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Background: Deep sternal wound infection (DSWI) is a rare but potentially devastating complication of median sternotomy performed in cardiac surgery. The incidence of DSWI is reported to be between 0.2% and 3%. Identifying high-risk patients and strategies to optimize risk factors plays an important role in reducing the incidence of DSWI. Objective: This retrospective prospective study was designed to evaluate the management of deep median sternotomy wound infection after open heart surgery as regard the risk factors, rate and the outcome of its surgical treatment in Cardiothoracic Surgery Department, Mansoura University Hospital. Patients and methods: This retrospective prospective observational study was conducted in Cardiothoracic Surgery Department at Mansoura University Hospitals from January 2016 to December 2019. The data were obtained from 24 retrospective patient and 7 prospective patients. 31 patients had DSWI and treated surgically, the incidence was 2.9%. Results: We found that 16 (51.6%) patients were males and 15 (48.4 %) were females. The mean age was 58.23±7.898 (year), minimal age was 40 year and the maximal was 71 years. The mean BMI was 32.18 ±5.364. 14 (45.16%) of patients had diabetes mellitus (D.M). 18 (58.06%) patients were hypertensive. 10 (32.3%) patients were smokers. 51.6% of patients had coronary artery bypass graft (CABG). The most common causative organism was MRSA in 35% of patients. Conclusion: Using of vacuum and pectoral flap in DSWI management is more effective with better healing, higher success rate and less mortality.

Background: Keratoconus is a corneal ectatic disease characterized by progressive, non-inflammatory corneal disorder, which is characterized by thinning, protrusion of central or paracentral portion of the cornea resulting in irregular astigmatism, myopia, corneal scarring and reduction in visual acuity. The onset of the keratoconus usually occurs at puberty with the progression until the third to fourth decade of the life in most of the cases. Objective: To estimate the prevalence of keratoconus in Egyptian people who have corneal astigmatism using pentacam as an imaging device. Patients and Methods: A retrospective study was done at Al-Sayed Galal University Hospital in Ophthalmology outpatient clinics. The retrieved data revealed 80 eyes of 40 patients photographed during the period from June 2019 to December 2019 by using Scheimpflug imaging device (pentacam) as screening device for keratoconus. All such cases underwent a complete ophthalmic examination that includes visual acuity measurement, refraction, slit lamp biomicroscopy, retinoscopy, fundus examination and corneal topography (pentacam). Results: Mean age of our study cases was 26.55 ± 8 years, which included 22 (55%) males and 18 (45%) females. Cases with KC have higher keratometric corneal values (k1, k2, kmax) and thinner pachymetric values than normal astigmatic eyes. Conclusion: The higher the astigmatism was the higher risk to have keratoconus. Cases with astigmatism ≥ 1.5D who present to outpatient clinics, should undergo corneal topography screening for early diagnosis of KC even if visual acuity is not affected. Pentacam may provide more accurate information about anterior and posterior corneal anatomy especially in suspected eyes.

Tourniquet is a well-established model of hind limb ischemia–reperfusion (HLI/R) in rats. Nevertheless, measures should be taken to alleviate the expected injury from ischemia/ reperfusion (I/R). In the present study, 30 adult male Sprague-Dawley rats were randomly divided into 5 groups (n = 6): control, HLI/R, HLI/R given candesartan (1 mg/kg, P.O); HLI/R given Coenzyme Q10 (CoQ10) (10 mg/kg, P.O); HLI/R given candesartan (0.5 mg/kg) and CoQ10 (5 mg/kg). The drugs were administered for 7 days starting one hour after reperfusion. Candesartan and CoQ10 as well as their combination suppressed gastrocnemius content of angiotensin II while they raised angiotensin-converting enzyme 2 (ACE2) activity, angiotensin (1–7) expression, and Mas receptor mRNA level. Consequently, candesartan and/or CoQ10 reversed the oxidative stress and inflammatory changes that occurred following HLI/R as demonstrated by the rise of SOD activity and the decline of MDA, TNF-α, and IL-6 skeletal muscle content. Additionally, candesartan and/or CoQ10 diminished gastrocnemius active caspase-3 level and phospho-p38 MAPK protein expression. Our study proved that CoQ10 enhanced the beneficial effect of candesartan in a model of tourniquet-induced HLI/R by affecting classical and non-classical renin-angiotensin system (RAS) pathway. To our knowledge, this is the first study showing the impact of CoQ10 on skeletal muscle RAS in rats.

Background: Both superficial tinea and pityriasis versicolor are very popular fungal skin infections that affect people all over the world. Recent research suggests that certain antimi-crobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The purpose of the current research would be to investigate the tissue expression of b2-defensin mRNA in lesions of tinea versicolor and lesions of tinea circinata and hence studying its role in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls were included in this case control study. For real-time PCR (RT-PCR) gene expression of b2-defensin mRNA, a punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as normal skin from a control. Results: b2 defensin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA b2 defensin in tinea versicolor and tinea circinata (p-value

Background: Fungal skin infections such as superficial tinea and pityriasis versicolor are very common and affect people all over the world. Recent research suggests that certain antimicrobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The aim of this research is to look at the tissue expression of Cathelicidin mRNA in tinea versicolor and tinea circinata skin lesions to learn more about its function in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls partic-ipated in this case-control study. A punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as the control's normal skin, for real time PCR (RT-PCR) gene expression of cathelicidin mRNA. Results: Cathelicidin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA cathelicidin in both diseases (p-value

The prevalence of antibiotic resistance has considerably increased and as a result, the elimination pace of Helicobacter pylori (H.pylori) infection have decreased significantly to an unacceptable level. High dose dual therapy (HDDT) has been suggested as an alternative to standard triple therapy (TT) for the first-line treatment of H. pylori infection. The aim of the present work was to compare the effectiveness and tolerability of HDDT with standard TT, for treatment of H. pylori infection. This randomized parallel interventional study was carried out on 130 treatment naïve H. pylori infected patients, selected from outpatient clinic of Hepatology and Gastroenterology department of Zagazig University Hospitals, in the duration between November 2017 and December 2018. All patients were H. pylori positive as was evidenced by stool antigen test. Patients were divided into two groups; group A (n=65) received a 14-day HDDT (esomeprazole 40 mg twice daily and amoxicillin 1 g three times daily) whereas group B (n=65) received a 14-day TT (esomeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg, each administered twice daily). Eradication rates, side effects and drug compliance were compared among both groups. The eradication rate between the two regimens was not significantly different. The eradication rates were 80% for TT and 72.3% for HDDT (P= 0.3). No significant differences were observed between both groups regarding the side effects or patient adherence. HDDT is as effective and safe as TT as empiric first-line therapy for H pylori infection.

Objective: Neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) are markers of different neurological disorders. The aim was to investigate the relationship between NSE and S100B serum concentrations and the severity of diabetic ketoacidosis (DKA) in diabetic children. Methods: Eighty children with DKA, 40 with type 1 diabetes mellitus (T1DM) without DKA and 40 healthy controls were enrolled. Severity of DKA was assessed according to blood pH and bicarbonate concentration. Serum NSE and S100B were measured in all participants. In the DKA group serum NSE and S100B were measured at three time points, at admission and at 12 hours and 24 hours after starting treatment. Results: Children with DKA showed significantly higher serum levels of NSE at all time points compared to children with T1DM without DKA and controls (p0.05). Younger age, lower GCSS, higher glucose and HbA1c, lower pH and lower serum bicarbonate were the risk factors associated with elevated NSE. Conclusion: Serum NSE is elevated in all patients with type 1 DM and, in patients with DKA, correlates with severity of DKA. However, serum S100B concentration did not differ between T1DM with or without DKA and healthy controls.

