complications and death. Objective: The aim of this study was the early determination of neonatal serum vitamin A levels as a possible novel predictor for neonatal RDS. Patients and Methods: A case-control study with the identification number TCTR20210206001, was performed on 100 neonates who were admitted to the Neonatal Intensive Care Unit (NICU) of Tanta University Hospital (TUH) suffering from RDS (patient group) and 100 healthy neonates (control group). Estimation of serum vitamin A (retinol) was made for all neonates of this study within the first four hours after birth before any nutrition or therapies. Results: Showed The results showed no significant difference between serums retinol (RT) levels in grade 1 & 2 RDS neonates (patient group) and the serum RT levels in the control group, while there was a significant difference between serums retinol levels in grade 3 & 4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006 and 0.002 respectively.no significant difference between serums retinol (RT) levels in grade 1&2 RDS neonates (patient group) and the serum RT levels in the control group while there was significant difference between serums retinol levels in grade 3&4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006, 0.002 respectively. Conclusion: Serum vitamin A levels in neonates were found to be decreased in RDS neonates and could be used as a predictor for the development and severity of RDS. Recommendation: It is recommended to carry out routine estimation of serum vitamin A levels in neonates as a novel predictor for neonatal RDS.

Background: Female sexual dysfunction [FSD] is a significant challenge. Some researchers reported an association between FSD and delivery mode, while others did not report such association. Aim of the work: To study the long term effect of delivery mode on female sexual function in primiparous mothers.Subjects and Methods: This is a cross-sectional analytical study aiming to evaluate FSD and its related factors after delivery. It included 260 primiparous mothers who attended the healthcare centers in Dakahlia and Damietta governorates. They were divided according to the delivery mode into two groups, each of 130 mothers; the first for normal vaginal delivery [NVD], and the second for cesarean delivery [CD]. All participants were evaluated by complete history taking [demographics, obstetric and medical history, duration since delivery, mode of delivery and use of contraception], and female sexual function assessment. Female sexuality was assessed by an Arabic version of the Female Sexual Function Index [FSFI] questionnaire, which is a brief, multidimensional, validated tool for evaluation of female sexual function [FSF] during sexual activity.Results: Results revealed a non-significant difference between females delivered by NVD and those delivered by cesarean section [CS]. Also, there was no significant difference between groups regarding female sexual dysfunction index [FSDI] single domains and total score. Female sexual dysfunction [FSD] was reported in 20.8% and 25.4% in NVD and CS groups, respectively. The duration since the last delivery, recurrent urinary tract infection [UTI], and Vulvo-vaginitis were the individual risks of female sexual dysfunction. Vulvovaginitis was the only independent predictor factor for sexual dysfunction. Conclusion: Female sexual function was not affected by the delivery mode, and there was no basis for advocating the cesarean section for delivery to prevent future female sexual dysfunction. However, identifying vulvovaginitis as the sole significant factor affecting FSD represented significant findings in the current work.

Background: Neonatal respiratory distress syndrome (RDS) is a common dangerous chest problem that is caused by a lack of surfactant. Aim: The aim of this study was to show the role of zinc as an adjuvant anti-inflammatory therapy in neonatal RDS. Objective: To study the effect of zinc supplementation in cases of neonatal RDS. Methods: A prospective randomized controlled trial (RCT) study was done on 90 neonates suffering from respiratory distress (RD) who had been diagnosed as RDS. The included neonates were classified into two groups: group 1, which received Zinc (Zn) supplementation, and group 2, which received a placebo. Down score, grades of RDS Malondialdehyde (MDA), Superoxide Dismutase (SOD) andInterleukin-8 (IL-8) were estimated on the 1st and 5th day in the presence of incubators. Results: There were statistically significant differences (SSD) in grades of RDS, Down score, MDA, SOD and IL-8 on the 5th day between group 1 and 2(p = 0.001), and between 1st and 5th day in group 1 (p = 0.001) in the presence of an incubator. There was an SSD between groups 1 and 2 in the duration of hospitalization (p = 0.001) and the number of cases that needed mechanical ventilation (MV) (p = 0.049). Conclusion: Zn supplementation is associated with clinical and laboratory improvement in cases of neonatal RDS. Recommendation: Zn supplementation for RDS neonates.

PURPOSE To investigate the long-term effect of scleral buckling on corneal biomechanics and the effect of change of scleral properties on intraocular pressure (IOP) measurements. METHODS This is a prospective case series, patients with rhegmatogenous retinal detachment prepared for scleral buckling were included. Goldmann applanation tonometry was used to measure IOP (GAT IOP). Ocular Response Analyzer (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), goldmann-corrected IOP (IOPg), and corneal-compensated IOP (IOPcc) preoperatively, and 1, 3, and 6 months postoperatively. RESULTS Thirty-three eyes included in the final analysis, with an average age 38.4 ± 16.2 years. CH and CRF decreased significantly at first, third, sixth months post-scleral buckling; however, this effect decreased with time as follows; preoperative: 8.9 ± 1.5 and 8.5 ± 2.1, first month: 6.8 ± 1.6 and 7.1 ± 1.8 (P value = 0.00, 0.002), third month: 7.8 ± 1.5 and 7.6 ± 1.6 (P value = 0.001, 0.008), and sixth month: 7.7 ± 1.3 and 7.6 ± 1.7 (P value = 0.002, 0.055). IOP cc was 19.3 ± 3.6, 17.1 ± 4, and 17.6 ± 2.9 at 1, 3, and 6 months, and these readings were significantly higher than GAT (13.6 ± 7.6, 12.4 ± 5.1, and 12.1 ± 2.9, P values = 0.00) and IOPg (14.9 ± 3.6, 13.5 ± 4.1, and 13.9 ± 3.5, P values = 0.00). The change in CH at each visit is correlated with the difference between the IOPcc and GAT measurements. CONCLUSION The conventional Goldmann applanation tonometry underestimates post buckle IOP measurements due corneal biomechanics changes. ORA might be an alternative and accurate method of measurement; however, further investigation is warranted.

Increased environmental pollution and unhealthy lifestyle are blamed for escalated chronic diseases. Exposure to aflatoxins was recently suggested to have a role in the increased incidence of type 2 diabetes mellitus. Diet modification and consumption of different functional food are now gaining attention, especially in diabetes management. This study investigates the effect of a diet containing barley microgreen against diabetes induced by streptozotocin with or without aflatoxin administration in rats. Barley microgreen was rich in 3′-Benzyloxy-5,6,7,4′-tetramethoxyflavone (48.8% of total) followed by 5β,7βH,10α-Eudesm-11-en-1α-ol (18.46%). Streptozotocin injection and/or aflatoxin administration significantly elevated glucose level, decreased insulin level, decreased β-cell function, deteriorated liver and kidney function parameters, and induced oxidative stress in the liver. Histopathology revealed irregular small-sized islets and decreased area % of insulin-positive beta cells in the pancreas, hepatic degeneration, nephropathy, and neuropathy in diabetic and/or aflatoxin administered rats compared to control. Barley microgreen diet fed to diabetic rats with or without aflatoxin alleviated all evaluated parameters. Barley microgreen diet also ameliorated the toxic effect of aflatoxin. In conclusion, exposure to aflatoxin aggravated diabetes and its complication. The incorporation of barley microgreen in the diet was able to control type 2 diabetes mellitus and the improved outcomes observed with barley microgreen treatments involved or occurred in conjunction with improved biomarkers of oxidative stress.

