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Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and

Background: Dyspepsia is a clinical syndrome including manifestations related to the upper gastrointestinal tract. Options for evaluating dyspeptic patients include therapeutic trials, testing for Helicobacter pylori, upper gastrointestinal (UGI) radiography, and endoscopy. Objective: To compare the endoscopic and histopathologic diagnosis of gastritis in patients presented with chronic gastric dyspepsia to evaluate the relative frequency and pattern of different types of gastritis in patients presented with chronic gastric dyspepsia. Patient and method: Prospective cross-sectional study on 120 patients with chronic dyspepsia more than 8 weeks. All patients underwent gastroscopy. The findings of gastric inspection were recorded for all patients. Biopsy specimens were taken. Two from the anterior and posterior antrum, two from the anterior and posterior body, and two from any additional area of abnormality. Diagnostic criteria were applied to histological features and each histopathological parameter (chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori density) were graded for assessment of their severity as 0= absent, 1= mild, 2=moderate or 3= severe in the corpus and antrum. Results: Endoscope revealed normal gastric mucosa in 33 patients (27.5%), gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). As regard gastritis, there was edema in 61 patients (95.3%), erythema in 45 patients (70.3%), atrophy in 10 patients (15.6%) and mucosal nodularity in 10 patients (15.6%). As regard location of gastritis, it was pan-gastritis in 44 patients (68.8%), Antrum predominant gastritis in 10 patients (15.6%) & corpus predominant gastritis in 10 patients (15.6%).As regard other lesions, there was Duodenal ulcer in 7 patients (30.4%), peptic ulcer in 3 patients (13%), esophagitis in 2 patients (8.7%), erosive gastritis in 4 patients (17.4%), upper GIT suspecting malignancy in 2 patients (8.7%) and hiatal hernia in 5 patients (21.7%). Histopathology results were Normal in 18 (18.6%), Chronic inflammation in 79 (81.4%), Neutrophilic infiltration in 60 (61.7%), Glandular atrophy in 10 (10.3%), Intestinal metaplasia in 3 (3.1%) and H. pylori density in 47 (48.5%). Gastritis was detected by Endoscopy in 64 (53.3%) and in 79 (81.4%) by histopathology. This difference was statistically significant (p-value: 0.014). Conclusion: The prevalence of gastritis among the dyspeptic patients is very high since we observed endoscopically gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). The concordance between endoscopic findings and histopathological diagnosis of gastritis was (81%). High prevalence of H.Pylori among the dyspeptic patients (48.5%). Gastritis was better detected by histopathology.

Background: Bell’s palsy (BP) is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis and idiopathic, unilateral or bilateral paralysis of the facial nerve without any associated disorders. Aim: To evaluate the effect of health educational guidelines on knowledge and practices of mothers having children with Bell's Palsy. Design: A quasi-experimental research design was used. Setting: This study was conducted at physical therapy department of Beni-Suef Hospital. Subject: 100 mothers and their children were selected randomly. Tools: Two tools were used for data collection, Tool1: A Self-administered questionnaire: Developed by the researchers and used to assess characteristics of mothers and their children also mothers’ knowledge about Bell's palsy (pre, post, and at follow up) phases of guidelines implementation. Tool2: An observational checklist (pre/post and follow up tests) to evaluate mothers’ practices in relation to their children with Bell's palsy such as pain relieving, eye care, follow up with doctor, mouth and dental hygiene, maintaining muscle tone and facial palsy yoga exercise. Results: There were highly statistically significant differences (P

Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.

Background: Colorectal carcinoma (CRC) is one of the most common human cancers. It is the fourth most common cause of death from cancer. Colorectal cancer is the third most common cancer in men and the second in women worldwide. Objective: To evaluate the immunohistochemical expression of KAI-1/CD82 in different stages of colorectal carcinoma and to evaluate the biological behavior of tumor and target therapy. Patients and Methods: Thirty formalin-fixed, paraffin-embedded tissue of colorectal carcinoma (obtained from archive of Al-Azhar University Hospital Labs and some private labs). Clinicopathological and histological features were taken from files and confirmed by H&E examination. Immunohistochemical study was done by using CD82/ (KAI-1) marker. Results: CD82 showed an insignificant relation with age, sex, site of tumor and degree of differentiation. A significant inverse relationship was detected between CD82 expression in tumor cells and tumor stage according to modified Duke's staging. Insignificant relation between age, sex, site and grade. Conclusion: The decreased membranous and/or cytoplasmic expression of CD82 might be used as a prognostic marker to monitor patient with colorectal cancer.

Objectives We aimed to determine outcomes and predictors of intraoperative-detected portal vein thrombosis in liver transplant recipients. Materials and methods We retrospectively analyzed 806 adult liver transplant recipients from Shiraz, Iran, to determine those with intraoperative-detected portal vein thrombosis. Patients with this complication were compared with age- and sex-matched patients without this complication. Background diseases, surgery parameters, hospital admission, reoperation, rethrombosis, acute rejection, and use of antico-agulants were assessed. Cox proportional hazards, logistic regression, and random classification forest and random survival forest plots were used for data analyses. Results Mean age of patients was 44.7 ± 13.2 years. Patients with intraoperative-detected portal vein thrombosis (n = 91; 11.3%) had mortality ratio of 2.9 (range, 1.0-8.6) and 2-year survival of 78% versus 2-year survival rate of 92% in patients without this disease. Median time of survival in patients with this complication who died was 2 weeks versus 10 months in patients who died and did not have this complication. Random classification forest plots showed that high fasting blood sugar, autoimmune hepatitis, low prothrombin time, and cryptogenic cirrhosis were (in order) the main predictors of this complication. Random survival forest plots revealed that low prothrombin time, having intraoperative-detected portal vein thrombosis, Model for End Stage Liver Disease score, primary sclerosing cholangitis, diabetes mellitus, and hepatocellular carcinoma were (in order) the main predictors of death in liver transplant recipients. Low body mass index was associated with mortality in patients with intraoperative-detected portal vein thrombosis (by Cox proportional hazards). Conclusions One of every 9 liver transplant patients had intraoperative-detected portal vein thrombosis. Hazard of death was 2.9, and death occurred far earlier in patients with this complication. Improvements in diabetes mellitus care, prothrombin time, Model for End-Stage Liver Disease score, and body mass index may improve outcomes of these patients.

Objectives: The aim of this study is to see the surgical outcome of Sellar and Suprasellar brain tumors with retractorless modified subfrontal approach. Material and Methods: We did cohort study of 15 patients who were operated in Neurosurgery Unit 2, PINS. Our study duration is 1 year and follow up duration is of 3 months. Clinical features were related to cranial nerves 2nd, 3rd ,4th, and pituitary gland, dural irritation and temporal lobe compression i.e., diplopia, decrease vision, CSF rhinorrhea, abnormal olfaction, headache, GTCS etc. Results: In our study, age range was 8 – 62 years with mean age was 35 years. Our 5 patients were male and 10 patients were female. Surgery was performed in all patients through subfrontal approach with retractorless method. In Histopathological report of 2 patients’ findings was Craniopharyngioma, 12 were of pituitary adenoma and 1 was of sellar meningioma. Seven 46.67 percent patients operated successfully with no new neurological deficit. Three 20 percent patients operated but no post op improvement in clinical symptoms, no patients were re-explored postoperatively due to CSF Rhinorrhea. Diabetes Insipidus occurred in 5 (33.3%) patients post-operatively which was managed later on. Conclusion: Surgery subfrontal approach with retractorless method is the safe corridor for treatment of sellar and Suprasellar brain tumors.

