The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Review Article: Prognostic Value of CK5/6 Expression in Urinary Bladder Carcinoma1441144711526010.21608/mjcu.2020.115260ENGEHAD R.A. EL-GAPHRAWY, M.Sc.;MARWA M. SERAG EL-DIEN, M.D.SHEREEN F. MAHMOUD, M.D.;ASMAA G. ABDOU, M.D.The Department of Pathology, Faculty of Medicine, Menoufia UniversityJournal Article20200525Abstract Background: Bladder cancer in Egypt is the most prevalent malignancy among Egyptian males (16%), producing >7900 deaths annually, which is strikingly higher than most other parts of the world. The genesis and progression of urothelial bladder carcinoma (UBC) is known to involve alterations in several molecular pathways. Subtyping of bladder carcinoma patients based on the molecular alterations in their primary tumors may permit risk stratification and administration of more personalized therapies. Aim of Study: The aim of this study is to review the studies investigating the frequency of CK 5/6 expression and its value in the stratification of urothelial bladder carcinoma in English literature. Material and Methods: The data were retrieved from databases (PubMed, Medscape and Google scholar) and also material available on the Internet from 2001 till 2019. A structured systematic review was performed with the results tabulated. Results: The initial search presented 8 articles (2001- 2019). The frequency of CK 5/6 expression in UBC cases ranged between 19.7% and 62%. Positivity of CK 5/6 showed significant association with female gender, advanced tumor stage and pure SCC and UC with squamous differentiation. Positivity for CK 5/6 showed significant association with shorter overall survival in UC cases with squamous differen-tiation. CK5/6 expression alone was not associated with clinical outcome in any of the articles but showed significant association when combined with other markers. Conclusions: CK 5/6 as a basal marker could identify aggressive subtypes of urothelial carcinoma as those associated with squamous differentiation and advanced stage, however, it is not related to grading.https://mjcu.journals.ekb.eg/article_115260_ef4cd9d17533af2312fbff7ad36f6b8e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Uncommon Causes of Pyloric and Duodenal Obstruction in Pediatric Population: Radiological and Surgical Correlation1449146011526410.21608/mjcu.2020.115264ENMOHAMMED ZAKI A. MOURAD, M.D.;MEDHAT I.M. AHMAD, M.D.MOHAMED Y. BATIKHE, M.D.;ASHRAF ABOU-TALEB, M.D.HISHAMABDEL GHANY, M.D.The Department of Radiology*, Pediatric Surgery Unit, Department of Surgery** and Pediatrics*** Department, Faculty of Medicine, Sohag University, EgyptJournal Article20200525Abstract Background: Duodenal and pyloric obstruction in neonates and young children have diverse causes such as atresia, volvulus, and foreign body or may be extra-luminal obstruction. Aim of Study: To assess causes of pyloric and duodenal obstruction in pediatric population (other than CHPS) and determine the causes of obstruction radiologically and compare them with surgical data. Patients and Methods: Our study included 22 patients (12 boys and 10 girls), age range from 1 day to 6 years. This study was done on cases of pyloric and duodenal obstruction in newborns, infants and young children less than 6 years in the period from 2017 through 2019. Cases of Congenital Hypertrophic Pyloric Stenosis (CHPS) were excluded from the study. The clinical, radiological data were gathered and compared to each other. Results: The spectrum of causes of pyloric and duodenal obstruction was as follow: 4 cases of pyloric atresia, 5 cases with duodenal atresia, 3 cases with duodenal stenosis by incomplete web, one case with annular pancreas, 4 cases with midgut volvulus, one case with duodenal duplication cyst, 3 cases with foreign body obstruction and one case with trichob-ezoar. All cases were treated surgically to alleviate the ob-struction. The radiological data were well correlated with surgical findings. Conclusion: Pyloric and duodenal obstruction in pediatric population has different causes. Radiological imaging could determine the cause of obstruction with good correlation with surgery.https://mjcu.journals.ekb.eg/article_115264_24bd0ed8ebbf8328bfaa4aeeec61810f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Mouth Mask versus Pursed Lip Breathing on Ventilatory Functions and Dyspnea Index in Chronic Obstructive Pulmonary Disease1461146811537310.21608/mjcu.2020.115373ENSOMA A.G. ABD-ELGHANY, M.Sc.;NESREEN G. ELNAHAS, Ph.D.ZAHRA M.H. SERRY, Ph.D.;YOUSSEF M.A. SOLIMAN, M.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy* and The Department of Chest, Faculty of Medicine**, Cairo UniversityJournal Article20200526Abstract Background: Chronic Obstructive Pulmonary Disease (COPD) is a rising health problem. Dyspnea causes reduction of functional status and quality of life in it. Pursed Lips Breathing (PLB) and mouth mask use to reduce dyspnea and improve quality of life. Aim of Study: To compare the effect of mouth mask versus pursed lip breathing on ventilatory functions and dyspnea index in patient with chronic obstructive lung disease. Subjects and Methods: Forty men patient presented with chronic obstructive pulmonary disease (FEV1/FVC <0.70) were selected from outpatient clinic at Chest Department Kasr El-Ainy Hospital, age ranged from 50-65 years old. Ventilatory functions, Dyspnea index, oxygen saturation, CATscore ques-tionnaire, were measured pre and post training program. Patients were assigned in two groups. Group (A): Consisted of 20 patients were treated by expiratory breathing through Mouth Mask plus standard chest physiotherapy. Group (B) consisted of 20 patients were treated by pursed lip breathing plus standard chest physiotherapy Program was for five days per week for 8 weeks. Results: There was a significant increase in FVC, FEV1 and FEV1/FVC post-treatment compared with that pre-treatment with a percent of improvement 19.25%, 44.29%, 21.5% respectively in the group A and 8.7%, 18.37%, 8.9% respectively in group B (p < 0.001). There was a significant decrease in CAT post-treatment compared with that pre-treatment with apercent of improvement 61.07% and 46.07% respectively in the group A and B (p < 0.001). There was a significant increase in FEV1 with the mean difference between both groups was 0.28L and a significant decrease in CAT of the group A compared with that of the group B the mean difference between both groups was –5.1 (p < 0.05). There was a significant decrease in DI pre and post 3min step test post-treatment in the group A and B compared with that pre-treatment (p < 0.0001). Pre-treatment the median value of DI (pre 3min step test) of the group A was 2 and group B was 2 and that post-treatment was 0 for group A and 1 for group B. Pre-treatment the median value of DI (post 3min step test) of the group A was 3 and group B was 3 and post-treatment for group A was 1 and group B was 1.5. and comparison between the A and B post-treatment revealed a significant decrease in DI pre and post 3min step test of the group A compared with that of the group B. Conclusion: Mouth mask and pursed lip breathing are effective in improving ventilatory functions, improving of dyspnea, improving of health status and physical activity in patient with chronic obstructive lung disease. As there is improvement in CAT score questionnaire ventilatory param-eters and Dyspnea index in COPD.https://mjcu.journals.ekb.eg/article_115373_0ec48903e1c7ea2ed2ceac26b72a5755.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Acute Effect of Chest Physical Therapy on Arterial Blood Gases for Mechanical Ventilated Patients1469147511537710.21608/mjcu.2020.115377ENHEBA A. ABDEEN, Ph.D.;SAAD M. ELGENDY, M.Sc.NAGY L. NASSEF, Ph.D.;YOUSSEF M.A. SOLIMAN, M.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University* and The Department of Chest Diseases, Faculty of Medicine, Cairo University**Journal Article20200526Abstract Background: Patients receiving mechanical ventilation have an increased risk of complications resulting in excess morbidity and mortality. Aim of Study: This study aimed to identify the acute effect of chest physical therapy on arterial blood gases of mechanically ventilated patients. Material and Methods: Sixty mechanically ventilated patients participated in the study. Their age ranged from 40 to 60 years. The patients were assigned into one study group including both sexes who received a chest physiotherapy protocol in form of (manual hyperinflation, vibration, percus-sion, suctioning, upper and lower limbs exercise and ending position) for one session. Arterial Blood Gases (ABG) includ-ing (pH, PaO2, SO2, PaCO2 and HCO3) were assessed by arterial blood sample analysis through the Laboratory GEM premier 3000 device. All the assessment was done for every patient pre and post chest physiotherapy protocol. Results: The results revealed a marked improvement in arterial blood gas exchange as compared to base line reflected by a highly significant statistical increase in PaO2 and SaO2 (p < 0.001) and a significant decrease in PaCO2 (p < 0.001) while with no significant changes regarding pH and HCO3 (p=0.36 and 0.15 respectively). Conclusion: Chest physiotherapy protocol is an effective method for improving arterial blood gases of mechanical ventilated patients acutely.https://mjcu.journals.ekb.eg/article_115377_d6651ceb67bdbf12e52ddd091ce1ca95.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Quality of Life in Childhood Epilepsy1477148511562410.21608/mjcu.2020.115624ENNAHID S. AHMED, M.D.;MAHA A. NADA, M.D.DOAA A. EL'AIDY, M.D.;ABDI HAKIM S. MOHAMMED, M.Sc.The Department of Neurology, Faculty of Medicine, Ain Shams UniversityJournal Article20200627Abstract Background: Epilepsy is a common chronic neurological condition in developing years that can negatively impact one's physical, social and emotional function. Aim of Study: The aim of this study was to assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt, comparing the relationship between different types of seizures and the HRQOL and increasing the awareness of the importance of assessing physical, psychosocial, and behavioral well-being of children with epilepsy in Egypt. Patients and Methods: To assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt during the period from August 2019 and December 2019. This cross-sectional study was conducted at Ain Shams Neurology Department and included 75 children with epilepsy of 11-18 years. The tools used to assess children's QOL were pediatric QOL questionnaires. Parents' QOL was assessed using SF36 inventory. Results: Children with epilepsy have an affected quality of life according to the PedQOL assessment tool with a mean PedQOL total score 64.4±6.9 and ranged from 56.1 to 83.6. Among the different domains of the PedQOL inventory, the results of our study showed that children with epilepsy have got higher scores in the physical and the school domains than in the emotional and social domains. Our sample was drawn from Ain Shams University Hospital. Patients attending this health facility are usually from low to intermediate socio-economic status which may explain this result. Conclusion: Epilepsy in children has a great impact on the quality of life of those children particularly on the emotional and social domains. Some antiepileptic drugs like valproic acid have a better effect on the quality of life than others. The higher the children's quality of life the higher is the parents' quality of life. The highly impacted domains of the parents quality of life according to the SF36 questionnaire were role limitation (physical or social), social functioning and mental health domain.https://mjcu.journals.ekb.eg/article_115624_105eeb248d26e79104bfbb159558150b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Vascular Endothelial Growth Factor (VEGF): An Important Marker of Cure Progression in Schistosomiasis Mansoni Disease1487149111623810.21608/mjcu.2020.116238ENMANAL A. MOUSTAFA, M.D.;RANIA M. SARHAN, M.D.ABEER A. ABDEL-RAHMAN, M.D.;HEBA N.A.H. ABDEL MENAEM, M.B.B.Ch.SAMIA W. ABDEL SAYED, M.D.;SHIMAA A. ELGOHARY, M.D.The Department of Medical Parasitology, Faculty of Medicine, Ain Shams University*; The Department of Medical Parasitology, Theodor Bilharz Research Institute** and The Department of Surgical Pathology, Faculty of Medicine, Ain Shams University***Journal Article20200630Abstract Background: Schistosomiasis is a major health problem infecting about 7.2 million in Egypt. Praziquantel (PZQ) is the only drug effective against Schistosoma mansoni infection without effective available alternatives. VEGF was used to assess the associated schistosomal inflammatory and hepatic histopathological changes. Aim of Study: The aim of this work is to evaluate the expression of VEGF in hepatocytes and sinusoids of experi-mental infected mice with Schistosomiasis mansoni compar-ative to treated group with PZQ. Material and Methods: Swiss albino mice housed at the Animal House at Theodor Bilharz Research Institute (TBRI), Giza, Egypt were divided into three major categories: Group I (positive control); Group II (negative control); Group III (Infected mice treated with PZQ). They were infected by (60±10) S. mansoni cercariae. VEGF was measured. Results: VEGF expression was reduced in hepatocytes and sinusoids in treated group compared with positive control group with non expression in negative control group. Conclusions: VEGF is an important marker in reflection of infection and progression of treatment. It is a good marker of cure.https://mjcu.journals.ekb.eg/article_116238_6e3b0e43f24d768e6a68debbe7ec1516.