This is a single center, retrospective, observational study carried out in Ohud hospital, the main referral hospital for SARS-CoV-2 infections in the region of Madinah, Kingdom of Saudi Arabia. The study was carried on hospitalized patients with moderate to severe symptoms, including critically ill patients in the intensive care unit mostly of them requiring oxygen or mechanical ventilator support. Medical records from 432 cases were investigated showing that the majority of infected population were adults with an average age of 48 years, where 68.3% were males and the mortality rate was 5.6%. Duration of the disease was determined as the period between the first positive and the first negative PCR results. Patients who received antibiotics or Metoclopramide showed shorter duration of the disease time course while those who received Hydroxychloroquine, Omeprazole or Calcium exhibited longer durations before obtaining a negative PCR result. Regression analysis furtherly confirmed that antibiotics administration was associated with shorter course of disease while hydroxychloroquine or omeprazole were correlated with longer duration of the disease. Antiviral drugs, however, showed no correlations to the COVID-19 duration of stay in hospital. Finally, combining antibiotics and antiviral agents did not result in a better outcome, suggesting that the use of antibacterial agents helps in the recovery of SARS-CoV-2 patients.

Background: Inflammation of the skin marked by itchy, pigmented, dry areas is known as Atopic Dermatitis (AD), also known as Atopic Eczema (AE) or Eczema. Symptoms include red, itchy pimples that leak fluid and crust, scaly or raw skin, or raw or scaly skin. Dermatitis can come in many different forms, such as atopic, contact, or seborrheic. In children, atopic dermatitis is the most prevalent kind of eczema and often occurs in association with other allergic or asthmatic conditions. Eczema is most commonly found on the face, neck, elbows, knees, and toes, among other places. In terms of phototherapy, ultraviolet B phototherapy (280–320 nm) is the "oldest" method that is used in treatment of atopic dermatitis. Platelet rich plasma (PRP) injection utilizes the body's own regenerative mechanisms to help treat disease in the patient. Objective: Determination of the updated treatment modalities in Atopic Dermatitis management. Conclusion: Clearly there remains a need to find more potent topical agents with fewer side effects. The most gratifying advances in AD therapy have come from better understanding of immune and inflammatory mechanisms.

Background: The anterior cruciate ligament (ACL) runs from the femur to the tibia in the knee joint and is a thick band of connective tissue that may be exposed to tears. Accurate MR imaging evaluation of these patients requires an understanding of the usual postoperative MR imaging appearance of postoperative ACL graft and any abnormalities. Objective: To assess the complications and associated findings by conventional MRI in post-operative ACL reconstruction. Patients and methods: This study included 27 symptomatic patients (23 males and 4 females). The study was carried out at the Radiology Department at Zagazig University Hospitals. They were assessed by conventional MRI after the ACL operations. Results: The mean age of the studied patients was 29.26 ± 7.79 years old. Most of the studied patients were males (85.2 %). 14.8% of the studied patients had anterior tibial translation, graft impingement in 2/27 (7.4 %) of patients and anteriorly displaced tibial hardware was found in 3/27 (11.1 %) of the studied patients. 18.5% of the studied patients had joint effusion. PCL buckling and bone marrow edema were found in 7.4% of the studied patients and PHMM degeneration was found in 11.1% of the studied patients. Conclusion: In order to properly evaluate the post-operative knee, particularly in patients who had cruciate ligament repair, magnetic resonance imaging (MRI) of the knee is required.

Background: Neonatal jaundice is a common neonatal disease that has adverse effects on neonates, especially preterm neonates, when indirect bilirubin level is adequately high to pass the blood-brain barrier, causing bilirubin encephalopathy or kernicterus. Aim: This study aimed to investigate the value of zinc (Zn) supplementation in preterm neonates with jaundice and whether it will be beneficial. Patients and Methods: A prospective randomized clinical trial, with the identification number TCTR20200504007, was conducted at Tanta University Hospital from July 2016 to March 2018 on 200 preterm neonates with jaundice. The studied neonates were divided into two groups: group 1, which received Zn and phototherapy, and group 2, which received phototherapy only and did not receive Zn. In group 1, 100 preterm neonates with jaundice received Zn as 0.6 mL (cm3) of zinc origin/kg/day orally through the oro-nasogastric tube divided into two doses (every 12 h), which was equal to 1.2 mg elemental zinc/kg/day orally for 10 days. Results: There was no significant difference in serum bilirubin level between the two groups on the 2nd, 4th, and 6th days of admission, while the serum bilirubin level was significantly decreased in group 1 compared with that in group 2 only on the 8th, 9th, and 10th days of admission. The p-- values were 0.045*, 0.027*, and 0.004*, respectively. Conclusions:: Zn administration to preterm neonates with jaundice was found to be beneficial in decreasing serum bilirubin level. Recommendation: Zn supplementation should be provided to preterm neonates with jaundice.

Background: Severe pre-eclampsia occurring remote from the term is a decision-making dilemma for the obstetrician, the general recommendation is that women with severe pre-eclampsia should be delivered to avoid maternal complications; others recommend prolonging pregnancy in most cases of severely premature pre-eclamptic gestation until the development of fetal lung maturity, development of fetal or maternal distress, or achievement of gestational age of 34 to 36-week of gestation. The cut-off level of pulmonary artery acceleration time to ejection time ratio [PAT/ET] that determines fetal lung maturity in cases of severe pre-eclampsia [PE] is not determined yet.Aim of the work: To study the Doppler indices of the main fetal pulmonary artery and their role in predicting respiratory distress syndrome [RDS] in severe pre-eclampsia.Patients and Methods: A prospective longitudinal cohort research was designed in which 102 pregnant women with PE were chosen and fetal pulmonary artery flow velocity data were acquired by Doppler ultrasound and linked with the development of neonatal RDS.Results: The AT/ET ratio in the fetal pulmonary artery velocity waveform was found to be directly related to the development of newborn RDS. A cut-off value of 0.3 resulted in a sensitivity of 71.4%, specificity of 79.7%, and total accuracy of 77.5%.Conclusion: A high AT/ET ratio in the fetal pulmonary artery is related to the future development of RDS in neonates of mothers with severe pre-eclampsia, implying that fetal pulmonary artery Doppler ultrasound may be a valuable tool in the identification of fetal lung maturity in situations of severe pre-eclampsia.

Background: Neonatal hyperbilirubinemia is a serious neonatal problem which has hazardous effects on the neonates when the level of indirect bilirubin is increased to the levels that could cause kernicterus. Aims: The aim of this research is to study the cord blood levels of erythropoietin (EPO), bilirubin and reticulocyte count (RC) as early predictors of neonatal hyperbilirubinemia. Methods: This is a case-control study, which was conducted at Tanta University Hospital (TUH) from July 2016 to March 2018 on 90 neonates. The studied neonates were divided into 2 groups: Group 1 (45 neonates) who developed pathological hyperbilirubinemia and required treatment and group 2(45 neonates) who did not develop pathological hyperbilirubinemia and did not require treatment. Cord blood levels of EPO, bilirubin and RC were measured in all the studied neonates in both groups. Results: There was a significant difference between both groups with regard to cord blood bilirubin (CBB), hemoglobin, EPO and RC levels where the P. value is 0.001*,0.027, *0.001*&0.001*respectively. There was a significant positive correlation between cord blood EPO levels and both CBB and cord blood RC with r=0.610 and 0.579, respectively and P. value is 0.001* & 0.001* respectively. With regard to ROC curve, there were high cord blood EPO levels where the cut off value was 22.5 mIU/ml while the sensitivity and specificity were 96 and89, respectively. In the cord blood RC, the cut off value was 5.7% while the sensitivity and specificity were 93 and 85, respectively, and lastly, CBB where the cut off value was 1.8 mg/dl while the sensitivity and specificity were 89 and 78 respectively. Conclusion: Cord blood levels of EPO, bilirubin and RC were increased in cases of pathological neonatal hyperbilirubinemia. Recommendation: Cord blood levels of EPO, bilirubin and RC could be used for early prediction of pathological neonatal hyperbilirubinemia.

