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Objective: The primary aim of this study was to investigate the guidance effect of the bispectral index (BIS) on the target plasma concentration (TPC) of propofol required for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). Second, to identify propofol consumption, recovery time, and adverse events. Methods: A total of 42 consecutive patients with liver cirrhosis and 43 consecutive patients with healthy livers were enrolled. Propofol was administered via a target control infusion (TCI) syringe pump (Marsh Model) at BIS 60-70. Patients were not intubated, were placed in the prone position, and underwent spontaneous breathing. Propofol TPCs (µg mL-1) and BIS values were recorded at T0 (baseline), T1 (5 min after induction), T2 (5 min into ERCP), T3 (15 min), T4 (30 min), and T5 (recovery). Results: TPCs and propofol consumption were lower in patients with cirrhosis than in those without cirrhosis (T4: 2.7±0.5 vs. 3.3±0.4 µg mL-1), P=0.001, and 270.4±6.9 mg vs. 390.8±13.4 mg, P=0.001), respectively. Patients with cirrhosis required more time to recover (8.5±2 vs. 6.2±0.9 min, P=0.001), despite comparable ERCP durations (31.1±11.1 vs. 34±12.5 min, P=0.28). A significant decline in TPC values among patients with cirrhosis with time (T1: 3.3±0.3, T2: 3.1±0.3, T3: 2.9±0.4, T4: 2.7±0.5 µg mL-1, P=0.001), indicating a cumulative effect. One patient with cirrhosis required bag-mask ventilation, while three patients without cirrhosis were converted to general anaesthesia. Conclusion: Combining the TCI Marsh pharmacokinetic model with BIS monitoring lowered the TPC levels required for deep sedation in patients with cirrhosis compared with healthy patients and allowed for individual variations. The prone position in deeply sedated and non-intubated spontaneous breathing patients is not without the risk of hypoxia.

BackgroundSchistosomiasis affects approximately 250 million people worldwide, with 200,000 deaths annually. It has been documented that the granulomatous response to Schistosoma mansoni (S. mansoni) oviposition is the root cause of progressive liver fibrosis in chronic infection, in 20% of the patients, and can lead to liver cirrhosis and/or liver cancer. The influence of helminths coinfection on schistosomiasis-induced liver pathological alterations remains poorly understood. Therefore, in this study, we investigated the effect of Trichinella spiralis (T. spiralis) infection on S. mansoni-induced hepatic fibrosis.Materials and methodsThirty adult male Balb-c mice were divided into three groups. Group 1 was left uninfected; group 2 was infected with S. mansoni cercariae and group 3 was orally infected with T. spiralis larvae, then 28 days later, this group was infected with S. mansoni cercariae. All groups were sacrificed at the end of the 8th week post infection with S. mansoni to evaluate the effect of pre-infection with T. spiralis on S. mansoni induced liver fibrosis was evaluated parasitologically (worm burden and egg count in tissues), biochemically (levels of alanine aminotransferase and aspartate aminotransferase), histopathologically (H&E and MT staining, and immunohistochemical staining for the expression of α-SMA, IL-6, IL-1β, IL-17, IL-23, TNF-α, and TGF-β).ResultsThe results in the present study demonstrated marked protective effect of T. spiralis against S. mansoni induced liver pathology. We demonstrated that pre-infection with T. spirais caused marked reduction in the number of S. mansoni adult worms (3.17 ± 0.98 vs. 18 ± 2.16, P = 0.114) and egg count in both the intestine (207.2 ± 64.3 vs. 8,619.43 ± 727.52, P = 0.009) and liver tissues (279 ± 87.2 vs. 7,916.86 ± 771.34; P = 0.014). Consistently, we found significant reductions in both number (3.4 ± 1.1 vs. 11.8.3 ± 1.22; P = 0.007) and size (84 ± 11 vs. 294.3 ± 16.22; P = 0.001) of the hepatic granulomas in mice pre-infected with T. spiralis larvae compared to those infected with only S. mansoni. Furthermore, pre- infection with T. spiralis markedly reduced S. mansoni- induced hepatic fibrosis, as evidenced by decreased collagen deposition, low expression of α-SMA, and significantly reduced levels of IL-17, IL-1B, IL-6, TGF-B, IL-23, and TNF-α compared to mice infected with S. mansoni only.ConclusionsOur data show that pre-infection with T. spiralis effectively protected mice from severe schistosomiasis and liver fibrosis. We believe that our findings support the potential utility of helminths for the preventing and ameliorating severe pathological alterations induced by schistosomiasis.