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Biliary Leakage after Laparoscopic Cholecystectomy versus Open Cholecystectomy1493150211623910.21608/mjcu.2020.116239ENEMAD ELDIN F. IBRAHIM, M.D.;SHABAN M. ABDEL MAGEED, M.D.FAWZY S. FAWZY, M.D.;AMR KHEDAWY D. MOHAMMED, M.Sc.The Department of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. In spite of the advantages of a distinctly faster recovery and better cosmetic results, the laparoscopic approach bears a higher risk for iatrogenic bile duct injury and injury of the right hepatic artery. Bile leak after laparoscopic cholecystec-tomy is uncommon but can occur in 0.3-2.7% of patients. A bile leak may result in a biliary fistula, a subhepatic/subphrenic collection and localised or generalised peritonitis. Despite the widespread notion that the risk of bile leak is higher after LC, there is a scarcity in the published literature that directly compared the risk of bile leak after LC versus open cholecys-tectomy. Aim of Study: To provide cumulative data about the outcome of biliary leakage after laparoscopic versus open cholecystectomy. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till December 2018. The search retrieved 12157 unique records. We then retained 45 potentially eligible records for full-texts screening. Finally, 17 studies were included in the present systematic review and meta-analysis. Data Extrac-tion: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Results: In terms of the primary outcomes of the present study, the overall effect estimates showed that LC significantly increased the risk of bile leak compared to OC (OR 2.01, 95% CI [1.3-3.09]; p=0.002); the pooled studies showed no signif-icant heterogeneity (p=0.74; I2=0%). Conclusion: Surgeons experienced a very low rate of postoperative bile leak following laparoscopic or open chole-cystectomy; however, the risk of bile leak appears to be higher with laparoscopic compared to open cholecystectomy. The present systematic review and meta-analysis showed that the laparoscopic cholecystectomy significantly increased the risk of bile leak compared to open cholecystectomy. These data draw attention to the importance of early identification of patients, at high risk of bile leak, as it may allow specific measures or conversion to open cholecystectomy.https://mjcu.journals.ekb.eg/article_116239_81ae2ef608b5152797424fef670de0bd.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Use of Botulinum Toxin as an Adjuvant in Managing Children with Chronic Constipation and Obstructed Defecation1503150611624010.21608/mjcu.2020.116240ENAYMAN A. TALAAT, M.D.;AYMAN A. ALBAGHDADY, M.D.AHMED B. ARAFA, M.D.;MOHAMMAD R. EL-SHAHAWY, M.Sc.The Departments of General Surgery* and Pediatric Surgery**, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Pediatric chronic constipation and obstructed defecation is a challenging problem, with bad impact on quality of life affecting both the child and family. It is a complex disorder of multifactorial etiology and pathophysi-ology. Many symptoms-based systems have been instructed for clarifying definitions for chronic constipation and obstruct-ed defecation such as ROME IV criteria, PACCT criteria, NICE guideline. Most protocols of management of functional constipation usually include; disimpaction enemas, feeding regulations, bowel diaries and laxatives. Aim of Study: To evaluate the effectiveness of adding anal Botox injection to those already following management plan for pediatric age group suffering from chronic constipation and obstructed defecation. Patients and Methods: The current study included 40 children with functional constipation, and obstructed defeca-tion. The study started in April 2017 and completed the patients follow-up in November 2019. Bowel management program was applied with Botulinum toxin injection. Patients were followed-up at 2 months, and 6 months using Rintala Scores. Results: The study included 45% female members and 55% male ones, with age range between 3-12 years. Improve-ment was achieved in 22.5% of children after 2 months of the management, all patients were followed-up at least for 6 months period, with a mean follow-up of 11.35 months. Rintala scores at initial presentation, 2 months and 6 months follow-up showed improvement. Overall, across all the study subjects, females did better and showed more improvement. Conclusion: This study has confirmed that BT injection did not add any significant effect, to children with obstructed defecation and chronic FC.https://mjcu.journals.ekb.eg/article_116240_c75a3c64241b6c245a09e0b2ec853003.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Efficacy of Interval Training on Quality of Life in Women with Vitamin D Deficiency1507151211624110.21608/mjcu.2020.116241ENMOHAMED A. RABEE, M.Sc.;NESSRIN G. EL NAHASS, Ph.D.HEBA A. ABDEEN, Ph.D.;FATMA ABD EL KADER, M.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University* and Faculty of Medicine, Al-Azhar University**Journal Article20200630Abstract Background: Vitamin D deficiency affects individuals in all age groups worldwide. Aim of Study: This study aimed to identify the efficacy of interval training combined with vitamin D supplementation on quality of life in women with vitamin deficiency. Subject and Methods: Forty women with vitamin D defi-ciency participated in this study. Their age ranged from 40 to 50 years. They were assigned randomly into 2 groups. The first group (A) included 20 patients who participated in an interval training exercise program with vitamin D supplemen-tation. The second group (B) included 20 patients who received vitamin D supplementation only. The interval training exercises were conducted for one hour, three times per week on a total period of 12 weeks. The quality of life was assessed by short form health survey (SF-12). Results: Before the study, there was no significant differ-ence in the mean values of all variables among the two groups. After study there was a significant improvement in both components of SF-12 in all groups with significant difference between 2 groups (p < 0.05). Conclusion: Combined interval training and vitamin D supplementation are effective for improving quality of life in women with vitamin D deficiency than either of them alone.https://mjcu.journals.ekb.eg/article_116241_c8d3ceac1b3d7e39ad675e2797bd9483.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Kinesiotaping versus Acupressure in Treatment of Postnatal Low Back Pain1513152111624210.21608/mjcu.2020.116242ENMAHMOUD A. MAHMOUD, M.Sc.;HALA M. HANAFY, Ph.D.WAFAA M. KAMAL, Ph.D.;MOHAMMED F. ABO-ELENIEN, M.D.The Department of Physical Therapy for Gynecology & Obstetrics, New Cairo Police Hospital, Ministry of Interior* and Faculty of Physical Therapy, Cairo University** and Department of Gynecology & Obstetrics, Om Elmasryeen General Hospital, Ministry of Health***, EgyptJournal Article20200630Abstract Background: Back pain was a dull ache starting soon after delivery and made worse by effort and relieved by rest. Examination showed only mild tenderness over the lumbar vertebrae. Other women had postural backache combined with pain over the sacroiliac joints. This pain was worse after sitting for long periods. Aim of Study: The aim of this study was to compare between kinesio tape and acupressure in treatment of postnatal low back pain. Patients and Methods: This study was conducted on thirty women suffering from post natal low back pain (fifteen days after labor to ensure complete involution of uterus), their age ranged from 20-35 years and their body mass index not exceeding 30 Kg/m2. The women were randomly selected from outpatient clinic of obstetrics and gynecology in New Cairo Police Hospital and Madinet Nasr Police Hospital. They were randomly assigned into two equal groups: Group A (kinesio tape group) 15 women and Group B (acupressure group) 15 women. Group A: They had kinesiotaping on their back upwards from S2 to L1, three times per week for 4 weeks, the tape lasts on the skin till the next session and removed two hours before the new session. Group B: They received acupressure therapy by both thumbs at a rate of one minute pressure followed by one minute relaxation, on four points (B22, B23, B25, B27) at lumbar region, three times for each point, three times per week for 4 weeks. The session lasts for 24 minutes. All women were evaluated for pain severity using visual analogue scale (VAS) and lumbar mobility using tape measurement immediately before participation in the study and after end of treatment program (4 weeks). Results: There were statistically significant decrease in pain severity and increase in lumbar range of motion in favor to group A when compared with group B. Conclusion: It can be concluded that taping-in comparison to acupressure - is amore effective physiotherapeutic modality for treating postnatal low back pain.https://mjcu.journals.ekb.eg/article_116242_c67b27eda022f97729da75da0e7e5b3f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Ultrasound Role in Management of Female Infertility1523153011624310.21608/mjcu.2020.116243ENMAYSA S. ELKERDAWY, M.Sc.;MOHAMMED A. ALI, M.D.NERMEENN. KERIAKOS, M.D.The Department of Radio-Diagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Investigation of the probable causes of female infertility is complex and in many instances a compli-cated process. Aim of Study: To discuss the role of ultrasound in detection of causes of female infertility (including those disorders of cervix, ovaries, fallopian tube and uterus) illustrated by few cases. Patients and Methods: This cross sectional study was conducted on thirty female patients seeking fertility at Itay scan private radiology center, Itay Elbaroud and Al Dlangat General Hospitals, during the period from January 2018 to January 2020. All patients were subjected to examination using (GE healthcare Voluson P8 and Toshiba Nemio 30 and Medison Sono Ace R3) Ultrasound Machines. Results: Uterine abnormalities represent about 60%, cervical abnormalities represent 3.3% and ovarian abnormal-ities represent 23.3%, while tubal abnormalities represent 13.3% of the study group. Mean age of uterine abnormalities is about 30.5 years old, cervical abnormalities about 26 years old, ovarian abnormalities about 26 years old while mean age of tubal abnormalities is 30.5 years old in the study group. In most cases of female infertility in our study, ultrasound has been of great value: e.g. uterine malformations (sub septate and bicornuate uterus), endometrial abnormalities (endometrial polyp and focal endometrial hyperplasia), myometrial diseases (fibroids and uterine adenomyosis), tubal abnormalities (in-cluding hydrosalpinx and endometriosis), ovarian functional abnormalities (polycystic ovary) and cervical abnormalities (cervical masses). Conclusion: Ultrasound is a reliable tool in the diagnosis of many anatomical causes of female infertility and is com-parable to gold standard investigations in many circumstances, so we recommend it as primary investigation modality that could be complemented by other tools e.g. MRI, HSG, and laparoscopy when needed.https://mjcu.journals.ekb.eg/article_116243_0dc932c9224597bb1dca72acaa918b7c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Comparative Study of the Combined Effect of Therapeutic Exercises and Mobilization between Stage II and Stage III Frozen Shoulder1531153711624410.21608/mjcu.2020.116244ENOLA I. IBRAHIM, M.Sc.;SALWA F. ABDEL-MAJID, Ph.D.WALID R. MOHAMED, Ph.D.;MOHAMED A. SARHAN, Ph.D.The Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo1,2 and South Valley3 Universities and The Department of Orthopedic Surgery, Faculty of Medicine, Cairo University4, EgyptJournal