BACKGROUND: Coronary artery diseases are the most important cause of premature death, and these diseases are predominantly related to atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 and microRNAs are closely associated with atherosclerotic coronary heart diseases. AIMS: To investigate the relationship between the severity and risk of coronary artery disease and plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 and miR-98. STUDY DESIGN: Case-control study. METHODS: Angiographically documented patients with 38 single-vessel, 75 double-vessel, and 62 multi-vessel coronary artery disease; 62 healthy control participants; and 24-hour hypoxic (1% oxygen) human umbilical vein endothelial cells were included in this study. Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations were determined through enzyme-linked immunosorbent assays, and miR-98 expressions were measured by quantitative real-time polymerase chain reaction. RESULTS: The expressions of plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were progressively and significantly higher in patients with single-vessel, double-vessel, and multi-vessel coronary artery disease than in healthy controls (p

Background: Heart failure (HF) is a major and growing public health problem across the world for both males and females in all ethnic groups. Therefore, this study aimed to evaluate the causes and associated risk factors of HF patients in Aljouf, Saudi Arabia. Methodology: Total 274 consecutive patients including 165 males and 109 females who were diagnosed with HF and admitted to Cardiac center of King Abdul Aziz Specialized Hospital (KAASH) over a period of January 2019 to December 2019, were enrolled in this retrospective study. All information was collected from the hospital records including medical history, age, causative factors and associated risk factors. Result: It was found that majority of female (31.1%) and male (45.4%) HF patients were over 65 years of age and between 55 to 64 years, respectively. The common causes were ischemic heart diseases (47.4%), hypertensive heart disease (30.2%), and dilated cardiomyopathy (22.2%) among HF patients. Furthermore, risk factors included diabetes (88%) and obesity (80.7%) which were higher in female as compared to males (p < 0.05). Besides, the family history of coronary artery disease and cardiovascular diseases (71.5%), and hypertension (32.7%) were significantly higher in male HF patients than female HF patients (p < 0.05). Smoking (58.39%) was considered as a major risk factor for male HF patient. Conclusion: The HF patient’s incidence as well as its complications might be reduced remarkably by early prevention with proper management of its associated risk factors and major causes.

Background: Inverted Papilloma (IP) is the most common benign neoplasms arising from the mucosal lining of the of the Sino-Nasal tract with single or multifocal attachment sites. The high propensity to recur, local aggressive behavior and possibility of malignant transformation attract considerable interest. Objective: To assess the factors affecting Sino-nasal IP, malignant transformation rate, and post-operative recurrence rate. Methods: A retrospective study was carried out on all cases diagnosed as Sino-Nasal Papilloma between January 2010 and December 2020 at Salmaniya Medical Complex, Bahrain. Data gathered from medical records were analyzed using SPSS. A total of 49 Sino-Nasal Papilloma cases were recorded of which 37 were IP. Factors affecting Sino-Nasal IPs are presented. Results: Sino-Nasal IP was recorded in 37 cases, composed of 28 males and 9 females with first presentation average age of 45.86 years. These involved 20 cases in the left side, 14 in the right side and 3 were bilateral. Recurrence in males and females was found to be 35.7% and 33%, respectively, with an average of 12.6 months. The symptoms include nasal blockage (97.3%), epistaxis and postnasal drip (13.5% each), headache (8.1%) and hyposmia and rhinorrhea (5.4%, each). The main recurrence was at stage T2 (60.5%), while in smokers (26.7%) and non-smokers (50%). Malignant transformation occurred in one patient only (2.6%). Conclusion: IP is the most common type of SNP with male predominance. The recurrence rate is high with an average of a year and the malignant transformation occurred in 2.6 % of the cases.

Background: Cancer is a leading cause of death for children worldwide. More than 80% of children with cancer are cured in high-income countries, but only 20% are cured in many low-income countries. Aim: To assess the knowledge and performance of mothers having children with cancer undergoing chemotherapy. Research design: Descriptive research design was used in the current study. Sample: A purposive sample of 35 mothers having children with cancer and undergoing chemotherapy participated in the study. Setting: The current study was conducted at the pediatric unit at Minia Oncology Center. Tools:Tool (I): Structured Interview Sheet: covered the personal data of the mothers and the characteristics of the child; Tool (II): mothers Knowledge Assessment Sheet and Tool (III): mothers Performance Assessment Sheet. Results: There was lacking knowledge and performance of mothers having children with cancer undergoing chemotherapy. There were no statistically significant relationships between the total mean scores of mothers' knowledge and total mothers' practice regarding childhood cancer and chemotherapy as well as their personal data as age, level of education, their children's age, gender and the child's rank in the family (p=>0.05). Conclusion: The study concluded that the overall level of mothers' knowledge and performance was unsatisfactory. Personal variables have no impact on the knowledge and performance of the mothers. Recommendation: The study recommended that developing periodic educational programs and instructions to mothers having children with cancer undergoing chemotherapy would improve their knowledge and performance regarding childhood cancer and chemotherapy.

background: Postoperative sore throat (POST) is defined as pain or discomfort in the throat following general anesthesia. Throat packs are used by many surgical subspecialties for different benifits, however they may increase the incidence of POST. Many interventions can be used to decrease incidence of POST. Triamcinolone acetonide (TA) is a moderately potent topical corticosteroid preparation. In this study, we hypothesized that soaking the throat pack with TA may decrease POST. Methods and Material: This prospective interventional comparative study was performed on 54 patients planned for Functional Endoscopic Sinus Surgeries (FEES) surgery. After endotracheal intubation, a standard length of oro-pharyngeal pack was placed, then patients were randomly allocated into: Group I: Oro-pharyngeal packs were soaked with 15 mg Triamcinolone acetonide 0.1% and Group II: packs were soaked with the same volume of lubricating gel (K-Y gel®). The patients were postoperatively asked about: sore throat, dysphagia, hoarseness of voice and nausea and vomiting. Results: Thirty minutes and 24 hours after extubation, Group I patients showed lower but statistically insignificant sore throat scores. Two to six hours after extubation, Group I showed a statistically significant reduction in sore throat scores. Six patients suffered dysphagia in group I compared with 8 patients in group II. Hoarseness of voice occurred in 1 patient in group I and 3 patients in group II. No patient complained of nausea or vomiting. Conclusión: Soaking oropharyngeal pack with triamcinolone acetonide in orabase gel was able to decrease POST in FESS patients.