Abstract Background members of the genus Sarcocystis are intracellular obligate protozoan parasites classified within the phylum Apicomplexa and have an obligate heteroxenous life cycle involving two hosts. A more comprehensive understanding of the prevalence and geographic range of different Sarcocystis species in marine ecosystems is needed globally and nationally. Hence, the objective of this study was to document the incidence of Sarcocystis infection in sharks within the aquarium ecosystem of Egypt and to identify the species through the characterization of the SSU rDNA gene. Methods All organs of the mako shark specimen underwent macroscopic screening to detect the existence of a Sarcocystis cyst. Ten cysts were collected from the intestine and processed separately to extract the genomic DNA. The polymerase chain reaction (PCR) was accomplished by amplifying a specific 18S ribosomal RNA (rRNA) gene fragment. Subsequently, the resulting amplicons were subjected to purification and sequencing processes. Results Macroscopic examination of the mako shark intestinal wall sample revealed the presence of Sarcocystis cysts of various sizes and shapes, and sequencing of the amplicons from Sarcocystis DNA revealed a 100% nucleotide identity with the sequence of Sarcocystis tenella recorded from sheep in Iran; The mako shark sequence has been deposited in the GeneBank with the accession number OQ721979. This study presents the first scientific evidence demonstrating the presence of the Sarcocystis parasite in sharks, thereby documenting this specific marine species as a novel intermediate host in the Sarcocystis life cycle. Conclusions This is the first identification of Sarcocystis infection in sharks, and we anticipate it will be an essential study for future screenings and establishing effective management measures for this disease in aquatic ecosystems.

IntroductionLeucocytozoon is an intracellular blood parasite that affects various bird species globally and is transmitted by blackfly vectors. This parasite is responsible for leucocytozoonosis, a disease that results in significant economic losses due to reduced meat and egg production. There is limited knowledge about the epidemiological pattern of leucocytozoonosis and its causative species in Egypt, particularly in pigeons.MethodsThe current study involved the collection of 203 blood samples from domestic pigeons from various household breeders and local markets across Qena Province, Upper Egypt. Samples were initially examined for potential Leucocytozoon infection using blood smears, followed by an evaluation of associated risk factors. Molecular identification of the parasite in selected samples (n = 11), which had initially tested positive via blood smears, was further refined through nested PCR and sequence analysis of the mitochondrial cytochrome b gene to ascertain the Leucocytozoon species present. Additionally, histopathological examination of the liver, spleen, and pancreas was conducted on animals that tested positive by blood smears.ResultsInterestingly, 26 out of 203 samples (12.08%) had confirmed Leucocytozoon infections based on microscopic analysis. Additionally, all 11 samples that initially tested positive via blood smears were confirmed positive through nested PCR analysis, and their sequencing revealed the presence of Leucocytozoon sabrazesi, marking the first report of this parasite in Egypt. The study into potential risk factors unveiled the prevalence of Leucocytozoon spp. seems host gender-dependent, with males exhibiting a significantly higher infection rate (33.33%). Additionally, adult birds demonstrated a significantly higher infection prevalence than squabs, suggesting an age-dependent trend in prevalence. Seasonality played a significant role, with the highest occurrence observed during summer (37.25%). Histopathological examination revealed the presence of numerous megaloschizonts accompanied by lymphocytic infiltration and multiple focal areas of ischemic necrosis.ConclusionTo our knowledge, this is the first study to shed light on the epidemiological characteristics and molecular characterization of leucocytozoonosis in pigeons in Egypt. Further research endeavors are warranted to curb the resurgence of Leucocytozoon parasites in other avian species across Egypt, thereby refining the epidemiological understanding of the disease for more effective control and prevention measures.

