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Sustainable chemistry established one of kind standards to maintain protection of environment through using safer mobile phase composition and/or lower solvent consumption. A fast green micellar HPLC method was developed and applied for the first time aiming at simultaneous determination of chlorpheniramine maleate, one of the most widely used antihistamine in combination with levochlopersatine fenodizoate or dextromethorphan hydrobromide or dexamethasone, in their pure forms, laboratory prepared mixtures and pharmaceutical dosage forms used in alleviating the symptoms of cough resulting from common colds and allergy. The separation was achieved on Kinetex C18 column (100 mm × 4.6 mm i.d., 2.6-μm particle size) using micellar aqueous mobile phase consisting of (30 mM sodium dodecyl sulfate and 50 mM sodium dihydrogen phosphate, pH 5) and ethanol (85:15) with UV detection at 230 nm. The four drugs were successfully separated using isocratic elution in a single run not exceeding 7 min. According to ICH guidelines, the method was confirmed to be linear, accurate and precise over the concentration ranges of 5–60 μg mL−1 for chlorpheniramine maleate, 10–100 μg mL−1 for levocloperastine fenodizoate and dextromethorphan hydrobromide and 5–30 μg mL−1 for dexamethasone. In addition, the greenness of the developed method was assessed using two different tools indicating their least hazardous effect on the environment.

Introduction: Colon and rectal cancers are common malignancies all over the world. The estimated 5-year relative survival is about 65%. Although curative resection of the primary lesion improves survival, still about 40% of patients, mostly patients with distant metastasis, die from colon and rectal cancer.The most common site of distant metastasis is considered the liver. This is true regarding many types of malignancies. Although Metastases of the liver can result from a wide variety of malignancies, with the most widely known being from colorectal origins PET/CT is a very valuable tool in the follow up of colorectal cancer patients, SUVmax is the most commonly used PET parameter and represent the voxel of the highest activity within the ROI. However, other parameters as MTV and TLG gain an interest in recent studies.Aim of the work: The objective of this review is to highlight the value of PET/CT metabolic parameters as SUVmax, MTV and TLG in colorectal patient with liver metastasis.

Background: Urinary biomarkers may help in identification and assessment of the activity of lupus nephritis (LN).Urinary osteoprotegerin may reflect renal disease activity better. Objective: To investigate urinary osteoprotegerin level as a potential marker of lupus nephritis activity. Patients and Methods: The study included 90 individuals classified into three equal groups: Group (I): clinically and laboratory free, Group (II): patients without renal involvement (non active renal group) and Group (III): patients with active lupus nephritis. Measurement of the level of urinary osteoprotegerin has been done by ELISA from January 2018 till June 2019. Results: All patients with systemic lupus erythromatosus SLE in group II and III had significant higher levels in urinary Osteoprotegerin compared to the control group (I). Moreover, SLE patients with lupus nephritis activity (Group III) had marked increase in urinary osteoprotegerin more than SLE patients without renal involvement (Group II). The study showed also that, with advance of renal histopathological class in lupus nephritis patients, the urine OPG level showed more increase. Conclusion: Urinary level of osteoprotegerin may be used as a biomarker for early prediction of lupus nephritis. Also, it may be used for monitoring the progression and follow up of lupus nephritis as well as with shifting from one class to another.

Introduction: Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. Objective: We aimed to study the effect of increasing hemodialysis session time on blood pressure control. Methods: This observational study was conducted on 50 hypertensive prevalent HD patients on thrice-weekly maintenance HD. Patients were divided into 2 groups: (A) 25 patients who received longer hemodialysis session (4.5 hours) and (B) 25 patients HD who received the usual 4 hours session. They were followed up for a period of 6 months to assess changes of pre-dialysis blood pressure to monitor response. Results: Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value < 0.001 versus 0.523). Longer HD session time group was associated with highly significant decline in mean SBP, (p-value < 0.001). Moreover, longer HD session time group was associated with highly statistically significant decline in mean DBP, (p-value < 0.001). The decline in mean perdialysis SBP & DBP was -17.27 & -9 mmHg respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg respectively at 6th month compared to values in 1st month of follow up period. Conclusion: Longer HD session duration is associated with better improvement in UF volume, mean SBP & DBP, pre-dialysis SBP & DBP and post-dialysis SBP & DBP as well.

