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Arrhythmia, one of the most common complications of COVID-19, was reported in nearly one-third of diagnosed COVID-19 patients, with higher prevalence rate among ICU admitted patients. The underlying etiology for arrhythmia in these cases are mostly multifactorial as those patients may suffer from one or more of the following predisposing mechanisms; catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte disturbance, and pro-arrhythmic drugs usage. Obviously, the risk for arrhythmia and the associated lethal outcome would rise dramatically among patients with preexisting cardiac disease such as myocardial ischemia, heart failure, cardiomyopathy, and hereditary arrhythmias. Considering all of these variables, the management strategy of COVID-19 patients should expand from managing a viral infection and related host immune response to include the prevention of predictable causes for arrhythmia. This may necessitate the need to investigate the role of some drugs that modulate the pathway of arrhythmia generation. Of these drugs, we discuss the potential role of adrenergic antagonists, trimetazidine, ranolazine, and the debatable angiotensin converting enzyme inhibitors drugs. We also recommend monitoring the level of: unbound free fatty acids, serum electrolytes, troponin, and QTc (even in the absence of apparent pro-arrhythmic drug use) as these may be the only indicators for patients at risk for arrhythmic complications.

Background Understanding the pathological changes in varus osteoarthritic knees will help the surgeon to correct the deformity while performing total knee arthroplasty. The currently available MRI resolution allows us to recognize the anatomical details of the posteromedial corner and the changes associated with osteoarthritic knees. The study aims to assess the pathological changes of the varus osteoarthritic knees on MRI and to compare it to non-arthritic knees. Methods MRI of 26 patients with varus osteoarthritic knees (Kellgren and Lawrence grade 4) scheduled for total knee arthroplasty were reviewed and compared to MRI of 10 other patients without knee arthritis. The superficial Medial Collateral Ligament (sMCL) was assessed in terms of medial and posterior bowing, and the posteromedial corner (PMC) was evaluated in terms of thickness and signal integrity. Results The superficial Medial Collateral Ligament (sMCL) was medially and posteriorly displaced in all severely varus arthritic knees compared to its position in non-arthritic knees, in addition to significant increase in posteromedial corner thickness with heterogenous appearance indicating scarring in the posteromedial corner (PMC). (p-value lower than 0.05). Conclusion The apparent tightness of the superficial Medial Collateral Ligament can be secondary to the pathology that affects the posteromedial corner (scarring) where sMCL is retracted and bowed posteriorly and medially, not simply contracted and shortened. Understanding the pathological changes of severely varus osteoarthritic knees on MRI can lead to a better algorithm to perform soft tissue balance during Total knee replacement surgery without releasing sMCL and subsequent knee instability.

رحلة الفداء والعتق عبر الازاحة قراءة التحليل النفسى فى رواية عصر الحديد آليات الدفاع هى وسائل يلجأ اليها الاسوياء من الناس من اجل تجنب القلق الناشئ عن بعض المشاعر السلبية تجاه موقف او شخص ما تعد اللزاحة احد اکثر آليات الدفاع الشائعة التى تعمل لا اراديا فى العقل وتقوم بتحويل المشاعر السلبية تجاه هذف ما الى مشاعر مقبولة فى هذه الراوية يتبع جى ام کوتزى منهج التحليل النفسى فى رسم شخصية اليزابيث کارن لا براز سخطه الشخصى تجاه نظام التمييز العنصرى السائد فى جنوب افريقيا متخدا فى ذلک آلية الدفاع الازاحة کوسيلة للتکيف مع الموقف الذى وجدت نفسها فيه اليزابيث کارن سيدة بيضاء ترفض التمييز العنصرى وممارساته القمعيه وتتخذ من الکتابه لابنتها الغائبة وسيلة للتعبير عن رفضها لهذا النظام الحاکم فى ذلک تمثل علاقتها مع من حولها من السود الذين يعيشون المادة لهذا الخطاب الاعترافى حيث تقوم بازاحة مشاعرها السلبية تجاه النظام الحاکم کوسبلة للتکيف مع موقفها کعضو ينتمتى الى الجنس الابيض رافضة لهذا النظام فى محاولة منها لاايجاد معنى لحياتها.. Abstract: Defense mechanisms are coping techniques that people unconsciously employ to avoid the tension arising toward a certain situation, person, idea or any object. Displacement is one common defense mechanism that unconsciously operates in the mind to turn the negative feelings toward a certain target to acceptable ones. J.M.Coetzee adopts the psychoanalytical approach in portraying the character of Elizabeth Curren to convey his own contempt toward Apartheid in South Africa taking Displacement as a means of coexistence with the situation in which she finds herself. Coetzee gives an example of a white character who is not in line with the oppressive Apartheid. Because of her inability to openly express her negative feelings toward the regime, she finds in writing a letter to her daughter a means to adapt to her situation. In doing so, she finds in her relationship with the Blacks in her community the substance of her confessional writing. In a word, the present study aims to underscore the importance of defense mechanisms as coping techniques to make their life meaningful.