INTRODUCTION Healthcare providers' anthropometric characteristics can adversely affect adult cardiopulmonary resuscitation (CPR) performance quality. However, their effects on infant CPR are unknown. We aimed to determine any relationships between healthcare provider characteristics (anthropomorphic, demographics, training, occupational data) and simulated infant CPR performance at multiple international sites. Our secondary aim was to examine provider's CPR performance degradation. METHODS Providers from 4 international hospitals performed 2 minutes of single-rescuer simulated infant CPR using 2015 American Heart Association Basic Life Support criteria with guidance from a real-time visual performance feedback device. Providers' characteristics were collected, and the simulator collected compression and ventilation data. Multivariate analyses examined the entire 2 minutes and performance degradation. RESULTS Data from 127 participants were analyzed. Although median values for all compression variables (depth, rate, lean) and ventilation volume were within guideline target ranges, when looking at individuals, only 52% chest compressions and 20% ventilations adhered to the American Heart Association guidelines. Age was found to be independently associated with ventilation volume (direct-relationship), and height was associated with chest compression lean (shorter participant-deeper lean). No significant differences were noted based on sex or body mass index. Neonatal intensive care unit participants were noted to perform shallower chest compressions (P < 0.001). Overall, there was minimal evidence of performance degradation over 2 minutes. CONCLUSIONS Isolated provider characteristics were noted among a diverse cohort of healthcare providers that may affect the CPR quality on a simulated infant. Understanding the relationships between provider characteristics and CPR quality could inform future infant CPR guidelines customized for the provider and not just the patient.

Non-alcoholic steatohepatitis (NASH) is a worldwide health problem. Alternate-day fasting (ADF), although thought to be aggressive, has proven safety and efficacy. We aimed to evaluate the effect of short-term ADF against already established high-fat-fructose (HFF)-induced NASH, independent of the amount of calorie intake, and to study the effect of ADF on lipogenesis, apoptosis, and hepatic inflammation. Male Sprague Dawley rats were divided into two groups: (1) negative control and (2) NASH group fed on HFF for 9 weeks, and then randomized into two subgroups of either HFF alone or with ADF protocol for 3 weeks. The ADF could improve HFF-related elevation in serum lactate dehydrogenase and could decrease the mRNA expression of lipogenesis genes; acetyl CoA carboxylase, peroxisome proliferator-activated receptor γ, and peroxisome proliferator-activated receptor α; apoptotic genes caspase-3, p53, and inflammatory cyclo-oxygenase 2; and immunohistochemical staining for their proteins in liver with upregulation of LC3 and downregulation of P62 immunoexpression. Moreover, ADF ameliorated HFF-induced steatosis, inflammation, ballooning, and fibrosis through hematoxylin and eosin, Oil Red O, and Sirius Red staining, confirmed by morphometric analysis, without significant weight loss. Significant correlation of morphometric parameters with levels of gene expression was found. These findings suggest ADF to be a safe effective therapeutic agent in the management of NASH

In breast reconstruction, augmenting the blood supply to the abdominal flap decreases the risk of adverse effects. This technique is utilized in patients with risk factors such as smoking, obesity, and a history of chest wall irradiation. A surgeon may opt to use procedures such as free bipedicled flaps, vascular delay, or conventional bipedicled transverse rectus abdominus myocutaneous flaps. The free bipedicled deep inferior epigastric perforator (DIEP) flap is the best option; however, information on the reliability of bipedicled DIEP compared to that of unipedicled flaps is lacking. We aimed to determine if there was a significant difference in complication rates between bipedicled and unipedicled DIEP flaps. Electronic search in PubMed, Cochrane Library, Ovid, and Scopus databases was performed. After screening, data were extracted based on the donor site, recipient site, and adverse effects. Descriptive statistics were generated for all pooled data. A meta-analysis was performed to determine the relative risk (RR) ratios with 95% confidence intervals (CIs) using a random-effects model. Our search yielded 19 unrelated studies of 920 bipedicled DIEP flaps that met the inclusion criteria and were included. The meta-analysis conducted on five papers showed that the risk of fat necrosis was significantly higher in unipedicled flaps than in bipedicled flaps (RR 0.30 [95% CI 0.19–0.48]; P

Coronavirus disease 2019 (COVID-19) currently represents a major health emergency worldwide. Early recognition of severe forms of this virus is essential to align effective management and treatment strategies. Presepsin (PSP), the soluble cluster of differentiation (CD14) subtype; is a useful biomarker not only for early diagnosis of sepsis but also could be used as a predictive for the severity and mortality in septic patients, as well as in pneumonia. This study aimed to investigate the potential utility of PSP as a predictive indicator of disease severity in COVID-19 patients. A total of 42 COVID-19 patients were enrolled in this study and stratified into moderate and severe groups, in addition to 15 healthy patients as controls. The PSP levels were measured using Enzyme Linked Immuno-Sorbent Assay (ELISA) within 24 h (1 day) as well as on the 5th day of admission to the Geriatrics hospital, Ain Shams University, Cairo, Egypt, in addition to other relevant laboratory tests performed during the study period from July to October, 2020. Results showed that the PSP levels were significantly higher in COVID-19 patients compared to the controls (p< 0.001), and were also noticeably elevated in severe group than in moderate group on the 1st day 1 (p= 0.008) and the 5th day (p= 0.003) of hospital admission. Significant correlation between PSP level and hospital stay (r = 0.332, p= 0.032) was detected; however, no significant correlation was recorded with the different laboratory parameters. For severity prediction, PSP revealed significant values for the 1 st day and the 5th day (AUC 0.737; p= 0.003 and AUC 0.810; p< 0.001), respectively. Data obtained in this study suggested the potential utility of PSP as a predictive indicator of severity in COVID-19 patients, thus allowing for earlier identification of high-risk patients and those who will be hospitalized for longer periods.

This study was aimed at validating the diagnostic accuracy of ultrasound (US) scans in pre-operative evaluation of flexor tendon injuries in the hand and to determine its value in the management of such injuries and in the prediction of patient outcome. This descriptive cross-sectional prospective study included 35 patients with penetrating trauma to the volar aspect of the hand or wrist with questionable clinical findings. They had 50 injured tendons and were candidates for exploratory surgery versus physiotherapy. They underwent pre-operative US to guide their management. Ultrasound results were compared with the operative findings as the gold standard test. Patients were followed up postoperatively, and functional outcome was assessed and correlated with pre-operative sonographic findings. Our results indicate that sonographic examination of hand tendon injury has high accuracy in diagnosing complete or partial flexor injuries, with 100% accuracy, sensitivity and specificity in diagnosing full-thickness tears as well as tenosynovitis of hand flexor tendons. Zonal II injury was the most frequent among our study population and correlated with poorest functional outcome after rehabilitation at 3 mo follow-up. US of the hand is a fast, inexpensive and potentially indispensable dynamic tool for accurate assessment of flexor tendon injuries. It provides data on the extent of injury that effectively helps both set up an appropriate operative plan and predict the patient's functional outcome post-operatively, which in turn will have a direct impact on the patient's rehabilitation plan and lifestyle. Thus, it should be a fundamental part of the management of patients with tendon injuries.

BACKGROUND Long-term remission and total clearance in Psoriasis can only be achieved in a few patients. AIM To compare the efficacy and safety of intradermal Botulinum toxin (BTX) in the treatment of plaque psoriasis. SUBJECTS AND METHODS A comparative study conducted in thirty-five patients with chronic plaque psoriasis was treated by split-body therapy. The patients were either treated with intradermal BTX or with intralesional 5-fluorouracil (5-FU) to each of 2 bilaterally symmetrical psoriatic plaque lesions. The outcomes were assessed using the following criteria: the sum of erythema, scaling, and induration scores and the clearing percentage of the target plaque lesion assessed by 2 blinded observers. RESULTS At the end of the study, the response rate was 85% on the BTX treatment side and 90% on the 5-FU side. There was no significant difference between both sides regarding a clinical response or side effects. The recurrence rate was 15% on both sides. CONCLUSIONS Botulinum toxin was a novel, safe, single injection, and effective therapy for plaque-type psoriasis. More studies are required to further prove the efficacy of BTX in the treatment of plaque psoriasis.

