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Background and aim: Uremic pruritus (UP) is one of the most distressing symptoms in hemodialysis (HD) patients. Subclinical hypothyroidism (SCH) is a biochemical condition with high prevalence in HD patients. The present multicentric study aimed to assess the relationship between UP and SCH in HD patients. Methods: The present cross-sectional study included 328 HD patients. All patients were submitted to careful history through clinical examination and standard laboratory assessment. Pruritis was evaluated using the pruritis visual analog scale (VAS). Patients were diagnosed with SCH if they had TSH levels above the upper limit of the normal reference range in association with normal free thyroxine (FT4) levels. Results: Among the studied patients, there were 196 patients (59.8 %) with UP. Comparison between patients with UP and patients without revealed that patients in the former group had significantly longer HD duration (median (IQR): 47.5 (27.0-72.5) versus 36.0 (23.0-50.5) months, p0.001) and lower Kt/v (median (IQR): 1.4 (1.09-1.7) versus 1.54 (1.12-1.91), p=0.009). Moreover, they had significantly higher ferritin (median (IQR): 653.0 (526.0-800.0) versus 628.0 (470.8-716.0) ng/mL), hsCRP (median (IQR): 12.0 (8.0-14.0) versus 8.0 (6.0-9.0) mg/dL,p0.001) and TSH levels (median (IQR): 4.34 (1.98-5.2) versus 3.34 (1.9-4.85) µIU/ml) with a significantly higher frequency of SCH (45.9 % versus 28.8 %, p=0.002). Logistic regression analysis identified hemodialysis duration (OR (95%) CI): 1.02 (1.009-1.028), p0.001), ferritin levels (OR (95% CI): 1.002 (1.001-1.003), p0.001), and SCH (OR (95% CI): 0.54 (0.32-0.89), p=0.016) as significant predictors of UP. Conclusion: The present study suggested a possible link between SCH and the development of UP in HD patients.

BACKGROUND The incidence of colorectal cancer (CRC) is increasing among young individuals in the Arab world as well as in other regions of the world. AIM To explore the incidence and prevalence of CRC in the Arab world. METHODS The PubMed, Scopus, Web of Science, EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year. The search terms were “("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal") AND ("cancer OR malignancy OR malignant OR neoplasm") AND ("Jordan" OR "United Arab Emirates" OR "Bahrain" OR "Tunisia" OR "Algeria" OR "Djibouti" OR "Saudi Arabia" OR "Sudan" OR "Syria" OR "Somalia" OR "Iraq" OR "Oman" OR "Palestine" OR "Qatar" OR "Comoros" OR "Kuwait" OR "Lebanon" OR "Libya" OR "Egypt" OR "Morocco" OR "Mauritania" OR "Yemen"). Reviews, meta-analyses, and articles containing nonoriginal data were excluded. Retrieved articles were screened, and relevant data were extracted. Descriptive statistics were used for data analysis. RESULTS Nine studies were included. Five of the studies provided information regarding the prevalence of CRC. The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate, while in Egypt, it ranged from 0.4% to 14%. Four studies showed information regarding the incidence. The annual incidence rate of CRC in Qatar was 7.5/100000/year. In Egypt, the crude incidence rate (CIR) in males was 3.1 for colon cancer and 1 for rectal cancer, while in females, it was 2.3 for colon cancer and 0.8 for rectal cancer. The age-standardized rate for CRC incidence in 2003 was 36.90 for males, 26.50 for females, and 30.49 for both sexes in Saudi Arabia. In 2016, the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer, respectively, while in males, it was 3.3 and 2.8 for colon cancer and rectal cancer, respectively. One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old. CONCLUSION There is a considerable prevalence of CRC in some Arab countries. More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.