The purpose of this study to determine the clinical characteristic of the associated risk factors of acute myocardial infarction patients (AMI) among the Hunan Han population in China. The retrospectively collected the records data of 595 both STEMI and NSTEMI patients from the first Xiangya hospital, Hunan, China over a period of January 2018 and December 2018. These studies revealed clinical characteristics with associated risk factors among acute myocardial infarction patients. A total of 595 diagnosed acute myocardial infarction patients participated in this study among males 70.9% and females 29% with mean age e 52.9+11.3 years. While 90% had STEMI and 9.9 % had NSTEMI. The chest pain 94.4%, 86% and shortness of breath 55%, 100% presented with STEMI and NSTEMI groups respectively. Smoking incidence in male subject 70.3% had higher than in female subject 29.1 % (P

Background: Delayed healing of diabetic wounds has been well-documented. Currently, the use of platelet-rich plasma (PRP) has attracted great attention in many medical fields including wound healing. Aim: Histological, immunohistochemical and ultrastructural evaluation of the effect of PRP on wound healing in the tongue of normal and Streptozotocin-induced diabetic albino rats. Methodology: A total number of 108 adult male albino rats with average weight 200gm, were used in the study. The animals were classified into two main groups: non-diabetic and diabetic groups. Each group was further divided into three subgroups: non- treated wound, PRP-treatment before wound, and PRP-treatment after wound. Tongue specimens were dissected on postoperative days 1, 3, and 7. The specimens were examined histologically by H&E, immunohistochemically by p63 and vimentin, and ultra-structurally by TEM. Results: The most accelerated wound healing was revealed in the subgroups treated with PRP before the wound, whether non-diabetic or diabetic, which occurred very early at the 3rd day postoperative in both cases. While complete wound healing was revealed at the 7th day postoperative in both the non-diabetic and diabetic subgroups treated with PRP after the wound, which was like the non-diabetic control subgroup. Whilst, the diabetic non-treated subgroup only showed partial wound healing at the 7th day postoperative. Conclusion: A single injection of PRP could be used as a prophylactic to prevent expected impaired wound healing in diabetic oral mucosal wounds and to enhance wound healing in non-diabetic wounds. PRP could be used as a therapeutic to enhance wound healing in diabetic and non-diabetic oral mucosal wounds. Key Words: platelet rich plasma, wound healing, diabetes, rat, tongue, p63, vimentin, TEM BACKGROUND: Delayed healing of diabetic wounds has been well-documented. At present, the use of platelet-rich plasma (PRP) has attracted great attention in many medical fields including wound healing. AIM: Histological, immunohistochemical, and ultrastructural evaluation of the effect of PRP on wound healing in the tongue of normal and streptozotocin-induced diabetic albino rats. METHODOLOGY: A total number of 108 adult male albino rats with average weight 200 g were used in the study. The animals were classified into two main groups: Non-diabetic and diabetic groups. Each group was further divided into three subgroups: Non-treated wound, PRP-treatment before wound, and PRP-treatment after wound. Tongue specimens were dissected on post-operative days 1, 3, and 7. The specimens were examined histologically by H&E, immunohistochemically by p63 and vimentin, and ultrastructurally by TEM. RESULTS: The most accelerated wound healing was revealed in the subgroups treated with PRP before the wound, whether non-diabetic or diabetic, which occurred very early at the 3rd day post-operative in both cases. While complete wound healing was revealed at the 7th day post-operative in both the non-diabetic and diabetic subgroups treated with PRP after the wound, which was like the non-diabetic control subgroup. While, the diabetic non-treated subgroup only showed partial wound healing at the 7th day post-operative. CONCLUSION: A single injection of PRP could be used as a prophylactic to prevent expected impaired wound healing in diabetic oral mucosal wounds and to enhance wound healing in non-diabetic wounds. PRP could be used as a therapeutic to enhance wound healing in diabetic and non-diabetic oral mucosal wounds.

Background White matter hyperintensities (WMHs) is the most frequent type of cerebral small vessel diseases and a common incidental finding in MRI films of the geriatric population. The objectives of this work were to study the existence of occult cognitive and balance impairments in subjects with accidentally discovered WMHs. Methods The study was conducted on 44 subjects with accidentally discovered WMHs and 24 non-WMHs subjects submitted to the advanced activity of daily living scale (AADLs), a neurocognitive battery assessing different cognitive domains, Berg balance test (BBT), computerized dynamic posturography (CDP), and brain MRI diffusion tensor tractography (DTT). Results WMHs subjects showed a significant decrease in AADLs as well as visual and vestibular ratios of CDP. Regarding the neurocognitive battery, there were significant decreases in MoCA as well as arithmetic test and block design of Wechsler adult intelligence scale-IV in WMHs compared to non-WMHs subjects’ groups (p value < 0.001). Concerning Wisconsin Card Sorting subtests, each preservative response, preservative errors, non-preservative errors and trials to complete the 1st category showed a highly significant increase in WMHs compared to non-WMHs subjects (p values < 0.001). DTT showed a substantial reduction in fractional anisotropy (FA) of each corticospinal tract, thalamocortical connectivity, and arcuate fasciculi. Conclusion Subjects with WMHs have lower cognitive performance and subtle balance impairment which greatly impair their ADLs.

Introduction: BPD (bronchopulmonary dysplasia) is the most common complication of preterm birth for all gestational ages. The phenotype seen with BPD is the end result of a complex multifactorial process in which various pre-and postnatal factors compromise normal development in the immature lung. The aim of this study was to monitor the pulmonary function in preterm infants with bronchopulmonary dysplasia, and to declare the hypothesis that BPD has different phenotypes, that could be detected by iPFT during their initial NICU stay. Materials and Methods: This is a prospective study, in the period from Feb 2015 till April 2018. It includes 32 preterm infants (gestational age bronchopulmonary dysplasia (BPD). Pulmonary Function Test (PFT) was done for all patients one day before discharge from NICU. Results: the median gestational age at birth was 29.6 weeks ([IQR], 27.6-28.9) and the median birth weight was 1500 g (IQR, 945-1760). At the time of iPFT, the median postmenstrual age 44 weeks (IQR, 39-47), the median weight was 4.25 kg (IQR, 3.25-5.350). There were 19 patients (60%) with obstructive, 9 patients (29%) with mixed, 4 patients (11%) with restrictive phenotypes. Conclusions: our findings reveal that BPD has 3 distinct phenotypes. The different phenotypes of BPD must be taken into consideration in the management of such patients for better outcome. Future researches are needed in a larger scale to define accurately the bronchopulmonary dysplasia phenotypes Keywords: Bronchopulmonary dysplasia, Infant pulmonary function, Premature.

Background: Thyroid dysfunction and autoimmunity are relatively common clinical scenario in women within reproductive age group and have been correlated and linked to a spectrum of adverse pregnancy outcomes such as recurrent miscarriage. Aim: To investigate the correlation and linkage between anti-TPO antibody and recurrent miscarriage.Materials and Methods: This case control observational research study was conducted on 90 pregnant female out which 45 with history of recurrent miscarriage were cases and 45 without such history were controls.Results: The mean age of control group was 25.29 while it was 26.69 in cases group. The prevalence of anti-tpo antibody positivity in the study group was 18.8%.out of 90 pregnant female ;17 were positive for anti-tpo antibody. The prevalence of thyroid autoimmunity in pregnant women with recurrent abortion was (37.8%) while it was (0%) in the healthy group (P=0.0). Conclusion:There was significant relationship between anti thyroid antibody positivity and recurrent miscarriage. Thyroid autoimmunity can be considered as risk marker for recurrent miscarriage.