Background: Polymorphisms of genes encoding the pro-inflammatory and anti-inflammatory cytokines can affect the clinical presentation of the infection. We aimed to assess the role of EGF gene single-nucleotide polymorphism in the outcome of chronic hepatitis B virus (HBV) infection in children. Methods: One hundred HBV-infected children and 75 healthy matched controls were enrolled in this prospective study. Patients included 18 chronic inactive and 82 chronic active carriers. EGF rs4444903 A>G genotypes were determined using allele-specific amplification. Results: Significant differences regarding EGF genotypic frequency (p=0.001) in patients compared to controls (p=0.001). Eighteen percent were inactive, and 82% were active carriers. AA, AG and GG genotypic frequency were 66.7%, 33.3%, 0% and were 3.7%, 37.8% and 58.5% in the inactive and active carriers, respectively, with significant differences regarding AA, AG, GG genotypic frequency (p=0.001 for all). EGF AA, AG, GG genotypes frequency were 1.9%, 33.3%, and 64.8%, respectively, with significant differences between cirrhotic and non-cirrhotic patients regarding AA, AG, GG genotypic frequency (p=0.001 for all). Conclusion: Increased G allele frequency in EGF rs4444903 A > G polymorphism in HBV- Egyptian children is associated with worse outcomes.

Background: Comparison between spinal anaesthesia with conventional land mark (blind) technique and with preprocedural ultrasonographic guidance technique. Ultrasound (US) can be used effectively and accurately to identify the anatomical landmarks of neuraxial blockade, in order to improve the safety and efficacy of spinal anaesthesia. Objective: To assess the effectiveness and safety of US to improve the technique of spinal anaesthesia, anddecrease it's complications in comparison to the conventional landmarks technique. Patients and Methods: The study was performed in Zagazig University Hospital. Hundred and four ASA classes I and II adult cooperative patients of both sexes were scheduled for surgery in the lower part of the body under neuraxial blockade. They were randomly allocated into two equal groups, preprocedure ultrasonography guided spinal anaesthesia (PS) group, and conventional landmark group (CL). Results: It was found that there was a statistically significant difference between PS and CL groups regarding the number of attempts, number of needle pass (bone hitting), successful dural puncture after the first attempt, and total time for technique performance. Conclusion: ultrasound guidance improves the success rate of midline spinal anaesthesia. It reduces the number of attempts required, improves the success rate of a single needle pass, and shortens the time to dural puncture. Further trials can be done to establish the role of ultrasound-guided neuraxial block among high-risk groups, such as obese, elderly, and patients with spinal deformity.

Obesity is a worldwide prevalent problem which negatively affects most of the human body systems. Male sexual dysfunction is a frequent problem in obese individuals. Nowadays, bariatric surgery is the most successful way for the management of morbid obesity. Recent research has concluded that it has a significant improving effect on sexual function. This study aimed to assess the long-term effect of bariatric surgery on male sexual function. Sixty-six male patients indicated for bariatric surgery were enrolled in this prospective study. Only forty-eight of them completed the study. Patients were invited to fill the International Index of Erectile Function (IIEF) questionnaire twice, preoperatively (T1) and 12 months postoperatively (T2). Simultaneously, patients’ serum testosterone levels were assayed. At T2, the patients showed highly significant increase in the IIEF scores and the serum testosterone levels (p

Prior research has identified abnormal platelet procoagulant responses in COVID-19. Coated-platelets, a form of procoagulant platelets, support thrombin formation and are elevated in ischemic stroke patients with increased risk for recurrent infarction. Our goal was to examine changes in coated-platelet levels over the course of COVID-19 infection and determine their association with disease severity, thrombosis, and death. Coated-platelet levels were assayed after admission and repeated weekly in COVID-19 patients, and in COVID-19 negative controls. Receiver operator characteristic (ROC) analysis was used to calculate area under the curve (AUC) values for a model including baseline coated-platelets to predict death. Kaplan–Meier and Cox proportional hazards analysis was used to predict risk for death at 90 days. We enrolled 33 patients (22 with moderate and 11 with severe infection) and 20 controls. Baseline coated-platelet levels were lower among moderate (mean ± SD; 21.3 ± 9.8%) and severe COVID-19 patients (28.5 ± 11.9%) compared to controls (38.1 ± 10.4%, p 33.9% was 40.99 when compared to those with levels ≤ 33.9% (p

Background/Aim: Spontaneous bacterial peritonitis is a common bacterial infection of ascitic fluid mainly in ascites due to liver cirrhosis. Mannose-binding lectin (MBL) can activate phagocytosis and the complement system. Spontaneous bacterial peritonitis was detected to be higher in MBL deficiency. This study aimed to assess ascitic fluid MBL in liver cirrhosis and spontaneous bacterial peritonitis. Methods: Ninety patients with cirrhotic ascites were included. Forty five of them had SBP. Child-Pugh score, Model for End Stage Liver Disease (MELD) and its update (uMELD) scores were used to assess severity of liver cirrhosis. Ascitic fluid samples were obtained for differentiation of leucocytic count, estimation of albumin, protein, glucose, and serumascitic albumin gradient. Ascitic fluid levels of MBL were measured for all patients. SBP was documented if polymorphonuclear leucocytic count ≥250/mm in ascitic fluid. Results: Ascitic fluid MBL level was significantly lower in patients with SBP. MBL had a significant negative correlation with ascitic total leukocytic count (TLC), also with serum creatinine, bilirubin, PT, INR and MELD score among SBP patients. However, it had a significant positive correlation with ascitic protein and with platelets. According to multivariate analysis; fever, TLC, platelets, creatinine, MBL, glucose and polymorphs were independent predictors for SBP development. Conclusion: Ascitic fluid MBL could be a good predictive and prognostic marker in patients with cirrhosis and spontaneous bacterial peritonitis.

Body dysmorphic disorder (BDD) is a controversial topic in the field of plastic surgery. Our aim was to determine whether BDD knowledge, attitude and practice (KAP) are affected by the experience of the surgeon in the field, sex of the surgeon, country of practice, and the number of patients the surgeon sees annually. We were particularly interested in uncovering any significant relations in KAP of BDD between plastic surgeons practicing in developed versus developing countries. We created a two-page survey of 24 questions about the KAP of BDD. The survey was sent to aesthetic plastic surgeons worldwide via ISAPS global email list. The data were collected over a period of 20 days at the end of 2020. A total of 464 plastic surgeons completed the survey. The only factor that determines the awareness of BDD is the experience of the surgeon. The more experienced the surgeon is, the more likely he/she is to be familiar with the clinical picture of BDD. Although aware, the more experienced surgeons tend to dismiss the importance of referring BDD patients to psychiatrists/psychologists. Male surgeons tend to diagnose more patients with BDD than female surgeons. Surgeons who estimated the correct prevalence of BDD among patients seeking surgery acquired knowledge of BDD from scientific journals. The KAP is relatively similar between surgeons practicing in developed and developing countries, and the main statistically significant difference was in the questions used during the course of the interviews to diagnose BDD. We can deduce from the results that most aesthetic surgeons worldwide have got knowledge of the presentation of BDD and are keen to diagnose the disorder in their practice. It is worth noting that surgeons usually have their unique approach in the management of BDD. Our study highlights the importance of not only raising awareness of the best management of BDD, but also of establishing a consensus that BDD is a contraindication to aesthetic treatment. The best methods to raise awareness are through journals and plastic surgery residency. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Background We evaluated the validity of some non-invasive scores and ultrasound findings to predict fibrosis and steatosis in a cohort of NAFLD patients who underwent liver biopsy. Ninety-seven NAFLD patients were enrolled and classified into NASH (66) and simple steatosis groups (31) based on liver biopsy. ROC curves were constructed for Fibrosis-4 index (FIB4), aspartate aminotransferase to platelet ratio index (APRI), and NAFLD fibrosis score (NFS) in fibrosis prediction, also for (hepatic steatosis index; HSI, fatty liver index; FLI) and ultrasonographic subcutaneous and visceral adipose tissue measurements (SAT and VAT) for steatosis prediction. Results FIB4 had AUC of 0.6, APRI and NFS at cutoffs of 0.3 and -.2.4 had AUC of 0.64 and 0.63 in detecting the presence of any grade of fibrosis, and of (0.52, 0.55, and 0.58) for significant fibrosis. FIB4 at a cut-off of (0.76) had the highest AUC in detecting any grade of fibrosis in the simple steatosis group (0.81). SAT (at cutoff of 2.1 and 2.5) was superior to VAT. HSI (at cutoff 45.35 and 45.7) was superior to FLI in detecting moderate or marked steatosis. Conclusion FIB4 and NFS can be used in screening for silent liver disease with ongoing fibrosis in simple steatosis. They are unsatisfactory predictors for significant fibrosis in NAFLD. SAT is better than VAT in predicting moderate steatosis and is slightly better than biochemical HSI.