Article20200630Abstract Background: It is clear that therapeutic exercise plus mobilization have significant benefits on range of motion in frozen shoulder however it is important to consider the patient's symptoms and the stage of the condition and suggest if the disease prognosis is affected by treatment. Aim of Study: To compare the combined effect of shoulder mobilization and therapeutic exercises on pain, range of motion, and overall shoulder functions between stage II and stage III frozen shoulder. Material and Methods: Thirty patients referred as frozen shoulder, were divided according to their stage of illness equally into two groups; group A (stage II) and group B (stage III). Both groups were treated with mobilization, stretching exercises, active exercise and Codman pendulum exercises and that was 2 times per week for successive two months. Each patient was assessed for shoulder ROM using universal goniometer pretreatment, post 6 sessions and post treatment and pain and disability using shoulder pain and disability index (SPADI) pretreatment and post treatment. Results: There was significant effect of mobilization and therapeutic exercises on pain and overall shoulder functions in both groups with more significant effect in group A compared with group B (p=0.0001). Also there was significant effect on shoulder ROM of flexion and abduction in group A com-pared with that of group B (p=0.0001). But there was no significant difference in shoulder internal rotation and external ROM between both groups (p=0.8 & p=0.12). Whereas there was a significant increase in shoulder extension ROM of group B compared with that group A (p=0.001). Conclusion: The combined effect of mobilization and therapeutic exercises has significant effect on pain and overall shoulder functions in stage II frozen shoulder than stage III and a significant effect on shoulder ROM in both stages.https://mjcu.journals.ekb.eg/article_116244_d18497b1f7ecee09b30cf4ea70871aa6.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study1539155211624610.21608/mjcu.2020.116246ENMICHAEL W. SHAKER, M.Sc.;MOHAMED FAYEK, M.D.ABD M.EZZAT, M.D.The Department of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Preventive strategies and safe surgery are of utmost importance to minimize BDI during cholecystectomy. The impor-tance of frank communication with the patient and accurate documentation cannot be overemphasized. Diagnosis requires a high index of suspicion with focused clinical, biochemical, and radiological examination. Aim of Study: Is to evaluate the best protocol in manage-ment of iatrogenic biliary injuries sustained during either laparoscopic or open cholecystectomy. Patients and Methods: 40 patients with iatrogenic bile duct injuries following cholecystectomy (open and Laparo-scopic) referred to the Department of Hepatobiliary Surgery at Sohag Teaching Hospital, Sohag Univeristy, Egypt from January 2016 to January 2018 and treated by multidisciplinary approach team including hepatobiliary surgeons, gastroenter-ologists, and interventional radiologists. Results: In this retrospective study there were 12 cases that detected intraoperatively; 2 cases of them with complete cut of CBD. 8 cases (66, 67%) with partial injury of CBD and the other 2 cases (16.67%) with partial injury of CHD; 9 cases were repaired by primary repair of CBD and 3 cases by repair over stent. There were 14 cases detected early postoperative 1 (7.14%) case with complete injury of CBD and 4 (28.57%) cases with with partial injury of CBD and 6 (42.86%) cases with ligation of CBD and one (7.14%) case with slipped cystic duct ligature and 2 cases with ligation of CHD. There were 14 cases were detected late postoperatively 3 cases of them were with slipped cystic duct ligature and 11 cases with stricture of CBD. Conclusion: Advanced laparoscopic fellowship training may decrease conversion rates of laparoscopic cholecystecto-my. This may translate into a slightly shorter duration of hospitalization for these patients, which for a high volume procedure could make a significant impact on hospital eco-nomics.https://mjcu.journals.ekb.eg/article_116246_12fe12210d21bedc20d90f77c5f89782.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Dynamic Contrast-Enhanced Breast MRI for Evaluating Residual Tumor Size after Neo-Adjuvant Chemotherapy1553155911624710.21608/mjcu.2020.116247ENSHERINE K. AMIN, M.D.;AHMED EL SHIMY, M.D.MAHMOUDM.A. ABDUL SALAM, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Breast cancer is the most commonly occur-ring cancer in women and one of the most important causes of death. 1.67 million new cases of breast cancer were iden-tified worldwide, accounting for 25% of all cancers. The incidence and mortality rates of breast cancer is rising. Patient survival rates depend on both early diagnosis and improved treatment modalities including surgery, radiotherapy and chemotherapy. Aim of Study: To investigate the accuracy of dynamic contrast material-enhanced (DCE) breast MRI for determining residual tumor size after neoadjuvant chemotherapy (NAC) and detect the value of measuring residual size in delayed phase compared to early phase. Patients and Methods: The study started at December, 2019 and included twenty female patients who were newly diagnosed breast cancers after completion of NAC referred from surgical oncologists to Radiodiagnosis Departments of Ain Shams University and Nasser Institute Hospitals. Each patient was subjected to full history, reviewing medical sheet and dynamic contrast enhanced MRI using 1.5 T unit (GE). Results: DCE-MRI after NAC underestimation rate was found to be about 50% Vs 15% overestimation rate. 51% NPV Vs 93% PPV was reported. Delayed phase better correlated with postsurgical histopathological size than early phase. Conclusion: DCE-MRI has lower accuracy when per-formed after NAC. It tends to underestimate residual tumor size. Delayed phase is more accurate than early phase in evaluating residual tumor size.https://mjcu.journals.ekb.eg/article_116247_09723416a8c6f9749c6359fe3ae98853.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Diagnosis of Breast Micro calcifications with Contrast Enhanced Digital Mammography and Histopathological Correlation1561156911624910.21608/mjcu.2020.116249ENHANA HAMDY NASSEF, M.D.;AMIR LOUIS LOUKA, M.D.AMIRALOTAIF ABDULLAH, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Backgroud: Microcalcificaitons constitute up to 31% of lesions detected at screening mammography. Ductal carcinoma in situ (DCIS) often presents with microcalcificaitons on mammography. Of all mammographically detected DCIS lesions, up to 79% manifest with microcalcifications only. However, not all microcalficications are associated with in situ or malignant disease. Aim of Study: To evaluate diagnostic value of contrast enhanced digital mammography in breast microcalcificaations. Methods: A retrospective study of 30 patients having mammographic suspicious breast calcifications under BIRADS 4, 5 and 6 categories. A high-energy and a low-energy digital mammograms were obtained and then images were subtracted, isolating the iodine signal in the region of angiogenesis. 1.5mg/kg of the contrast agent was injected by hand over a period of 1 minute at a rate of 3mL per second, followed by a saline solution flush. Breast compression was applied to reduce the thickness of the breast and images obtained exactly 2 min after contrast administration. Image acquisitions: Cranio-caudal and the medio-lateral oblique projections for the abnormal breast were obtained exactly 2 minutes after contrast injection followed by cranio-caudal and medio-lateral oblique projections of the normal breast. The lesions were analyzed by specialized radiologist for the presence, morphology, and pattern of enhancement. Finally, Correlation with histopatho-logical findings was done. Results: The sensitivity of CEDM in detecting malignant pathology with contrast uptake was 96%. Compared to sensi-tivity of 86.7% in FFDM. There were lesions of IDC in (69.2%), lesion of DCIS in (11.5%), lesion of IDCS & IDC in (11.5%) and lesions of ILC in (3.8%). Enhancement was also observed in 3/4 (75%) of the benign lesions. Conclusion: Dual-energy contrast-enhanced digital mam-mography is a useful technique in the diagnosis of underlying disease in mammographically detected breast microcalcifica-tions.https://mjcu.journals.ekb.eg/article_116249_e9197cd6c2e2759235f81a3bed9be12d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Age Related Changes in Common Bile Duct Transverse Diameter Among Egyptian Population: Ultrsonographic and Magnetic Resonance Study1571157911625010.21608/mjcu.2020.116250ENRADWA M. AHMED, M.D.;ESSAM A. HASSAN, M.D.MOHAMED F. ZAIDAN, M.D.کMAHMOUD ABOELNOR MOHAMED, M.D.AMAL M. MAHER, M.D.;EMAN A. ABD EL-MEGUID, M.D.The Departments of Anatomy & Embryology, Tropical Medicine, General Surgery, Radiodiagnosis Diagnostic Radiology and Internal Medicine, Faculty of Medicine, Fayoum UniversityJournal Article20200630Abstract Background: Measurement of transverse diameter of the Common Bile Duct (CBD) was performed in several studies by Ultrasonography (US) and magnetic resonance imaging using Magnetic Resonance Cholangiopancreatography (MRCP). The size of the extrahepatic bile duct increases with age which should be taken into consideration by the surgeons during the surgery of the gallbladder, pancreas and duodenum. US plays a crucial role in the initial imaging work-up of a patient with jaundice. Because a dilated extrahepatic duct distinguishes obstructive from non-obstructive causes of jaundice. The size of the bile duct is considered to increase normally with age as proved by various studies especially MRCP which is more accurate than US. Aim of Study: The aim of the present work is to demon-strate anatomical variation concerning assessment of transverse diameter of CBD both in adult and geriatric age groups without biliary or hepatic manifestations and detection of age related changes in CBD as one of the causes of non obstructive biliiary dilatation. Material and Methods: The patients were divided into three groups according to their age: 1- Group I: 21-40 years. 2- Group II: 41-60 years, 3- Group III: Over 60 years. Ultra-sound and MRCP techniques were used in this study to assess the diameter of CBD in different age groups. Results: Group I: In US: In this age group the mean of the widest transverse diameter of extrahepatic bile duct was 0.25 with a range: 0.18-0.41. In males the mean was: 0.23 with a range: 0.19-0.26. In females: The mean was: 0.28 with a range: 0.18-0.41. In MRCP: In this age group the mean of the widest transverse diameter of extrahepatic bile duct was 37.5 with a range: 21-49. In males: The mean was: 36 with a range: 21-46. In females: The mean was: 40 with a range: 0.29-49. Group II: In US: The mean of the widest transverse diameter of extrahepatic bile duct was 0.32 with a range: 0.19-0.41. In males: The mean was: 0.31 with a range: 0.19- 0.39. In females: The mean was: 0.33 with a range: 0.27-0.41. In MRCP: The mean of the widest transverse diameter of extrahepatic bile duct was 46.5 with a range: 24-62. In males: The mean was: 52.6 with a range: 41-62. In females: The mean was: 40.4 with a range: 0.24-51. Group III: In US: The mean of the widest transverse diameter of extrahepatic bile duct was 0.40 with a range: 0.26-0.63. In males: The mean was: 0.39 with a range: 0.28-0.52. In females: The mean was: 0.42 with a range: 0.26-0.63. In MRCP: The mean of the widest transverse diameter of extrahepatic bile duct was 88.31 with a range: 49-180. In males: The mean was: 94.27 with a range: 69-170. In females: The mean was: 81.93 with a range: 49-180. Conclusion: Both US and MRCP modalities revealed that the widest transverse diameter of CBD increases with age.https://mjcu.journals.ekb.eg/article_116250_8c182662bee22b1a59658543e7f92b67.