Mustafa AA Osman,1 Mohamed Alkhouly,1 Ghada F Elmohaseb,2 Eman Mostafa Nassef,2 Ibrahim Ghonim Ramadan Mohamed,2 Ismail Mohamed El mancy,2 Seham Sabry,2 Marwa M Abdulrehim,2 Ahmed Eliwa,2 Yasmine H Eisa,3 Ahmed Abdel-Ghany,4 Yasser Abdelghani5 1Gynecology and Obstetrics Department, Al-Azhar University, Cairo, Egypt; 2Internal Medicine Department, Al-Azhar University, Cairo, Egypt; 3Community Medicine Department, October 6 University, Giza, Egypt; 4Gynecology and Obstetrics Department, Minia University, Minia, Egypt; 5Tropical Medicine Department, Minia University, Minia, EgyptCorrespondence: Eman Mostafa Nassef, Internal Medicine Department, Al-Azhar University, Cairo, Egypt, Tel +20 1098002232, Email nassef.eman@yahoo.comBackground: Polycystic ovary syndrome (PCOS) is the most common endocrinological disease affecting women in the reproductive age. Non-alcoholic fatty pancreas disease (NAFPD) can promote many aspects of pancreatic dysfunction. The present study aimed to determine the prevalence of NAFPD and to identify its association with clinical and biochemical parameters in PCOS patients.Methods: The present study included 150 patients with PCOS and 150 age-matched healthy controls. All patients were submitted to careful history taking and thorough clinical examination. Performed laboratory investigations included fasting and postprandial blood glucose, lipid profile, liver function tests, serum prolactin and total testosterone. Fatty pancreas was diagnosed using abdominal ultrasound.Results: Among PCOS women, NAFPD was diagnosed in 57 women (38.0%) in contrast to 18 women (12.0%) in the control group (p < 0.001). Patients with NAFPD were significantly older [median (IQR): 38.0 (35.0– 43.0) versus 29.0 (25.5– 33.0) years, p = 0.001] with higher BMI [median (IQR): 31.5 (29.1– 34.7) versus 30.4 (28.6– 32.4) kg/m2, 0.042]. Moreover, they had significantly higher frequency of metabolic syndrome (84.2% versus 54.8%, p = 0.001), insulin resistance (68.4% versus 26.9%, p < 0.001) and severe NAFLD (22.8% versus 2.2%, p < 0.001). NAFPD patients had significantly lower sex hormone binding globulin (SHBG) [median (IQR): 36.0 (30.8– 40.7) versus 38.1 (35.15– 42.7), p = 0.002] and significantly higher free androgen index (FAI) [median (IQR): 4.08 (3.3– 4.92) versus 3.47 (3.12– 4.05), p < 0.001].Conclusion: NAFPD is prevalent PCOS. It is related to metabolic syndrome, insulin resistance, dyslipidemia and hyperandrogenism.Keywords: polycystic ovary, non-alcoholic fatty pancreas, free androgen index

CD62P is a surface marker for platelet activation. Platelet dysfunction contributes to disproportionate intravascular microthrombosis in SARS-CoV-2. We aimed to assess the clinical significance of CD62P as a biomarker of platelet activation and its correlation to the clinical severity and outcome of COVID-19 infections.The study included 80 COVID-19 patients and, in addition, there were 20 age and gender-matched healthy controls. Laboratory measurements included CBC, serum ferritin, LDH, CRP, D-dimer and flow cytometric assessments of the platelet markers CD42b and CD62P. The primary study outcome was patients' survival at the end of study.Among the studied patients, 24 patients (30.0%) died by the end of the study. Survivors had significantly lower CD62P values when compared with non-survivors [median (IQR): 75.5 (73.0 - 91.0) versus 96.0 (93.5 - 97.8), p0.001]. Patients with severe disease had significantly higher levels of CD62P levels [median (IQR): 95.5 (92.0 - 97.8) versus 75.0 (72.0 - 76.8), p0.001]. Logistic regression analysis identified D-dimer levels [OR (95% CI): 0.14 (0.03 - 0.74) and CD62P levels: OR (95% CI): 0.4 (0.17 - 0.94)] as significant predictors of mortality in multivariate analysis.CD62P expression on admission may be a useful prognostic maker in hospitalized Covid-19 patients. Its expression is related to other markers of inflammation and coagulopathy.