Background Chronic venous leg ulcer reduces the patients' activities and their overall quality of life. Platelet-rich plasma (PRP) was previously investigated as promising less invasive management for leg ulcers. This study aims To re-assess the efficacy and safety of PRP in the management of chronic leg ulcers due to venous factors. Patients/methods RCT enrolled 80 patients who clinically presented with chronic venous leg ulcers. Forty patients were allocated randomly for the treatment with autologous platelet-rich plasma (PRP). Intradermal and subdermal injection of PRP by 27guage syringe weekly, in all edges and in the granular floor of the ulcer for 4-6 sessions. Another 40 patients managed by conventional treatment by compression and dressing for the same period were allocated as Group B. Objective assessment achieved by the percentage of reduction of the size of the ulcer area, rate of healing, incidence of recurrence, and if side effects have been reported. Results PRP therapy showed better results and high p value significance when compared to conventional therapy. Conclusion This study shows that PRP is effective and significant in promoting the wound healing process in chronic leg venous ulcers. PRP is simple, safe, and has a short learning curve technique.

Ergonomics is the scientific study of people and their working environment. If ergonomic principles are applied in dentistry field, it helps to prevent occupational health hazards. The aim of this study was to assess the knowledge, attitude, and practice of group dentists in Upper Egypt regarding to dental ergonomics. Subjects and methods: a total of 430 dentists were included in the current study after sample size calculation, and then an additional number of dentists were added to guard against nonresponse. They were randomly selected from four governorates in Upper Egypt . Data were collected by face-to-face interview using pre-validated questionnaire. The questionnaire consisted of 24 items divided into five sections; first part demonstrates sociodemographic. The second part concerned with the knowledge about dental ergonomics. The third part consists of 4 questions to determine attitude of participants, The fourth part consists 5 questions focused on the practice of dentists regarding dental ergonomics and finally, the last part assess musculoskeletal disorders and treatments received of participants .Chi‐square test was used to compare between the two or more proportions. A correlation was used for describing the relationship between two mutually numerical dependent variables and significant level was set at p < 0.05. Results: revealed high response rate among participant (93%). The overall knowledge level in the current study was 11.8% had good knowledge, more than half had positive attitude towards dental ergonomic and only 8.0% had good practice. Conclusion: Dentists in Upper Egypt have problems in their knowledge and practice of dental ergonomics.

Background: Degenerative disc disease represents a common cause of chronic low back pain that makes some disabling and requires surgical intervention. Posterior lumbar interbody fusion (PLIF) represents one of the techniques used to deal with this disabling. Objective: To assess the results of the posterior lumbar interbody fusion (PLIF) without instrumentation in cases of degenerative disc diseases without instability. Patient and method: This was a prospective study of twenty patients who underwent surgical lumbar laminectomy and discectomy with interbody fusion and graft for degenerative lumbar diseases that not responsive to medical treatment for 6 months at Sayed Galal Hospital, Al-Azhar Faculty of Medicine. Result: There was a highly statistically significant decrease in the level of pain (VAS score) one week postoperatively compared to preoperative level with p-value < 0.001, and a statistically significant difference was found between preoperative pain (VAS score) level ,and post 6 months level with p-value < 0.001. Conclusion: Posterior lumbar interbody fusion technique without instrumentation showed several potential benefits in the treatment of degenerative disc disease (DDD).

Background Data: Surgical fixation of the cervicothoracic junction (CTJ) is difficult due to the complex anatomy and biomechanical properties of this area. Several important vascular, visceral, and soft tissue structures make access to this region challenging; therefore, knowledge of these structures is essential for decompression and fixation. The posterior approach is commonly used in many diseases of the spine but is inadequate when targeting the anterior spinal elements; thus, it can result in a higher complication rate and can disturb spinal stability. For these reasons, different posterolateral and anterior approaches have been developed. Study Design: Systematic review of the literature Purpose: To compare these different anterior and posterior surgical approaches to the CTJ, indicating pathologies, outcomes, and complications. Patients and Methods: This review was done using the standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. An initial search has been carried out using PubMed, Embase, Cochrane Library, Ovid, Scopus, and Google Scholar databases using the following keywords; cervicothoracic junction, C7/T4, surgical fixation; posterior approach; anterior approach. Results: Our systematic review yielded 12 studies with 419 patients that met our inclusion criteria, including seven studies using the anterior and five posterior approaches for treating different spinal pathologies. In this review, most patients with traumatic and neoplastic injuries were treated through the anterior approach, and those with degenerative and infectious diseases were treated through the posterior one. Assessment of the reported neurological status change pre- and postoperatively showed a significant difference between the anterior and posterior groups favoring the anterior one, and the rate of complications of the posterior approach was higher than that in the anterior approach. Conclusion: The data in this review may demonstrate both the effectiveness and safety of the anterior approach compared to the posterior one. These data indicate that patients who underwent the anterior approach have a higher incidence of improvement in their neurological functions and that complications in the anterior group are relatively less than those in the posterior one.(2021ESJ231)

Background: Persistence of primary reflexes can indicate poor neurological development and immaturity within the nervous system. As dyslexia is a neurodevelopmental disorder that involves more than just reading difficulties so it’s important to investigate primitive reflexes and balance functions in dyslexics. Aim of the Work: To assess balance functions, primitive reflexes in dyslexics. Subjects and Methods: The present study was conducted on 60 children divided into two subgroups. Control group consists of 20 normal children and study group consists of 40 children with dyslexia (diagnosed by Arabic Reading Screening test (ARST) and Modified Arabic Dyslexia Screening Test (MADST). Both study and control groups aged from 6 6/12 to 9 years old. They were subjected to clinical diagnostic tests for primitive reflexes and balance office tests (Romberg, unilateral stance, Fukuda stepping test, modified clinical test of sensory interaction in balance (mCTSIB). Results: The study group demonstrated poor balance measured with unilateral stance compared to control group. Sixty percent of the study group has retained primitive reflexes. Conclusions: Dyslexic children have poor balance compared to normal children and they have retained primitive reflexes supporting poor neurological development. Assessment of balance functions is recommended to be included within the test battery of dyslexics for better quality of life.

Purpose We investigated meetings of the Dermatologic and Ophthalmic Drug Advisory Committee (DODAC) and the Ophthalmic Devices Panel (ODP) of the Food and Drug Administration (FDA) to determine whether a relationship exists between receipt of industry payments by speakers of the Open Public Hearing (OPH) portion and the nature of their recommendations regarding treatment approval. Design Cross-sectional study. Methods We reviewed publicly available transcripts of all DODAC and ODP meetings from February 2009 to December 2019. For each meeting, information about each public speaker including presence of conflict of interest (COI) and whether their testimony regarding the drug or device was positive, negative, or neutral toward treatment approval was extracted in a blinded fashion using a pilot-tested Google Form. Results Of the 86 speakers, 66 (76.7%) included a COI disclosure statement and 41 (47.7%) disclosed a COI. Regarding classification of the speakers' testimonies, 70 (81.4%) of 86 were positive, 9 (10.5%) of 86 were negative, and 7 (8.1%) of 86 were neutral. Each one of the 41 speakers with a COI gave a positive testimony. Speakers who disclosed a COI were significantly more likely to give a positive testimony than speakers who did not (P Conclusion We recommend the DODAC and ODP require full disclosure of COI information and introduce stricter policies to manage COIs, allowing the committee to fully understand the context of the public speakers' comments, including the possible influence of COI on these comments.