ABSTRACTBackground The aim of the study was to evaluate the effect of automatic gas control (AGC) on sevoflurane gas monitoring, safety, and recovery of patients during pancreatico-duodenectomy operation.Methods Forty patients scheduled for the pancreatico-duodenectomy operation were allocated into group I manual gas control group (MGC, n = 20) and group II AGC (n = 20) group. In (the MGC group): The vaporizer set ranged from 3 to 5% Sevoflurane until reaching 1 MAC, fresh gas flow (FGF) 1–2 L/min, and FiO2 of 0.4 was set. In (the AGC group): Set target FiO2 of 0.4, end-tidal anesthetic agent (EtSev was set to 1.5–2%) with safely ventilate the patient with an FGF down to 0.3 liters per minute. Hemodynamics, anesthesia gas analysis (FiSev, EtSev, FiO2, and EtO2), total gas consumption, extubation time, incidence of perioperative hypercapnia, hypoxia, and accidental awareness were recorded.Results The volume of sevoflurane administered in the MGC group was in a mean ± standard deviation of 81.20 ± 16.47 ml which was statistically significantly greater than that administered in the AGC group (58.80 ± 10.54), P ≤ 0.001. ETSevo, FISevo, and the EtO2 were significantly larger in the MGC group than in the AGC group. The extubation time was statistically prolonged in the MGC group than in the AGC group (14.10 ± 4.75 versus 7.70 ± 1.59 min, P

Abstract Background: Dogs are the most popular pet animals worldwide, and their frequent and close contact with humans poses an increased risk of zoonotic parasite transmission. Toxocara canis infection is a highly pervasive and economically significant zoonotic infection transmitted by dogs worldwide, commonly in tropical and subtropical regions, particularly in developing countries. Objectives: This study evaluates the epidemiological profile and associated risk factors of T. canis exposure among humans and T. canis infection in domestic dogs in two climatically different governorates in Egypt. Methods: Faecal samples from 360 domiciled dogs were examined using the flotation technique to detect T. canis eggs. In addition, 276 human serum samples were evaluated by enzyme‐linked immunosorbent assay over a period of 10 months from May 2021 to February 2022 in the Alexandria and Qena Governorates, Egypt. Results: Shedding of T. canis was identified in 33.33% (120/360) of dogs and the overall seroprevalence in the human population was 20.65% (57/276). Lower Egypt, represented by the Alexandria Governorate, had higher canine infection (39.47%) and human seropositivity (29.87%) rates than those of Upper Egypt, represented by Qena Governorate (26.47% and 9.02% in dogs and humans, respectively). Statistical analysis of the sociodemographic characteristics of the participants revealed that handwashing, washing of vegetables and fruits and sex were associated with human T. canis exposure. Conclusion: The prevalence rates of confirmed T. canis infection in the Egyptian dogs population and the associated human seropositivity rates reflect its importance as a public health concern and support the call to increase public awareness of this issue. The risk factors identified in this study can contribute to the development of more effective control and prevention strategies.

