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Background and Aim: Subclinical hypothyroidism (SCH) is frequently seen in diabetic patients. Elevated levels of uric acid (UA) were also reported in diabetic patients. No study assessed the relation between SCH and UA levels in diabetic patients. We aimed to evaluate this relation and the association of both conditions with other clinical and laboratory parameters in diabetic patients. Subjects and Methods: This cross-sectional study included 100 T2DM patients in addition to 50 age and sex matched healthy controls. Diabetic patients comprised 50 patients with SCH and 50 euthyroid patients. All participants were subjected to careful history taking, thorough clinical examination and standard laboratory work up. The performed investigations included fasting and postprandial blood sugar, fasting insulin levels, HbA1c levels, thyroid hormones (FT3, FT4 and TSH), renal profile and serum UA. Results: Comparison between the studied groups regarding serum UA levels revealed significantly higher levels in the diabetic group (5.4 ± 1.9 versus 4.2 ± 1.0 mg/dl, p Conclusions: The present study suggests an association between SCH and increased UA levels in diabetic patients.

Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease prevention strategies, but the serotype distribution varies among patient groups. The objectives of this study were to establish the group B Streptococcus (GBS) serotype distribution in patients from Egypt and to assess antibiotic sensitivity of invasive GBS isolates. A total of 490 patients participated in this multicenter study; 160 had urinary tract infection, 115 complained of diabetic foot ulcers, 125 men had genital tract infections, and 30 women females had genital tract infections. Others had bronchopneumonia, otitis media, synovitis, or meningitis. Serotyping of the isolated GBS was performed at the CDC in the United States. Antibiotic sensitivity patterns were determined using the disk diffusion method. In men, the most common serotypes were II, III, and V, whereas types Ia, II, III, and V were isolated from women. Macrolides (erythromycin) resistance occurred in 4.1% of the isolates; 10.2% were resistant to both clindamycin and inducible resistance of macrolides, lincomycin, and streptogramin; 17.3% were resistant to quinolones; and 95.9% were resistant to tetracyclines. GBS primarily infected the urinary tract, skin, soft tissue, and genital tract in both genders. Isolates were sensitive to beta-lactam drugs, vancomycin, and linezolid; 14.0% were resistant to macrolides with or without clindamycin. Only 6.0% of the strains were sensitive to tetracyclines. Although GBS causes invasive infections in Egyptian adults, it rarely causes neonatal meningitis or sepsis. Future studies should determine whether GBS isolates are transmitted sexually, by performing a follow-up study of the partner of the infected patient.

Background: Eradication rate of hepatitis C virus (HCV) infection had dramatically increased in era of direct acting antivirals (DAAs). However, predicting relapse post-treatment had to be more speculated. Aim: to evaluate role of peripheral blood monocytes (PBMCs) HCV PCR as predictor of post-treatment relapse. Methods: For chronic HCV patients who achieved end of treatment response, HCV PCR at PBMNs was assessed in relation to SVR. Results: 112 out of 118 cases had SVR 24 with only six relapsers (5.1%). Negativity of triple HCV RNA was significantly lower in relapsers than in patients who achieved SVR (16.7% versus 92.9%, p= 0.001). Cases with two positive strands were relapsers (n= 2,33.3%). Single RNA positive strand was detected in 50% of relapsers (n=3) and in 8 out of 112 (7.1%) of patients who achieved SVR. Significant factors affecting treatment response were absence of esophageal varices, negativity of triple HCV RNA, albumin, platelets, INR, creatinine and MELD score. On multivariate analysis, negativity of triple HCV RNA was significant predictor of achieving SVR with 208.38 Odds Ratio and 95% CI (4.93-8809.97, p= 0.005). Conclusion: Relying on presence of HCV on PBMCs at end of treatment with DAAs might be a trustworthy independent predictor of relapse.

Background As physicians in a referral hospital, we observed the association between history of enteric fever and somatic disorders associated with low mood. At the Al-Hussein University Hospital, Cairo and the National Liver Institute Hospital, Menoufia, we receive patients from all over Egypt, including rural areas where enteric fever is endemic. Aim Here in, 60 Egyptian patients referred to us for evaluation of different somatic disorders are reported. Methods After extensive evaluations, the patients' symptoms were function-related. Also, their typhoid carrier states were documented, and the severity of depression using Hamilton-D (HAM-D) questionnaire was evaluated and recorded. All patients were treated with ceftriaxone, 2 gm, IV, daily for 15 days. The clinical evaluation and Hamilton score were reassessed at the end of the treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the Salmonella species, and not by serology, isolated from stool culture along with febrile condition, plus the absence of fever in the past 3 weeks. The Widal test was not accepted as a criterion for enrollment. Results Patients showed clinically significant improvement in the somatic complaints, and their HAM-D score immediately post-treatment that was consolidated for 6 weeks post-treatment completion. Conclusion In this study, the typhoid carrier was associated with the psychosomatic depression that improved by antibiotic therapy.