Hepatitis A is caused by hepatitis A virus (HAV). Hepatitis A virus (HAV) is classified as a picornavirus. Hepatitis A virus infection occurs globally and is causing a public health concern, primarily in developing countries due to its persistent circulation in the environment. The improved sanitary condition and increase in awareness of personal hygiene have led to the marked reduction of HAV prevalence in industrialized countries during childhood and to a shift of the infection towards adulthood. HAV is an environmentally stable, positive single stranded RNA virus that is primarily transmitted by the fecal-oral route, person to person contact or ingestion of contaminated food and drink. One of the main causes leading to HAV infection is epidemiologically linked to the consumption of raw or undercooked shellfish particularly oysters and clams. Due to their filter-feeding style, these shellfishes readily concentrate viruses from the surrounding water containing municipal sewage, and as a consequence pose a health threat to consumers. Therefore, development of detection techniques possessing the requisite sensitivity and specificity for the practical routine monitoring purposes is of great importance necessary for the protection of shellfish-consuming public. Nucleic acid based method such as reverse transcription PCR has emerged as the popular method of choice in view of rapidity, accuracy and sensitivity in contrary of the time-consuming conventional cell culture and hybridization techniques. The low concentration of viral genome present in the environmental sample which requires effective isolation and concentration of virions and the labor-extensive purification, removal of PCR inhibitors will be unfavorable

Ammar Abdulrahman Jairoun,1,2 Sabaa Saleh Al-Hemyari,2,3 Moyad Shahwan,4,5 Faris El-Dahiyat,6 Maimona Jairoun,4 Saleh Karamah AL-Tamimi,7 Ramzi A Mothana,8 Ahmed Husham Khattab4 1Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates; 2Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11500, Malaysia; 3Department of Pharmacy, Ministry of Health and Prevention, Dubai, United Arab Emirates; 4Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates; 5Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, Ajman, 346, United Arab Emirates; 6College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates; 7Faculty of Pharmacy, Aden University, Aden, Yemen; 8Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ammar Abdulrahman JairounHealth and Safety Department, Dubai Municipality, Dubai, 67, United Arab EmiratesTel +971558099957Email Dr_ammar_91_@hotmail.comBackground: The flux of pharmaceutical data can have a negative impact on the complexity of a pharmacist’s decision-making process, which will demand an extensive evaluation from healthcare providers trying to choose the most suitable therapeutic plans for their patients.Objective: The current study aimed to assess the beliefs and implementations of community pharmacists in the UAE regarding evidence-based practice (EBP) and to explore the significant factors governing their EBP.Setting: Community pharmacies in Dubai and the Northern Emirates, UAE.Methods: A descriptive cross-sectional study was conducted over six months between December 2017 and June 2018. Community pharmacists who had three months’ professional experience or more and were registered with one of three regulatory bodies (Ministry of Health, Health Authority Abu Dhabi, or Dubai Health Authority) were interviewed by three trained final-year pharmacy students. Face-to-face interviews were then carried out and a structured questionnaire was used.Metrics: The average beliefs score was 36% (95% CI: [34%, 39%]) compared to an implementation score of 35% (95% CI: [33%, 37%]).Results: A total of 505 subjects participated in the study and completed the entire questionnaire. On average, participants scored higher in beliefs score than implementation score. The results of the statistical modelling showed that younger, female, higher-position pharmacists with more experience and with low percentages of full-time working, and graduates from international/regional universities were more likely to believe in and implement the concept of EBP.Conclusion: A gap was identified between the beliefs and implementation of EBP. Developing educational EBP courses in undergraduate pharmacy curricula is of high importance, not only to increase knowledge levels but also to encourage commitment in those pharmacists to strive for professionalism and to support the provided patient care with evidence.Keywords: evidence-based practice, beliefs, practice, community pharmacist

OBJECTIVE To evaluate the predictive role of the uterocervical angle and the cervical length in preterm birth. METHODS This was cross-sectional analytical study, recruiting 167 women at high-risk for preterm birth (delivery before 37 weeks of pregnancy). They had transvaginal ultrasound for evaluation of the uterocervical angle and the cervical length between at 30 and 32, 32+1 and 34, and 34+1 and 36+1 weeks of pregnancy. The primary outcome was to determine the predictive role of the uterocervical angle and the cervical length in preterm birth. RESULTS The mean uterocervical angle was significantly greater in those who delivered preterm (115.4° ± 9.1° versus 101.1° ± 8.3°, p

Graphical abstract, Highlights • Cloroquine (CQ) has reduced the adverse bone changes caused by d-galactose. • It improved bone health, switched off nuclear factor kappa-B ligand (RANKL) receptor activator activation and decreased ERK bone expression. • CQ treatment inhibited osteoclastogenesis and consequently restored the RANKL/OPG ratio. • CQ demonstrated an antioxidant effect in bone where it increased both catalase (CAT) and superoxide dismutase (SOD). • CQ is a possible anti-osteoporotic agent through the suppression of osteoclastogenesis associated with ERK., Chloroquine (CQ); a lysosomotropic agent used for decade ago as anti-malarial, was tested against aging induced osteoporosis. Osteoporosis in male rats was induced using d-galactose (D-gal) as a reducing sugar at a dose of 200 mg/kg/day; i.p. Osteoporotic rats were orally treated with CQ (10 mg/kg/day) for four successive weeks. Bone densitometry of tibia and femur were evaluated. Bone formation biomarkers; osteoprotegrin (OPG), bone specific alkaline phosphatse (BALP), and osteocalcin (OCN), and bone resorption biomarker; receptor activator of nuclear factor kappa-B ligand (RANKL), cathepsin-k (CTSK), tartrate-resistant acid phosphatase (TRAP) were estimated. Moreover, the expression of extracellular regulated kinase (ERK) in bone was determined. CQ ameliorated the bone detrimental changes induced by d-galactose. It enhanced bone health as revealed by measurement of bone densitometry, halted the activation of receptor activator of nuclear factor kappa-B ligand (RANKL) and reduced bone manifestation of ERK. Furthermore, CQ treatment abated serum cathepsin-k (CTSK) and serum tartrate-resistant acid phosphatase (TRAP) thus inhibited osteoclastogenesis and consequently restored the RANKL/OPG ratio. CQ demonstrated an antioxidant effect in bone where it increased both Catalase (CAT) and Superoxide dismutase (SOD). These CQ preserving effect in rats treated with d-galactose were confirmed by the histopathological examination. The present study points to the potential therapeutic effect of CQ as anti-osteoporotic agent possibly through its antioxidant effects and suppression of ERK associated osteoclastogenesis.

Objective Neonatal sepsis (NS) is a serious neonatal disease. The aim of this study was to detect the role of zinc (Zn) supplementation in preterm neonates with late-onset sepsis (LOS). Study Design A prospective randomized clinical trial study which was done at Tanta University Hospital from August 2016 to March 2018 on 180 preterm neonates with LOS. The studied neonates were divided into two groups: group 1 (90 neonates), which received Zn and antibiotics, and group 2 (90 neonates), which received antibiotics and placebo. In group 1, the neonates received 1.4 mg elemental Zn/kg/d orally for 10 days. Sepsis score, C-reactive protein (CRP), and procalcitonin (PCT) were done for both groups. Results As regards sepsis score, it showed that before beginning the treatment, there were 85 and 84 neonates who had high probable sepsis (HPS) in intervention and control groups, respectively, and this revealed nonstatistically significant difference (non-SSD) between both groups (p-value is 0.756) and after 10 days of treatment, there were 1 and 4 neonates who had HPS in intervention and control group, respectively, and this revealed SSD between both groups (p-value is 0.045*). As regards CRP and PCT, the results showed that before beginning the treatment, the mean ± standard deviation (SD) of CRP and PCT were 39.4 ± 10.1 mg/L and 5.2 + 1.8 ng/mL, respectively, in intervention group, while it was 39.6 + 9.9 mg/L and 5.1 + 1.9 ng/mL, respectively, in control group and this revealed non-SSD between both groups (p-value is 0.893 and 0.717, respectively) and after 10 days of treatment, the mean ± SD of CRP and PCT were 5.3 ± 1.8 mg/L and 0.39 ± 0.13 ng/mL, respectively, in intervention group and 6.1 + 2 mg/L and 0.61 + 0.22 ng/mL, respectively, in control group and this revealed SSD between both groups (p-value is 0.008* and 0.044*, respectively). Conclusion Zn supplementation in preterm neonates with LOS is beneficial in improving the clinical and laboratory finding. Recommendation Zn supplementation for preterm neonates with LOS. Key Points