Background: Tibial component malrotation is one of the commonest causes of pain and stiffness following total knee arthroplasties, however, the assessment of tibial component malrotation on imaging is not clear-cut. The objective of this study was to assess tibial component rotation in cases with pain following total knee replacement using MRI with metal artifact reduction technique. Methods: In 15 consecutive patients presented in our clinic — a high-volume arthroplasty institution — between January 2017 and June 2017 with persistent unexplained moderate to severe pain for at least 6 months following total knee arthroplasties, which were ALL done outside our institution, after exclusion of infection and loosening (tibial or femoral), MRI evaluation of tibial component rotation using metal artifact reduction for orthopedic implants (O-MAR) technique — to improve visualization of soft tissue and bone by reducing artifacts caused by metal implants — was done according to the technique of Berger et al. [Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 144–153, 1998]. Results: Eleven cases showed an internal rotation of tibial components (73.3%), four cases showed a neutral or external rotation of tibial components (26.6%), however, with the presence of abnormal intraarticular fibrous bands in two of them. Conclusions: Two main conclusions are obtained from this study: Firstly, internal rotation of tibial component must be excluded in all cases of persistent pain following total knee replacement. Secondly, magnetic resonance imaging with the newly developed metal artifact reduction techniques is a very useful tool in evaluating cases of unexplained pain following total knee replacement.

Chronic hepatitis C virus infection (HCV) is a common health problem. Before the advent of the direct acting anti-viral treatment, the only approved treatment of HCV was the combined Interferone α (INF-α) and ribavirin. Unfortunately, INF-α had a limited success rate and many side effects including thyroid dysfunction in the form of hypothyroidism, hyperthyroidism or silent auto-antibodies production. This study was done on 60 patients (42 males and 18 females) with HCV –related chronic hepatitis receiving treatment in the form of combined pegylated Interferone and ribavirin with a mean age of 46.37 ± 12.97 years, and 24 age and sex matched healthy controls. Thyroid function tests and serum chemokine 10 (IP 10) were done for all patients before starting treatment, after 6 months and after one year. We found that IP 10 level was higher in patients than control subjects, and it progressively increasing during treatment. On the other hand, thyroid stimulating hormone (TSH) level tended to decrease during treatment.

Type 2 diabetes is a polygenic disease characterized by interaction of environmental and genetic factors. The paraoxonase 1 gene (PON1) 55 and 192 polymorphisms have been reported to be associated with type 2 diabetes and its complications. Our aim is to study the PON1 55, 192 gene polymorphisms and enzyme activity in type 2 diabetic Egyptian population with complications. 100 type 2 diabetic patients with complications (34 with cardiac and 66 with microvascular complications (neuropathy, retinopathy and/or nephropathy)). This was in addition to 100 healthy control subjects of matched age and sex were taken. PON1 55 L⁄M and 192 Q⁄R gene polymorphisms and PON1 enzyme activity serum levels were detected. The LL genotype of PON1 55 polymorphism and QR and QQ genotypes of PON1 192 polymorphism were more frequent among the patients with diabetic complications. The PON1 enzyme activity levels were lower among the diabetic patients than in control subjects. PON1 55 and 192 polymorphisms and enzyme activity seems to be related to diabetic complications in this population.