In clinical trials, dabrafenib plus trametinib improved overall survival (OS) compared with single-agent BRAF inhibitors (BRAFi) in patients with BRAF V600-mutant unresectable or metastatic melanoma. We investigated dabrafenib plus trametinib therapy in a compassionate-use setting [Named Patient Program (NPP); DESCRIBE II]. A retrospective chart review of patients with BRAF V600-mutated unresectable stage III/IV melanoma receiving dabrafenib plus trametinib as compassionate use was conducted. Treatment patterns and duration, clinical outcomes, and tolerability were evaluated. Of 271 patients, 92.6% had stage IV melanoma, including 36.5% with brain metastases. Overall, 162 patients (59.8%) were BRAFi naive and 171 (63.1%) received first-line dabrafenib plus trametinib. Among BRAFi-naive patients, the overall response rate (ORR) was 67.3%, median OS (mOS) was 20.0 months, and median progression-free survival (mPFS) was 7.5 months. In BRAFi-naive patients with known brain metastases (n = 62), ORR was 61.3%, mOS was 15.5 months, and mPFS was 6.2 months. Eighty-four patients received BRAFi monotherapy for >30 days and switched to dabrafenib plus trametinib prior to progression. Of these 84 patients, 63 had known disease status at the time of switch, and 22 improved with the combination therapy. No new safety signals were identified, and dabrafenib plus trametinib was well tolerated. Dabrafenib plus trametinib showed substantial clinical activity in NPP patients with BRAF V600-mutated unresectable or metastatic melanoma. Analysis of treatment patterns demonstrated the effectiveness of the combination in patients with brain metastases and across lines of therapy with a well tolerated and manageable safety profile.

Background The long-term results of soft tissue rebalancing procedures of the shoulder in obstetric brachial plexus palsy have been scarcely reported. The effect of this procedure on the evolution of secondary bone changes has been a subject of controversy. Methods Twenty-six children are included in this study. All initially had postganglionic C5-6 or C5-7 (Narakas types I and II) obstetric brachial plexus palsy, which spontaneously recovered. Children included are those who had persistent external rotation weakness with or without internal rotation contracture, nondysplastic glenohumeral joint, and functioning teres major. All had anterior shoulder release and teres major to infraspinatus transfer to correct internal rotation deformity and/or increase active shoulder external rotation. Patients were 18 males and 8 females. The right upper limb was affected in 16 patients, and the left in 10. Surgery was performed at an average age of 3.01 years (range, 1-10 years). Follow-up averaged 8.2 years (range, 5-16 years). Eight cases (30%) were followed up for 10 years or greater. Age at final follow-up averaged 10.5 years (range, 6-17.8 years). Results The results showed to be significant: 67 degrees (63%), 71.3 degrees (412%), and -32 degrees (-35%), respectively. There was no single recurrence of internal rotation deformity. Global Mallet score averaged 20 ± 2.7. Global abduction and external rotation averaged 3.5 ± 0.8 and 4 ± 0.3, respectively. Shoulder abduction range included an average of 45 degrees glenohumeral and 65 degrees scapulothoracic motion. Postoperative internal rotation in adduction was limited to 55.96 ± 25.65 degrees and was significantly lower that the preoperative value. Radiological measurements showed no significant differences between the operated and normal sides. Conclusions We conclude that the long-term results after soft tissue rebalancing, combined with open reduction when required, demonstrated significant improvement of abduction and external rotation and significant loss of internal rotation. The difference in glenoid version and humeral head subluxation continued to be insignificant compared with the normal side.

Objectives: The current study investigated the potential acceptability and effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) in developing children’s participation and mothers’ parenting self efficacy. Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) involving contextually reflective occupational therapy combines 3 elements: parent coaching, child’s sensory processing patterns, and social support of parents. Intervention sessions comprised group parents training and (individualized) coaching sessions, which reflective questions and discussions with mothers support them in identifying best plans to achieve their therapeutic goals. Method: In this pilot research, we employed a single subject, A-B-A interrupted time series design across 3 participants (3 mothers of children with the diagnosis of Autism Spectrum Disorders) reffered to Navid-e-asr rehabilitation center in Tehran, in spring of 2017. The participants were selected among families who have children with diagnosis of Autism Spectrum Disorders, ages 3-10 years and had at least one sensory pattern outside typical range based on the Short Sensory Profile II. Recruitment was based upon parent reports, Short Sensory Profile II data, demographic questionnaires and informed consents. The mothers’ education participated in this research were diploma or above diploma, and they could understand and speak Persian very well. We conducted the study for eighteen weeks in 3 phases. During baseline period or phase 1, the participants received treatments as usual (TAU) for 4 weeks. During intervention period or phase 2, the participants received Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) for 10 weeks, 1 week group parents mothers training (two sessions) and 9 weeks individualized coaching sessions (1 session per week), in addition to treatments as usual (TAU). During phase 3 or follow up, participants received only treatment as usual (TAU) for 4 weeks. The intervention therapist and coach was an occupational therapist, with 20 yrs. of clinical experience in pediatric rehabilitation implemented CI-ASD sessions during the study. In this pilot research, we administered outcome measures four times: prior to the study before phase 1 (pre- intervention1), after phase 1 (pre- intervention2), after phase 2 (post- intervention) and, after phase 3 (follow- up). We measured child participation by Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), and parental self efficacy by Parent Self Efficacy Measure (PSEM). We conducted semi-structured interviews after completing the intervention period to explore acceptability of treatment and participants’ experiences of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). We used visual inspection of graphed data to identify variations between phases. Results: Two of three participants )two mothers( completed the program and described growth in children occupational performance (COPM1) [13, 14, 22, 26] and [12, 12, 23, 29], satisfaction of occupational performance (COPM2) [13, 17, 22, 25] and [7, 7, 23, 29], goal attainment (GAS) [-6, -6, +2, +6] and [-6, -6, +2, +6], and parental self efficacy (PSEM) [50, 53, 57, 57] and [44, 43, 49, 55]. Two participants (mothers) found Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) highly acceptable. Data showed development in occupational performance (COPM1), satisfaction of occupational performance (COPM2), goal attainment (GAS) and parental self efficacy (PSEM) continued after 4 weeks follow up. One of three participant (one mother) had difficulty accepting Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) and left the study after 3 coaching sessions. Conclusion: On the report of two participants, Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) was acceptable to deliver and may show promise as an intervention for children with the diagnosis of Autism Spectrum Disorders and their families. Further research is needed to determine the effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). Since one family did not accept the Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD), it would be useful to identify characteristics of families who may benefit most from this intervention.