Background Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders affecting females in their reproductive age. In PCOS, an imbalance between androgens, anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH), cause a halt of follicular growth. Insulin resistance (IR) is another important component of PCOS. There is increasing evidence that vitamin D affects insulin and glucose metabolism, Vitamin D plays a vital role in the regulation of glucose-insulin homeostasis. Objectives to assess the efficacy of vitamin D supplementation in improving ovulation induction in PCOS women (1ry outcome) and increasing pregnancy rate (secondary outcome). Patients and Methods 120 women diagnosed PCOS according to Rotterdam criteria and were resistant to CC treatment were randomly allocated into equal two groups: Group V: number of 60 patients received cholecalciferol + Metformin for 2 months. Group C: 60 patients received Metformin 2 months. After two months from the start:Both study groups started induction with Clomiphene Citrate added every month starting from the 3rd month to the 5th month (3 cycles of ovulation induction) in addition to previous drugs mentioned. Results In our study results, regulation of menstrual cycle occured in 63.6% of women who recieved vitamin D + metformin (group V) and ovulation was confirmed in 34.5% of the total number (55 women). Later, 18% of them got pregnant after 3 months of treatment. Added to that 16 women out of 39 (41%) got pregnant by the end of the follow up period with cumulative pregnancy rate (53%). On the other hand menstrual regularity in (group C: metformin) recorded 61% with ovulation percentage of 26.9% (n = 54). Followed by 14.8% pregnancy rate at the 3rd month., which increased to 27.5% by the end of the study out of 47.5% ovulated women (n = 40). Cumulative pregnancy rate 40%. Conclusion From the current study we can conclude that there is no significant difference of adding vitamin D to CC resistant PCOS regarding ovulation and pregnancy rates. However, it can augment metformin action and improves its outcome.

Background Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair. Results There was a significant improvement in the measured variables for both groups after treatment. The post-treatment results of the two groups of grasping and visual motor integration for age equivalent scores revealed significant difference (p=0.008 and p=0.011 respectively) in favor of the experimental group. Conclusions Therapy ball could be used as a seat alternative to using typical chair to facilitate visual motor integration and grasping in the children with hemiparetic cerebral palsy.

Background In children with spastic diplegia, efficient use of the upper extremity especially the hands play an important role in participation in daily living. Hands can perform heavy activities and also enable to perform extremely gentle, skillful, and precise activities. Inadequate hand strength and fine motor skills may lead to functional limitations. This study was planned to investigate the pinch grip strength and fine manual control in children with spastic diplegic cerebral palsy and to determine if there is a relation between them. Thirty children with diplegic cerebral palsy and 30 normal developed children from both sexes between 5 and 10 years old were included in this study as diplegic and control groups. For all children, pinch grip strength measured by Baseline Mechanical Pinch Gauge and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition used to evaluate fine manual control. Results Children with diplegic cerebral palsy have significant impairment in the pinch grip strength (tip, tripod, and key) and the fine manual control (fine motor precision and integration) compared to their healthy peers of the same age. There was large positive significant correlation (r > 0.5, p < 0.05) between tip and tripod pinch strength, and fine motor precision and medium positive significant correlation (r = 0.47, p < 0.05) between key pinch and fine motor precision in children with spastic diplegia. Also, there was large positive significant correlation between tip pinch and fine motor integration (r = 0.54, p < 0.05). The correlations are small and medium positive between tripod and key pinch strength, and fine motor integration respectively but they are not statistically significant. Conclusions Pinch grip strength and fine manual skills are affected in children with spastic diplegia. Also, there is a significant correlation between the pinch strength and activities require precise control of the hand.

Background: Diabetes mellitus (DM) is a chronic disease characterized by insulin deficiency or its peripheral resistance resulting in hyperglycemia and non-enzymatic glycation of protein.The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. MicroRNAs (miRNAs) are a class of highly conserved 19–25 nucleotide noncoding RNAs that regulate gene expression. Objective:This study aimed to assess plasma miR-27b expression in diabetic retinopathy patients as an early diagnostic parameter in both proliferative and non-proliferative and to assess the correlation between plasma levels of miR-27b with the clinico-pathological parameters of diabetic patients as well as determination of the level of thrombospondin-1 (TSP1). Patients and Methods: This study was conducted on 60 diabetic retinopathy Egyptian patients that were recruited from the Research Institute of Ophthalmology - RIO (Medical Retina Clinics) during their routine screening for diabetic retinopathy. Results: Micro RNA 27b shows a highly significant difference (increase) among PDR compared to non-PDR & control groups (P value: 0.001) and shows a moderately significant increase in expression in PDR group compared to control group (P value: 0.01). This significant increase in microRNA between PDR group and control group has the ability of being a non-invasive biomarker for diagnosis of PDR versus control group, as miRNA-27b expression showed AUC = 0.889 with (95% CI 0.744–1.000). The best cut-off point of miRNA-27b is 1.95 with 88.9% sensitivity & 100% specificity and the p value

Background: The transparent cornea forms the anterior portion of the outer casing of the eye and has the dual functions of protecting the inner contents of the eye as well as providing about two thirds of the eye's refractive power. Objectives: The purpose of this study was to evaluate the correlations between central corneal thickness and degree of hyperopia in adult populations. Patients and Methods: This was a prospective cross-sectional, observational study conducted in Ophthalmology Department, Al-Azhar University Hospitals, were divided equally into two groups according to their ages : Group 1 included patients with age range from 20-37, and group 2 consisted of patients aged 42-56. Each group contained 15 males and 15 females. Approval of Al-Azhar University ethics committee was obtained for the study. The nature and methodology involved in the study were explained to the patient and informed consent were obtained. Results: The results of the current study showed that the range of central corneal thickness (CCT) in group 1 was 512-631 um with mean ± SD of 570.87 ± 25.31. In group 2, CCT ranged from 530 to 694 um with mean ± SD of 567.37 ± 30.89. In addition, there was no significant correlation between CCT and age in either group. The present study delineated that the mean ± SD of refraction of both groups was 3.91 ± 1.20 and 3.17 ± 1.01 respectively. The median of cylinder in both groups was -1.5 and -1 respectively, and the median of axis was 75 and 92.5 respectively. Significant association between CCT and refraction could not be noticed in both groups besides the non-significant association between CCT with either cylinder or axis in them. Conclusion: Among adult subject with age range 20-60, central corneal thickness did not correlate with age change. Degree of hyperopia did not affect central corneal thickness of adult subjects. Central corneal thickness did not correlate with degree of intraocular pressure in hyperopic adults with normal IOP.