Subtalar distraction arthrodesis is advocated as a salvage procedure for isolated posttraumatic subtalar arthritis. This study aimed at evaluating combined subtalar distraction arthrodesis with peroneus brevis tenotomy for such cases.Twenty patients with isolated posttraumatic subtalar arthritis managed by combined subtalar distraction arthrodesis and peroneus brevis tenotomy were reviewed for a retrospective study. The American orthopaedic foot and ankle society [AOFAS] hindfoot scoring, talocalcaneal height [TCH], talocalcaneal angle [TCA] and heel valgus angle [HVA] were used for both pre and postoperative assessments.The mean postoperative [TCH] [70.3±1.9mm] was statistically better than the preoperative value [64.7±2.2mm] [p0.001]. There was a statistically significant decrease in [HVA] [p0.001]. On the contrary, there was a statistically significant increase in both [AOFAS] hindfoot scoring and the [TCA] [p0.001].Applying this technique for isolated posttraumatic subtalar arthritis with peroneal tendinitis improved both lateral retromalleolar swelling and deformity correction.

Background: Health care-associated infection (HCAI) is a major problem for patient safety. Personal protective equipment (PPE) as defined by OSHA is specialized clothing or equipment, worn by an employee for protection against infectious materials. So, Proper education of health care workers (HCWs)about PPE is very important in clinical teaching and consider essential part of the undergraduate nursing programs. Web-based learning is rapidly emerging as a predominant paradigm in the delivery of education in society and it can be efficiently used for different types of education. It is platform independent, convenient in access, cost saving, easily updated contents and with emerging technologies it can be made more effective. The aim of this study is to assess the effect of web-based learning on academic achievement of community health nursing students in personal protective equipment module. Method: A randomized control trial research was used. The study was carried out in skill lab of community health nursing at faculty of nursing, Mansoura University from February to May 2017. The subjects of the study included 140 community health nursing students. These students were assigned randomly into two groups: web based group which included 70 students studying with web based learning module (WBL) and traditional group which included 70 students studying with traditional learning using face to face lecture and demonstration. Four tools were used for data collection: Structured self-administered questionnaire to assess students' socio demographic &occupational characteristics, students' knowledge about PPE and students' attitude toward web based learning and finally the practice assessment checklist. Results: the students in the web based group had significantly higher scores on both personal protective equipment knowledge and skill learning than students in the traditional group (P≤ 0.01).The students also showed positive attitude toward the web-based learning module. Conclusion: The study concluded that both traditional and web-based learning resulted in improvement of knowledge and practice regarding PPE. However, the web-based learning was more effective than traditional learning in increasing students’ knowledge and improving skills regarding PPE.

Section Title Several major risk factors for hepatocellular carcinoma (HCC) have been identified, including chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Nevertheless, only a fraction of infected patients develops HCC during their lifetime suggesting that genetic factors might modulate HCC development. X-ray repair cross complementing group1 (XRCC1) participates in the repair pathways of DNA. Aim: to investigate the association between XRCC1 gene polymorphism and HCC in Egyptian chronic hepatitis C patients. Methods: This study was assessed on 40 patients with HCC secondary to chronic HCV infection who were compared to 20 cirrhotic HCV patients and 40- age and gender- matched healthy control group. After collection of relevant clinical data and basic laboratory tests, c.1517G>C SNP of XRCC1 gene polymorphism was performed by (PCR-RFLP) technique. Results: A statistically higher frequency of XRCC1 (CC, GC) genotypes and increased (C) allele frequency in patients with HCC was found in comparison to cirrhotic HCV patients as well as control group. In addition, patients with the XRCC1 (CC, GC) genotypes had significantly higher number and larger size of tumor foci and significantly higher Child Pugh grades. Multivariate analysis showed that the presence of c.1517G>C SNP of XRCC1 gene is an independent risk for the development of HCC in chronic HCV patients with 3.7 fold increased risk of HCC development. In conclusion: XRCC1 gene polymorphism could be associated with increased risk of HCC development in chronic HCV Egyptian patients.