Background: Diabetes mellitus (DM) is associated with a greater risk of cardiovascular disease and almost one third of patients with acute myocardial infarction (AMI) may have undiagnosed DM on admission. DM is associated with abnormal endothelial function, increased inflammatory response, increased platelets and leukocytes plugging and seems to be an important factor deteriorating microvascular reperfusion in acute phase of MI. Objective: The purpose of this study was to evaluate the impact of diabetes mellitus on: (1) Myocardial microvascular reperfusion after primary PCI in patients with acute myocardial infarction utilizing two well validated measures of myocardial reperfusion, resolution of ST- segment elevation and myocardial blush grade (MBG) and (2) Left ventricular systolic function recovery and incidence of remodeling after primary PCI in patients with acute myocardial infarction. Patients and Methods: The study population consisted of 100 patients with STEMI (50 diabetic and 50 non-diabetic) conducted at coronary care unit of El-Zyton specialized hospital .All patients underwent Primary percutaneous coronary intervention (1ry PCI), ECG (pre and post PPCI) to assess ST segment resolution and Conventional 2D echocardiography to asses left ventricular ejection fraction ( LVEF) (by M-Mode and Simpson rule), end diastolic volume (EDV) and end systolic volume (ESV) and wall motion score index(WMSI) was done within 72hr of admission and after 3 months later and patients with LV remodeling, i.e. an increase >20% in LV end-diastolic volume (LVEDV), were identified. Results: No significant difference was found regarding baseline demographic, clinical and lab data except in dyslipidemic number of patients (92% in diabetic group vs. 36% in non-diabetic group. There was a statistically significant difference between both studied groups as regard ECG post PPCI finding, no significant difference between 2 groups as regard baseline ECHO (EF by M-Mode, EF by Simpsons rule, LVEDV, LVESV, E/A ratio, deceleration time (DT) and wall motion score index). As regard coronary angiography and 1ry PCI data there was a significant difference between diabetic and non-diabetic group as regard number of diseased vessel and myocardial blush grade (MBG): MBG(0) was 1 % in diabetic group and was 1% in non-diabetic group, MBG (1) was 12 % in diabetic group and was 4% in non-diabetic group ,MBG(2) was 48 % in diabetic group and was 14% in non-diabetic group and MBG(3) was 38 % in diabetic group and was 80% in non-diabetic group . Conclusion: The microvascular reperfusion in STEMI patients with diabetes was worse than STEMI patients without diabetes. The incidence of remodeling was more in STEMI patients with diabetes than STEMI patients without diabetes.

Objective: To evaluate the diagnostic accuracy of fine needle aspiration (FNA) in detecting malignant parotid tumors. Design: A retrospective study of cases series. Setting: Salmaniya Medical Complex, Otorhinolaryngology Department, Kingdom of Bahrain. Methods: A retrospective study was carried out, between January 2009 and December 2018, for all patients diagnosed with parotid tumors at the Department of Otorhinolaryngology, Head and Neck Surgery at Salmaniya Medical Complex, Manama, Kingdom of Bahrain. Data collection was made from medical records, I-seha and laboratory information system (LIS). 87 patients underwent parotidectomy, of which 30 were excluded due to unsatisfactory diagnoses or missing data. The results of fine needle aspirations were analyzed and compared with the corresponding histopathologic diagnosis. Estimation of sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FNA were calculated. Results: Among the 57 evaluated cases, four cases were further excluded from the final analysis due to unsatisfactory FNA results, therefore only 53 cases remained. The mean age of patients was 48.6 ± 17.2 years. A concordance with histopathology results was observed. 47 cases were diagnosed as benign and five cases were malignant, however, 1 case was diagnosed as malignant by FNA, but not in histopathology. The overall diagnostic accuracy was 98.1% and the prevalence of parotid malignancy was 9.4%. Sensitivity and specificity were 100% and 97.9%, respectively. Positive predictive value was 83.3% while negative predictive value was 100%. Conclusion: Fine needle aspiration is a highly sensitive and specific test in evaluating malignant parotid gland tumors. It is useful and accurate, especially when used hand by hand with the clinical assessment and radiological findings.

Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life. So, the aim of this study was to assess nurses' knowledge and practices related Neonatal Sepsis in the Neonatal Intensive Care Units atEl-Minia Hospitals. Descriptive design was utilized. A convenient sample of 50 nurses was included. This study was conducted in NICUS at Der-Mwas hospitals and Mallawy hospitals. The methods of data collection were a structured interview questionnaire, knowledge assessment sheet, and observational checklist. Results: all nurses of nurses had satisfactory knowledge related to environmental risk factors of neonatal sepsis, and more than three quarters of them had satisfactory knowledge related to maternal risk factors and therapeutic management regarding neonatal sepsis (78.0% and 76.0% respectively). Also, the majority of nurses had good practices in caring for neonates with sepsis and the minority of them had poor practice. Conclusion: the majority of nurses' in the neonatal units at der-Mwas hospital and Mallawy hospital had satisfactory knowledge and good practices related to neonatal sepsis in the neonatal intensive care units while the minority of them had unsatisfactory knowledge and average practices. Recommendations: Provision of continuing education programs on regular basis is suggested in order to refresh and update nurse's knowledge, as well as reinforce proper practices related to neonatal sepsis in neonatal units.

Background: The objective of this study is to compare between the free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot as regard the function, the aesthetic outcome, the complications and the patient satisfaction.Method: The study was conducted on 40 patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were allocated randomly into two groups. In group1 (20 patients), the defect was reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap.Result: In group 1 (ALT flap), Complete flap survival was achieved in all cases. Thirteen patients required secondary debulking procedures and scar revisions.In group 2 (MSAP Flap), Complete flap survival was achieved in 17 cases with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement.Conclusion: MSAP flap is good alternative in soft tissue reconstruction of the dorsum of the foot. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. ALT flap is better than MSAP flap in larger defects coverage but may need secondary debulking procedures or primary thinning at the time of reconstruction.

Review question / Objective: The aim of this systematic review is to evaluate AI-based models in identifying predictors of cardiovascular events and risk predtion in patients with diabetes mellitus type2. Condition being studied: T2DM patients have an increased risk of macrovascular and microvascular complications, lead to decreased quality of life and mortality. Considering the significance of cardiovascular complications in these patients, prediction of such events would be important. Different traditional statistical methods(such as regression) and new AI-besed algorithms are used to predict these complications in diabetic patients.

Background Post-operative throat complaints frequently arise after general anesthesia in the first 2 postoperative days, but they are of limited intensity and duration and often regard it as a relatively minor complication. Objectives The aim of this study was to determine the effect of adding triamcinolone acetonide to Oropharyngeal packs on decreasing the postoperative throat discomfort. Patients and Methods After obtaining approval from the Research Ethical Committee, Faculty of Medicine, Ain Shams University No. FWA 000017585 at 10th of April 2019, this study was conducted in the operating theaters of Otorhinolaryngology department, Ain Shams University Hospitals, Cairo, Egypt. Prospective, interventional double – blinded, randomized, controlled trial. Study Period: From 10th of April 2019 to 10th of September 2019. Results Post was followed up in the studied patients in 30 minutes postoperative, and at the duration of 2 to 6 hours postoperative and 24 hours postoperative and the median was calculated. The median IQR of patients who developed sore throat after use of oral packs in our study from 2 to 6 hours postoperative in control group was 4 with range (3 -5), median IQR in study group during the same period was 3 with range (4 -5) with test value 2.194 using Mann-Whitney test with P-value 0.028 with significant result. Conclusion The use of oral packs with triamcinolone acetonide showed lower proportion of patients who developed dysphagia and hoarseness of voice in patients group compared to control group, while no one of the studied patients showed postoperative nausea and vomiting as complication of use of oral packs.