Though soybean isoflavones (SBI) have pharmaceutical properties, the compounds also have endocrine disrupting activities that may adversely affect fertility of mammals. The effects of SBI on metabolism, antioxidant capacity, hormonal balance and reproductive performance of male rabbits were investigated. Adult male rabbits (n = 21) fed an isoflavone-free diet were orally treated with 0 (control; CON), 5 (small; LSBI) or 20 (large; HSBI) mg of SBI/kg body weight/day for 12 weeks. Both SBI doses resulted in lesser blood plasma total protein concentrations, while there were no effects on glucose and cholesterol concentrations compared to CON. The HSBI-treated males had the greatest (P 0.05) blood plasma total antioxidant capacity and least malondialdehyde. Treatment with both SBI doses induced a 43% increase in triiodothyronine concentrations (P0.05) and 82% in reaction times (P 0.001), while decreased sperm concentrations (P = 0.01) and blood plasma testosterone concentrations (P = 0.017) 26% and 19%, respectively. The total functional sperm fraction was less (P 0.05) in the HSBI group; however, there was no effect of the LSBI treatment as compared to values for the CON group. The kindling rates of females mated to HSBI-treated males tended to be less (P = 0.081) than those of does mated with LSBI or CON males. In conclusion, only the HSBI treatment improved antioxidant status; whereas, treatment with both LSBI and HSBI doses induced a hormonal imbalance which led to an impaired testis function indicating the sensitivity of the adult male reproductive system to SBI actions.

Background: Attention-deficit hyperactivity disorder (ADHD) is a common disorder in children, but its etiology and pathogenesis are still unclear. Aims: The aims of this study were to measure the level of serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) as markers of immune system involvement in children with ADHD, and to study their correlation with symptoms severity of ADHD. Materials and Methods: The study was conducted on 80 children diagnosed as ADHD based on the criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Eighty healthy children of matched age and sex served as a control group. All children enrolled in the study were subjected to history taking, clinical examination, and psychometric tests. Assay for serum IL-6 and TNF-α for all patients and controls was performed using enzyme-linked immunosorbent assay. Results: The mean serum level of IL-6 was 26.11 ± 11.14 and 6.23 ± 2.52 in children with ADHD and controls, respectively. Children with ADHD showed significantly higher serum IL-6 levels than the control group (P = 0.001). Serum IL-6 showed no significant correlation with the intelligence quotient (IQ) or the Abbreviated Conners’ Rating Scale scores for parents. However, TNF-α showed no significant differences between the two groups and no significant correlation with the IQ or the Abbreviated Conners’ Rating Scale scores for parents. Conclusion: Serum IL-6 levels were significantly higher in children with ADHD compared to controls; however, the IL-6 levels did not correlate with ADHD symptoms severity. Increased IL-6 levels may contribute to the etiology of ADHD.

Background The aim of our work was to compare the myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) as a non-invasive, relatively non-expensive test versus the instantaneous wave-free ratio (IFR) for the evaluation of functional significance of the borderline coronary artery lesions in the view of results of fractional flow reserve (FFR) which is considered the gold standard reference test. Results Our study was conducted in the Cardiology Department. It included 50 patients with borderline coronary artery lesions; they underwent physiological evaluation by stress/rest myocardial perfusion imaging using followed by an invasive physiological assessment by Instantaneous wave-free ratio (IFR) and Fractional flow reserve (FFR). Finally, the results of both SPECT MPI and IFR were compared to FFR as a gold standard reference. There was a strong (kappa = 0.754) significant (P value < 0.001) agreement between the MPI results and FFR results and the overall agreement was 88%. The sensitivity of the MPI was 81.8%, the specificity was 92.9%, the positive predictive value was 90%, the negative predictive value was 86.7%, the positive likelihood ratio was 11.45, and the negative likelihood ratio was 0.20. There was a strong (kappa = 0.918) significant (P value < 0.001) agreement between the IFR results and FFR results and the overall agreement was 96%. The sensitivity of the IFR was 90.9%, the specificity was 100%, the positive predictive value was 100 %, the negative predictive value was 93.3%, and the negative likelihood ratio was 0.09. Conclusions The instantaneous wave-free ratio (IFR) may be a valid alternative to fractional flow reserve to assess the functional significance of intermediate coronary lesions. The myocardial perfusion imaging may be an alternative, non-invasive, relatively non-expensive test for the evaluation of the physiological significance of intermediate coronary lesions.

AIM: The current study was designed to investigate the effectiveness of locally applied Strontium ranelate to induce bone formation.MATERIALS AND METHODS: Forty-eight female rats were divided into six groups (eight rats in each group): The three test groups included Strontium (SR) 2.5 mg, 5 mg and 10 mg that was dissolved in methylcellulose gel. The control groups included methylcellulose, simvastatin 5 mg and a negative control where the defect was left to heal without any intervention. At 44 days the groups were sacrificed, and the bone defects were assessed histomorphometically to assess bone formation. The data was statistically analysed.RESULTS: There was a statistically significant difference in the amount of new bone formation between all groups, where the 2.5 mg SR group showed the highest median bone percentage, is 41.95 %, followed by the 5, and 10 mg SR demonstrating a median bone are a percentage of 39.89%, and 30.19% respectively. Simvastatin showed a median bone percentage of 36.07 %, while the methylcellulose and the negative control groups demonstrated the lowest median area percentage of 23.12 and 20.70 % respectively.CONCLUSIONS: The study showed that the local application of an SR could up-regulate the bone formation and may prove to be a cost-effective method of bone regeneration.

This study aimed to evaluate the effectiveness of hormonal treatments on ovarian activity and reproductive performance in Barki and Rahmani ewes during non-breeding season. Forty-eight multiparous ewes, 24 Barki and 24 Rahmani ewes were divided into two groups, 12 lactating and 12 dry ewes for each breed. Controlled internal drug release (CIDR) device was inserted in all ewes for 14 days in conjunction with intramuscular 500 IU equine chronic gonadotrophin (eCG) at day of CIDR removal. Data were analysed using PROC MIXED of SAS for repeated measures. Breed, physiological status and days were used as fixed effects and individual ewes as random effects. Barki ewes recorded higher (p < .05) total number of follicles, number of large follicles, serum estradiol concentration and estradiol: progesterone (E2 :P4 ) ratio compared to Rahmani ewes. Lactating ewes recorded higher (p < .05) number of small follicles and lower concentration of total antioxidant capacity (TAC) compared to dry ewes. Number and diameter of large follicles recorded the highest (p < .05) values accompanied with disappearance of corpora lutea at day of mating. Serum progesterone concentration recorded lower (p < .05) value at day of mating and the highest (p < .05) value at day 35 after mating. CIDR-eCG protocol induced 100% oestrous behaviour in both breeds, but Rahmani ewes recorded longer (p < .05) oestrous duration compared to Barki. Conception failure was higher (p < .05) in Barki compared to Rahmani ewes. In conclusion, CIDR-eCG protocol was more potent in improving ovarian activity in Barki compared to Rahmani ewes, but this protocol seems to induce hormonal imbalance in Barki ewes that resulted in increasing conception failure compared to Rahmani ewes.