Abstract Albendazole is the most common benzimidazole derivative used for trichinellosis treatment but has many drawbacks. The quest for alternative compounds is, therefore, a target for researchers. This work aims to assess the in vitro anthelmintic effect of nifedipine, a calcium channel blocker, and a methanol extract of the flowers of Chrysanthemum coronarium as therapeutic repurposed drugs for treating different developmental stages of Trichinella spiralis in comparison with the reference drug, albendazole. Adult worms and muscle larvae of Trichinella spiralis were incubated with different concentrations of the studied drugs. Drug effects were evaluated by parasitological and electron microscopic examination. As a result, the effects of these drugs on muscle larvae were time and dose-dependent. Moreover, the LC50 after 48 h incubation was 81.25 µg/ml for albendazole, 1.24 µg/ml for nifedipine, and 229.48 µg/ml for C. coronarium. Also, the effects of the tested drugs were prominent on adult worms as the LC50 was 89.77 µg/ml for albendazole, 1.87 µg/ml for nifedipine, and 124.66 µg/ml for C. coronarium. SEM examination of the tegument of T. spiralis adult worms and larvae showed destruction of the adult worms' tegument in all treated groups. The tegument morphological changes were in the form of marked swellings or whole body collapse with the disappearance of internal contents. Furthermore, in silico studies showed that nifedipine might act as a T. spiralis β-tubulin polymerization inhibitor. Our results suggest that nifedipine and C. coronarium extract may be useful therapeutic agents for treating trichinellosis and warrant further assessment in animal disease models.

Hymenolepis nana infections are among the most important global socioeconomic and health problems worldwide notably in developing countries with hot temperature and dry climates. This study aimed to estimate the linkage between the prevalence of H. nana infection in humans at variant ages and its presence in different sources. A cross sectional study was achieved in the period between 2019 and 2021 during which 100, 50, 50, and 175 samples of rodent feces, water, green salad, and human stool were gathered, respectively and investigated for H. nana eggs. For checking the diagnostic efficacy of direct smear and flotation techniques compared to formalin-ethyl acetate concentration technique, rodent and human fecal samples were examined by the three methods. It has been found that one (1.0%), two (2.0%), and five (5.0%) out of 100 rodent fecal samples contained H. nana eggs, respectively. In Parallel, 2 (1.14%), 5 (2.86%), and 7 (4.0%) of 175 human fecal samples were positive, respectively by the three methods emphasizing that formalin-ethyl acetate concentration technique is the most sensitive. On the other hand, samples of water and green salad were examined by direct smear method only yielding 6.0% (3/50) contaminated vegetable samples while tape water samples weren’t contaminated by H. nana eggs. Interestingly, the prevalence of hymenolepiasis was significant (p

Background and Aim: In Egypt, there is a scarcity of recent data on trichinellosis in pigs and humans. Therefore, this study aimed to determine the epidemiological profile and risk factors associated with Trichinella spiralis infection as well as to assess the effectiveness of the trichinoscope and digestion technique in diagnosing trichinellosis. Materials and Methods: Data were collected on 33812 pigs slaughtered during a year at the Al-Basateen abattoir, Cairo Governorate, Egypt. The slaughtered pigs had already been examined by trichinoscope in the abattoir. The diagnostic effectiveness technique was randomly conducted on 170 pork muscle samples, which were examined using the digestion technique. Furthermore, 90 serum samples from high-risk individuals in Qena and Sohag Governorates, Upper Egypt, were analyzed using an enzyme-linked immunosorbent assay. Results: The investigation revealed that the overall prevalence was 1.06% in pigs by trichinoscope. Of the examined 170 samples, 2.35% and 3.35% were found to harbor Trichinella by trichinoscope and artificial digestion, respectively. Trichinella was identified as T. spiralis using a polymerase chain reaction (PCR) technique. A significant relationship was affirmed between the prevalence of trichinellosis and the sex and age of the examined pigs. Likewise, for the first time, there was a considerable seasonal trend in the prevalence of Trichinella with the maximum infection, which was observed during Autumn (1.18%). The prevalence of trichinellosis in humans was 10%, with a significant association with age. Conclusion: Our findings are intended to serve as a starting point for developing effective preventive and control measures for trichinellosis (as application of Hazard Analysis Critical Control Points (HACCP) in pig farms, stop feeding pigs on garbage as well as, preventing illegal slaughter of pigs outside the slaughterhouses). It also fortifies the establishment of the digestion technique because of its high specificity and sensitivity, although it is difficult to apply to a large number of samples.