BACKGROUND Pneumonia is the foremost cause of child death worldwide. M-ficolin is encoded by the FCN1 gene and represents a novel link between innate and adaptive immunity. OBJECTIVES To investigate the FCN1 -144 C/A (rs10117466) polymorphism as a potential marker for pneumonia severity and adverse outcome namely complications or mortality in the under-five Egyptian children. METHODS This was a prospective multicenter study that included 620 children hospitalized with World Health Organization-defined severe pneumonia and 620 matched healthy control children. Polymorphism rs10117466 of the FCN1 gene promoter was analyzed by PCR-SSP, while serum M-ficolin levels were assessed by ELISA. RESULTS The FCN1 A/A genotype and A allele at the -144 position were more frequently observed in patients compared to the control children (43.4% vs 27.6%; odds ratio [OR]: 1.62; [95% confidence interval {CI}: 1.18-2.2]; for the A/A genotype) and (60.8% vs 52.5%; OR: 1.4; [95% CI: 1.19-1.65]; for the A allele); P

Background:Balloon pulmonary valvuloplasty is the treatment of choice for patients with moderate to severe pulmonary valve stenosis.Methods:An observational retrospective cross-sectional study including neonates, small infants, and children who underwent balloon pulmonary valvuloplasty in the period from 2007 to 2016 in the cardiac catheterisation unit of the paediatric cardiology department in Cairo University. Multivariable models were built to report the predictors of the outcome of balloon pulmonary valvuloplasty and its complications.Results:A total of 1200 patients were included in the study and divided according to age into 3 groups: neonates and early infants (n = 282), infants (n = 362), and children (n = 556). Procedural success, defined as a drop pressure gradient across the pulmonary valve to less than or equal to 50% of the baseline measurements, was achieved in 82.7% of the patients. Multivariate analysis revealed that only infundibular pulmonary stenosis (p value 0.032), supravalvular in association with valvular pulmonary stenosis (p value Conclusion:The absence of infundibular and supravalvular stenosis and a large pulmonary valve diameter were the most significant predictors of success.

Background: Head injury remains one of the most common causes of death worldwide. Approximately 10 to 50% of patients with head injury developed disability at some point in their illness, and represent one of the most common brain casualty encountered by neurosurgeons. Objective: This study was aimed to assess and evaluate a group of patients with open head injury including depressed skull fracture and skull fractures associated with epidural hematoma, subdural hematoma, intracerebral hematoma or foreign body penetration regarding surgical management and post-operative results. Patients and methods: The study was done prospectively in the Neurosurgery Department, Al-Azhar University Hospitals and Matareya Teaching Hospital; the study included 30 patients with acute open traumatic head injury requiring surgical intervention in the form of Decompressive. Craniotomy with evacuation of hematomas if existed or elevation of depressed skull fractured bones. Results: In this study, depressed fracture was present in 17 cases, fissure fracture in 7 cases, skull base fracture in 2 cases, diastatic fracture in 1 case and beveling (bullet inlet and exit) in 1case. Also, in this study, 9 cases (30%) had Glasgow Outcome Score I (GOS I), 3 cases (10%) had GOS III, 3 cases (10%) had GOS IV and 15 cases (50%) had GOS V. Regarding the overall complications, chest infections were detected in 4 cases, frontal manifestations in 1 case, grade 4 Lt. sided weakness in 1 case, stable GCS at 14 in 2 cases, reoperation in 1 case and right hemiparesis in 1 case. Conclusion: It could be concluded that surgical intervention is the ideal solution for the management of acute traumatic brain injury (TBI) with persistent increased ICP when the other medical management fail under the good circumstances of early intervention and the other factors.