An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are major causes of viral hepatitis in Egypt since ≥ 50% of the Egyptian population are already exposed to HAV infection by the age of 15 years. In addition, > 60% of the Egyptian population tested seropositive for anti-HEV in the first decade of life. They mainly cause self-limiting hepatitis, however cases of fulminat hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (HCC) in Egypt. Globally, Egypt has the highest age standardized death rate due to cirrhosis from 1990 until 2017. The prevalence rate of HBV (1.3-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt since HDV antibodies (IgG) range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after direct antiviral agents (DAA) treatment are lacking. Hepatocellular carcinoma (HCC) incidence of 29/1000/year in cirrhotic patients after DAA treatment, is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized Viral hepatitis is one of the major public health concerns in Egypt that need more attention and funding from health policymakers. This article is protected by copyright. All rights reserved.

BACKGROUND Clearly, infection with severe acute respiratory syndrome coronavirus 2 is not limited to the lung but also affects other organs. We need predictive models to determine patients’ prognoses and to improve health care resource allocation during the coronavirus disease 2019 (COVID-19) pandemic. While treating COVID-19, we observed differential outcome prediction weights for markers of hepatocellular injury among hospitalized patients. AIM To investigate the association between hepatocellular injury and all-cause in-hospital mortality among patients with COVID-19. METHODS This multicentre study employed a retrospective cohort design. All adult patients admitted to Al-Azhar University Hospital, Assiut, Egypt and Abo Teeg General Hospital, Assiut, Egypt with confirmed COVID-19 from June 1, 2020, to July 30, 2020 were eligible. We categorized our cohort into three groups of (1) patients with COVID-19 presenting normal aminotransferase levels; (2) patients with COVID-19 presenting one-fold higher aminotransferase levels; and (3) patients with COVID-19 presenting two-fold higher aminotransferase levels. We analysed the association between elevated aminotransferase levels and all-cause in-hospital mortality. The survival analysis was performed using the Kaplan–Meier method and tested by log-rank analysis. RESULTS In total, 376 of 419 patients met the inclusion criteria, while 29 (8%) patients in our cohort died during the hospital stay. The median age was 40 years (range: 28-56 years), and 51% were males (n = 194). At admission, 54% of the study cohort had liver injury. The pattern of liver injury was hepatocellular injury with an aspartate aminotransferase (AST) predominance. Admission AST levels were independently associated with all-cause in-hospital mortality in the logistic regression analysis. A one-fold increase in serum AST levels among patients with COVID-19 led to an eleven-fold increase in in-hospital mortality (P < 0.001). Admission AST levels correlated with C-reactive protein (r = 0.2; P < 0.003) and serum ferritin (r = 0.2; P < 0.0002) levels. Admission alanine aminotransferase levels correlated with serum ferritin levels (r = 0.1; P < 0.04). Serum total bilirubin levels were independently associated with in-hospital mortality in the binary logistic regression analysis after adjusting for age and sex but lost its statistical significance in the fully adjusted model. Serum ferritin levels were significantly associated with in-hospital mortality (P < 0.01). The probability of survival was significantly different between the AST groups and showed the following order: a two-fold increase in AST levels > a one-fold increase in in AST levels > normal AST levels (P < 0.0001). CONCLUSION Liver injury with an AST-dominant pattern predicts the severity of COVID-19. Elevated serum ferritin levels are associated with fatal outcomes.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2), is an ongoing pandemic that has already affected millions of patients worldwide, and is associated with significant morbidity and mortality burden. Objective: To characterize the clinical manifestations and outcomes of COVID-19 in Egyptian patients. Patients and Methods: This was a retrospective cohort study conducted on 333 subjects with COVID-19 who were admitted to Al-Azhar University Specialized Hospital, Quarantine Hospital, and some patients during follow up after discharge from other quarantine hospitals, during the period from 15th of April, 2020 to 31st of August, 2020. Presenting clinical manifestations, laboratory findings, imaging findings and mortality rate were recorded from electronic medical records and sometimes from patients. Results: The vast majority had cough (82.6%) and fever (51.7%), while 23.4% had dyspnea among COVID-19 patients. There was a significant older age among died cases (66.4 ± 17.4 years old) than recovered cases (40.3 ± 14.9 years old) (p- value