Recent findings indicate that certain cytokines are capable of interfering with insulin sensitive glucose uptake and induce insulin resistance. To test for the association of IL-10– 1082 and IL-6– 174 genetic polymorphisms with type 2 diabetes mellitus in Egyptian patients. Participants included 69 cases with type 2 DM (31 males and 38 females) with a median age of 57 years in addition to 98 healthy unrelated controls from the Nile Delta region, Egypt. Compared to controls, cases with type 2 diabetes mellitus showed a highly significant increase in the frequency of IL-10– 1082 GG genotype (p 0.05). Polymorphisms related to IL-10– 1082 GG and IL-6– 174 CC genotypes may be considered as a risk factor for type 2 diabetes mellitus among Egyptian subjects with a potential impact on family counseling and management.

Type 2 diabetes mellitus is the most common type of diabetes worldwide with serious macro- and microvascular complications. It is a polygenic disease characterized by interaction of environmental and genetic factors. The paraoxonase 1 gene (PON1) 55 and 192 polymorphisms have been reported to be associated with type 2 diabetes and its complications. Our aim is to study the PON1 55 , 192 gene polymorphisms and enzyme activity in type 2 diabetic Egyptian population with complications. 100 type 2 diabetic patients with complications (34 with cardiac and 66 with microvascular complications (neuropathy, retinopathy and/or nephropathy). This was in addition to 100 healthy control subjects of matched age and sex were taken. PON1 55 L⁄M and 192 Q⁄R gene polymorphisms and PON1 enzyme activity serum levels were detected. The LL genotype of PON1 55 polymorphism and QR and QQ genotypes of PON1 192 polymorphism were more frequent among the patients with diabetic complications. The PON1 enzyme activity levels were lower among the diabetic patients than in control subjects. PON1 55 and 192 polymorphisms and enzyme activity seems to be related to diabetic complications in an Egyptian type 2 diabetic patients.

To explore the association of TNF-α-308 and IFN- γ +874 genetic polymorphisms with type 2 diabetes mellitus (DM) in Egyptian cases. Participants included 207 cases with type 2 DM, 93 males and 114 females. Their mean age was 57 years. They were compared to a control group of 212 healthy unrelated subjects from the same locality. DNA was amplified using PCR with sequence specific primers for detection of polymorphism related to TNF-α-308 (G/A) and IFN-γ+874 (A/T). The combined homozygote pat tern of TNF-α-308 (AA) and IFN-γ+874 (A/A) was significantly higher in diabetic cases versus controls (p=0.023) that was manifest (although non-significant) among complicated, uncontrolled cases and cases with marked insulin resistance. Polymorphism related to TNF-α-308 AA and IFN-γ+874 AA may be considered as a genetic biomarker for type 2 DM in Egyptian subjects with potential impact on family counseling and management.

Non-alcoholic steatohepatitis can progress to cirrhosis and hepatocellular carcinoma. Our aim is to evaluate serum ferritin and iron levels in patients with non-alcoholic steatohepatitis (NASH). 53 patients with NASH (36 males and 17 females) were selected from the Specialized Medical Hospital, Mansoura, Egypt. This is in addition to 50 apparently healthy subjects (30 males and 20 females) of age and sex matched as a control group. We detected serum ferritin, iron, immune-reactive insulin (IRI) and the calculated homeostasis model for assessment of insulin resistance (HOMA-IR), in addition to markers of oxidative stress (MDA and thiol) and tumor necrosis factor alpha (TNF-α). Patients with NASH have higher levels of ferritin, iron, IRI, HOMA-IR, MDA, TNF- α (p= 0.001) and thiol (p= 0.01) than control subjects. Serum ferritin has a significant positive correlation with body mass index, ALT, AST, fasting plasma glucose (FPG), total cholesterol, LDL-cholesterol, triglyceride, IRI, HOMA-IR, MDA, thiol and TNF-α (p=0.001) in NASH patients. However, after adjustment for age, sex, BMI and HOMA-IR in cases of NASH, ferritin still has a significant positive correlation with ALT, FPG, total cholesterol, TNF-α, MDA (p=0.001) and thiol (p=0.003). Serum iron has no significant correlation with grade of NASH or fibrosis. Serum ferritin level is higher in patients with NASH more than control subjects. Moreover it has a significant positive correlation with oxidative stress even after adjustment for age, sex, BMI and HOMA-IR.