Idiopathic nephrotic syndrome (INS) is the most common cause of NS in children. It is characterized by the existence of edema, proteinuria, and hypoalbuminemia, as well as repeated relapses. The etiology remains unknown, but new evidence for its pathogenesis relates to the dysfunction of T-regulatory (T-reg) cells, which could be caused by dysbiosis of the gut microbiota. Our study aimed to investigate the effect of prebiotics and probiotics as adjuvant therapies for children with relapsing INS. The study was designed as a prospective open-label randomized clinical trial involving 30 children diagnosed with relapsing INS. The children were randomly divided into two groups. Group 1 was treated with prednisone only, and Group 2 was treated with prebiotics and probiotics in addition to prednisone. Fresh stool samples were collected from the children. Lactobacillus species were isolated and identified by conventional microbiological methods. The total number of Lactobacillus species was counted for each stool sample. The population of T-reg cells in the peripheral blood mononuclear cells was analyzed using flow cytometry. Children treated with prebiotics and probiotics in addition to steroids showed a significant increase in T-reg cells (CD4+/CD25+/FOXp3+) in the peripheral blood and a higher count of Lactobacillus species in their stool alongside a significant decrease in the rate of relapses in this group compared with Group 1. Treatment with prebiotics and probiotics signi-ficantly increased T-reg cells and decreased the rate of relapse in INS.

Objective(s): Liver fibrosis eventually develops into cirrhosis and hepatic failure, which can only be treated with liver transplantation. We aimed to assess the potential role of hydrogen sulfide (H2S) alone and combined with bone marrow-derived mesenchymal stem cells (BM-MSCs) on hepatic fibrosis induced by bile-duct ligation (BDL) and to compare their effects to silymarin.Materials and Methods: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), and alkaline phosphatase (ALP) were investigated in serum. Gene expression levels of CBS (cystathionine β-synthase), CSE (cystathionine γ-lyase), and alpha-smooth muscle actin (α- SMA) were measured in liver tissues using RT-PCR. Hepatic protein kinase (Akt) was assessed by Western blot assay. Liver oxidative stress markers, malondialdehyde (MDA), and reduced glutathione (GSH) were analyzed by the colorimetric method. Lipocalin-2 (LCN2) and transforming growth factor-β (TGF-β) were measured using ELIZA. Liver tissues were examined by H&E and Masson trichome staining for detection of liver necrosis or fibrosis. Caspase 3 expression was evaluated by immunohistochemistry. Results: H2S and BM-MSCs ameliorated liver function and inhibited inflammation and oxidative stress detected by significantly decreased serum ALT, AST, ALP, TB, and hepatic MDA, Akt, TGF-β, LCN2, and α-SMA expression and significantly increased CBS and CSE gene expression levels. They attenuated hepatic apoptosis evidenced by decreased hepatic caspase expression.Conclusion: Combined treatment with H2S and BM-MSCs could attenuate liver fibrosis induced by BDL through mechanisms such as anti-inflammation, anti-oxidation, anti-apoptosis, anti-fibrosis, and regenerative properties indicating that using H2S and MSCs may represent a promising approach for management of cholestatic liver fibrosis.