This work was an attempt to prepare a new eco-friendly adsorbent for the recovery of uranium from the Egyptian radioactive deposits. So, cellulose/p-toluidine was prepared as a potential sorbent for uranium (VI) in highly alkaline solutions, from a condensation reaction of p-toluene with dialdehyde cellulose which resulting from periodate selective oxidative of cellulose. We have studied the kinetics, isotherm models, and thermodynamic of uranium adsorption from aqueous solutions by dissolved the deposits uranium in sodium carbonate aqueous solution. The effect of adsorption time, and temperature, pH, as well as uranium concentration on adsorption capacity were investigated. The adsorption capacity of uranium by cellulose p-toluidine has been found to attain 80 mg/g. Scanning electron microscopy, X-ray diffractometer, and Fourier transform infrared spectroscopy were used to study the morphological characterization, and chemical structure of the prepared adsorbent. In addition, the computational calculation of dialdehyde cellulose, p-toluidine, and cellulose/p-toluidine by DFT/B3LYP/6-31G (d) basis sets was studied. The adsorption of uranium using cellulose p-toluidine followed fitted with pseudo-second-order reaction as well as Langmuir isotherm. Also, the prepared adsorbent displayed excellent antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, E. coli and Candida albicans.

Erythropoietin (EPO) resistance is frequently reported in hemodialysis (HD) patients. Metabolic syndrome (MetS) is a common biochemical condition that comprises central obesity, dyslipidemia, hypertension, and hyperglycemia. The present study aimed to assess the relation between MetS and EPO resistance in HD patients. The present multicentric study included 150 patients with EPO resistance and 150 patients without EPO resistance. Short-acting EPO resistance was diagnosed if the erythropoietin resistance index is ≥1.0 IU/kg/gHb. Comparison between patients with EPO resistance and patients without resistance revealed that the former group had significantly higher body mass index, lower hemoglobin levels, lower albumin levels, higher ferritin levels, and higher high-sensitivity C-reactive protein (hsCRP) levels. In addition, patients in the EPO resistance group had significantly higher frequency of MetS (75.3% vs 38.0%, p

Coronavirus disease 2019 (COVID-19) has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system. Blood biomarkers are affordable, rapid, objective, and useful in the evaluation and prognostication of COVID-19 patients.To investigate the association between aspartate transferase-to-platelet ratio index (APRI) and in-hospital mortality to develop a COVID-19 mortality prediction model.A multicenter cohort study with a retrospective design was conducted. Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital (Assiut, Egypt) and Chest Hospital (Assiut, Egypt) with confirmed COVID-19 from July 1, 2020 to October 1, 2020, were retrieved and analyzed. The patient cohort was classified into the following two categories based on the APRI: (1) COVID-19 presenting with APRI ≤ 0.5; and (2) COVID-19 presenting with APRI (0.5 and ≤ 1.5). The association between APRI and all-cause in-hospital mortality was analyzed, and the new model was developed through logistic regression analyses.Of the 353 patients who satisfied the inclusion criteria, 10% were admitted to the intensive care unit (APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality, independent of other relevant predictors.

Background: Like other viruses, hepatitis C virus (HCV) needs constituents of host cells to proliferate and iron is considered as one of the most important constituents. So, chronic HCV often appears to be associated with disturbances in iron homeostasis. Objective: The aim of this study was to evaluate the iron metabolism dynamic changes in response to direct antiviral agents (DAAs) among Egyptian chronic HCV patients. Patients and Methods: This prospective cohort study was conducted on 180 subjects, 150 of them had chronic HCV whom received different DAAs regimens at one of the specialized HCV treatment facilities (Group A), as well as another 30 healthy volunteers (Group B), in the period from January 2017 to September 2018. The study was approved by the medical ethics committee of Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Result: Before treatment, serum iron, ferritin, transferrin saturation and triglycerides were significantly higher among HCV patients when compared to controls (p

Background : Perioperative bleeding and excessive fluid absorption are inherent complications of TURP. These complications are related directly to the size although transurethral prostatectomy is still considered the gold standard for operative treatment of benign prostatic hyperplasia, it is not a procedure without morbidity. the prostate is an androgen dependent organ. This study was aimed to compare the impact of use cyproteron acetate versus dutasteride in reduction of perioperative bleeding in transurethral resection of prostate for treatment of large size prostate. Patient & Methods: This a randomized controlled trial study was conducted for 6 months on 63 patients, from December 2018 to May 2019, who were admitted to urology department in zagazig university patients were randomized through a computer randomization into three equal groups. Results: The current study revealed that Control group was statistically significant decrease of HB and HCT post operative than other two groups and significant less operative time in patients received pre operative medication than control group with consequence decrease need for transfusion as well as less hospital stay .Conclusion: The pre operative use of anti androgen drugs (CPA & dutasteride) in TURP of large size prostate is well tolerated in the properly selected patients and it can help in decreasing the perioperative bleeding and fluid absorption during this surgery also ,operative time ,hospital stay.