Resistance against commonly used insecticides is a serious obstacle against eliminating mosquito-borne diseases. There is a demand for novel safe insecticides to control mosquito populations. This study aimed to evaluate the larvicidal action of essential oils extracted from Citrus limon, Myristica fragrans, Citrus sinensis, Syzygium aromaticum, Carumcarvi, Prunusdulcis, Eucalyptus staigeriana, Rosmarinu sofficinalis, Jasminum officinale, and fixed oil extracted from Linum usitatissimum against Culex pipiens 3rd instar larvae. The LC50 value of lemon oil was the lowest and consequently it has been used for subsequent experiments. Lemon oil was characterised using gas chromatography/mass spectrometry (GC/MS), revealing 36 compounds. Treatment with sublethal lemon oil doses significantly reduced fecundity and fertility of the 3rd instar larvae. Transmission electron microscopy revealed histopathological changes in integument layers of lemon oil-treated larvae. The titre of octopamine was increased in 3rd instar larvae. Additionally, lemon oil demonstrated low cytotoxic effects in WI-38 human cells as evaluated. Given the relative non-lethality of lemon oil to non-targets, it is proposed as a promising and environmentally safe alternative to synthetic insecticides for controlling mosquito populations.

Aims: To develop methods with complete validation according to ICH guidelines and to be applied for the determination of avanafil in pure form and in pharmaceutical formulation in the presence of its degradation products. Study Design: High performance thin layer chromatography (HPTLC) and different spectrophotometric methods (dual wavelength, first derivative, first derivative of ratio spectra and ratio difference are developed for simultaneous determination of avanafil in laboratory-prepared mixtures of avanafil with its degradation products and in pharmaceutical formulation. Place and Duration of Study: Sample: Department of Analytical Chemistry, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt, between May 2019 and September 2019. Methodology: Two techniques have been developed for the determination of avanafil in the presence of its degradation products. The first was HPTLC where separation was performed on silica gel 60 F254 plates, with chloroform: toluene: methanol: conc. ammonia (6:5:3:0.1, by volume) as a developing system and UV detection at 230 nm. The second one was UV- spectrophotometry which included dual wavelength between 267 and 292 nm, first derivative determination of the drug at 261 nm, first derivative of ratio of peak amplitudes at 275.6, 305.4 and 329 nm and the ratio difference with the amplitude difference between (266 and 250 nm). Results: HPTLC method was applied over the concentration range of 0.5-5. μg/spot, while spectrophotometric methods were linear over the concentration range 5-50 μg/mL for avanafil. Conclusion: Novel, simple and accurate method for the determination of avanafil in laboratory-prepared mixtures of avanafil with its degradation products and in pharmaceutical formulation.

Background HCC is one of the most common malignancies worldwide and is a major cause of death, because of its high frequency and poor prognosis. It is especially common in Egypt, where it develops on top of cirrhosis secondary to viral hepatitis C and B. Since HCV infection is highly prevalent in Egypt, it accounts to most of the cases of HCC in Egypt. HCV infection is found in a variable proportion in HCC cases in different populations, accounting for 75-90% of cases in Japan, 31-47% in the U.S, 44-76% in Italy, and 60%-75% of HCC cases in Spain. Objective To compare between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection. Patients and Methods Our study was a comparative study including 60 patients divided into 2 groups as follow patients successfully treated with Ledipasvir based regimen (Group A) and patients successfully treated with Daclatasvir based regimen (Group B) from January 2016 to June 2017. Results There were no statistically significant difference between the two groups as regard demographic and laboratory data. In comparison between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection in the first group there were 3/30 cases of percentage of 10% has developed HCC and in the second group there were 2/30 cases of percentage 6.6% has developed HCC after successful therapy for each group, there were no statistically significant difference between the two groups as regard the incidence of HCC after successful treatment, but generally DAA as Ledipasvir based regimen and daclatasvir based regimen both have low incidence of HCC after successful therapy of HCV infection. Conclusion There were several researches to study relation between DAA as treatment for HCV infection and HCC incidence after successful therapy. Our study was done to compare between Ledipasvir based regimen and Daclatasvir based regimen as regard incidence of Hepatocellular Carcinoma after successful Therapy for patients with chronic hepatitis C virus infection.