The objective of this study was to compare the efficiency of hormonal treatments on ovarian activity and reproductive performance in anestrous Anglo-Nubian does during the nonbreeding season (February to May). A total of 48 multiparous does were divided into 2 groups (24 lactating does and 24 dry does). In each group, animals were allocated randomly into 2 equal subgroups (12 does each). In the first subgroup, does received a single 18-mg melatonin implant for 42 d followed by a controlled internal drug release (CIDR) device for 19 d in conjunction with 500 IU of equine chorionic gonadotropin (eCG) i.m. on the day of CIDR device removal. The second subgroup received CIDR combined with eCG in parallel with the first subgroup. Melatonin implantation induced a luteotrophic effect, expressed as an increasing number of corpora lutea, increased serum progesterone concentration, and reduced estradiol concentration. Regardless of treatment, dry does showed greater value of progesterone concentration. With the advancement of day of treatment, number of total follicles, small follicles, and medium follicles tended to increase to the greatest values at the day of CIDR device insertion. Furthermore, at day of mating, the numbers of large follicles reached the greatest value, which was associated with the lowest value of the number of corpora lutea. At day of mating, serum progesterone concentration achieved the lowest value, which increased until d 56 of pregnancy. The estradiol:progesterone ratio showed the opposite trend. The detrimental effect of reproductive seasonality, expressed as cessation of estrus behavior and fertile mating during the nonbreeding season, was successfully alleviated by the CIDR-eCG protocol. Furthermore, melatonin implantation in conjunction with the CIDR-eCG protocol enhanced conception rate and fecundity at d 28 of pregnancy and prolificacy at d 56 of pregnancy compared with does that were not implanted. Interestingly, does that failed to conceive did not come to heat again. In conclusion, the beneficial effect of melatonin implantation in conjunction with the CIDR-eCG protocol on the luteotrophic effect was reflected in the increasing number of corpora lutea, increasing progesterone concentration, and decreasing estradiol concentration. Furthermore, conception rate, prolificacy, and fecundity were improved compared with does that were not implanted during the nonbreeding season.

The effect of a flushing diet supplemented with calcium salts of fatty acids (CSFA) high in palmitic (37%) and oleic (33.6%) fatty acids on reproductive performance was studied using 30 Barki ewes with a mean weight of 40.0 ± 0.2 kg (mean ± SD). The control group (n = 15) received the basic diet of 1 kg/h/d concentrate plus Egyptian clover ( Trifolium alexandrinum ) hay ad lib and the CSFA group received the basic diet plus 50 g/h/d CFSA. The diets were offered for 60 days, prior to (30 d) and subsequent (30 d) to mating. Estrus was synchronized using a single injection of PGF 2α prior to the introduction of rams. CSFA-fed ewes had non-significantly different twinning (20.0 vs. 7.1%), prolificacy (1.2 ± 0.1 vs. 1.0 ± 0.1) and female: male lamb sex ratio (72.2 vs. 50.0%) compared to controls; also, pregnancy, embryo survival and lambing rates were not affected by diet. Feeding CSFA resulted in a higher ( P = 0.06) total number of follicles and number of large follicles; however, the number of small follicles, and diameters of small and large follicles were not significantly different. Serum concentrations of estrogen at estrus were higher ( P = 0.06) 3 days after PGF 2α administration in CSFA (52.3 ± 4.2 pg/ml) compared to for control (41.6 ± 3.8 pg/ml) ewes. There were no significant differences in total number of corpora lutea (CL) or serum concentrations of progesterone during the luteal phase. Diameters of nascent CL were increased ( P P

The EMHJ was established in 1995 to provide a peer-reviewed platform for health professionals to share their research with the scientific community. The objective of this review was to examine EMR public health research trends, as reflected by EMHJ publications in 20 years (1995-2014), through secondary data analysis. Published articles were categorized according to EMR strategic priority areas (93%), i.e. health systems strengthening (25%); reproductive and child health (22%); communicable diseases (26%); noncommunicable diseases (25%); emergency preparedness (1.5%). Most papers were original research articles (85 %), published in English (94 %), but just over half (52 %) mentioned obtaining a form of ethical clearance in the text. Six countries had each over 100 papers published during the study period, i.e. Iran, Egypt, Saudi Arabia, Jordan, Iraq, Pakistan. Half EMHJ publications during this period came from 4 countries only (Iran, Egypt, Saudi Arabia, Jordan), which calls for further study to evaluate why other EMR nations are less well represented and how to encourage greater contribution from them over the coming years.المجلة الصحية لشرق المتوسط: لمحة عامة عن المجلة خلال عشرين عامًا (1995 – 2014).أحمد منديل، فيونا كيرليت، حاتم نور الدين، نادية أبوصالح، محمد سليمان.تأسَّست المجلة الصحيّة لرق المتوسط في عام 1995 لتكون منراً مراجعاً من قِبَل النظراء، للمهنيّن الصحيّن كي يشاركوا أبحاثهم مع الأوساط العلميّة. ولقد هدفت هذه الدراسة فحص اتجاهات الصحة العامة في إقليم شرق المتوسط، والتي أبرزتها الأعداد الصادرة عن المجلة طيلة عقدَيْن كاملَنْ (1995-2014)، من خال التحليل الثانوي للبيانات. وقد بلغت نسبة الأبحاث المنشورة وفقاً للمجالات الاسراتيجية ذات الأولوية في إقليم شرق المتوسط (% 93)، واشتملت عى: تقوية النُّظُم الصحيّة (% 25)؛ والصحة الإنجابية وصحة الطفل (% 22)؛ والأمراض السارية (% 26)؛ والأمراض غر السارية (% 25)؛ والتأهُّب للطوارئ (% 1.5). وكانت معظم الأبحاث المنشورة عبارة عن مواد بحوث أصليّة (% 85) نُرَت باللغة الإنجليزية (% 94). وقد نُر لستة بلدان أكثر من 100 ورقة بحثيّة، كلٌ عى حدة، أثناء فرة الدراسة، وهي الأردن، وباكستان، وجمهورية إيران الإسامية، والعراق، ومر، والمملكة العربية السعودية. وخال تلك الفرة، وُجِدَ أن نصف منشورات المجلة الصحية لرق المتوسط من 4 بلدان فقط (هي: الأردن، وجمهورية إيران الإسامية، ومر، والمملكة العربية السعودية)، ما يدعو إلى إجراء مزيد من الدراسة بُغْيَة تقييم السّبَب وراء انخفاض مشاركة بقية بلدان إقليم شرق المتوسط في المجلة، وبيان السبيل لتشجيعها عى زيادة مساهماتها عى مدى السنوات المقبلة.La Revue de la Santé dans la Méditerranée orientale : survol de 20 années (1995–2014).La Revue de Santé de la Méditerranée orientale a été créée en 1995 afin de servir de plateforme avec examen collégial où les professionnels de la santé peuvent partager leurs travaux de recherche avec la communauté scientifique. L’objectif de la présente étude était d’examiner les tendances de recherche en santé publique dans la Région de la Méditerranée orientale, telles que reflétées par les publications de la Revue sur 20 ans (1995-2014), au moyen d’une analyse des données secondaires. Les articles publiés ont été catégorisés selon les domaines de priorités stratégiques de la Région de la Méditerranée orientale (93 %), à savoir le renforcement des systèmes de santé (25 %), la santé génésique et infantile (22 %), les maladies transmissibles (26 %), les maladies non transmissibles (25 %), et la préparation aux situations d’urgence (1,5 %). La plupart des publications étaient des articles de recherche originaux (85 %) publiés en anglais (94 %), mais seulement un peu plus de la moitié (52 %) ont mentionné avoir obtenu une forme d’approbation éthique dans le texte. Six pays ont publié plus de 100 articles chacun au cours de la période étudiée (Arabie saoudite, Égypte, République islamique d’Iran, Jordanie, Iraq, Pakistan). La moitié des publications de la Revue durant cette période ont été produites par quatre pays (l’Arabie saoudite, l’Égypte, la République islamique d’Iran et la Jordanie). Il serait donc intéressant d’étudier les raisons pour lesquelles d’autres pays de la Région de la Méditerranée orientale sont moins représentés, ainsi que la façon de les encourager à contribuer davantage dans les années à venir.