BackgroundTrichinellosis is a helminthic disease caused by Trichinella spiralis via the ingestion of raw or undercooked meat of infected animals. Current estimates indicate that 11 million humans have trichinellosis, worldwide. The effective use of anti-trichinella medications is limited by side effects and resistance which highlight the critical need for safe and effective drugs, particularly those derived from medicinal plants. Therefore, in the present study, we aimed to evaluate the efficacy of the ethanolic extract of Artemisia annua (A. annua) in treatment of experimentally induced trichinellosis.Materials and methodsTrichinellosis was induced experimentally in male 6–8 weeks BALB/c mice. BALB/c mice were divided into four groups, 10 mice each. One group was left uninfected and untreated, whereas three groups were infected with T. spiralis. One infected group of mice was left untreated (negative control) while the remaining two infected groups received either 300 mg/kg of the ethanolic extract of A. annua or 50 mg/kg of albendazole (positive control). All treatments started from the third day post-infection (dpi) for 3 successive days. All animals were sacrificed on the 7th dpi for evaluation of treatment efficacy.ResultsOur findings showed that A. annua treatment reduced the T. spiralis adult-worm count in the intestine of infected animals. Moreover, treatment with A. annua restored the normal intestinal architecture, reduced edema, alleviated inflammation as demonstrated by reduced inflammatory infiltrate and expression of TGF-β in intestinal tissues of A. annua-treated animals compared to infected untreated animals.ConclusionsOur findings show that A. annua extract is effective in treating experimentally induced trichinellosis which highlight the therapeutic potential of A. annua for intestinal trichinellosis.

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI.Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI.Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials.Trial registration number NCT04165369.

Background:Toxoplasma gondii (T. gondii) is an opportunistic parasite that causes serious diseases in humans, particularly immunocompromised individuals and pregnant women. To date, there are limited numbers of therapeutics for chronic toxoplasmosis which necessitate the discovery of effective and safe therapeutics. In the present study, we aimed to evaluate the antitoxoplasmosis potential of ginger extract in mice with experimentally induced chronic toxoplasmosis. Results: Treatment with ginger extract significantly reduced cysts count in the brains of T. gondii-infected mice with a marked alleviation of edema and inflammation, and a reversal of neuronal injury. Moreover, ginger extract treatment reduced inflammation in liver and lungs and protected hepatocytes from infection-induced degeneration. Consistently, apoptosis was significantly mitigated in the brains of ginger extract-treated mice compared to infected untreated animals or spiramycin-treated animals. Methods: Four groups of Swiss albino mice (10 mice each) were used. The first group was not infected, whereas 3 groups were infected with Me49 T. gondii strains. One infected group remained untreated (infected untreated), whereas the other two infected groups were treated with either ginger extract (250 mg/kg) or spiramycin (positive control; 100 mg/kg), respectively. The therapeutic potential of ginger extract was evaluated by calculation of the parasite burden in infected animals, and examination of the infected tissues for reduced pathologic changes. Conclusions: Our results showed for the first time that ginger extract exhibited marked therapeutic effects in mice with chronic T. gondii infection which indicates that it can be used as a safe and effective treatment for chronic toxoplasmosis.

To eliminate schistosomiasis, appropriate diagnostic tests are required to monitor its prevalence and transmission, especially in the settings with low endemicity resulting from the consecutive mass drug administration. Antibodies that react with either crude soluble schistosome egg antigens or soluble worm antigen preparations have been used to monitor infection in low-prevalence regions. However, these detection methods cannot discriminate current and past infections and are cross-reactive with other parasites because both antigens contain numerous proteins and glycans from schistosomes, and standard preparations need maintenance of the life cycle of the schistosome. To evaluate the potential utility of nine recombinant Schistosoma mansoni proteins as single defined antigens for serological diagnosis, we monitored the kinetics of antibodies to each antigen during S. mansoni infection in mice before and after the treatment with praziquantel. C57BL/6 mice were infected with 50 cercariae. The levels of immunoglobulin G (IgG) raised against five recombinant antigens (RP26, sm31, sm32, GST, and LAP1) significantly increased as early as 2-4 weeks after infection and rapidly declined by 2 weeks after the treatment, whereas those raised against crude S. mansoni egg antigens or other antigens remained elevated long after the treatment. The IgG1 raised against RP26, sm31, and serpin decreased after the treatment with praziquantel, whereas the IgE raised against serpin declined strikingly after the treatment. This study clarifies the dynamics of the serological responses to recombinant S. mansoni proteins during infection and after the treatment with praziquantel and identifies several candidate antigens with potential utility in the monitoring and surveillance of schistosomiasis toward the elimination of schistosomiasis.