BACKGROUND Pancreatic cancer (PC) is among the deadliest cancers of the gastrointestinal tract worldwide and a growing global health concern. AIM This study was aimed to evaluate the survival rate and prognostic factors of survival in patients with PC. METHODS In this retrospective cohort study, the records of 556 patients with PC registered in the hospital cancer registration system from September 2007 to September 2020 were evaluated. In this regard, demographic data, tumor characteristics, received treatments, and patients' final status were analyzed. Kaplan-Meier and Cox's regression were used for univariate and multivariate analyses, respectively. RESULTS The 5-year survival rate was found to be 4.3%. The median survival time was 12.4 ± 6.6 months. Univariate analysis showed that age, BMI (kg/m2 ), blood transfusions, differentiation, tumor stage, tumor size, number of involved lymph nodes, lymph node ratio (LNR), and type of treatment received were significantly associated with patient survival (p 2.5 cm (HR = 4.61, 95% CI = 3.30-6.78), metastasis presence (HR = 1.97, 95% CI = 1.49-2.60), more than two involved lymph nodes (HR = 1.52, 95% CI = 1.31-1.77), LNR

Eosinophilic pleural effusion can be the first presenting feature of a wide range of diseases, with malignancy being the commonest cause. Elevated levels of eosinophils could be an indicator of a favourable prognosis. In clinical practice, malignant lymphomas have been rarely associated with eosinophilic pleural effusions. In this report, we present the case of a 37-year-old otherwise healthy woman, who initially presented with a cough of five months' duration. Diagnostic workups including pleural and lymph node biopsies confirmed the diagnosis of nodular lymphocyte-predominant Hodgkin’s lymphoma.

Abdominal aortic aneurysm (AAA) repair in kidney transplant recipients may cause ischemia in the transplanted kidney. As a result, various techniques have been described for protection of the renal allograft during AAA repair including temporary shunt, extracorporeal bypass, cold renal perfusion, endovascular aortic aneurysm repair (EVAR), and operation without renal allograft protection. We successfully treated a 56-year-old man, a case of kidney transplantation with AAA, using a temporary hybrid percutaneous brachiofemoral shunt using vascular prosthesis with a long 7-French (Fr) catheter sheath introducer (CSI) in the aortic arch via the right brachial artery and 8 Fr CSI in the right femoral artery that were connected together with a 7 Fr guiding catheter, before aortic cross-clamping and repair of AAA using a Dacron tube graft. The patient recovered well from the surgery without any complication and was discharged on the 6th postoperative day. To our knowledge, this is the first report of using a temporary hybrid percutaneous brachiofemoral shunt for renal allograft protection in AAA repair surgery in a patient with kidney transplantation, and we think that this temporary shunt is an easy, safe, and rapid method for renal allograft protection from ischemia.

A low-lying peroneus brevis muscle belly has been described as a risk factor for the development of peroneal tendon pathology, but this finding has primarily been described based on cohorts with pre-existing clinical findings. Therefore, the objective of this investigation was to evaluate the frequency of apparently abnormal low-lying muscle bellies from a series of subjects without clinical or imaging findings of peroneal tendon pathology. One hundred consecutive MRIs were reviewed with measurement of the distance from the distal peroneal myotendinous junction to the tip of the fibula. This distance was observed to be 23.9 ± 8.8 mm (10.8-55.4 mm; 95% confidence interval 22.2-26.7 mm). If one assumed that a myotendinous junction within 2 cm of the distal tip of fibula represented an abnormal low-lying muscle, then we observed 37% of extremities without clinical or radiographic evidence of peroneal tendon pathology that would be considered anatomically “abnormal.” When a low-lying muscle belly was defined as occurring within 2 cm of the distal tip of the fibula, then a probability analysis of our data distribution found a 32.6% probability for individuals to have an “abnormally” low-lying muscle belly. These results indicate that what has traditionally been defined intraoperatively as an abnormally low-lying peroneus brevis muscle belly might simply represent intraoperative confirmation bias of relatively normal structural anatomy.

The objective of this investigation was to analyze the surgical anatomy of the endoscopic gastrocnemius recession procedure with reference to the curved nature of the aponeurosis. A consecutive series of 34 magnetic resonance imaging scans were evaluated under the direction of a musculoskeletal radiologist. An angular calculation of the effective curvature of the aponeurosis was measured 2 cm distal to the musculotendinous junction based on the maximal posterior excursion and terminal medial and lateral edges. A frequency count was additionally performed of the number of deep intramuscular septa extending from the aponeurosis, as well as a description of the location of the neurovascular bundle in this location. The mean effective curvature was 126.5 degrees (standard deviation [SD] = 6.3 degrees, range 115-143 degrees, 95% confidence interval 124.3-128.7 degrees). We observed an average of 1.2 (SD = 0.5, range = 0-2) deep intramuscular septa extending from the aponeurosis, and that 20.6% of neurovascular bundles were located superficial to the aponeurosis in this location. In conclusion, we found that a straight cannula needs to be navigated around an approximate 125-degree angle during performance of the EGR procedure. We think that this information provides evidence of potentially unrecognized complications of this procedure and leads to future investigations demonstrating anatomic and procedural outcomes.

Background and study aim: Still there is percentage of HCV patients not responding to Direct Acting Antiviral Agents (DAAS), even the responder HCV patients need to follow up. Gut flora (Microbiota) include all the microorganisms in the intestine and liver can be greatly affected by changes in gut microbiota. The study was done to evaluate the association between gut flora and the response to DAAS in chronic HCV patients. Methodology: Two groups; group 1 (No=15 of HCV responders patients) and group 2 (No=15 non responder HCV patients) treated by DAAS according to the treatment protocol of the Egyptian National Committee for Control of Viral Hepatitis (NCCVH). Healthy control subjects (No=15)age and sex matched to the study groups as third group. All investigations were done plus stool culture using VITEK 2 KITS according to the manufacturer. Results: The results show statistically significant difference between the patients (responders and non responders) and control, where p1 comparison between control and responders, p2 between control and non responders, p3 between responders and non responders. Enterobacter organism in p2, p3 was Clostridium perfringens in p2 was 0.009 and 0.04 respectively. Klebsiella organism in p1 and p2 was 0.04 and 0.01 respectively while Streptococci in p2 was 0.007. Conclusion: Gut microbiota have a crucial role in HCV patients especially the non responders compared to the control even the responders need to be followed up to adjust the gut flora of them to the normal because this proved to play an important role in micro environmental changes that lead to hepatocellular carcinoma (HCC).

Background: Despite major advances in perinatal care, preterm delivery (PTL) is still the predominant cause of perinatal mortality and a major cause of neurological morbidity in surviving infants. Objective: the objective of this study is to find any association between maternal group B streptococcus (GBS) colonization and preterm delivery. Patients and Method: This study is a prospective study including 100 pregnant women between 28 – 36 weeks of gestation from those who attended the Emergency Department at Al-Galaa Maternity Teaching Hospital from April 2015 to August 2015. All patients were tested for genital colonization with Group B streptococcus (GBS) by taking low vaginal swab that was sent for microbiological examination. Results: In this study there was a significant difference between positive and negative cases as regard obstetric data. As regard preterm labor, 80% of positive swab cases had preterm labor compared to 46.2% of negative swab cases and this was statistically significant. Positive vaginal swab cases are at 7 times higher risk to have preterm labor compared to negative cases. Conclusion: GBS vaginal colonization was associated with premature labour in the studied population. Women with GBS vaginal colonization qualify for intrapartum chemoprophylaxis. The study results suggest that the early prenatal screening for GBS may identify pregnant women at risk of PTL.