Background: stimulation of the PPAR-γ axis was efficient in inhibiting the proliferation of human bladder cancer cells through different pathways, in part converging to Cyclin D1, so this study aimed to determine the role of PPAR-γ and Cyclin D1 expressions in both non-invasive and invasive muscle urothelial carcinoma patients. Methods: This study was carried out using 80 paraffin-embedded specimens of urothelial carcinoma of them non-muscle invasive carcinoma (N=44) and invasive muscle carcinoma (N=36). Non-invasive carcinoma shown (65.9%) with low grade and (34.1%) with high grade while invasive carcinoma showed (33.3%) with low grade and (66.7%). According to staging, non-invasive reported (75%) Ta, (25%) T1 while invasive carcinoma reported (61.1%) T2, (27.8%) T3, (11.1%) T4.Immunohistochemical staining was performed to study the relationship between PPAR-γ and Cyclin D1 expressions with the clinicopathological parameters and its prognostic outcomes. Results: positive PPAR-γ expression was significantly associated with a high tumor grade, more lymph node metastasis, and advanced tumor stage. As well as positive Cyclin D1 expression was significantly associated with tumor grade, lymph node metastasis, and advanced tumor stage. Both positive PPAR-γ and Cyclin D1 expression were significantly associated with disease recurrence, short disease-free survival and overall survival. A significant positive correlation between PPAR-γ and Cyclin D1 expression was found (p < 0.001).Conclusion: the expression of PPAR-γ and Cyclin D1 are associated with the progression of urothelial carcinoma, advanced-stage and presence of lymph node metastasis. carcinoma and used as prognostic factors for bladder cancer patients. Keywords: PPAR-γ, Cyclin D1, bladder carcinoma.

Aims: The aim of this study is to compare between transrectal ultrasound (TRUS)-guided aspiration and transurethral (TU) deroofing in the treatment of prostatic abscess regarding safety and efficacy. Settings and Design: This prospective randomized study was done during the period between April 2009 and March 2015 and included 32 patients with prostatic abscess. Subjects and Methods: All patients were enrolled in the study after obtaining a written informed consent and approval of the local ethical committee. The patients were randomly allocated into two groups; Group A treated by TRUS-guided aspiration, saline wash, and local injection of antibiotics and Group B treated by TU deroofing of the abscess. All patients received broad-spectrum antibiotics during the period of treatment, and the follow-up was done on the 5th day by TRUS to ensure complete resolution of the abscess. Statistical Analysis Used: Statistical analysis was done using online social science statistical calculators http://www.socscistatistics.com/Default.aspx using t-test for two independent means, Chi-square test, and Mann–Whitney U-test with P < 0.05 considered statistically significant. Results: The mean age was 59 ± 11.46 and 60 ± 13.65 years for Groups A and B, respectively. Diabetes mellitus was detected in 9 (56.25%) and 6 (37.5%) patients in Groups A and B, respectively, hypertension in 7 (43.75%) and 6 (37.5%) patients in Groups A and B, respectively, and two patients (12.5%) with liver cirrhosis in each group. The mean size of the abscess was 3.36 ± 0.86 and 3.04 ± 0.86 cm in Groups A and B, respectively (P = 0.29). The abscess recurred in five patients (31.25%) and one patient (6.25%) in Groups A and B, respectively (P = 0.08). TRUS-guided aspiration was done for all recurrent cases except for two patients (12.5%) in Group A required trans urethral deroofing of the recurrent abscess. The mean hospital stay was 12.9 ± 4.05 and 7.25 ± 2.40 days for Groups A and B, respectively (P = 0.000). In Group A, one patient (6.25%) was complicated by urethrorectal fistula, whereas in Group B, one patient (6.25%) was complicated by septic shock, three patients (13.75%) with epididymo-orchitis and two patients (12.5%) with urethral stricture. Conclusion: Patients with prostatic abscess treated with TRUS-guided aspiration show less morbidity, higher recurrence rate, and longer hospital stay than those treated with TU deroofing.