This study was conducted to investigate effects of supplementing two doses of quebracho tannins (QT; 100 or 200 g/cow/d; QT100 or QT200) pre and post parturition to thirty Holstein dairy cows on Dry Matter Intake (DMI), milk yield and composition, blood metabolites and reproductive performance for 12 weeks. There were no significant changes in DMI due to QT at transition period of dairy cows. QT supplementation at either level decreased (P 0.05) the total number of ovarian follicles, number of large follicles, diameter of largest follicle, number of small follicles, number and diameter of corpus luteum, and progesterone concentration. The inclusion of QT increased days open and number of services per conception, which consequently decreased conception rate, compared to the control cows. QT100 decreased (P < 0.05) serum total protein, globulin, glucose and triglycerides concentrations as compared with their values in control cows. Thus, the supplementation of commercial QT to dairy cows at their transition period had negative impacts on productive and reproductive performance.

Background: The role of nutrients and dietary factors in attention-deficit hyperactivity disorder (ADHD) remains unclear. Objectives: The primary objective was to evaluate the serum vitamin D level in children with a diagnosis of ADHD. The secondary objective was to detect the effect of vitamin D supplementation on cognitive function in those with vitamin D deficiency. Methods: A total of 50 children with ADHD and 40 healthy controls were included in the study. We measured the serum level of vitamin D. Patients with vitamin D deficiency were subdivided into 2 groups: one with vitamin D supplementation and the other without vitamin D supplementation. Further assessment and follow-up of children with ADHD was done. The Wisconsin Card Sorting Test, Conners’ Parent Rating Scale, and Wechsler Intelligence Scale for Children were performed at baseline and follow-up in all cohorts with an ADHD diagnosis. Results: The diagnosis of vitamin D deficiency was significantly greater in children with ADHD compared with the control group ( P < 0.05). Children with ADHD had significantly ( P = 0.0009) lower values of serum vitamin D (17.23 ± 8.98) than the control group(31.47 ± 14.42). The group receiving vitamin D supplementation demonstrated improvement in cognitive function in the conceptual level, inattention, opposition, hyperactivity, and impulsivity domains. Conclusion: Vitamin D supplementation in children with ADHD may improve cognitive function.

To assess the diagnostic accuracy of three-dimensional (3D) ultrasound measurements of fetal adrenal gland volume (AGV) and fetal zone enlargement (FZE) as predictors of PTB compared to measurements of cervical length (CL) and cervicovaginal fetal fibronectin (CVFF). This prospective study included women presenting at 28–36 weeks of gestation with threatened preterm labor (TPL). Fetal AGV and FZE were measured using 3D ultrasound. Two-dimensional (2D) ultrasound was used to measure the CL. The AGV was corrected for the ultrasound-estimated fetal weight (cAGV). Qualitative CVFF detection was also performed. The diagnostic accuracy of cAGV, FZE, CL, and CVFF was compared considering preterm birth (PTB) within 7 days of recruitment as the main outcome measure. Seventy-five pregnant women were included in the final statistical analysis. Twenty-seven women (36 %) delivered within 7 days. cAGV and FZE had the highest sensitivities and specificities to predict PTB within 7 days when compared with CL and CVFF. Multivariate analysis, including cAGV, FZE, CL, and CVFF, revealed that cAGV and FZE were independent predictors of PTB within 7 days in the study participants. In women who presented at 28–36 weeks of gestation with TPL, cAGV and FZE can be used as independent predictors of PTB.

This study was designed to evaluate the effect of GnRH treatment during different times of the reproductive cycle on ovarian activity, progesterone (P4) concentration, and subsequent fertility of low-prolific, subtropical, Rahmani ewes during breeding season. Forty-five ewes were synchronized for estrus using a double injection of 0.5 mL of PGF2α agonist (125-μg cloprostenol), 11 days apart. Ewes showing estrus (Day 0) were treated with 1 mL of GnRH agonist (4-μg buserelin) on the day of estrus (GnRH0, n = 12) or 7 days post-mating (GnRH7, n = 10) or on both days (GnRH0+7, n = 11) or not (control, n = 12). Ovarian response to the treatment and diagnosis of pregnancy were ultrasonographically monitored. Also, serum P4 concentration was determined weekly throughout 28 days post-mating. Results showed that neither total number of follicles nor their populations were changed on Day 0 or 7 days post-mating by the GnRH treatment. GnRH treatment on Day 0 or Day 7 post-mating or both days did not enhance ovulation rate compared with the control. The mean numbers of accessory CL increased (P0.05) in the GnRH7 group than those in the control and GnRH0 groups, whereas it was intermediate in the GnRH0+7 group. The greatest (P0.05) overall mean of serum P4 concentration was for the GnRH7 and GnRH0+7 groups, followed by the GnRH0 and control groups. Serum P4 concentration increased (P0.05) on Day 14 post-mating and continued higher (P0.05) until Day 28 post-mating in the GnRH7 and GnRH0+7 groups compared with the control. Regardless of the time of GnRH administration, GnRH treatment reduced (P0.05) pregnancy loss from Day 40 post-mating to parturition and tended to enhance (P0.20) lambing rate compared with the control. In conclusion, a single dose of GnRH at the time of estrus or 7 days post-mating could be used as an effective protocol to decrease pregnancy loss from Day 40 after mating to parturition in low-prolific Rahmani ewes.

Introduction: Acne Vulgaris (AV) is a common inflammatory disease of pilosebaceous units. Liver X Receptor-α (LXR-α) is a ligand activated transcription factor. It controls transcription of genes involved in lipid and fatty acid synthesis. Cyclooxygenase 2 (COX2) is a rate limiting enzyme in prostaglandin synthesis. It plays important role in inflammation. Aim: To evaluate the immunohistochemical expression of LXR-α and COX2 in acne vulgaris skin biopsies to explore their possible pathogenic role in this disease. Materials and Methods: Sixty five subjects were included (45 cases with AV and 20 age and gender-matched healthy controls). Skin biopsies were taken from lesional and perilesional skin of cases and from site-matched areas of control subjects. The evaluation of LXR-α and COX2 was done using immunohistochemical technique. Data were collected, tabulated and statistically analysed using a personal computer with “(SPSS) version 11” program. Chi-square test was used to study the association between qualitative variables. Mann– Whitney test was used for comparison between quantitative variables. Student’s t-test was used for comparison between two groups having quantitative variables. Spearman’s coefficient was used to study the correlation between two different variables. Differences were considered statistically significant with p

The effects of inclusion of different sources of dietary phytoestrogens on antioxidant capacity, hormonal balance, libido, semen quality, and fertility of rabbit bucks were studied. Twenty-one, adult, fertile, V-line bucks were randomly allocated into 3 homogenous groups (n = 7/treatment) and received control diet (phytoestrogens-free diet, CON) or soybean meal isoflavones-containing diet (SMI) or linseed meal lignans-containing diet (LML) for 12 wk. The diets were formulated to be isocaloric and isonitrogenous. The concentrations of isoflavones in the SMI diet were 24.04 mg/100 g dry matter (DM) daidzein and 13.10 mg/100 g DM genistein. The major phytoestrogen detected in the LML diet was secoisolariciresinol (36.80 mg/100 g DM). Treatment had no effects on body weight, feed intake and rectal temperature of bucks. Compared with control, bucks fed the SMI and LML diets had higher (P0.001) blood plasma total antioxidant capacity (0.98 ± 0.12, 1.50 ± 0.13, and 2.29 ± 0.17 mM/L for CON, SMI, and LML, respectively), and lower (P 0.01) blood plasma malondialdehyde (2.76 ± 0.23, 1.76 ± 0.16, and 1.70 ± 0.18 nmol/mL for CON, SMI, and LML, respectively), whereas activities of reduced glutathione and superoxide dismutase (SOD) enzymes were not affected. Bucks fed the SMI and LML diets had greater (P0.001) concentrations of blood plasma triiodothyronine. Feeding the SMI and LML diets decreased (P0.01) libido (8.26 ± 0.71, 12.18 ± 0.97, and 14.12 ± 1.12 s for CON, SMI, and LML, respectively), sperm concentration (327.7 ± 21.6, 265.8 ± 36.8, and 226.5 ± 20.1 × 10