BACKGROUND Dual checkpoint inhibition improves response rates in treatment naïve patients with metastatic melanoma compared to monotherapy. However, it confers a higher rate of toxicity, including immune-related colitis. Steroids may not resolve symptoms in all cases. The use of vedolizumab, a humanized monoclonal antibody against α4β7 integrin has proven effective in cases refractory to standard treatment. CASE SUMMARY We report the case of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab. She developed severe colitis refractory to methylprednisolone, infliximab and mycophenolate mofetil but responded to vedolizumab. CONCLUSION This case report supports vedolizumab use in severe immune related colitis refractory to standard immunosuppression.

Although hypothyroidism with primary etiology could cause small pericardial effusion, massive one leading to cardiac tamponade and ventricular diastolic compression is rare and less reported in the literature. Here we described a patient with severe primary hypothyroidism leading to pericardial effusion and right ventricular compression. A 56-year-old diabetic man referred to the emergency department complaining of dyspnea worsening over the prior month. Further evaluations including electrocardiography, chest X-ray, and echocardiography plus laboratory data were requested. Para-clinic data revealed massive pericardial effusion in the presence of primary hypothyroidism. Pericardiocentesis was performed due to his severe symptoms which symptoms improvement were considerably achieved. Despite its rareness, hypothyroidism should be kept in mind whenever evaluating patients with massive pericardial effusion, especially after exclusion of other more common etiologies.

Background Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan. Methods We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015–2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children. Results Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index. Conclusion Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.

Background: one of most blood disorder hereditary is sickle cell anemia; it has a series crises and results to children who have it. Also, empowerment is measurement that established in order to enhance the self-determination and autonomy via support and engagement. Therefore, the level of mothers' education and their engagement are important elements for caring with high-quality the children who have sickle cell crises (SCC). Objective: To empower mothers of fewer than five children to manage sickle cell crises through engagement and education. Method: A quasi-experimental (pretest/ posttest) research design was used. Setting: The study was conducted in pediatric hematology clinic at Minia University Hospital for Obstetrics and Pediatrics. Sample: A purposive sample composed of 50 mothers who have fewer than five children to manage sickle cell crises. Tools: Two tools were used to collect data including, first: Interview questionnaire sheet, second: Empowerment scale. Results: Result of this study showed that there was significant improvement in mothers' knowledge about sickle cell crises in post/test. Conclusion: after the implementation of the program there was remarkable improvement of mothers' knowledge. Mothers' empowerment was low in pre/test and improved in post/test with statistical significant difference between pre and post/test. Recommendations: There should be a continuous developing educational program for empowering and engaging mothers in caring for their children with sickle cell anemia.

Introduction: Venous outflow obstruction is a common condition among patients with chronic venous insufficiency. Endovascular treatment is favourable over open surgery. This study aimed to assess s...

The main purpose of the study is to determine if the presence of a particular computed tomography (CT) imaging finding, a bursal lipohematoma, portends the presence of a concomitant rotator cuff tear (RCT) in patients with proximal humerus fractures by reviewing previous CTs. Three hundred eighty-six CT scans were retrospectively reviewed by two board-certified radiologists to determine the presence of a proximal humerus fracture and to assess for the presence of a subacromial/subdeltoid or subcoracoid bursal hematoma. The medical record including operative documentation was then examined in the patients with proximal humerus fractures, with or without a concomitant bursal lipohematoma. Of the surgically managed patients, four had an intraoperative diagnosis of RCT. The preoperative CT scans of all of these patients demonstrated a bursal lipohematoma. Additionally, a non-surgically managed patient with a subacromial/subdeltoid bursal lipohematoma on CT scan was found to have a RCT on subsequent MRI. Of note, a rotator cuff tear was not documented in operative reports of patients with CT scans that were not found to contain a bursal lipohematoma. Bursal lipohematoma is a potentially useful preoperative CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures, providing the clinician with more information in the optimization of the management approach.

Coronary artery disease (CAD) is the leading cause of death worldwide. Atherosclerosis as the main underlying mechanism of CAD is associated with inflammation and adipose tissue dysfunction. C1q/TNF-related protein12 (CTRP12) is a newly discovered adipokine which is a paralog of adiponectin. CTRP12 has anti-inflammatory and insulin sensitizing effects. Circulating levels of this adipokine have been reported to be lower in patients with type 2 diabetes and women with polycystic ovarian syndrome. The present study was undertaken for the first time to evaluate serum levels of CTRP12 in CAD patients and its association with anthropometric and biochemical parameters. Serum levels of CTRP12 were measured using ELISA kit in 188 CAD patients (angiography confirmed) and 70 controls. The serum levels of adiponectin, TNF-α and IL-6 were measured using ELISA kits. Serum levels of CTRP12 were found to be lower in CAD patients (585.48 ± 201.67 pg/mL) than in the controls (814.86 ± 247.85 pg/mL; p 0.001). CTRP12 also showed an independent association with the risk of CAD (OR [CI] = 0.998 [0.996-0.999]; p = 0.019). Moreover, it showed an inverse correlation with HOMA-IR (r = -0.298; p = 0.012) and TNF-α (r = -0.269; p = 0.023) and a positive correlation with adiponectin (r = 0.344; p = 0.003) in the controls. In CAD patients, CTRP12 was inversely correlated with BMI (r = -0.181, p = 0.013), HOMA-IR (r = -0.199; p = 0.006), TNF-α (r = -0.259; p 0.001) and IL-6 (r = -320; p 0.001) and a positive correlation with high density lipoprotein-cholesterol(r = 0.342; p 0.001) and adiponectin (r = 0.398; p 0.001). The present study showed for the first time that serum levels of CTRP12 are independently associated with CAD and that CTRP12 is associated with several CAD risk factors. The results suggest a possible link between CTRP12 and pathogenic mechanisms of atherosclerosis, such as inflammation and high density lipoprotein-cholesterol metabolism; however, more study is required in this regard.

Rationale and Objectives The conceptualization of acetabular fractures can present a daunting challenge to radiology residents. 3D models have been shown to aid in the spatial perception of complicated anatomy and may help residents grasp the elaborate classification systems for these anatomically complex fractures. Prior studies have explored the utility of 3D printed models for surgical planning in various settings. To our knowledge, no study has evaluated their efficacy in radiology resident training. Materials and Methods Following IRB approval, 22 radiology residents were randomized and stratified by Post Graduate Year into two groups of 11 residents. Both groups received separate identical presentations on the 5 most common acetabular fractures given by a musculoskeletal trained radiologist. Residents in the experimental group received 3D printed models of the five most common fracture types with which to interact during the presentation, while the control group did not. Both groups received a pretest and a follow up posttest three weeks later. Results A Wilcoxon rank sum test was performed to determine if statistically significant differences between the pretest and posttest scores of the experimental and control groups existed. There was no statistically significant difference in scores on the pre-test, which confirmed successful randomization. There was a statistically significant difference (P = 0.02) on the posttest scores between the experimental and control groups. Conclusion 3D printed models promise as an effective educational tool for resident learning with respect to acetabular fractures, improving short-term understanding of complex anatomy and classification systems.