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Evaluation of (PARP-1) Expression in Gastric Carcinoma by Immunohistochemistry and Quantitative Real-Time PCR and its Relation to HER2 Status1581158711625110.21608/mjcu.2020.116251ENMARWA S. ABD ALLAH, M.D.;HEBA M. ABD EL KARIEM, M.D.HEBAM. RASHAD, M.D.The Departments of Pathology* and Biochemistry**, Faculty of Medicine, Benha University, EgyptJournal Article20200630Abstract Background: PARP-1 overexpression has been identified in several malignancies. Few studies have handled the expres-sion of PARP-1 protein in gastric carcinoma and its associations with outcome. Aim of Study: This study aimed at exploring the signifi-cance of PARP-1 expression in gastric adenocarcinoma and correlation with HER2 status. Subjects and Methods: Quantitative expression of PARP-1 proteins was assayed by Immunohistochemistry in 40 cases of gastric adenocarcinoma. PARP-1 mRNA was moreover evaluated by Quantitative Real-Time Polymerase Chain Re-action. Results: The level of expression of mRNA expression level was significantly increased in 25 of 40 (62.5%) of gastric adenocarcinoma tissues compared with the corresponding adjacent non cancer tissues (p < 0.001). Positive expression of PARP-1 protein was detected in 23/40 (57.5%) of gastric adenocarcinoma. PARP-1 expression in cancer tissues was significantly higher than adjacent non-cancerous tissue (p < 0.001). The aberrant high expression of PARP-1 showed significant correlation with depth of invasion (p < 0.001), advanced stage (p < 0.001), nodal (p < 0.05) and distant metas-tasis (p < 0.001). Positive correlation was detected between PARP-1 and positive HER2 status (p < 0.001). Conclusion: PARP-1 level is up regulated significantly in gastric adenocarcinoma tissue. PARP-1 is positively corre-lated with positive HER2 status and poor prognostic factors. PARP-1 might be potential prognostic marker for gastric adenocarcinoma.https://mjcu.journals.ekb.eg/article_116251_83d4bb62a8a63fb31fb59ff6d16d5c9f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Role of MRI & US in the Evaluation of Knee Joint Affection in Patients with Juvenile Idiopathic Arthritis1589160011625210.21608/mjcu.2020.116252ENAYA M.B.F. HASHEM, M.D.;BASMA M.A. ALKALAAWY, M.D.NOURM.M. KANDIL, M.D.The Department of Radiology, Faculty of Medicine, Cairo University, EgyptJournal Article20200630Abstract Background: Juvenile Idiopathic Arthritis (JIA) is defined as arthritis of unknown etiology beginning before the age of 16 years and persisting for at least 6 weeks, while excluding other known conditions. Aim of Study: The purpose of this study is to highlight the beneficial role of MRI & US in the evaluation of knee joint affection in patients with juvenile idiopathic arthritis, especially in early cases. Patients and Methods: The study was carried out on fourty patients (26 females and 14 males), referred to the Radiology Department of Kasr El-Ainy Hospital from Abo El-Rish Pediatric Hospital. Their age ranged from 2.5 years up to 13 years. All patients underwent examination of the more symp-tomatic knee joint using MRI with intravenous contrast (Gadolinium) and Ultrasound (US) examinations. The results of the ultrasound were compared to those of MRI, with the MRI being the gold standard of diagnosis. Results: Among the studied cases ultrasound was able to detect joint effusion in all cases as a compressible anechoic area. It was able to detect synovitis as synovial thickening and increased vascularity on power Doppler in all cases which is evident mainly in the suprapatellar recess. The accuracy of US regarding both effusion and synovitis was 100%. Ultra-sound had great potential to identify the normal cartilage and allows for differentiation of the abnormal morphology such as loss of clarity, irregularity, and defects on the surface. In our study ultrasound was able to demonstrate most of the cases. The overall accuracy regarding cartilage changes was 90%. In this study six of the cases had bone erosions which were detected on MRI. US was able to detect four of these cases. The overall accuracy of US regarding erosions was 95%. Conclusion: Ultrasound has the ability to demonstrate knee joint pathology in early JIA which can help start early treatment or modify already existing one to prevent permanent joint damage. At this point in time, however, it is not possible to determine that ultrasound is superior to MRI, especially regarding bone erosions and the fact that it is operator depend-ent and needs experience.https://mjcu.journals.ekb.eg/article_116252_1189e0b0ec6a367e2820f8e3ebdae3b2.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Efficacy of Sensory Re-Education Paradigm on Functional Outcomes in Patients with Carpal Tunnel Syndrome1601161411625310.21608/mjcu.2020.116253ENFATIMAH I. ABDUL-SHAFY, M.Sc.;YOUSUF M. AL-BA'LAWY, Ph.D.HODA M. ZAKARIA, Ph.D.;EBTESAM M. FAHMY, Ph.D.The Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy* and The Department of Neurology, Faculty of Medicine**, Cairo University, EgyptJournal Article20200630Abstract Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Aim of Study: The aim of the study was to investigate the efficacy of sensory re-education paradigm on functional outcomes of patients with carpal tunnel syndrome. Subjects and Methods: Thirty participants was be randomly assigned to either the sensory re-education paradigm group or the traditional physical therapy group. First group (control group), the patients received standard physical therapy program including progressive active and resisted therapeutic exercises, median nerve gliding exercises and tendon gliding exercises. Second group (experimental study group), the patients received sensory re-education paradigm as the followings; Step 1: Splinting as a constant maintained touch for fifteen minutes, Step 2: Topical anesthesia for pain reduction by using 8% Lidocaine spray for 15 minutes, Step 3: Massage using different textures; graduating from the softest to rougher one with same speed and pressure, Step 4: Proprioceptive Neuromuscular Facilitation (PNF) technique using extension, adduction and internal rotation with extended elbow pattern. Sensory function was assessed by Semmes-Weinstein monofilament, pain intensity level was assessed by a Visual Analogue Scale (VAS), hand grip was assessed by using hand held dynamom-eter and functional outcomes were assessed by using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: There was a statistically significant improvement in the measured parameters in both groups when comparing their pre and post-treatment mean values. However, significant difference was recorded between the two groups after treatment in favor of the study group. Conclusion: The obtained results suggest that the appli-cation of sensory re-education paradigm become a beneficial therapeutic technique in improving the functional outcomes as a whole in patients with CTS when adjunct to a physical therapy program.https://mjcu.journals.ekb.eg/article_116253_d9bacb45329dcbae3a43ab8959271f26.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Assessment of Spino Pelvic Alignment in Patients with Cervical Radiculopathy1615162011625410.21608/mjcu.2020.116254ENASMAA F. GABRE, M.Sc.;HODA M. ZAKRIA, Ph.D.MAGDY K. AHMED, M.D.;AHMED S. ALI, Ph.D.The Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy* and The Department of Neurosurgery, Faculty of Medicine**, Cairo University, EgyptJournal Article20200630Abstract Background: Cervical radiculopathy is a relatively com-mon neurological disorder resulting from nerve root dysfunc-tion which is often due to mechanical compression. Much less attention has been given to the effect of cervical radicu-lopathy on spino-pelvic alignment. Aim of Study: To investigate the effect of cervical radic-ulopathy on spino-pelvic alignment. Material and Methods: A cross-sectional observational study was carried out over one hundred (100) subjects of both sexes with age ranged from 30-50 years, the subjects were assigned in to two equal groups: Group (I): The study group (fifty subjects with unilateral, lower cervical radiculopathy (c3-c7) which is more than six months), Group (II): The control group (fifty normal matched subjects. Rasterstereog-raphy (Formetric 2), was used to measure the effect of cervical radiculopathy on thoracic kyphosis and lateral spinal deviation. Results: The results revealed a significant increase of the mean values of the thoracic kyphosis and lateral spinal devi-ation in the study group (GI) in comparison to the control group (GII) (p < 0.05). Conclusion: Cervical radiculopathy has a significant effect on spino-pelvic alignment. The thoracic kyphosis and the lateral spinal deviation have been increased in patients with cervical radiculopathy and this should be taken in consideration in the rehabilitation of patients with cervical radiculopathy.https://mjcu.journals.ekb.eg/article_116254_1a3b1528101ce2556037223141dca40a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Relation between High Myopia and Diabetic Retinopathy1621162811625510.21608/mjcu.2020.116255ENKAMAR G.E. SHAMS, M.Sc.;ABD EL-RAHMAN G. SALMAN, M.D.MOMEN M. HAMDI, M.D.;NANCY E. KHAMIS, M.D.The Department of Ophthalmology, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: The prevalence of myopia is growing world-wide, and myopia is becoming a major epidemiological problem. A higher prevalence of myopia has been observed in people with diabetes compared with people without diabetes and poorer glycaemic control considered to be a risk factor. Aim of Study: To determine the relation between High Myopia and Diabetic Retinopathy and to detect whether high Myopes are self-protected against diabetic changes and diabetic retinopathy or not. Patients and Methods: The study included 140 eyes from 96 diabetic patients recruited from National Institute of Diabetes and Endocrinology in the Ophthalmic Clinic. They were classified according to the refractive status into four groups: Emmetropia (0.00 to –0.50 {DS}), Low Myopia (–0.50 DS to –3.0 DS), Moderate Myopia (3.00 DS to –5.00 DS) and High Myopia (more than –5.00 DS). High myopia (70 eyes of 41 patients), moderate myopia (10 eyes of 7 patients), low myopia (39 eyes of 29 patients) and emmetropia (21 eyes of 19 patients). Results: Total male patients represent 52.08% and females 46.92% in our study. There were statistically significant difference between groups as regard mean of refraction. Mean of refraction represented by Spherical equivalent among groups (Emmetrope, high myope, mild myope and moderate myope) was (2.08±0.495, 14.94±3.73, 3.23±0.642, 5.505±0.41) respectively. From our results the frequency of NPDR totally was 70 eyes (50%) and no DR was 70 eyes (50%). All high myopic eyes (70 eyes) showed no DR and all eyes of other groups which are totally (70 eyes) showed DR with its different grades. All high myopic eyes (70 eyes of 41 patients) had no DR in their fundus photograph while (low myopic, moderate myopic eyes and emmetropic eyes (39, 10, 21 eyes) respec-tively showed DR with its different grades: Low myopic eyes (39 eyes of 29 patients) showed moderate NPDR, the moderate myopic eyes (10 eyes of 7 patients) showed mild NPDR and the emmetropic eyes (21 eyes of 19 patients) showed severe NPDR. There were statistically significant difference between groups as regard severity of diabetes in which p-value <0.005. From our results as the degree of myopia increases the severity of DR decreases.<br />Conclusion: There is a protective role for high myopia against DR.https://mjcu.journals.ekb.eg/article_116255_20924e471e2efb280370453c2f42843e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901CD5+ B Lymphocytes in Systemic Lupus Erythematosus Patients: Relation to Disease Activity1629164011625610.21608/mjcu.2020.116256ENNAHED M. SHERIF, M.D.;AHMED M. ELYASAKI, M.D.SOHA E. IBRAHIM, M.D.;HADEEL TAHA ALI MAHDI, M.Sc.The Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Systemic Erythematosus (SLE) is a chronic, complicated and challenging disease to diagnose and treat. The etiology of SLE is unknown, but certain risk factors have been identified that lead to immune system dysregulation with pathogenic autoantibody formation and immune complex deposition. Am of Study: To assess blood concentration of CD5+ B cells in patients with SLE and to evaluate their relationship with SLE disease activity. Patients and Methods: The present study included forty SLE patients who were selected from outpatient clinic of Rheumatology and Rehabilitation of Ain Shams University Hospital and diagnosed according to new EULAR and ACR classification criteria. Based on SLEDAI, the patients were selected and divided into two groups. The first group included 20 patients with inactive disease and the second group included 20 patients with active disease. They were matched with ten healthy individuals as a control group, and all were subjected to full history, clinical examination, ESR, CRP, serum com-plements, anti-dsDNA, ANA, serum creatinine twenty-four hours urinary proteins as well as CD5+ B lymphocytes by flow cytometric analysis. Results: In the present study, the percentage of CD5+ B lymphocytes per total lymphocytes were significantly de-creased in SLE patients compared to healthy individuals. Moreover, the percentage of CD5+ B lymphocytes per total B cells were significantly decreased in SLE patients compared to controls. We also have found a statistically highly significant decrease in the percentage of CD5+ B cells in active SLE patients compared to inactive patients. As regards the corre-lation studies, the results revealed a positive correlation between CD5+ B cells and each of platelets, C3 and C4. Moreover, the diagnostic performance of CD5+ B cells was evaluated and our results showed that CD5+ B cells can discriminate SLE patients from controls, and can predict the disease activity. Conclusion: The proportions of CD5+ B cells were sig-nificantly decreased in SLE patients than normal people, and were significantly decreased in active SLE patients than inactive ones. These findings denote that CD5+ B cells may have a potential role in preventing autoimmunity development.https://mjcu.journals.ekb.eg/article_116256_1124f4950b5b863fec7890a1c8412459.