The study aims to evaluate the clinical significance of serum levels of tumor necrosis factor alpha (TNF-α) and -308 A/G promoter polymorphism in juvenile idiopathic arthritis (JIA) patients and find any association to the subsets, clinical and laboratory features, disease activity, and damage as well as functional disability. Forty-eight JIA children and 30 controls were included in the present study. Juvenile arthritis disease activity score in 27 joints (JADAS-27) was calculated, juvenile arthritis damage index (JADI) was assessed, and Childhood Health Assessment Questionnaire (CHAQ) measured the functional status. Serum TNF-α was assayed by ELISA and gene (-308) promoter polymorphism was determined by polymerase chain reaction. The 48 JIA children (mean age 11.5 ± 2.8 years) were 13 systemic, 17 oligoarticular, and 18 polyarticular onset. The serum TNF-α was significantly higher in patients (90.4 ± 6.3 ng/ml) compared to control (3.5 ± 2.6 ng/ml) (p

Background: The diagnosis of systemic lupus erythematosus (SLE) in children is challenging. The heterogeneous manifestations and disease impact on the child’s growth highlight the importance of timely diagnosis and management. Objective: The aim of the work was to assess and compare the clinical characteristics, disease activity and damage between children with juvenile SLE (JSLE) and adult patients with juvenile-onset (JO-SLE). Patients and methods: 78 SLE patients; 26 children (JSLE) and 52 JO-SLE adults were included in this study. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI) and organ damage using the Systemic Lupus International Collaborating Clinics (SLICC) index. Results: The mean age of the JSLE children was 13.25 ± 2.09 years and 23.17 ± 4.26 years for JO-SLE cases. Age at disease-onset and female gender tended to be higher in JO-SLE cases than in children with JSLE. There was a significantly higher frequency of serositis, nephritis and hematological involvement in the JO-SLE (57.7%, 76.9%, 73.1%, respectively) compared to the JSLE cases (15.4%, 30.8%, 30.8%, respectively) (p

Objectives To describe the incidence, clinical characteristics, microbiological profile and in-hospital outcome of infective endocarditis (IE) in our center. Methods A prospective study that was conducted on 50 consecutive patients admitted to our cardiology department diagnosed as Duke definite IE. The study was conducted for a period of one year and started on the 1st of September 2009 till the end of August 2010. All patients were subjected to detailed history taking, clinical examination, blood culture and echocardiography. Results The study was carried out on 29 males (58%) and 21 females (42%) with a mean age of 33 years. The mean duration of delay from onset of symptoms till diagnosis was 54 days. Native valve endocarditis was found in 34 patients (68%). Blood cultures were positive in 27 patients (54%). Staphylococci were the prevalent microorganisms (52%). In-hospital events included: heart failure in 29 patients (58%), systemic embolization in 13 patients (26%), para-valvular abscess in 8 patients (16%), septic pulmonary emboli in 7 patients (14%), dehiscence of prosthetic valves in 5 patients (10%) and renal failure in 2 patients (4%). Surgical intervention was indicated in 41 patients (82%). Only 16 patients (39%) had early surgical intervention. In-hospital mortality was 22%. However, the mortality rate improved in the patients who had undergone early surgical intervention (18.75% versus 32%). Conclusions Infective endocarditis remains a major health problem. It carries high in-hospital events with a high mortality rate. Delayed diagnosis of the disease and culture negative IE are common. Staphylococci are the prevalent microorganisms. Early surgical intervention improves survival.

Background and aim Culture-negative infective endocarditis (CNIE) is a diagnostic dilemma. The study was carried out to estimate the prevalence of CNIE among definite IE cases, to describe the epidemiologic and clinical characteristics of CNIE patients and to diagnose the microbial etiology of CNIE using molecular and serological techniques. Subjects and methods Sixty-five definite IE cases were enrolled in a prospective observational study between January and December 2010. CNIE cases were tested by 16SrRNA and seminested PCR for 35 blood samples, serological tests and the study of ten valve tissue specimens. Results CNIE constituted 39 (60%) cases. The mean age of CNIE patients was 31 years. Male to female ratio was 2.9:1. Healthcare associated IE accounted for 15.4%, native valve IE for 66.7% and intravenous drug abuse for 20.5% of cases. The mitral valve was the most frequently involved (56.4%). Out of 39 CNIE cases, seminested blood PCR detected 12 cases (ten Staphylococci , two Streptococci ). Five cases were reactive by serology (three Bartonella , one Coxiella , and one Brucella ). Six cases were positive by analysis of valve tissue (three Staphylococci , three Streptococci ). The combined results of all diagnostic tools decreased the percentage of non-identified causes of CNIE from 60% to 24.6%. Conclusions Our data underlined the role of collecting blood culture before starting antibiotics and the role of seminested PCR in the diagnosis of conventional causes of CNIE. The importance of serology to identify non conventional causes was also highlighted.

Consanguineous marriages have been practiced since the early existence of modern humans. Until now, consanguinity is widely practiced in several global communities with variable rates. The present study was undertaken to analyze the effect of consanguinity on different types of genetic diseases and child morbidity and mortality. Patients were grouped according to the types of genetic errors into four groups: Group I: Chromosomal and microdeletion syndromes. Group II: Single gene disorders. Group III: Multifactorial disorders. Group IV: Diseases of different etiologies. Consanguineous marriage was highly significant in 54.4% of the studied group compared to 35.3% in the control group ( P < 0.05). Consanguineous marriages were represented in 31.4%, 7.1%, 0.8%, 6%, 9.1% among first cousins, one and a half cousins, double first cousins, second cousins and remote relatives respectively in the studied group. Comparison between genetic diseases with different modes of inheritance showed that recessive and multifactorial disorders had the highest values of consanguinity (78.8%, 69.8%, respectively), while chromosomal disorders had the lowest one (29.1%). Consanguineous marriage was recorded in 51.5% of our cases with autosomal dominant diseases and in 31% of cases with X linked diseases, all cases of mental retardation (100%) and in 92.6% of patients with limb anomalies ( P < 0.001). Stillbirths, child deaths and recurrent abortions were significantly increased among consanguineous parents (80.6%, 80%, 67%) respectively than among non consanguineous parents. In conclusion, consanguineous marriage is significantly higher in many genetic diseases which suggests that couples may have deleterious lethal genes, inherited from common ancestor and when transmitted to their offsprings, they can lead to prenatal, neonatal, child morbidity or mortality. So public health education and genetic counseling are highly recommended in our community. Keywords: Consanguinity; Chromosomal abnormality; Genetic counseling; Child death; Homozygosity The Egyptian Journal of Medical Human Genetics (2013) 14, 157–164