PURPOSE Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica. MATERIALS AND METHODS The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant. RESULTS Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00). CONCLUSIONS There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.

Background: Hyperbilirubinemia is the most common problem in the newborn period that requiring hospitalization and medical attention. Approximately 60% of all newborns develop some degree of jaundice in the first week of life. Aim of the study: To assess mothers’ knowledge and attitude regarding neonatal hyperbilirubinemia. Research design: A descriptive exploratory research design was used to achieve the aim of this study. Sample: A convenient sample of 375 mothers admitted to postpartum unit at Minia University Hospital for Obstetrics and Pediatrics. Tool: Structured interview questionnaire were developed by the researchers that include Part I: Personal data of the mothers including age, place of residence, level of education, occupation …etc. Part II: assessment of mothers’ knowledge regarding neonatal hyperbilirubinemia. Part III: assessment of mothers’ attitude regarding hyperbilirubinemia by using five levels Likert scale. Results: the results of the current study revealed that more than half of mothers had unsatisfactory level of knowledge regarding hyperbilirubinemia and the vast majority of them had an agree attitude toward hyperbilirubinemia. There was a fair a correlation between occupation and educational level of mothers and their total knowledge scores. More than half of mothers with past history of babies with hyperbilirubinemia have a satisfactory knowledge and there was no statistically a significance difference between mothers who have previous experience with hyperbilirubinemia and their attitudes to hyperbilirubinemia. Conclusion: More than half of mothers have an unsatisfactory knowledge regarding hyperbilirubinemia and the most of mothers have an agree attitude regarding hyperbilirubinemia. Recommendation: further health education program should be conducted to increase awareness of mother to how to deal and manage their newborn with hyperbilirubinemia.

An increase in liver gluconeogenesis is an important pathological phenomenon in type 2 diabetes mellitus (T2DM) and oxymatrine is an effective natural drug used for T2DM treatment. The present study aimed to explore the effect of oxymatrine on gluconeogenesis and elucidate the underlying mechanism. Male Sprague-Dawley rats were treated with a high-fat diet and streptozotocin for 4 weeks to induce T2DM, and HepG2 cells were treated with 55 mM glucose to simulate T2DM in vitro. T2DM rats were treated with oxymatrine (10 or 20 mg/kg weight) or metformin for 4 weeks, and HepG2 cells were treated with oxymatrine (0.1 or 1 µM), metformin (0.1 µM), or oxymatrine combined with MK-2206 (AKT inhibitor) for 24 h. Fasting blood glucose and insulin sensitivity of rats were measured to evaluate insulin resistance. Glucose production and uptake ability were measured to evaluate gluconeogenesis in HepG2 cells, and the expression of related genes was detected to explore the molecular mechanism. Additionally, the body weight, liver weight and liver index were measured and hematoxylin and eosin staining was performed to evaluate the effects of the disease. The fasting glucose levels of T2DM rats was 16.5 mmol/l, whereas in the control rats, it was 6.1 mmol/l. Decreased insulin sensitivity (K-value, 0.2), body weight loss (weight, 300 g), liver weight gain, liver index increase (value, 48) and morphological changes were observed in T2DM rats, accompanied by reduced AKT phosphorylation, and upregulated expression of phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase). High-glucose treatment significantly increased glucose production and decreased glucose uptake in HepG2 cells, concomitant with a decrease in AKT phosphorylation and increase of PEPCK and G6Pase expression. In vivo, oxymatrine dose-dependently increased the sensitivity of T2DM rats to insulin, increased AKT phosphorylation and decreased PEPCK and G6Pase expression in the liver, and reversed the liver morphological changes. In vitro, oxymatrine dose-dependently increased AKT phosphorylation and glucose uptake of HepG2 cells subjected to high-glucose treatment, which was accompanied by inhibition of the expression of the gluconeogenesis-related genes, PEPCK and G6Pase. MK-2206 significantly inhibited the protective effects of oxymatrine in high-glucose-treated cells. These data indicated that oxymatrine can effectively prevent insulin resistance and gluconeogenesis, and its mechanism may be at least partly associated with the regulation of PEPCK and G6Pase expression and AKT phosphorylation in the liver.

Background: Becoming infected with hepatitis A virus (HAV) is deadlier in patients with end-stage liver disease. Objectives: This study aimed to determine the seroprevalence of chronic immunity to HAV in liver transplant (LT) candidates to determine whether HAV vaccination is necessary for them or not. Methods: This cross-sectional study was conducted on adult LT candidates who were referred to the LT center of Shiraz, Iran. The patients were interviewed for filling the data collection forms. These forms consisted of demographic information, medical backgrounds, etiology of chronic liver disease, a model for end-stage liver disease (MELD) score, laboratory findings, and abdominal sonography report. Furthermore, a 3-cc blood sample was obtained from each patient, and anti-HAV IgG was detected by Enzyme-linked Immunosorbent assay (ELISA) using standard Diapro kits. Univariable and multivariable data analyses were performed using SPSS version 20. A P-value of less than 0.05 was considered the significant cutoff in regression analysis. Results: A total of 291 patients with a mean age of 47.73 ± 12.9 years were recruited in this study of whom, 197 (67.7%) patients were males, 237 (81.4%) were married, 229 (78.7%) were educated lower than 12 years, 250 (85.9%) were living in urban areas, and (221) 75.9% had access to sanitary water in their living area. anti-HAV IgG was detected in 269 (92.4%, 95% CI: 89.4 - 95.4%) patients. Multivariable analysis showed that lower knowledge of hepatitis A transmission routes (OR: 11.9, 95% CI: 1.39 - 101.8, P = 0.024), no waterpipe smoking (OR: 9.5, 95% CI: 1.6 - 55.5, P = 0.014), and older age (OR: 1.12, 95% CI: 1 - 1.24, P = 0.03) were the main predictors of HAV immunity, in sequence. Conclusions: Most LT candidates are HAV IgG positive, but due to the growing number of LT candidates and high mortality of HAV in non-immune cases, LT candidates should be checked for HAV IgG, especially younger or waterpipe smoking patients who are less immune. Also, all non-immune patients should be vaccinated against HAV, if possible.

This is a case series of five patients with acute abdomen requiring surgery who tested positive for coronavirus disease 2019 (COVID-19) and were asymptomatic, with the purpose of detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in peritoneal fluid. Nasopharyngeal swab was done as a prerequisite for admission or prior to admission as part of random testing. Two methods of viral testing were employed: Xpert® Xpress SARS-CoV-2 (rapid test) and real-time reverse transcription polymerase chain reaction (RT-PCR). Either or both tests were done, with the former performed for patients requiring surgery immediately. Surgery was performed within 24–36 h from admission. Peritoneal fluid swabs were obtained for the detection of SARS-CoV-2 using RT-PCR test. Swabs were immediately placed in viral transfer media and delivered to the public health laboratory in an ice bag. SARS-CoV-2 was not detected in peritoneal swabs. Due to the limited number of patients, further studies are required; yet, protective measures should still be taken by surgeons when dealing with COVID-19 cases.