This study aimed to evaluate the use of Doppler ultrasound for determining alterations in uterine thickness and uterine arteries, use of chromohysteroscopy in evaluating endometritis with biopsies, and the impact of endometritis on oxidative and hormonal status. Twenty Arabian mares were divided into control and endometritis groups. Each underwent a physical examination, Doppler ultrasound, chromoendoscopy, and uterine biopsy. Blood samples from each animal were collected for hematologic, hormonal, and oxidative analysis. Results revealed a significant increase in estradiol, malondialdehyde (MDA), and nitric oxide metabolites (NOMs) associated with a significant decrease in progesterone and total antioxidant capacity (TAC) in the endometritis group. There was a significant difference in uterine thickness in the endometritis group. Uterine blood flow analyzed by color mode showed a significant increase in the endometritis group, while the spectral mode showed a significant increase in Doppler velocities and blood flow rate accompanied by a significant decrease in Doppler indices. The endometritis group showed ridged, bluish color in the endometrial wall, indicating hyperemia. Biopsy showed mononuclear inflammatory cells and edema in the endometrial interstitial tissue with sloughing of the epithelial lining. Conclusion: Endometritis in mares is associated with oxidative processes and presents with an increase in MDA and NOMs and a decrease in TAC. Doppler ultrasound improved endometritis diagnosis because it showed alterations in uterine vascularization. Chromoendoscopy improved the accuracy in taking biopsy samples because it allows the practitioner to select appropriate areas for biopsy to improve histopathological diagnostic outcomes. Therefore, this technique is worthy of further study in the field of veterinary equine reproduction.

Background: Upper Extremity Disorders (UEDs) are a common health problem, causing temporary and sometimes long-term work disability and implying considerable costs for employers and society. So, it is necessary to assess disability and symptoms in Egyptian patients with upper extremity disorders. Aim of Study: To examine the reliability and validity of the Arabic Shortened Version Disabilities of the Arm, Shoulder and Hand questionnaire (Arabic Q-DASH) in UEDs. Material and Methods: Sixty-two patients with UEDs completed the Arabic Q-DASH questionnaire at the beginning of study and after 3 days without any intervention between the baseline and second administration. Internal consistency was examined using Cronbach's alpha; test-retest reliability was measured using intra-class correlation coefficient (ICC). Results: Cronbach's alpha of the Arabic Q-DASH ques-tionnaire was high (Cronbach's alpha=0.88). Test-retest reli-ability was good (ICC: 0.84). Conclusions: The Arabic Q-DASH questionnaire is a reliable and valid upper extremity outcome measure for assessing patients with various upper extremity disorders, whose primary language is Arabic.

Pediatric sepsis is altered organ function in critically ill children and a main etiology of mortality for children. Therefore, the authors aimed to assess the role of serum thrombomodulin as valuable biomarker in the diagnosis and prognosis of sepsis in acutely ill pediatrics in the intensive unit. This prospective clinical study conducted on 140 acutely ill patients admitted to the Pediatric Intensive Care Unit (PICU) of Menoufia University Hospital and 50 apparently healthy controls from October 2018 through September 2019. All included children were subjected to clinical examination and the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality II (PIM II) scores were calculated. Serum thrombomodulin was measured for both patients and the control group upon admission. The children were followed for a period of 30 d. Serum thrombomodulin level was increased among all the patients and those with systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis compared with controls (p

OBJECTIVES 1: Describe subacute facial nerve paralysis after salvage stereotactic radiosurgery (SRS). 2: To analyze predictors of facial nerve weakness after dual modality treatment. PATIENTS Adult patients with Vestibular Schwannoma who underwent sub-total resection (STR) followed by salvage radiation. INTERVENTIONS Microsurgical resection of VS, stereotactic radiosurgery, intensity-modulated radiotherapy, proton radiotherapy. MAIN OUTCOME MEASURES Serial facial nerve function (House-Brackmann scale). RESULTS Thirteen patients who underwent dual modality treatment for large VS were included (mean age = 43.6 years, 77% females). The mean pre-operative tumor volume was 11.7 cm3 (SD = 6.5) and the immediate mean post-operative remnant volume was 1.5 cm3 (SD = 1.4) with a mean extent of resection of 86.7% (SD = 9.5). The mean salvage-free interval was 20.8 months (SD = 13.3). All patients had excellent one-year FN outcome (HB grade 1, 2) after resection. Three patients developed subacute facial nerve weakness after salvage SRS (4.2-9.4 months after SRS). This paralysis responded to high dose systemic steroids and no surgical interventions for facial rehabilitation were required. At last follow up (mean 61.6 months, SD = 28.5), facial nerve function was favorable (HB grade 1-2 in 12 patients and HB grade 3 in 1 patient). There were no significant associations between various predictors and subacute deterioration of facial nerve function after SRS. CONCLUSIONS Sub-acute transient facial nerve dysfunction can develop infrequently over a variable time frame after post-operative salvage SRS and usually responds to steroids. Patients should be adequately counseled about potential of transient deterioration of facial nerve function after salvage SRS.

Lifestyle and diet preferences are primarily responsible for developing type 2 diabetes. In this study, okara was manufactured into okara whey crackers (OWC) to investigate its dietary role in controlling diabetes in streptozotocin-diabetic rats with and without a high-fat diet. Forty-eight rats were divided into eight groups. G1–G4 were nondiabetic and fed a basal diet, a basal diet with 30% crackers, high fat diet, and a high-fat diet with 30% crackers, respectively. G5–G8 were diabetic groups that received similar diets as previous groups. Blood glucose, liver function, lipid pattern, pancreas and liver histopathology, and insulin immunohistochemistry were performed. OWC improved measured parameters and histopathology of the liver and pancreas in diabetic rats. The area % of positive insulin cells was increased in G6 (5.20%) and G8 rats (2.83%) fed OWC compared to diabetic rats (1.17%). In conclusion, the use of 30% OWC in a semi-modified diet has controlled the hyperglycemia and hyperlipidemia associated with diabetes.

Introduction keratoconus is a common disease in the general population, with prevalence ranging up to 200 per 100 000 with a reported increase in Saudi Arabia. Collagen Cross-Linkage is now an established treatment in isolation and in conjunction with other modalities for managing keratoconus. Our aim is to evaluate using a cohort study the impact of the treatment over a course of 18 months. Methods To evaluate the impact of 18 months after collagen cross-linkage treatment and its determinants in eyes with keratoconus in Western Saudi Arabia. A one-armed prospective cohort study design on 45 patients with Stage I, II, III and IV keratoconus who were treated by Collagen Cross-Linkage modality was developed at our institute between 2018 and 2019 to establish the success rate of corneal ectasia stabilization of the disease. Results Demographic data and grades of keratoconus (Amsler - Krumiech classification) at presentation were correlated to changes in corneal parameters 18 months after CXL compared to that at presentation. Stage I, II, III and IV keratoconus were 13, 14, 2 and 16 eyes respectively. The study showed that the K max significantly declined (P = 0.05) while spherical equivalent refractive status changed from median −1.5D to −2.27D (P = 0.002). Meanwhile, Central corneal thickness significantly reduced (P = 0.001). Conclusion CXL can prove to be efficient in the treatment of Keratoconus and more studies should study ways to improve and implement this treatment plan to such patients., Highlights • Keratoconus prevalence has been increasing in Saudi Arabia and the world. • Studying treatment procedures of the disease is important to determine the best course of action. • Collagen Cross-Linkage Treatment is a treatment option that showed variation of success rate in the literature.