Objective: This study aims to describe effects of the accreditation process of the National Commission for Academic Assessment and Accreditation (NCAAA) and its impact on the quality of medical education in one medical college in Saudi Arabia, and determines the extent to which the tools used for this purpose (the NCAAA Standards) are applicable to medical colleges. Methodology: We conducted a semi-qualitative study in Qassim University College of Medicine, where an accreditation exercise led by NCAAA was recently completed. Data pertaining to applicability and impact of the accreditation process were collected through semi-structured interviews, focus-group discussions and structured questionnaires. Data were aggregated and analyzed and compared with information prior to accreditation, where available. Results: The accreditation process lasted about two years, culminating in the preparation of a self-evaluation report and a visit of external reviewers. The process itself brought significant changes in the educational processes and administration and implementation of the curriculum. Our analysis also indicated significant improvements in the quality of medical education in the College. However, there were questions about the applicability of the NCAAA accreditation process on medical education. The process can be modified to suit the special requirements of medical colleges in Saudi Arabia. Conclusions: NCAAA accreditation process was successful in improving the quality of medical education, without imposing radical changes in curriculum philosophy or orientation. Better measurement of students learning outcomes, regular review and updating of the quality standards and continuous quality improvement are anticipated to deliver better medical education in the college.

Alloimmunisation was one of the most important causes of perinatal mortality and morbidity by the middle of the last century. The objective of the present study was to investigate the presence of the RHD gene in fetal cells (amniocytes) obtained from amniotic fluid by genotyping to compare it with the RhD serotyping. Also to correlate the presence of RhD gene with the neonatal outcome. This work was carried out at Maternity hospital and Medical Genetics center, while PCR testing was done at the Medical Research center, Faculty of Medicine, Ain Shams University in the period from 2008 to 2010. The present study included recruiting of 20 RhD negative (sensitized to the RhD antigen) pregnant mothers. The entire study group was subjected to complete general, obstetric and a detailed obstetric ultrasonographic examination. Rh typing and indirect Coomb’s test were also done. Amniocentesis was performed with a 20-gauge needle under continuous ultrasound guidance. RhD serotyping of the fetuses showed that, 14 fetuses (70%) were positive and six fetuses (30%) were negative. While using RhD gentyping 13 cases (65%) were positive and seven cases (35%) were negative (P value = 0.002). Among fetuses positive for RhD genotyping six fetuses (46%) had received postnatal treatment, while among fetuses negative for RhD genotyping, neither of them had received postnatal treatment (P value =0.032), which is statistically significant. From the present study we can conclude that, the identification of an antigen-negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN.Keywords: Maternal alloimmunization; Rhesus; RHD; Isoimmunization; Hydrops fetalis; Fetus; Rh negative

Ocular changes in genetically disabled children are great and of special importance. The aim of the present study was to delineate the nature and frequency of ocular defects in genetically disabled children. A cross sectional study was carried out. It included 95 genetically disabled children who were chosen from the medical genetics and ophthalmic departments, Ain-Shams University Hospitals, and examined for any associated ocular abnormalities. Studied patients were divided into six groups (Group I: Chromosomal disorders (Down syndrome), Group II: Genetic syndromes, Group III: Cranial anomalies, Group IV: Inborn errors of metabolism (IEM), Group V: Cerebral palsy, Group VI: Mental retardation). Anomalies of the eyelids were detected in 63.1% of our patients. They were significantly increased in group I [Chromosomal disorders (Down syndrome)], compared to other groups. Errors of refraction were detected in all Down syndrome patients.On the other hand some ocular findings were present in our Down syndrome patients and not reported in the literature before; these include, lacrimal fistula, lagophthalmos, heterochromia, macrocornea and ectropion in 3.3% of patients, tortous retinal vessels, entropion, and prominent upper punctum in 6.6%, ptosis in 10%, microcornea, absent foveal reflex, and blepharophimosis in 13.3% of our cases. Lacrimal apparatus abnormalities were detected in 11.5% of our patients, the highest frequency was detected among the chromosomal disorder group 27%. Conjunctival and scleral abnormalities were also detected in 10.5% of our patients, where the group of chromosomal disorders had the highest frequency (20%). Cornea and anterior chamber abnormalities were detected in 30.5%, these abnormalities had the same frequency (33%) in the groups of chromosomal disorders, genetic syndromes and inborn errors of metabolism. Iris and pupil abnormalities were detected in 15.7% of our patients. Lens abnormalities were detected in 10.5% of our patients, where the group of inborn errors of metabolism had the highest frequency (44%). Ocular muscles and mobility abnormalities were diagnosed in 47.3% of our patients. Fundus examination revealed abnormalities in 34.7% of patients,where the group of cerebral palsy had the highest frequency (50%).Our results emphasize that, the earlier and better the visual sense function, the greater the chance the child will achieve his potential.The ophthalmologist, paediatricians, geneticists must work hand in hand for detection of ocular disorders in genetically disabled children to initiate diagnostic and therapeutic measures to control the disease.Keywords: Disability; Genetics; Ocular changes; Handicap; Chromosomal abnormalities

Background: Celiac disease (CD) is the most frequent enteropathy in adults and its coexistence with other autoimmune diseases is frequent. Objective: To detect asymptomatic CD in children with rheumatic diseases by measuring tissue transglutaminase (tTG) antibodies and finding any relation to disease activity. Patients and methods: Setting and study design: The study included 60 children with juvenile rheumatic diseases consecutively from those attending the Rheumatology Clinics of Cairo University Hospitals: 30 juvenile rheumatoid arthritis (JRA), 10 juvenile systemic lupus erythematosus (SLE), 12 juvenile seronegative spondyloarthropathy and eight juvenile systemic sclerosis/polymyositis (SSc/PM) overlap syndrome were recruited during 2010. There were 22 male and 38 female patients. Thirty matched healthy controls were included. All children were subjected to thorough history taking, clinical examination and laboratory investigations. The body mass index (BMI) for age was used. All subjects had no gastrointestinal tract symptoms suggestive of CD and the tTG antibodies (IgA and IgG) were assessed. Results: The mean age of patients was 12.03 ± 3.3 years and disease duration 4.18 ± 3.24 years. The demographic, clinical and laboratory features of the children were studied and compared. The tTG was positive in 32 (53.3%) patients compared to 20% of the controls (P = 0.03), being higher in females. In tTG-positive patients, the BMI was significantly lower, while white blood cell count, erythrocyte sedimentation rate and disease activity were significantly higher. Conclusions: tTG antibodies may be used as a screening test to identify asymptomatic CD associated with juvenile rheumatic diseases, especially those with active JRA or marked reduction in BMI.

Aim: To detect the prevalence of shrinking lung syndrome (SLS) among systemic lupus erythematosus (SLE) patients and study their clinical, laboratory and radiological characteristics and differences in disease activity and damage. Methods: The study included 200 Egyptian SLE patients and SLS was considered in those with exertional dyspnea, restrictive pulmonary function tests (PFTs) and elevated copula of the diaphragm. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed for all the patients. High-resolution computed tomography scans of the chest were performed for patients with radiological findings consistent with SLS and those with pulmonary manifestations. Results: The mean age of the patients was 29.3 ± 8.4 years, mean disease duration 5.81 ± 4.32 years and female to male ratio was 9 : 1. SLS was present in 27 patients (13.5%) with a female to male ratio of 3.5 : 1.0. The demographic features, clinical and laboratory manifestations, renal biopsy class, disease activity and damage scores, PFTs and radiological findings of the SLE patients are presented. Conclusion: Shrinking lung syndrome is not rare and presents a considerable subset of SLE patients. In SLE patients with dyspnea or chest pain, SLS should be looked for and PFTs are highly suggestive.