Objectives: To evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults. Patients and methods: In all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of

Objective To report the functional results of continent cutaneous ileal urinary diversion using modified W-pouch with non-isolated extra limb for continence. Patients and Methods From January 2013 to January 2016, 21 patients with muscle-invasive bladder cancer with median (interquartile range) of 59 (56.5-62.5) years old underwent radical cystectomy with pelvic lymphadenectomy; they then had an ileal continent cutaneous pouch constructed from W-pouch with non-isolated extra limb for continence. The technique entails the creation of a detubularized ileal W-pouch with extra limb fashioned from 59 cm of the terminal ileum. This extra limb is not isolated from the pouch. The proximal part of this limb is tailored and fixed in a subserous extramural tunnel for continence, whereas the distal part is left continuous with the pouch. The median (interquartile range) of follow up was 12 (8-17) months. Evaluation of the technique included operative time, continence efficiency, overall complications, and quality of life questionnaire for the patients. Results The median (interquartile range) of operative time of the operation was 4.7 (3.9-5.4) hours. The median (interquartile range) of operative time of the cutaneous pouch creation was 39 (33-43) minutes. No perioperative mortality had occurred. The incidence of continence was 95.2%. The overall complications were 42.8%, and most of them were grade 1 or 2 on Clavien-Dindo classification system. Conclusion Modification of W-pouch with non-isolated extra limb as continent cutaneous pouch can simplify the technique and shorten the operative time with efficient continence, less side effects, and good quality of life.

Objective: To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL). Patients and methods: Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2 were excluded from the study. The following data were reported: patients’ demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR). Results: In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients’ demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P

The equilibrium and kinetic characteristics of rare earths adsorption process using the strong acid macro reticular resin Dowex 50X8 from El-Erediya chloride liqueurs have been determined. The adsorption parameters including pH, contact time, temperature, resin to aqueous ratio and rare earths initial concentration in aqueous have been optimized. The practical adsorption capacity of rare earths upon the resin under the optimum conditions has been found to attain 80 mg/g which matches with Langmuir theoretical capacity. The physical parameters including the adsorption kinetics, the isotherm models and the thermodynamic data have also been determined. The adsorption process has been found to agree with both the pseudo second order reaction, the Langmuir isotherm and confirms with the concept of the matrix diffusion controls. A successful preconcentration process for the rare earths content was done with a preconcentration factor of about 42.33. Considerable rare earths cake was precipitated from the chloride eluate solutions using oxalic acid.

The study area of Gabal El Sela at Halaib environ is located at about 20 km west of Abu Ramad City, Egypt. An uraniferous ore material associated with REE was subjected to sulphuric acid leaching for the extraction of uranium mainly and REEs as a by-product. 93.9% of U and 60% of REEs content were leached using −0.5 mm ground ore with 100 g/l sulfuric acid, acid/ore ratio of 2.0 and agitate for 6 h at 40 °C. After uranium extraction, effluent solutions containing 135 ppm rare earths were treated with 30% ammonium hydroxide to pH of 9.3 to enhance the rare earth elements concentration. The precipitated cake was filtered then dried at 110 °C. The dried cake containing 16.2% rare earth elements was dissolved by hydrochloric acid at pH 1.0. The rare earths precipitated cakes of 36.9, 45.7 and 48.7% REEs were recovered successfully from the chloride leach liquor of 900 ppm rare earths by using 5% v/v from 50% HF, 6% wt/v oxalic acid and 4.8% wt/v oxalic acid to chloride solution with heating for one hour which respectively. 73.5% REEs precipitated cake was achieved by double precipitation, firstly by hydrofluoric acid followed by oxalic acid precipitation.