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Role of Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy in Management of Type 2 Diabetes Mellitus1641164711625710.21608/mjcu.2020.116257ENAHMED E.A. EL KORDY, M.Sc.;AHMED M.I. KHALIL, M.D.MOHAMMEDM.M. OMAR, M.D.The Department of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Type 2 diabetes mellitus has reached pan-demic levels with associated many co-morbidities and decrease in life expectancy. Bariatric surgery presented its value as a definitive solution for type 2 diabetes mellitus management especially with the laparoscopic surgery evolution which occurred since the 1990s. Bariatric surgery has a significant role in remission or alleviation of type 2 diabetes mellitus, weight loss, remission of comorbidities, and the improvement in the quality of life. Aim of Study: We attempt to illustrate, through the available researches, the role of laparoscopic ileal interposition associ-ated with sleeve gastrectomy in management of type 2 diabetes mellitus and the feasibility and efficacy of this procedure as an option in management of type 2 diabetes mellitus and assess the risk to benefit profiles. Material and Methods: The search is carried out using the electronic national library of medicine's PubMed database plus manual reference checks of articles published on lapar-oscopic ileal interposition associated with sleeve gastrectomy in management of type 2 diabetes mellitus in the period between February 2019 to February 2020. The jejuno-ileal interposition associated with sleeve gastrectomy can be an effective method used for management of type 2 diabetes mellitus in patients with BMI less than 35 kg/m2. Results: The results of this procedure are promising regarding its outcome in remission of T2DM and remission of its co-morbidity diseases. The operative time of the proce-dure along with its reasonable post-operative hospital stay and its results in type 2 diabetes mellitus remission may present the procedure as an alternative for other more complex bariatric procedures in management of type 2 diabetes mellitus. Conclusion: The duration time of T2DM, the drug used, the dose of the drug and the BMI of the patient affect the rate of complete remission of T2DM. The procedure can produce adequate control of hyperglycemic state in T2DM patients and satisfactory weight loss without signs of nutritional deficiencies. The procedure seems to be safe and an effective option in the management of type 2 diabetes patients with affordable risk comparing to its long term benefits.https://mjcu.journals.ekb.eg/article_116257_46e193f67a51d3566ead2dc669c8b442.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Accuracy of C-Arm Guided Insertion of Ommaya Reservoir Tube in Recurrent Cystic Craniopharyngiomas1649165311625810.21608/mjcu.2020.116258ENMOHAMMED ADAWI, M.D.;MAHMOUD WAHDAN, M.D.MOHAMMEDMOURAD, M.D.The Department of Neurosurgery, Faculty of Medicine, Benha University, EgyptJournal Article20200630Abstract Background: Caniopharyngiomas in spite of being benign tumors they have a high rate of recurrence of which cysts constitute major component. Ommaya Reservoir System (ORS) is a simple manoeuvre for percutaneous drainage of cysts. Aim of Study: To evaluate the efficacy of using C-arm as a guiding tool for placement of Ommaya reservoir tube in predominantly cystic recurrent craniopharyngiomas. Patients and Methods: This study included 8 patients with clinically symptomatic and radiologically confirmed recurrent craniopharyngioma with significant cystic part. These patients were treated by C-arm guided insertion of Ommaya reservoir tube. The technique is described in details. CT brain was obtained in the first post-operative night to assess the position of the tube. Post-operative clinical and radiological evaluations were compared to the pre-operative. Results: This study included 6 males and 2 females, ranging in age from 5 years to 38 years with mean age of 18.4 years. Headache was the most common presenting complaint, followed by visual impairment. All surgeries were performed with C-arm guidance and post-operative CT brain documented satisfactory position of the tube in 7 cases and only one case required second look surgery for repositioning of the tube with the same technique. Significant post-operative improve-ment of headache and visual symptoms were encountered in all cases due to decompression of the optic chiasm by cyst drainage. Conclusion: C-arm assisted insertion of Ommaya reservoir tube is a reliable method that can minimize the errors of free hand technique and of special value in low facility centers.https://mjcu.journals.ekb.eg/article_116258_bb09be52bd6c35ec989633a25ee31fcf.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Serum CXCL16 in Relation to Diabetic Nephropathy in Type 2 Diabetes Egyptian Patients1655166111625910.21608/mjcu.2020.116259ENPHEBE L. ABDEL-MESSEIH, M.D.;EHAB M. REYAD, M.D.HEBAH. MANSOUR, M.D.The Department of Clinical and Chemical Pathology, Health Radiation Research, National Center for Radiation Research and Technology, Atomic Energy Authority, Cairo*, The Department of Clinical Pathology, National Hepatology and Tropical Medicine Research Institute** and The Department of Biochemistry, Health Radiation Research, National Center for Radiation Research and Technology, Atomic Energy Authority, Cairo***, EgyptJournal Article20200630Abstract Background: CXC chemokine ligand 16 (CXCL16) is both an oxidized low density lipoprotein receptor (ox-LDL) and a chemokine with a potential role in the pathogenesis of Diabetic Nephropathy (DN). Aim of Study: The aim of this work is to evaluate the relationship between serum CXCL16 levels and (DN) in type 2 Egyptian diabetic patients. Methods: This case-controlled study was conducted on 80 T2DM patients (group A1: 24 patients with normoalbu-minuria; group A2: 28 patients with microalbuminuria, and group A3: 28 patients with macroalbuminuria) and 20 age-and sex-matched healthy controls. All were subjected to a complete clinical evaluation and laboratory investigations which included quantitative measurements of urinary albu-min/creatinine ratio and serum CXCL16 levels by enzyme-linked immunosorbent assays. Results: Serum CXCL16 levels were significantly higher in all T2DM groups compared with healthy controls. There was a positive correlation between CXCL16, creatinine and ACR (r=0.48, p:0.039 and r=0.53, p:0.019, respectively), whereas it was significantly negatively associated to eGFR (r=–0.46, p:0.05). Regression analysis indicated that CXCL16 levels were continued significantly correlated with creatinine, eGFR and ACR (p:<0.05, for all). Conclusion: Egyptian type 2 DM patients are characterized by increased serum CXCL16 levels. There was a statistically significant correlation between CXCL16 levels and conven-tional renal markers reflecting disease progression.https://mjcu.journals.ekb.eg/article_116259_bc18d5001884303a7a2f2ca7ee4c9b01.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Evaluation of Alvarado Score in the Diagnosis of Acute Appendicitis1663167211626010.21608/mjcu.2020.116260ENSAMY G. AKHNOKH, M.D.;RAMEZ M. WAHBA, M.D.ARMIAS.F. KAMEL, M.Sc.The Departments of General Surgery* and Vascular Surgery**, Faculty of Medicine, Ain Shams UniversityJournal Article20200630Abstract Background: Acute Appendicitis (AA) remains the most frequent abdominal surgical emergency in the developed world. Failure to make an early diagnosis is a primary reason for the persistent rate of morbidity and mortality. Decision making in cases of acute appendicitis may be a problematic experience in developing countries where the facilities for investigations lack, especially in rural and semi-rural areas. Alvarado Score (AS) may be used as a guide. Aim of Study: To evaluate the effectiveness of Alvarado Score in diagnosing acute appendicitis by correlating it with the operative findings, and the pathologic findings if it is feasible. Also, to know the specificity and sensitivity of Alvarado Score as a diagnostic tool of acute appendicitis in both genders and all age groups, so we can apply it to all patients suspected to have acute appendicitis. To save time and money by diagnosing Acute Appendicitis with the help of Alvarado Score and using it as a guide in requesting a CT Abdomen for suspicious appendicitis. So, we can eventually reduce the number of negative appendices or complications of undiagnosed appendicitis. Patients and Methods: The study was conducted on 50 patients complaining of lower abdominal pain with a provi-sional diagnosis of acute appendicitis, selected non-randomly, in the Emergency Department of Harpur Memorial Hospital in Menof City, Menofeya Governorate-Egypt. Patients were assessed pre-operatively by the Alvarado scale. Post-operative histological examination of removed specimens was done. Results: The results showed that 60% of the patients were males. The mean age was 27.54, range (9-62) years old. 100% of cases had Right Lower Quadrant tenderness (RLQ) as well as Rebound tenderness, followed by; anorexia in (96%) of cases. The migration of pain to the right lower quadrant was present in (68%) of cases. Conclusion: We concluded that in our local setting, efficacy (sensitivity, specificity, and diagnostic odds ratio) of Alvarado Score, using a conventional cut off value of 7 for high-risk group, in the diagnosis of Acute Appendicitis is a good initial evaluation of patients with acute lower abdominal pain. Also, it is a cheap and quick tool to apply in Emergency Departments to rule our acute appendicitis.https://mjcu.journals.ekb.eg/article_116260_3dcc4967d0b595fa6e7938035de0f6ec.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Comparative Study between Unilateral Inguinal Hernia by Open Technique versus TAPP Repair1673167811626110.21608/mjcu.2020.116261ENAHMED A. BASIOUNY, M.Sc.;RAGHEB A. RAGHEB, M.D.ASHRAFE. ELSHARKAWY, M.D.The Department of General Surgery, Faculty of Medicine, Al-Azhar University (Girls)Journal Article20200630Abstract Background: Inguinal hernia repair is one of the most widely performed surgical procedure. Amongst the techniques used, the Open Lichtenstein Repair (OLR) is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the Trans-Abdominal Pre-Peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and earlyrecovery. Aim of Study: This study aims to compare between lich-tenstein repair of inguinal hernia and transabdominal preperi-toneal repair of inguinal hernia (TAPP) as regard their hospital stay, post-operative complications and short-term recurrence. Patients and Methods: Our study was carried out on (40) male patients with inguinal hernia attendees Kobry El-Qobba Military and Alzahraa Hospital; Al-Azhar University between April 2019-Octoper 2019, 20 patients underwent laparoscopic Trans-Abdominal Pre-Peritoneal (TAPP) repair and 20 patients underwent open Lichtenstein repair. Results: In our study the mean operative time was (97.50 ±19.97) minute for TAPP, (70.30±19.55) minute for open Lichtenstein repair. None of our patients had intra-operative complications such as (vascular injury... etc). There was one patient with wound infection (5%) for TAPP repair versus two patients seroma (10%), one patient hematoma (5%) and one patient wound infection (5%) but the difference between both groups was statistically insignificant. There was no significant difference in terms of hernia recurrence. This study confirmed less post-operative pain day 0, day 1 and day 7 post-operatively. There was no significant difference in 1 and 6 month post-operatively. Conclusion: Our study showed that laparoscopic TAPP approach for inguinal hernia repair is safe and reduces early post-operative pain. Furthermore, it is related to less compli-cations. Significantly although it takes a longer operative time.https://mjcu.journals.ekb.eg/article_116261_7116847a0ea6476c26c256cb760f4b47.