Background : Left ventricular hy­pertrophy (LVH) is an independent risk factor for cardiovascular morbidi­ty and mortality in hypertensive pa­tients. The identification of risk factors for the initiation of LVH in patients with hypertension (HTN) is important including microalbuminunuria (MAU) and hyperaldosteronism. Objectives : Evaluation of the rela­tionship of MAU and plasma aldoste-rone to blood pressure (BP) and LVH in patients with essential HTN. Subjects and Methods 467 Thirty male patients with essential HTN and 15 healthy subjects as a control group were subjected to thorough clinical examination, transthoracic echocardiography, lipid profile, serum potassium, serum aldosterone esti­mation. MAU was evaluated with dip­stick Micral-ll Test of fasting mid­stream morning urine on two successive days. Left ventricular mass index (LVMI) was calculated and values >134gm/m2 were consid­ered as LVH

Approximately 30% of patients with chronic hepatitis C have persistently normal serum alanine aminotransferase (ALT) levels. In most of the previous studies, the follow-up period of ALT levels did not exceed 12 months. Our objective was to redefine the terms persistently normal alanine aminotransferase (PNALT), persistently elevated ALT (PEALT), and fluctuating ALT (FLUXALT) and to determine the proportion of each group among Nile Delta patients. 348 patients infected with chronic hepatitis C were included, HCV infection was proved by a polymerase chain reaction. We studied an average of 19 ALT measurements for each participant between 2004 and 2007 with 2-month interval between successive measurements. We defined a patient as having PNALT, PEALT, or FLUXALT when all the 19 ALT levels were normal (40 IU/L), or did not fit either of the above two categories, respectively, during the 36-month follow-up period. 73 patients had PNALT, 157 had PEALT, and 118 had FLUXALT (P

The low serum level of testosterone in the elderly subjects may be a contributing factor for coronary artery disease (CAD) through many pathways.The aim of this work is to study serum levels of free testosterone in elderly men with CAD (both those with acute coronary syndrome (ACS) and those with stable CAD). This study was conducted on 100 elderly males with CAD ,one half of them (50 patients) was presented with ACS (with mean age 69.6± 2.44 year), and the other half (50 patients) was presented with stable CAD (with mean age 69.42± 2.14year), in addition to 50 apparently healthy elderly males (with mean age 69.06 ± 1.64year) as a control group. We detected the levels of serum free testosterone, cortisol, fibrinogen, plasminogen activator inhibitor-1(PAI-1), high sensitive C-reactive protein(hsCRP), interleukin-6(IL-6). Cases with CAD had significant lower values of free testosterone and HDL-c, but they had significant higher values of cortisol, fibrinogen, PAI-1, IL-6, hsCRP, in comparison to control group. Cases with ACS had significant higher values of cortisol, hsCRP, IL-6, fibrinogen, PAI-1, total cholesterol and BMI more than those with stable CAD. The free testosterone had significant negative correlation with fibrinogen, PAI-1, , hsCRP and IL-6 in both groups of patients. The lower value of serum free testosterone in elderly male subjects may contribute to CAD in them via multiple mechanisms including increase blood pressure, dyslipidemia, obesity, increased blood coagulation and increased inflammatory activity., Yaşlı bireylerde düşük testosteron düzeyi, birçok mekanizma ile koroner arter hastalığı (KAH) gelişimine katkıda bulunabilir. Bu çalışmada KAH olan (akut koroner sendromu(AKS) veyastabil KAH olan) yaşlı erkeklerde serbest testosteron düzeylerinin incelenmesi amaçlanmıştır. Çalışmaya 50AKS’lu (ortalama yaş 69.6± 2.44), 50 stabil KAH( ortalama yaş 69.42± 2.14) olan toplam 100 hasta ve kontrol grubu olarak 50 sağlıklı yaşlı (ortalama yaş 69.06± 1.64) alındı. Çalışmaya alınan kişilerin serumserbest testosteron düzeyleri,kortizol, fibrinojen, plazminojenetkinleştirici inhibitör- 1 (PAI-1),yüksek duyarlı C- reaktif protein (hsCRP), interlökin-6 (IL-6) düzeylerine bakıldı.Kontrol grubu ile karşılaştırıldığında, KAH olan olgularda serbest testesteron ve HDL-c düzeyleri anlamlı olarak düşük bulunurken, kortizol, fibrinojen, PAI-1, hsCRP,IL- 6 düzeyleri yüksek bulundu. AKS’lu hastalarda Kortizol, fibrinojen, PAI-1, hsCRP,IL- 6, total kolesterol ve BMI düzeyleri stabil KAH olan hastalardan önemli derecede yüksekti. Her iki grupta da serbest testesteron ile fibrinojen, PAI-1, hsCRP,IL-6 düzeyleri arasında negatif korelasyon vardı. Yaşlı erkek hastalarda serum serbest testosteron düzeyleri, tansiyon artışı, dislipidemi, aşırı şişmanlık, kogülasyon ve enflamatuar aktivite artışı gibi çoklu mekanizmalar yoluyla KAH’na katkıda bulunabilir