Objective: To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain. Materials and methods: 37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years ''mean age 28 years'' complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion. Results: MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically. Conclusion: MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain. Keywords: Chronic wrist pain, MRI, MRA, Arthroscope

Background and Aims: Liver resection can lead to hepatocellular dysfunction. The aim was to evaluate the effect of N-acetyl cysteine (NAC) on liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), international normalized ratio (INR), C-reactive protein (CRP), and intercellular adhesion molecule 1 (ICAM 1) in cirrhotic patients undergoing liver resection. Material and Methods: A randomized controlled trial (RCT), Pan African Clinical Trial registry (PACTR201508001251260). 60 Child A patients were studied. NAC group (n = 30) received intravenous infusion of NAC 10 g/24 h in 250 ml of 5% dextrose during surgery and for 2 days. Controls (C) (n = 30) received a similar volume of 5% dextrose. All above parameter were measured during and after surgery. Results: ALT and AST were significantly elevated after surgery, but to a less extent with NAC versus C (day 3; 118.3 ± 18.6 vs. 145.4 ± 14.0 U/L. P < 0.01) and (121.5 ± 19.5 vs. 146.6 ± 15.1 U/L, P = 0.00), respectively. Lower serum CRP and ICAM 1 with NAC versus C on day 3 (44.2 ± 13.4 vs. 68.7 ± 48.2 mg/l, P = 0.003), (308.8 ± 38.2 vs. 352.8 ± 59.4 ng/ml, P = 0.002), respectively. Hospital stay was shorter with NAC versus C (6.1 ± 0.8 vs. 6.9 ± 1.2 days, P = 0.006). Duration of surgery, INR, and hemodynamics were comparable. Conclusion: Prophylactic NAC in hepatic patients undergoing liver surgery attenuated postoperative increase in transaminases, ICAM 1, and CRP blood levels. The impact of these findings and the cost benefit of reduced hospital stay on enhanced recovery after surgery needs to be evaluated.

Background and Aims: Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters. Methods: After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index 0.05) and was sustained post-operatively. Conclusion: Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

Background: Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries. Materials and Methods: A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each.NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups. Results: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR

Objective: Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection. Methods: This study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded. Results: The total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group. Conclusions: Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays. [ABSTRACT FROM AUTHOR]

Introduction: Leucocytozoon is an intracellular blood parasite that affects various bird species globally and is transmitted by blackfly vectors. This parasite is responsible for leucocytozoonosis, a disease that results in significant economic losses due to reduced meat and egg production. There is limited knowledge about the epidemiological pattern of leucocytozoonosis and its causative species in Egypt, particularly in pigeons. Methods: The current study involved the collection of 203 blood samples from domestic pigeons from various household breeders and local markets across Qena Province, Upper Egypt. Samples were initially examined for potential Leucocytozoon infection using blood smears, followed by an evaluation of associated risk factors. Molecular identification of the parasite in selected samples (n = 11), which had initially tested positive via blood smears, was further refined through nested PCR and sequence analysis of the mitochondrial cytochrome b gene to ascertain the Leucocytozoon species present. Additionally, histopathological examination of the liver, spleen, and pancreas was conducted on animals that tested positive by blood smears. Results: Interestingly, 26 out of 203 samples (12.08%) had confirmed Leucocytozoon infections based on microscopic analysis. Additionally, all 11 samples that initially tested positive via blood smears were confirmed positive through nested PCR analysis, and their sequencing revealed the presence of Leucocytozoon sabrazesi, marking the first report of this parasite in Egypt. The study into potential risk factors unveiled the prevalence of Leucocytozoon spp. seems host gender-dependent, with males exhibiting a significantly higher infection rate (33.33%). Additionally, adult birds demonstrated a significantly higher infection prevalence than squabs, suggesting an age-dependent trend in prevalence. Seasonality played a significant role, with the highest occurrence observed during summer (37.25%). Histopathological examination revealed the presence of numerous megaloschizonts accompanied by lymphocytic infiltration and multiple focal areas of ischemic necrosis. Conclusion: To our knowledge, this is the first study to shed light on the epidemiological characteristics and molecular characterization of leucocytozoonosis in pigeons in Egypt. Further research endeavors are warranted to curb the resurgence of Leucocytozoon parasites in other avian species across Egypt, thereby refining the epidemiological understanding of the disease for more effective control and prevention measures. [ABSTRACT FROM AUTHOR]