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Effect of Lumbar Lordosis Rehabilitation on S1 Alfa Motor Neuron Excitability in Chronic Non Specific Low Back Pain1679168711637110.21608/mjcu.2020.116371ENHEND I. MOHAMED, M.Sc.;MOHAMED H. EL-GENDY, Ph.D.SALAH EL-DIN B. AHMED, Ph.D.;AMR ABD-ALLA AZZAM, Ph.D.The Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University* and The Department of Orthopedic Surgery, National Institute of Neuromotor System**Journal Article20200601Abstract Background: Chronic Mechanical Low Back Pain (CM-LBP) represents a significant public health problem and an economic burden to employers. There is a gap in literature concerning the investigations on changes of the motor nerve excitability during rehabilitation of lumbar lordotic curve which represent a major barrier preventing the exploration of the most effective conservative treatment on restoring the lumbar lordosis. The Denneroll is a relatively new sagittal plane orthotic device designed to passively stretch the lordotic curve into a more lordotic position. Aim of Study: This study designed to study the effect of lumbar Denneroll traction on motor nerve excitability on chronic low back pain patients. Material and Methods: Thirty patients had participated in this study; they were assigned randomly into two groups (A) experimental group, and (B) control group. Group (A) consisted of 15 patients; they received combined program of Denneroll traction and conservative physical therapy treatment. Group (B) which consisted of 15 patients; they received the same conservative treatment as group (A) in form of (ultrasonic therapy, infrared and stretching exercise). Treatment was given 3 times per week, each other day, for ten consecutive weeks. Patients were evaluated pre-treatment and post-treatment for the H-reflex, H/M ratio and Absolute Rotatory Angle (ARA). Results: Using repeated measures multivariate analysis of variance (MANOVA) test, patients showed significant improvement in the combined dependent variables in both groups but between groups difference group (A) showed a more significant improvement than group (B) in the combined dependent variables. Both of the Denneroll and traditional treatment had a significant effect onthe H-reflex, H/M ratio and absolute rotatory angle indicated that there were significant effects of the tested group (the first independent variable) on the all tested dependent variables; H-reflex, H/M ratio and ARA (F=31.357, p=0.0016). However, there were significant effects of the measuring periods (the second independent variable) on the tested dependent variables (F=114.404,p=0.0001). However, the interaction between the two inde-pendent variables was significant, which indicates that the effect of the tested group (first independent variable) on the dependant variables was influenced by the measuring periods (second independent variable) (F=26.035, p=0.0001). Conclusion: Therefore, the combination of Denneroll with traditional physical therapy treatment program more effective than the therapeutic exercises alone in the treatment of non-specific low back pain patients.https://mjcu.journals.ekb.eg/article_116371_16acbb3223272bbb63d9be4ece717800.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Comparative Study between Sublay versus Onlay Mesh Repair in Treatment of Incisional Hernia1689169711637510.21608/mjcu.2020.116375ENHAMED A. EL BADAWY, M.D.;MOHAMMED S. ZARAD, M.D.MOHAMEDA. DORBOK, M.Sc.The Department of General Surgery, Faculty of Medicine (for Girls), Al-Azhar University* and Damanhour Medical National Institute, Damanhour, El Beheira**, EgyptJournal Article20200601Abstract Background: Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study: The aim of this study was to compare between sublay and onlay mesh repairs in treatment of inci-sional hernia regarding the operative technique and post-operative complications. Patients and Methods: This prospective comparative study was conducted in General Surgery Department at Al-Zahraa University Hospital and Damanhour Medical National Institute in the period between October 2018 and April 2020. It included 120 patients with incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results: The mean operative time in group A was 112.2 minutes and in group B was 98.2 minutes. The mean time of drain removal in group A was 5.9 days while in group B was 14.17 days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 6 patients in group B (10%). The other postoperative complica-tions were comparable in both groups. During 6 months of follow-up, hernia recurrence occurred in 1 patient in group A (1.7%) and in 3 patients in group B (5%). Conclusion: Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.https://mjcu.journals.ekb.eg/article_116375_bfcd358047af4d4cbf5e2fcae643553d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Role of DWI MRI as a Recent Modality in Differentiation between Benign from Malignant Ovarian Tumors1699170611637610.21608/mjcu.2020.116376ENDAWLAT A. ABD EL-MAGEED, M.Sc.;NAGLAA SHEBREYA, M.D.NERMEENN. KERIAKOS, M.D.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200601Abstract Background: Determining whether a clinically diagnosed adnexal mass is benign or malignant is frequently not possible until surgical exploration and histologic examination are performed. Consequently, it may not be possible to decide pre-operatively whether conservative or radical surgery is appropriate. Areliable method with which to differentiate a benign from a malignant adnexal mass would provide a basis for optimal pre-operative planning. Aim of Study: To get judgment for the utilized MRI tools of assessment and to find out whether diffusion weighted imaging is a necessity or luxury in case we need to asses an adnexal mass. Patients and Methods: The current study is a prospective analysis that was conducted at Ain Shams University Hospital and Damnhour Scan Center from 2018 to 2019. The study was performed on 22 cases of ovarian tumors. 5 patients presented by abdominal enlargement, 5 were complaining of long standing abdominal pain, 7 came with other different complaints; 4 came complaining with frequency of micturition, dysuria, loss of weight and one case accidentally discovered during US examination. Results: DWI had shown 100% sensitivity in its individual performance; yet a low specificity which was 78.6%. Such low specificity value was attributed to the presence of benign masses that have mimicked malignancy on DWI; starting from their misleading signal intensities of restricted diffusion, down to their measured ADC values. These masses were: Mature teratomas and tubo-ovarian abscess. Conclusion: The solo performance of DWI is not an applicable way to discriminate benign from malignant adnexal masses due to its low specificity. According to us, DWI has sensitivity of (100%), but didn't improve the specificity (78.6%) or the accuracy (86.4%). DWI can help and increase confidence of MRI in assessment or exclude potential malig-nancy in complex adnexal masses; provided I) inclusion of the conventional MRI data, II) Combined analysis of DWI quantitative and qualitative criteria and iii) awareness of the possible sequence pitfalls.https://mjcu.journals.ekb.eg/article_116376_b74c0f6e3af07b5171cfd3ed0db7e2ce.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Is Laparoscopic Appendectomy Superior to Open Appendectomy?1707171311637710.21608/mjcu.2020.116377ENMOHAMED M. AHMED SAKRAN, M.Sc.;AMER H.E. BARRAWY, M.D.HAMEDA. ABDEL HAMEED ELBADWY, M.D.The Department of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20200601Abstract Background: The most common emergency for surgery in the population is acute appendicitis. Though laparoscopic appendectomy is widely performed today, the advantages of laparoscopic versus open appendectomy remain under contro-versy. Aim of Study: To determine whether Laparoscopic Ap-pendectomy (LA) is better than thetraditional Open Appen-dectomy (OA). Patients and Methods: It is a prospective study, involving 150 patients with acute appendicitis. All patients undertook abdominoal and pelvic ultrasonography, to exclude any con-comitant gynecological finding and other cause for right iliac fossa pain. The patients were admitted to in Al-Zahraa University Hospital and Kobry El-Koba Military Hospital during the period from November 2017 to November 2019. Operational time, post-operative pain, first bowel movement, hospital stay, early work return and post-operative complications were compared in patients with open versus laparoscopic appen-dectomy. Results: OA and LA were performed in 150 patients (75 patients for each procedure). The laparoscopic technique gave less length of hospital stay (p=0.025), better in operative time, short hospital stay, low visual pain analogue range, first bowel motion recorded and early return to normal activity (p < 0.01), less intraoperative and post-operative complications 6.7% of all patients had complications post-operatively all in open group. Conclusion: The advantage of laparoscopic appendectomy is decreased pain following surgery, a short hospitalization, and an early return to work. Laparoscopic appendectomy should be recommended for acute appendicitis as an effective and safe procedure.https://mjcu.journals.ekb.eg/article_116377_10a6c382621eadb7cb58adc64767834f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Breast Cancer Detection Using Automated Breast Ultrasound in Mammographically Dense Breasts1715172311637910.21608/mjcu.2020.116379ENSHERINE K. AMIN, M.D.;MOHAMED G. ABDEL MUTALEB, M.D.LATIFAE. GAD, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200601Abstract Background: Automated Breast Ultrasound technology (ABUS) allows the radiologist to interpret ultrasonography images in a separate time after acquisition. Different interpre-tation times have been reported, ranging from 5 to 10min, probably according to differences in readers' experience and complexity of each case. Aim of Study: To detect the impact of ABUS technique's advantages, pearls and pitfalls combining with mammography compared with mammography alone, significantly improved detection of breast cancers in women with dense breast tissue without substantially affecting specificity. Patients and Methods: This cross-sectional study was conducted on of 20 women at Radiodiagnosis Department, Shoubra General Hospital referred from surgery clinic during a period of about one year. The study was limited to only females who were willingness to undergo additional investi-gations after being diagnosed as dense breast on mammo-graphy. Results: We found that cases with ABUS study shows sensitivity about (60%) which is more than that of mammogram (30%) but less than HHUS (80%); while ABUS (70%) was less specific than both mammogram (100%) and HHUS (90%). Accuracy of HHUS (85%) was more than that of both mam-mogram (65%) and ABUS (65%), with p-value (0.257) to both mammogram and ABUS, and (0.008) to HHUS. Conclusion: Adding automated breast ultrasound to mam-mography is of great value in detection of breast cancer in mammographically dense breasts. It increases the detection rate of breast lesions mostly cancer. It is important as screening tool to decrease doses of radiation that female exposed to while mammogram screening.https://mjcu.journals.ekb.eg/article_116379_2030a7072d395e6519e67f192bf58f0e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Uses of Smart Phones Application on Physical Therapy for Pediatric Evaluation: Systematic Review1725173111654910.21608/mjcu.2020.116549ENSARA M.M. KORTAM, M.Sc.;ZIENAB A. HUSSEIN, Ph.D.SHIMAAM. REFAAT, Ph.D.The Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo UniversityJournal Article20200602Abstract Background: Rapid developments in technology have encouraged the use of smartphones in pediatric evaluation research and practice. Although many applications (apps) relating to physical activity are available from major smart-phone platforms, relatively few have been tested in research studies to determine their effectiveness in evaluation of children strength and muscle power. Aim of Study: The aim of the study to evaluate intra-rater reliability of smart phone application in measuring range of motion among normal children. Material and Methods: In this article, we summarize data on use of smartphone apps for estimating range of motion based upon bibliographic searches with relevant search terms in PubMed and Google scholar. Results: After screening the abstracts or full texts of articles, 20 eligible studies of the acceptability or efficacy of smartphone apps for increasing physical activity were identi-fied. Of the 20 included studies, 9 were comparative research studies, 8 were reliability studies and 2was across sectional studies. The results indicate that smartphone appscan be efficacious in pediatric evaluation although the magnitude of the intervention effectis modest. Participants of various ages and genders respond favorably to apps that automaticallytrack range of motion, track progress toward evaluation goals, and areuser-friendly and flexible enough for use with several types of range of motion. Conclusions: In conclusion, Dr Goniometer smart phone application can be used in clinical practice and research as an easy and convenient alternative to a digital and universal goniometer.https://mjcu.journals.ekb.eg/article_116549_5eab0d4c7fd181e6d7a1af8aaa022687.