Background: Alzheimer’s disease (AD) is the commonest cause of dementia among the elderly. Aluminium is a toxic metal that primarily affects the hippocampus. Bone marrow-derived mesenchymal stem cells (BM-MSCs) therapy is considered a recent strategy for treatment of several diseases including neurologic disorders.Aim: To study effect of BM-MSCs on CA1 of the experimentally induced AD in adult male albino rat.Materials & Methods: 35 adult male albino rats were divided into a control group and an experimental group which was further subdivided into subgroups E1, E2, E3 & E4. Rats of experimental group received 17 mg/kg of aluminium chloride (AlCl3) orally once daily for 4 weeks. 24 hours after last dose of AlCl3, each rat of subgroups E2 and E3 was once IV injected with 1 ml media and BM-MSCs respectively. Subgroup E4 was the recovery subgroup. Hippocampal CA1 specimens were obtained and processed for histological, immunohistochemical, electron microscopic and morphometric studies. Results: Subgroups E1 and E2 revealed many structural changes as disarrangement of pyramidal cell layer which exhibited deeply stained nuclei and vacuolated cytoplasm. Congo red stain of these subgroups showed Congo red positive pyramidal cells and electron microscopic examination showed swollen destroyed mitochondria and dilated saccules of Golgi stacks. Statistically, there was a highly significant increase in number of neurofibrillary tangles and a highly significant decrease in synaptophysin color intensity. In contrast, these changes were markedly ameliorated in the BM-MSCs-treated subgroup. On the other hand, the recovery subgroup showed persistence of some of the structural changes. Conclusion: BM-MSCs injection can ameliorate AD-like pathology which was induced by AlCl3 in CA1 of adult male albino rats.

Background: Management of large bone defects is a challenge for the surgeon and the patient as well, many functional and psychological disabilities results on and must be properly dealt with.Masquelet technique saves time, easily performed and can give good results in managing large bone defects.Methods: This is an interventional study in which 20 patients were treated using Masquelet technique for large intercalary bone defect. The recorded outcomes included bone union, residual deformity, infection, healing of soft tissues, returning to previous work, persistent pain, permanent joint contracture and patient satisfaction.Results: The period of follow up ranged from 2.2 to 4 years with a mean of 3.1 years. The bone defect ranged from 5 to13 cm with a mean of 7.5 cm. Fifteen patients out of 20 had an open fracture. Ilizarov was used in 13 cases, locked plates in 4 cases and an LRS in 3 cases. The interval between the 1st and the 2nd stages ranged from 42 to 84 days with an average of 56 days. 17 patients (85%) achieved bone union. The infection had relapsed in 4 patients, one of them with flap failure and 3 cases with insufficient debridement; one case was treated by another debridement using a free vascularized flap, 2 cases were shifted to bone transport technique and the last case ended with amputation. Conclusion: The Masquelet induced membrane technique was highly effective to achieve bone union especially in femoral cases.

Background and Aims Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control. Method This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medications&dosages,dry weight was reassessed regularly, andthey were instructed to restrict their salt intake as much as possible aiming at BP Results Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value Longer HD session time session was associated with highly significant decline in mean SBP, (p-value Conclusion Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.