Microalbuminuria is considered a marker of extensive endothelial dysfunction and is associated with excess of other cardiovascular risk factors. Our aim is to assess the importance of the presence of microalbuminuria in elderly diabetic patients. A total of 40 normotensive elderly type 2 diabetic patients of both genders with mean age >65 years were randomly included and were further subdivided according to the presence of persistent microalbuminuria into microalbuminuric and normoalbuminuric groups. All patients in both groups were subjected to thorough clinical and laboratory investigations including the assay of serum thrombomodulin (TM) and glycosylated hemoglobin level. Early-morning midstream urine samples were evaluated for levels of beta 2 microglobulin, alpha 1 microglobulin, TM, and N-acetyl-beta-d-glucosaminidase (NAG). There was no significant difference between both groups regarding the clinical demographic characteristics. There were statistically significant higher values for glycosylated hemoglobin percentage, serum triglycerides and serum TM and urinary B2 microglobulin, urinary alpha 1 microglobulin, urinary NAG and urinary thrombomodulin in microalbuminuric group in comparison to normoalbuminuric group (P

Background and study aims Patients with liver cirrhosis present an increased susceptibility to the systemic inflammatory response syndrome (SIRS), which is considered the cause of hospital admission in about 10% of patients and is present in about 40% of those admitted for ongoing complications. We tried to assess the prevalence of the SIRS with the possible effects on the course of the disease during hospital stay. Patients and methods Two hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The main clinical endpoints were death and the development of portal hypertension-related complications. Results Eighty-one patients met the criteria of SIRS (39.9%). We found significant correlations between SIRS and jaundice (p = 0.005), bacterial infection (p = 0.008), white blood cell count (p

Background. The low serum level of testosterone in the elderly subjects may contribute to coronary artery disease (CAD). Our aim is to study serum levels of free testosterone in elderly men with CAD.Subjects and Methods. This study was conducted on 100 elderly males with CAD, one half of them was presented with ACS (with mean age year), and the other half was presented with stable CAD (with mean age year), in addition to 50 apparently healthy elderly males (with mean age year) as a control group. We detected the levels of serum free testosterone, cortisol, fibrinogen, plasminogen activator inhibitor-1(PAI-1), high sensitive C-reactive protein(hsCRP), interleukin-6(IL-6).Results. Cases with CAD had significant lower values of free testosterone and HDL-c, but they had significant higher values of cortisol, fibrinogen, PAI-1, IL-6, hsCRP, in comparison to control group. Cases with ACS had significant higher values of cortisol, hsCRP, IL-6, fibrinogen, PAI-1, total cholesterol and BMI more than those with stable CAD. The free testosterone had significant negative correlation with fibrinogen, PAI-1, hsCRP and IL-6 in both groups of patients.Conclusion. The lower value of serum free testosterone in elderly male subjects may contribute to CAD.