Objective To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position (FFMSP). PCNL in the supine position is increasingly and successfully used in pediatric age group. Different modifications of supine positions have been described; however, the best supine position is not well established and remains a matter of debate. Patients and Methods This prospective study included 22 children presenting with single renal pelvis stone (2-3 cm) in the period between May 2012 and April 2014. Diagnosis was set by plain x-ray and computed tomography in all patients. PCNL was performed with the patients placed in the FFMSP. The operative time and hospital stay were estimated. The outcome and any perioperative complications or conflicts were recorded. Results The study included 22 children (15 boys and 7 girls) with a solitary renal pelvis stone. Mean ± standard deviation age of the patients was 9.5 ± 3.2 years (range, 3-15.5 years). Stone length, operative time, and hospital stay had mean ± standard deviation of 2.4 ± 0.23 cm, 65.1 ± 18.7 minutes, and 4.4 ± 0.9 days. Stone-free rate was 90.9% after 1 session of PCNL. One patient (4.5%) needed a second-look PCNL. Shock wave lithotripsy was performed for another patient. Postoperative fever occurred in 4 patients (18.2%). One patient received postoperative blood transfusion. Postoperative transient urinoma occurred in 2 patients (9.1%). Conclusion PCNL in pediatric age group via FFMSP was proved to be safe and effective in management of renal pelvis stones of size 2-3 cm. It provides stone clearance rate comparable with that reported of conventional PCNL in the prone position.

Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methods: Between June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8 mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation. Results: Success rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days. Conclusion: The one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate. Keywords: Lingual graft; Hypospadias; Urethroplasty; Augmentation

To compare the distance between the colon and the trajectory of percutaneous nephrolithotomy (PCNL) access both in prone and flank-free modified supine (FFMS) positions as measured on computed tomography and to study the effect of age, gender, BMI, side, and previous renal surgery as influencing factors.In this prospective study, we included 367 patients scheduled for PCNL. All patients underwent low dose abdominal computed tomography both in prone and FFMS positions. Patients18 years and those with previous colonic surgery or renal congenital anomalies were excluded. The perpendicular distance between the imaginary line of the renal access and the colon was measured. Findings were correlated to different influencing factors.Two hundred nineteen patients were males, and 148 were females. BMI of30 were reported in 158 patients whereas BMI30 in 209 patients. Data analysis showed that the mean perpendicular distance between colon and the renal access in FFMS and prone positions were 35.92 ± 0.22 mm and 17.78 ± 0.09 mm, respectively. In prone position only obesity, age, and overall interaction effect were the significant factors on the studied distance. In FFMS position, in addition to the effect of the prior factors, previous renal surgery also significantly reduces this distance.The distance between the colon and assumed PCNL trajectory at a puncture on the posterior axillary line was influenced mainly by patient position. In FFMS position the colon appears to be farther than in prone position. BMI and age significantly influence this distance to a lesser extent.

Background and Objectives Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). Methods Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCV-positive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). Results The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care work were significantly associated with anti-HCV seropositivity. Forty (81.63%) of 49 with anti-HCV-positive HCWs had positive hepatitis C viremia. The frequency of HCV RNA positivity increased with age. The frequency of eradicated past infection among nurses (36.85%) was markedly higher than that (6.7%) detected in non-health-care providers. Conclusion High rate of HCV infection is detected in Egyptian HCWs in rural Lower Egypt governorates. Health-care providers seem to eradicate HCV infection more frequently than non-health-care providers. National screening and treatment of infected HCWs are recommended.

Objective To evaluate the role of preoperative testicular shear wave elastography (SWE) in the prediction of improvement of semen analysis parameters after subinguinal microsurgical varicocele ligation in patients with primary infertility and clinically detectable varicocele. Patients and Methods Testicular SWE before the surgical intervention was done. Forty-eight patients were scheduled for subinguinal microsurgical varicocele ligation as a treatment option. Computer-assisted semen analysis was repeated 6 months after the intervention. Results At a cutoff value of 4.5 kPa, the stiffness index had a sensitivity of 86.4% and a specificity of 84.2% for semen parameter improvement after varicocelectomy. Correlation between different parameters of semen analysis and SWE showed a statistically significant negative correlation between SWE stiffness index and both sperm count (million/mL) and total motility. On the other hand, a nonsignificant negative correlation was found between SWE stiffness index and percentage of normal form. Conclusion Testicular SWE is a good test that can be used in the assessment of male infertility with clinically detectable varicocele, and its results may predict semen parameter improvement after varicocelectomy. Further studies on a larger number of patients are needed to verify our results.