Background: to report the anatomical and functional outcome based on patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with intravitreal ranibizumab (IVR) injection. Aim of the Work: to evaluate the role of OCT in detecting the patterns of DME and its effect on anatomical and functional outcome after IVR injection. Patients and Methods: this study enrolled 30 eyes of patients with DME. These patients were categorized into 3 groups according to OCT finding, group I- 10 eyes with diffuse retinal thickening (DRT), group II- 10 eyes with cystoid macular edema (CME), group III- 01 eyes with neurosensory detachment (NSD). All patients received a three monthly doses of intravitreal ranibizumab. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: at month 6, mean BCVA changed with 0.24 ± 0.057 Decimal (P

Background: Intestine anastomosis in pediatric surgery is a relevant matter because of the frequency of the procedure, nonetheless, there is no general agreement about the most appropriate surgical technique, nor are there records comparing the different methods in children. To validate the better technique in children, it is necessary to have clinically comparative experimental studies. Objective: the aim of this work is to evaluate both single layer simple interrupted extramucosal and single layer interrupted Connell sutures for intestinal anastomosis in children in elective and emergency laparotomy as regard technical, functional and financial aspects. Patients and Methods: his study was carried out on 40 patients candidate for intestinal anastomosis in elective and emergency laparotomy managed at Pediatric Surgery Department, Al-Azhar University in Cairo throughout the period from January 2017 to May 2019. Results: As regard the most frequent diagnosis or cause for anastomosis in our study, jejunal atresia was the most common cause of anastomosis with 9 cases (45%) in the extramucosal group and one case (5%) in the Connell group, then the intussusception with 2 patients (10%) in the extramucosal group, and 7 patients (35%) in the Connell group, then ileal atresia, 3 patients (15%) in the extramucosal group, and one patient (5%) in the Connell group. Conclusion: We concluded that both techniques for intestinal anastomosis are effective, safe and successful. We prefer single-layer interrupted extramucosal technique in elective and emergency laparotomy due to less operative time, and valuable cost-effectiveness.

Oral Direct-acting antivirals (DAAs) are safe, highly effective altering disease burden and prognosis in hepatitis C patients. Sustained virologic response (SVR) is achieved nowadays in more than 90% of the treated patients and related to the improvements in functions of the liver, fibrosis plus survival. Furthermore, portal hypertension is thought to be improved with achievement of virological response, parallel to the improvements in hepatic inflammation and fibrosis. We aimed to assess the recurrence rate of oesophageal varices by long-term follow-up in patients treated with different DAAs regimens who had achieved SVR. We studied 176 Child A cirrhotic HCV patients who achieved SVR after DAAs treatment and had a history of endoscopic oesophageal varices obliteration and were on maximum tolerated propranolol dose. They were subjected to follow-up upper gastrointestinal endoscopy repeated every 6 months for 4 years. Fifty-two patients (29.5%) had recurrence of oesophageal varices observed during the 4-years follow-up upper GIT endoscopy. On multivariate analysis, platelet count was the only significant variable, P-value = .007*. HbA1C, HOMA IR, BMI 1 and BMI 2 showed non-significant differences between the studied groups. By ROC analysis, we identified baseline platelet count of 96 000/µL with 100% sensitivity (95% confidence interval [CI] [91%-100%]) and 74% specificity (95% CI [65%-81%]). Spearman correlation showed a positive correlation between AFP, age, AST, Bilirubin, creatinine, INR. Patients who achieved SVR post DAAs showed a significant decrease in oesophageal varices recurrence post endoscopic obliteration. Baseline platelet count was found to be a strong independent predictor for oesophageal varices recurrence.

Background: Telogen Effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE may be a squeal of various metabolic alterations such as pregnancy, malnutrition especially iron deficiency anemia in premenopausal women. Hemoglobin concentration can be used to screen for iron deficiency, whereas serum ferritin concentration can be used to confirm iron deficiency. In this study we tried to put a light spot on the role of serum ferritin level in female patients with TE. Methods: A case control study was done including 100 female patients less than 40 years (their age ranged from 18 to 40 years) divided into 2 groups. The patient group containing 80 female patients with telogen effluvium the control group containing 20 normal females without hair loss. A full history was done with full clinical examination. Blood samples were collected from all studied groups and examined for: serum ferritin level (by Ferritin ELISA -EIA- 1872 test kits), Unbound T4 (by FT4 RIA KITS) and Complete blood counts (Haemoglobin level, RBCs, HCT values, MCV, MCH, MCHC). Results: The results of this study showed normal serum ferritin level in female patients suffering from telogen effluvium as well as normal serum Hg level, HCT value, RBCs count and Blood Indices. Insignificant relation was found between control and study groups using SPSS statistical data analysis. Conclusion: There was no closely linked relationship between iron metabolism and TE.