Objective To assess whether the use of optical detection system (ODS) as an adjunct to colposcopy increases the detection of biopsy confirmed CIN 2, 3 in women being evaluated for an abnormal cervical cytology. Methods This is a comparative study comparing the use of colposcopy alone with the use of colposcopy plus ODS system. Three hundred and six women were recruited from the out patient clinic of Suzan Mobark hospital, Minia University, referred to the Early Cancer Detection Unit for colposcopical evaluation. The main study outcomes were differences in true-positive rates (biopsy confirmed CIN 2, 3) and false-positive rates between the two methods. Results The true-positive (TP) rates were 17.8% versus 13.9% ( P = 0.001) for the combined colposcopy and ODS compared to colposcopy-only, respectively, in women with either an atypical squamous cell (ASC) or low-grade squamous intraepithelial lesion (LGSIL) cytology result. TP rates were 53.6% versus 50% for the combined colposcopy and ODS compared to colposcopy-only, respectively, among women referred for the evaluation of HGSIL. The 28.1% gain in true-positives observed with the use of ODS and colposcopy among women referred for an ASC or LSIL cytology was achieved with only a fractional increase in a number of biopsies obtained per patient (0.21). In the combined colposcopy and ODS among women with ASC or LSIL, the PPV of biopsies indicated by ODS was 24.3% and the PPV of biopsies indicated by colposcopy was 23.3%. All tests indicate that ODS and colposcopy provide benefit compared to colposcopy alone among women with ASC or LGSIL. Conclusions Combining ODS with colposcopy provides a clinically meaningful increase in the detection of CIN 2, 3 in women referred for the evaluation of abnormal cytology results.

Aim of the work The aim was to study the outcome characteristics of systemic lupus erythematosus (SLE) in Egyptians according to the age at disease onset and gender. Patients and methods We studied 239 SLE patients (185 adult and 54 Juvenile onset) with a female to male ratio of 9.39–1 and a mean age of 28.23 ± 8.91 years and disease duration of 5.45 ± 4.25 years. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed. Disease activity was assessed using SLEDAI and damage by SLICC. Renal biopsies were done in those with renal involvement. Results The clinical manifestations, disease activity and damage and laboratory investigations of the SLE patients varied according to the age at disease onset and gender. The prevalence of damage was obviously increased in juvenile patients and higher in males. Growth failure, delayed puberty and fibromyalgia were present more in Juvenile-onset patients. Adult onset SLE patients had a significantly higher secondary Sjogren syndrome especially in females. In the present study, there was a 2.5% mortality and the commonly involved kidneys were an important cause of death. Conclusion Measuring organ damage in SLE is important with special concern to juvenile-onset patients to allow for designing new treatments that improve control of disease activity and minimize the development of irreversible damage. The kidney appeared to be commonly involved, especially in males, indicating the importance of regular screening for early and appropriate management.

BackgroundOver recent years it has become apparent that the hepatocyte mitochondrion functions both as a cause and as a target of liver injury. Resultant dysfunction of mitochondria yields deficient oxidative phosphorylation, increased generation of reactive oxygen species, impairment of other metabolic pathways and activation of both necrotic and apoptotic pathways of cellular death.MethodsThis study was conducted on 26 children and adolescents with chronic liver disease who presented to or were following up in the Pediatric Hepatology Clinic, Children’s Hospital, Ain-Shams University. They were divided into three groups according to the aetiology of liver disease (GI=patients with Wilson’s disease (WD), GII=patients with chronic hepatitis C, GIII=patients with chronic liver disease other than Wilson’s and chronic hepatitis C). Ultrasound-guided gun liver biopsies were performed, under local anaesthesia for all the 26 patients, using a modified 18-gauge truecut needle. Two liver biopsy cores were taken from each patient. One for light and electron microscopic examinations and the other was immediately immersed in liquid nitrogen to be frozen and used for studying mitochondrial DNA deletions by PCR.ResultsLiver steatosis was higher in the group of patients with Wilson’s disease and other liver diseases. Electron microscopic examination of the mitochondria revealed significant mitochondrial pleomorphism in patients with Wilson’s disease and patients with chronic hepatitis C infection. Enlarged mitochondria were found to be more prevalent among patients with chronic hepatitis C infection. Three of our patients (11.53%) had mitochondrial DNA deletions. We developed a scoring system for mitochondrial affection in our patients, 7 patients (32%) were considered to have mild mitochondrial affection, 9 patients (41%) had moderate mitochondrial affection, while 6 patients (27%) had severe mitochondrial affection. Four of the studied patients had no mitochondrial affection.ConclusionMitochondria affection is common in chronic liver disease. This mitochondrial affection might be responsible for some of the chronic liver disease manifestation such as easy fatiguability and steatosis.

Background: Home glucose monitoring is an opportunity for patients with type II diabetes to control their own blood glucose and health, testing blood glucose at home helps to prevent the immediate and potentially serious consequences of very high or very low blood glucose levels. Objectives: This study aimed at ascertaining diabetic patients' performance of home blood glucose monitoring (SMBG), its perceived benefits, and its effectiveness in controlling type II diabetes mellitus. Methods: A cross sectional study was conducted on a 300 type II diabetic patients who follow up in the diabetes clinics at two university hospitals in Riyadh, Saudi Arabia. Data were collected through a structured interview questionnaire and records review. Results: Out of the total 300 diabetic patients, 145 (48.3%) use SMBG and 51.7% of them used it according to the doctors advice, and 52.4% of them checked it by themselves. Only 55.2% received education about use SMBG. Educational level and employment were significantly related to SMBG. Most of the patients (66.3%) who had SMBG presented with normal HbA1c range (OR=4.86, 95% CI= 2.37-10.28). Conclusion: The study provides a proof supporting effectiveness of SMBG for diabetic patients, however, it recommends to launch further indepth research to provide evidence about the effectiveness of self-monitoring and identify patients who might derive most benefit from different forms of blood glucose monitoring.

Lupus nephritis (LN) is a potentially devastating outcome of systemic lupus erythematosus (SLE). It is important to identify reliable, non-invasive methods to assess the kidneys in patients with SLE. The aim of the study was to measure the level of novel markers of renal involvement in these patients and assess their correlation with disease activity and damage. Sixtyone patients with SLE (33 adults and 28 juvenile) were included in the study. Fifty-two ageand sex-matched healthy individuals served as controls. Full history taking, thorough clinical examination and laboratory investigations were performed and disease activity and damage were assessed for all patients. Renal bio-markers including serum cystatin C, urinary neutrophil gelatinase-associated lipocalin (UNGAL) and N-acetyl-beta-D-glucosaminidase (UNAG) were assessed in patients and controls. There was a significant increase in serum cystatin C, UNGAL and UNAG levels in the adult SLE patients compared with controls (P = 0.000, P = 0.013 and P = 0.018, respectively); serum cystatin C and UNGAL levels were higher in the juvenile patients compared with controls (P = 0.038 and P = 0.000, respectively). Serum cystatin C significantly correlated with the damage index, renal biopsy class and negatively with the serum albumin; UNGAL correlated with albuminuria and the level of nephritis and UNAG negatively correlated with serum albumin level. Our study suggests that serum cystatin C, UNGAL and UNAG are important markers of LN and both cystatin C and UNAG would help in predicting the renal biopsy class.