Background Galectin-3 is a new biomarker, which plays an important role in tissue inflammation, cardiac remodeling, and fibrosis. It can be readily measured in the circulation to detect early heart failure (HF). This study aimed to assess the value of galectin-3 assay in early diagnosis of children with heart failure secondary to congenital heart disease (CHD) and correlate it with the patients’ outcome. Methods This prospective cohort study included 75 children diagnosed to have CHD; {Group A: 45 CHD children with HF symptoms and reduced ejection fraction (REF) and Group B: 30 CHD children with no HF symptoms and normal ejection fraction (NEF)}. They were compared to 40 age- and sex-matched controls (Group C). Children with CHD undergone history taking, Ross HF classification, Echocardiographic assessment and laboratory investigations including serum galactin-3 level. Results Galectin-3 serum level increased in CHD children, and it showed significant increase in (Gp A) compared to Gp B or Gp C (p = ≤ 0.001). In addition, serum level of Galactin-3 was correlated positively with Ross classification (r = 0.68, p = 0.018) and negatively correlated to EF% (r= -0.61, p ≤ 0.001). Galactin-3 showed better diagnostic value than Ross HF classification in early diagnosis of HF in CHD children with a cut point (≥ 10.4), significantly had 96.7% sensitivity, 90% specificity, 91% positive predictive value, 93.2% negative predictive value, with area under the curve (AUC = 0.96) and 93% accuracy. While there was a significant correlation between Ross HF classification and HF outcome in (Gp A) children (p = 0.05), we did not find any significant correlation between serum galectin-3 level and HF mortality in same group (p = 0.08). Conclusions Galectin-3 assay is a promising marker for early diagnosis of HF in children with CHD; but it has no role in detecting HF mortality.

Background Data: Neuromuscular scoliosis (NS) causes disorders to the spinal cord, which affects the innervation and tone of the musculoskeletal system. NS can affect the quality of life by causing spinal deformity, sitting difficulties, and back pain. Progression of NS after skeletal maturity is common, and the incidence of surgery in NS is high. Whether posterior surgical strategy in the management of NS results in higher correction and fewer complications than other approaches, either anterior alone or combined, is a controversial issue. Study Design: Systematic review of the literature. Purpose: To determine if the management of NS via the posterior approach has better results and fewer complications or not. Methods: This study was conducted using the PubMed and Cochrane databases; it includes patients treated for NS deformity and the type of surgery, degree of correction achieved, and rate of complications were reported. Results: Our systematic review yielded 104 citations with 9 studies meeting the required criteria. Six studies focused on the comparisons of posterior-only approach (POA) and anteroposterior approach (APA) and three studies on POA only regarding postoperative outcomes and complications such as correction angle of scoliosis (Cobb's angle), pelvic obliquity, lordosis, kyphosis, amount of blood loss, hospital stay and ICU stay, and operative time. Conclusion: Posterior-only approach has the same results in correction of neuromuscular scoliosis deformity as anterior-posterior approach but with fewer complications. However, the anterior-posterior approach has more advantage in correcting severe rigid neuromuscular scoliosis. (2020ESJ215)

Foundation: The epilepsies are persistent neurological issues in which groups of nerve cells, or neurons, in the mind now and then sign strangely and cause seizures. During a seizure, numerous neurons fire (signal) simultaneously – upwards of 500 times each second, a lot quicker than ordinary. This flood of extreme electrical action occurring simultaneously causes automatic developments, sensations, feelings, and practices and the impermanent unsettling influence of typical neuronal action may cause lost mindfulness. Epilepsy influences patients, all things considered, races, and ethnic foundations. As indicated by the National Institute of Neurological Diseases and Stroke (NINDS), about 2.3 million grown-ups and in excess of 450,000 kids and teenagers in the United States have epilepsy. Point of the Work: to evaluate the mental comorbidity and personal satisfaction in patients with epilepsy through poll 30 patients at the Neurology Unit in Pediatric Department in Benha University.Patients and Methods: At the Neurology Unit, Pediatric Department, Benha University Hospitals, the variables adding to mental comorbidity in epilepsy and to survey the effect of mental co-grimness on personal satisfaction were resolved in 30 patients with epilepsy and 30 benchmark group . The essential end purpose of this investigation is to distinguish the mental comorbidity and personal satisfaction in patients with epilepsy and their effect on personal satisfaction. Results: there is huge distinction between the contemplated bunches with respect to the downturn and tension evaluations, where 86.7% of the controls had no downturn contrasted with 0% of the patients, while just 13.3 % of them had gentle evaluation contrasted with 43.3% of the patients. Then again, 30% and 26.7% of patients endured moderate and extreme sorrow individually contrasted with 0% of the controls. End: mental comorbidity has solid effect on personal satisfaction in persistent with epilepsy.

Background Chemoradiation therapy (CRT) has become a primary definitive treatment modality for head and neck squamous cell carcinoma (HNSCC); however, not all patients respond completely to treatment. Ability to identify those patients, who would not achieve complete response, before or early during the course of CRT will allow treatment modifications to improve outcome and overall survival. The aim of this prospective study was to assess the usefulness of diffusion-weighted imaging (DWI) in prediction of early therapeutic response of HNSCC after CRT. Results Local control was achieved in 22 patients out of 46 patients with pathologically proven HNSCC treated by chemoradiation therapy and local failure was detected in 24 patients out of 46 patients. Pretreatment mean apparent diffusion coefficient (ADCpre) was significantly higher in local failure group (1.1 ± 0.2 × 10−3 mm2/s) than local control group (0.89 ± 0.1 × 10−3 mm2/s). An optimal cut-off value of more than 0.94 × 10−3 mm2/s was predictive of local failure with sensitivity 83.33%, specificity 59.9%, PPV 69%, NPV 76.5%. Early intra-treatment percentage change of ADC (ΔADC) was significantly lower in local failure group (21.8% ± 21.3) than in local control group (45.2% ± 27.8). An optimal cut-off value of ≤ 33% was predictive of local failure after CRT with sensitivity of 71.34%, specificity of 60%, PPV of 62.5%, and NPV of 69.2%. Conclusions Diffusion-weighted MRI could be a potential predictive biomarker for therapeutic response of HNSCC to CRT. Primary tumors with higher pretreatment mean ADC, and a smaller early intratreatment percentage increase of mean ADC would be more likely to fail treatment.

Background The inferior nasal turbinates have important role in the maintenance of nasal breathing function by providing the nasal valve mechanism necessary for the regulation of air flow through the nose. Hypertrophied inferior nasal turbinates are the second most common cause of chronic nasal obstruction. Our aim of this study is to evaluate the morphological and histopathological features of hypertrophied inferior nasal turbinate in Egyptian patients. Methods Our descriptive comparative study was carried on 30 patients presented with hypertrophied inferior nasal turbinate by clinical and radiological assessment. Patients are divided into two groups according to CT scan and endoscopic examination as group A for patients with deviated nasal septum with compensatory hypertrophied inferior nasal turbinate and group B for patients with hypertrophied inferior nasal turbinate due to allergic rhinosinusitis. Both groups underwent the same operation which partial controlled posterior inferior turbinectomy. During the period from June 2018 till May 2019, patients were selected from out-patient’s clinic of Otorhinolaryngology Department at Menoufia University Hospital and Shebin El-Kom Teaching Hospital, and Military Hospital. Results By histopathological examination of the specimens, we found out that the bony layer thickness was more prominent in group A and the mucosal layer thickness was more prominent in group B. The prominent inflammatory cells were lymphocytes in group A and eosinophils plus mast cells in group B. Conclusion The bony layer thickness should be excised during the surgical treatment of cases presented with deviated nasal septum with hypertrophied inferior turbinate where in cases of allergic rhinitis with hypertrophied inferior turbinate, the mucosal layer is enough to be excised.