Background: Elder abuse is a growing trend worldwide, posing a serious threat to public health and older adults' health. Aim: This study aimed to assess the relationship between elderly abuse and quality of nursing care in Outpatient Clinics. Design: A descriptive design was conducted to achieve aim of this study. Setting: This study was conducted in outpatient clinics at Beni-Suef university hospital, at Cairo governorate. Subjects: A convenient sample of elderly patients 80 elderly patients from the previously mentioned setting was included in the study aged from (60:75) years of both sexes, who attended the previously mentioned setting. Tools: it was divided into 4 parts; the first part is the Sociodemographic characteristics of the elder people and the medical history of elderly people. The second part is Quality of nursing care checklist includes actual performance regarding to care elder in outpatient unit, the last tool is Elderly abuse assessment sheet. Results: shows that, less than half of studied elderly people were reported moderate and poor quality of nursing care in outpatient clinics and more than one third of them reported high and moderate abuse toward elderly. additionally, there was positive correlation between all dimensions of quality of nursing care in outpatient clinics as reported by elderly people. Conclusion: there was positive correlation between total quality of nursing care in outpatient clinics and total elderly abuse during receiving outpatient services as reported by elderly people. Recommendations: Continuous service educational program should be designed for early detection of elderly Abuse and implementation to motivate nursing staff to achieve high quality level of nursing care. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the effect of automatic gas control (AGC) on sevoflurane gas monitoring, safety, and recovery of patients during pancreaticoduodenectomy operation. Methods: Forty patients scheduled for the pancreatico-duodenectomy operation were allocated into group I manual gas control group (MGC, n = 20) and group II AGC (n = 20) group. In (the MGC group): The vaporizer set ranged from 3 to 5% Sevoflurane until reaching 1 MAC, fresh gas flow (FGF) 1-2 L/min, and FiO2 of 0.4 was set. In (the AGC group): Set target FiO2 of 0.4, end-tidal anesthetic agent (EtSev was set to 1.5-2%) with safely ventilate the patient with an FGF down to 0.3 liters per minute. Hemodynamics, anesthesia gas analysis (FiSev, EtSev, FiO2, and EtO2), total gas consumption, extubation time, incidence of perioperative hypercapnia, hypoxia, and accidental awareness were recorded. Results: The volume of sevoflurane administered in the MGC group was in a mean ± standard deviation of 81.20 ± 16.47 ml which was statistically significantly greater than that administered in the AGC group (58.80 ± 10.54), P = 0.001. ETSevo, FISevo, and the EtO2 were significantly larger in the MGC group than in the AGC group. The extubation time was statistically prolonged in the MGC group than in the AGC group (14.10 ± 4.75 versus 7.70 ± 1.59 min, P < 0.001). No patient developed hypoxia, hypercapnia, or awareness in both groups. Conclusion: AGC maintained the targeted end-tidal sevoflurane concentration with the least sevoflurane consumption. It reduced the manual adjustment of delivered sevoflurane and oxygen. General anesthesia with manual and AGC is safe and maintains hemodynamic stability. [ABSTRACT FROM AUTHOR]