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Artificial Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion in the Management of Single Level Cervical Disc Prolapse: Randomized Control Single Blinded Study1733174211655010.21608/mjcu.2020.116550ENMOHAMED ELMALLAWANY, M.D.;HESHAM EDWAL, M.Sc.MOHAMMED A. SAWAN, M.D.;MOHAMED A. THABET, M.D.The Department of Neurosurgery, Faculty of Medicine, Cairo UniversityJournal Article20200602Abstract Background: Anterior cervical decompression and inter-body fusion can result in the loss of range of motion with accelerated adjacent disc degeneration. Aim of Study: This study details the analysis of the indi-cations, safety, efficacy and complications of cervical dynamic artificial disc replacement (CDR) for cases of cervical disc diseases compared to PEEK (polyetheretherketone) cage insertion, in addition statistical comparison between both techniques. Patient and Methods: The study included 30 patients with single level disc disease with radiculopathy both confirmed by clinical and radiological data, with failed medical treatment for 6 weeks at least. Results: Average age of presentation was 37.7 years (age range 18-50) for both groups, female ratio for the fixed group was 1:1.5, and 1:0.8 for the dynamic group. The average duration of symptoms was 51.4 weeks, 21 cases had left, while 9 had right sided radiculopathy. The most common presenting symptom after neck pain was the brachialgia, most common sign was sensory changes. Most common operated level was C5-6 for both groups. The average follow-up period in our study was 6 months, during which no recurrence, instability or progressive kyphosis occurred. The neck disability index, in the Anterior Cervical Dis-cectomy and Fixation (ACDF) group (66.7% scored from 5 to 14), (33.3% from 15 to 24), versus in the artificial disc group (53.3% scored from 5 to 14), (46.7% scored from 15 to 24). The clinical assessment as regard the motor and sensory shows no different out comes where the both study groups give the same final surgical results. Conclusion: Cervical dynamic implants offer many distinct advantages over the traditional (ACDF) to include preserved segmental motion, decreased adjacent level strain, offers adequate motion to avoid overloading and accelerating adjacent level degeneration.
Overall, the results provided suggest that CDR although being more expensive, but may be a safe and effective alter-native surgical procedure to fusion for the treatment for single level cervical disc.https://mjcu.journals.ekb.eg/article_116550_a35487a835e3fc8b557f9a99826cf2cb.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Diagnostic Value of CA19.9 in Predicting the Resectability of Pancreatic Cancer1743175111655110.21608/mjcu.2020.116551ENABDELGHANY M. ELSHAMY, M.D.;MOHAMED A. ABD ELHAMID, M.D.AHMEDI.A. IBRAHIM, M.Sc.The Department of General Surgery, Faculty of Medicine, Ain Shams UniversityJournal Article20200602Abstract Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the deadliest cancers presenting an increased mortality rate of about 3% of all cancers and about 7% of all cancer death in the United States and Europe. One of them, used for long as potential independent predictor of surgery is the Sialylated Lewis blood group carbohydrate antigen 19.9 (CA19.9). CA19.9 is detected in low levels in healthy indi-viduals (up to 37U/ml) and the level is elevated in several types of cancers including pancreatic, and also in benign conditions such as pancreatitis and choledocholithiasis. Aim of Study: To evaluate the diagnostic value of CA19.9 in predicting the resectability of pancreatic cancer. Patients and Methods: This is prospective and retrospec-tive study which was carried out on 25 patients diagnosed as patients with biopsy-proved adenocarcinoma of the pancreas. All patients were selected from Eldemerdash Hospital Uni-versity, Ain-Shams University Hospitals in the period from January 2016 to April 2019. Results: The majority of the patients have cancer head of pancreas (72%), while 20% were confined to the body and 8% were confined to the body and tail. The majority of patients (44%) underwent pancreaticoduodenectomy, 20% of patients underwent distal pancreatectomy, 4% of patients underwent total pancreatectomy, and 32% patients underwent only ex-ploratory laparotomy and biopsy. At present the best way for pre-operative staging of pancreatic cancer is bolous and tri-phase helical computed tomography, which have been showen to be almost 100% accurate in predicting unresectable disease. Serum CA19.9 level in patients with unresectable tumor was highly significantly higher compared with that in patients with resectable tumor. Positive significant correlation between CA19-9 with total bilirubin, ALT and AST. Conclusion: CA19.9 is one of the tumor markers for pancreatic adenocarcinoma. It can be used as marker to identify pancreatic adenocarcinoma with limited sensitivity and spe-cificity. The use of CA19.9 in conjunction with modern imaging techniques may improve the characterization of resectability and categorization of 'borderline-resectable' tumours, however this biomarker alone does not possess enough predictive value. Most likely, as suggested by many others, a combination of biomarkers is needed in order to achieve acceptable sensitivity and specificity in a disease with non-specific symptoms and low incidence.https://mjcu.journals.ekb.eg/article_116551_e5092f44a176245ffbf42bbba7a62381.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Bone Cement for Ossicular Chain Defects1753175911682110.21608/mjcu.2020.116821ENESSAM FATEHY, M.D.;WAEL A. ALZAMIL, M.D.The Department of Ear, Nose and Throat, Hearing and Speech Institute, General Organization for Teaching Hospitals and Institutes, Cairo, EgyptJournal Article20200603Abstract Background: The discontinuity of ossicular chain most commonly affects the incudostapedial joint in 80% of patients an absent incus, or an absent incus and stapes superstructure. This discontinuity leads to a conductive hearing loss of different degrees. The goals of surgery for chronic ear disease are eradication of the disease and reconstruction of a sound transformer mechanism, but reconstructing this defect is a challenging procedure for the surgeon with different treatment options such as total ossicular chain prosthesis, a partial ossicular chain prosthesis, incus interposition, or bone cement utilization. Extrusion of the prosthesis is still a challenge in ossiculoplasty with alloplastic materials, especially in patients with poor eustachian tube function. Bone cement is cost effective, because it is cheaper than other ossiculoplasty materials, and this cost-effectiveness plays an important role in the decision the surgeon has to make, and bone cement has a promising role in this so, there is a rising interest in the otologic surgical field to use bone cement because of its biocompatible profile, its easy application, its suitable cost, and its low extrusion rate. Also, it may have a potentiality of neo-osteogenesis. Aim of Study: To evaluate the post-operative results and usefulness of bone cement application in repairing ossicular chain defects, to discuss surgical technique, and to compare pre-operative and post-operative ABG. Patients and Methods: This study was carried out in the ORL-HNS Department, Hearing and Speech Institute, from April 2015 to March 2018, on 30 patients with ossicular chain defect. Bridging of ossicular discontinuity was done by glass monomer bone cement in all patients. Results: In this study, successful hearing restoration could be achieved in 96% of the patients represented, as 52% of the patients had hearing improvement (dB gain) of more than or equal 10 dB, and 26% of patients had hearing im-provement (dB gain) more than 20 dB, and 18% of patients had hearing improvement (dB gain) of more than 40 dB, after 12 months.<br />Conclusion: Incudostapedial joint rebridging ossiculo-plasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.https://mjcu.journals.ekb.eg/article_116821_94387e0d08f125d75dcce4a9fa92f029.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Role of Matrix Metalloproteinase-9 in Diagnosis of Dry Eye1761176511682310.21608/mjcu.2020.116823ENAYMAN A. GAAFAR, M.D.;MOHAMED O. YOUSIF, M.D.BASSEM F. AZIZ, M.D.;NARDEEN ADEL YACOUB, M.Sc.The Department of Ophthalmology, Faculty of Medicine, Ain Shams UniversityJournal Article20200603Abstract Background: Dry eye is a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface”. Symptoms of dry eye, which include visual disturbances and pain/dysesthesias, have been found to negatively impact quality of life. Aim of Study: To assess the presence of ocular surface Matrix Metalloproteinase-9 (MMP-9) in dry eye by Infla-mmaDry® test. Patients and Methods: A prospective cross-sectional study included a total of 40 eyes with dryness. This study was involved patients visiting outpatient clinic in Qalawoon Hospital from December 2018 till May 2019. The tear film was analyzed for MMP-9 by InflammaDry®test, symptoms and signs of dry eye disease were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Tear Breakup Time (TBUT), corneal staining, Schirmer and Meibomian gland examination. Results: Mean age of the study population was 39.45 years ±9.06 SD (range 30-60), sixty five percent of study population were females. Mean of Ocular Surface Disease Index was 23.05±5.00 SD (14-33 range), Schirmer test mean was 4.60mm/5 minutes ± 2.11 SD (1-8mm/5min range), Tear Breakup Time mean was 5.40 seconds ±1.61 SD (3-9 range) and corneal staining mean was 2.45±0.68 SD (2-4 range). Seventy five percent of the study population had Meibomian glad dysfunction. There was a highly statistically significant correlation between InflammaDry® results and Meibomian glands dysfunction. There were statistically non-significant correlations between Ocular surface disease index, Schirmer test results, tear breakup time, corneal staining and positive results of InflammaDry®test. Conclusion: There is direct correlation between inflam-mation and dry eye disease. Also, Matrix metalloproteinase testing in dry eye disease is a valuable new diagnostic tool to identify the presence of ocular surface inflammation.https://mjcu.journals.ekb.eg/article_116823_5d88e0ae9572edfa46e2129ce09a0165.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Nutritional Screening for 2-5 Years Old Children in Urban and Rural Outpatient Settings1767177511682610.21608/mjcu.2020.116826ENMOHAMED A. ABD EL WAHED, M.D.;MAY F. NASSAR, M.D.AHMED K. AHMED, M.Sc.;HEBA E. EL KHOLY, M.D.The Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20200603Abstract Background: Malnutrition in children is common globally and may result in both short-and long-term irreversible negative health outcomes. Conventional indices fall short of portraying the full consequence of under-nutrition in the population. Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) is another nutritional assessment tool which was created to solve this dilemma. Aims of Study: This study was designed to detect any deviation of nutritional status of children from 2-5 years in outpatient clinic of rural and urban areas using conventional indices (weight for age, height for age and BMI), and the newly developed STAMP. Patients and Methods: This cross-sectional study was conducted on 135 children aged 2-5 years attended the outpa-tient clinics in three hospitals, Bulaq El-Dakrur General Hospital (urban area), Al-Badrashin Central Hospital and Al-Wahat Al-Bahariya Hospital (rural areas), in Egypt. Weight and height measurements were obtained. Z-scores were cal-culated for weight-for-age (WAZ), height-for-age (HAZ) and BMI. World Health Organization growth charts were used to define underweight, stunted and obese patients and STAMP score was used to assess the risk for nutritional derangements. Dietary recall was also obtained and analyzed. Results: Children were classified as per the conventional indices and STAMP. The prevalence of normal weight, height and BMI were 80%, 59.2% and 37.7% respectively. The prevalence of marginal underweight, marginal stunting and overweight were 17%, 27.4%, and 34% respectively and the prevalence of underweight, stunting and obese were 2.9%, 11.8%, and 28.1% respectively. As per STAMP, 57% of children were at low risk, 17.7% were at intermediate risk and 25.1 % were at high risk of malnutrition. Concerning the difference between urban and rural areas, the prevalence of underweight and stunting in urban district were 0.00% and 6.7% respectively, and in rural district were 4.4% and 14.4% respectively. Conclusion: STAMP offers a valid screening tool for the detection of malnutrition and malnutrition risk in pediatric primary health care setting. It met the requirements of a nutrition screening tool in being quick and easy to use.https://mjcu.journals.ekb.eg/article_116826_6afb4a9f1ed7ffd49066548ff1070d2a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Effect of Kinesiotape versus Resistive Exercise on Dorsiflexors Functional Performance in Diabetic Peripheral Neuropathy1777178211682710.21608/mjcu.2020.116827ENMOHAMED N.H. IBRAHIM, M.Sc.;AHMED A. ELSHEHAWY, Ph.D.AHMED M. BAHAA EL-DIN, M.D.;MARIAM E. MOHAMED, Ph.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University*, The Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Tabuk, Saudi Arabia** and The Department of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University***Journal Article20200603Abstract Background: Diabetic peripheral neuropathies are a het-erogeneous group of disorders caused by neuronal dysfunction in patients with diabetes. DPNs cause different pathological changes in sensory, Motor and Function levels in Diabetic patients. Aim of Study: Was to investigate the effect of Kinesio tape and resistive exercise on dorsiflexors' functional perform-ance in diabetic patients with peripheral neuropathy and compare between them. Subjects and Methods: Forty Type II diabetic patients-controlled-diagnosed by Physician and confirmed by Labora-tory investigations (HbA1c, FBG) with Mild DPNs, their ages from 50-60 years old were assigned to two equal Groups (Group A) was treated with resistive exercise for eight weeks, three times per week. And (Group B) who were treated with KinesioTM tape that was applied to dorsiflexors 24 hours a day and was replaced every 5 days for 8 weeks. For evaluation of the muscle strength Hand held Dynamometer were used (Lafayette Manual Muscle Tester, Model #01163), while the functional performance was evaluated using the 6 minutes walking test. Results: In Group A the mean value of muscle strength of the right dorsiflexors improved from (295.4±84.7) to (334.5 ±104.0) with the mean difference (39.2±63.2) which is a significant difference. The mean value of muscle strength of the left side improved from (296.2±115.2) to (310.8±111.1) with the mean difference (14.7±68.8) which is not a significant difference. The mean value of functional performance im-proved from (345.6±62.8) to (376.4±70.9) with the mean difference (30.7±31.8) which is a significant difference. In Group (B) the mean value of muscle strength of the right side improved from (296.1±66.8) to (385.5±102.5) with the mean difference (89.4±78.0) which is a significant difference, the mean value of muscle strength of the left side improved from (293.5±72.8) to (385.5±102.5) with the mean difference (89.4±78.0) which is a significant difference and the mean value of functional performance improved from (344.1±73.2) to (388.4±84.7) with the mean difference (44.3±38.8) which is a significant difference. In Conclusion: Both KinesioTM tape and resistive exercise improve the dorsiflexors and functional performance without significant difference between them on Dorsiflexors' strength and patients functional performance in diabetic polyneuropathy.https://mjcu.journals.ekb.eg/article_116827_5de82ea273637d2962b34b6d4f023e13.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Coronary Slow Flow Phenomenon: The Role of New Echo cardiographic Indices1783179211682810.21608/mjcu.2020.116828ENMAGDY M. ABDELSAMEI, M.D.;MOHAMED GOUDA MOHAMED, M.D.ISLAM M. ABDELMONEM, M.Sc.;AHMED S. ELDAMANHORY, M.D.The Department of Cardiology, Faculty of Medicine, Zagazig UniversityJournal Article20200603Abstract Background: The Coronary Slow Flow Phenomenon (CSFP) is defined as a delayed distal vessel contrast opacifi-cation in the absence of obstructive epicardial coronary artery disease during coronary angiography. There is conflicting data in medical literature regarding the effects of CSFP on the left ventricular functions assessed by conventional echocar-diography or tissue Doppler imaging. Aim of Study: To evaluate whether there is impairement of Global Longitudinal Strain (GLS) of the Left Ventricle (LV) obtained by Speckle Tracking Echocardiography (STE) in patients with CSFP and the role of GLS of the left ventricle in prediction of CSFP. Patients and Methods: Patients with chronic stable angina referred for coronary angiography from February 2015 to Augusts 2017 at the Department of Cardiology, Faculty of Medicine; Zagazig University Hospitals were examined. 31 patients with CSFP and 52 age and sex matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TIMI Frame Count (TFC). GLS of LV was measured by two dimensional (2D) STE in addition to other conventional and tissue Doppler parameters to assess LV diastolic and systolic functions. Results: LV GLS was lower in CSFP group patients (–15 ±2.73) compared to control group (–17.19±2.54) (p=0.001). There was statistically significant negative correlation between mean TFC and LV GLS (r=–0.33, p=0.002). LVEF by modified Simpson method was lower in CSFP group (57.77±5.66%) compared to control group (59.29±3.32%) but with no statis-tical significance (p=0.18). Left atrial diameter, LAVI were larger in CSFP group compared to control group (p < 0.05). MV E/Ep and TV E/Ep was higher in CSFP group compared to control group (p < 0.001). Smoking was the only risk factors that showed statistical significance being more common in CSFP patients (p=0.003) with positive correlation between mean TFC and smoking index (r=0.28, p=0.002). Conclusion: CSFP impaires LV systolic and diastolic function, RV diastolic function. We found significant negative correlation between mean TFC and GLS of LV.https://mjcu.journals.ekb.eg/article_116828_c8f9c7450497f3a0b45ffd992ae685fc.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Serum Sclerostin Level in Relation to Bone Status in Children with Chronic Kidney Disease1793180511682910.21608/mjcu.2020.116829ENAMIRA R. ABASS, M.Sc.;ASHRAF A. ABDEL BASSET, M.D.AMANY K. EL-HAWARY, M.D.;MOHAMED M. ALI EL ASSMY, M.D.REHAMEL-FARAHATY, M.D.The Departments of Pediatrics* and Clinical Pathology**, Faculty of Medicine, Mansoura University and Minister of HealthJournal Article20200603Abstract Background: To assess the serum level of sclerostin as a bone marker in children with different stages of Chronic Kidney Disease and its relation to bone status in children with CKD. Aime of Study: Is to assess the serum level of sclerostin in children with different stages of CKD and its relation to bone status in those children. Patients and Methods: The study was conducted on total of 90 children, 60 children of them were followed-up for diagnosis of CKD stages from II to V at Mansoura University Children Hospital (MUCH) Nephrology Unit. This study was done from March 2015 to March 2016. They were 34 (56.7%) males and 26 (43.3%) females with mean age SD of 11.06±3.4. Control group of 30 healthy children and were 18 male (60%) and 12 (40%) female with mean age SD of 9.6±2.3. Age ranges from three to seventeen years, complete blood picture, serum creatinine, parathyroid hormone, alkaline phosphatase, calcium, phosphorous and sclerostin serum level and also DEXA scan were measured in both groups. All patients were free from acute illness or symptoms suggestive of a urinary infection in the previous 3 months and none of them were receiving corticosteroids. Children with CKD who have diabetes, vascular calcifications or had undergone renal transplantation were excluded. Results: Elevated serum sclerostin in CKD & ESRD groups compared to control. Non-significant correlation between serum sclerostin level, biochemical bone markers and different anthropometeric measures. Conclusions: Serum sclerostin was elevated in CKD & ESRD suggesting as an indicator of bone mineral density in CKD patients but it is level didn't correlate as expected with observed BMD or bone turnover markers, suggesting presence of confounding variables that must be taken into account before routine clinical implementation. Non-significant cor-relation between serum sclerostin level and other biochemical bone markers as regard Calcium, phosphate, alkaline phos-phatase and patathemone hormone. Non-significant correlation was also detected between sclerostin, bone mineral density and body composition.https://mjcu.journals.ekb.eg/article_116829_4af81d1277b5e4a3a9acde1c65269496.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Protective Role of Ursodeoxycholic Acid versus Seleniumon The Methotrexate Hepatotoxicity in Adult Male Albino Rat: Histological, Immunohistochemical and Histomorphmetric Study1807181911683010.21608/mjcu.2020.116830ENHANAN N.GADALLAH, M.D.The Department of Anatomy and Embryology, Faculty of Medicine, Cairo UniversityJournal Article20200603Abstract Background: Methotrexate (MTX) isa folic acid antagonist withanti-inflammatory, anti-proliferative and immunosuppres-sive activities. MTX is very effective in the treatment of many inflammatory disordersand types of canceras it depleted thehepatic folate stores needed for DNA and protein synthesis. However, this drug has profoundly toxic effect particularly to the liver. Treatment with Ursodeoxycholic Acid (UDCA), a hydrophilic bile acid, is widely used due to its defensive mechanismof liver toxicity. Selenium (Se), one of the essential trace elements, has a protective role as antioxidant in the body. Aim of Study: The present work was designed to evaluate the adverse effect of Methotrexate on the histology of the liver and to investigate the possible protective role of Urso-deoxycholic acid versus Selenium on Methotrexate-induced hepatic toxicity. Material and Methods: Twenty-four adult male albino rats were utilized in the present study. The rats were divided into four groups, each group consisted of six rats. Group I (control group), Group II (receiving Methotrexate only), Group III (Ursodeoxycholic acid -treated group), Group IV (Selenium-treated group). The livers of all rats were removed for investigation using light microscopic, immunohistochem-ical, histomorphometrical and statistical studies. Results and Conclusion: Methotrexate receiving rats showed massive degenerative changes and loss of demarcation of the hepatocytes. These changes had been partially recovered in rats treated with Ursodeoxycholic acid. Therefore, using Selenium, the degenerative changes were much reduced. The present study concluded that Selenium was more effective in improving the structural changes in rats receiving Methotrexate.https://mjcu.journals.ekb.eg/article_116830_babb32c7ec55d97dc329c5709d700ad8.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Accuracy and Adequacy of Percutaneous CT-Guided Fine Needle Aspiration Biopsy in Cavitary Pulmonary Lesions1821182611683110.21608/mjcu.2020.116831ENAHMED I. EBEED, M.D.;AYMAN ELSAKA, M.D.YOMNAZAMZAM, M.D.The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Kafr El-Sheikh University* and The Department of Pathology, Faculty of Medicine, Tanta University**Journal Article20200603Abstract Background: Lung cavity is not a specific radiological finding, Computed Tomography (CT)-guided lung biopsy is a reliable method of diagnosing lung lesions cytologically, Fine Needle Aspiration Biopsy (FNAB) is considered as a relatively safe procedure & accurate procedure with less complication rate. Taking in consideration the serious complication of CT guided lung biopsy and the need for obtaining adequate sample to get benefit of the recent success in targeted therapy of non-small cell lung carcinoma and lung adenocarcinoma. Aim of Study: The aim of this study is to evaluate the accuracy of CT guided fine needle biopsy in cavitary pulmo-nary lesions and to establish technical parameters to bridge the gap between diagnostic accuracy and adequacy of CT guided fine needle biopsy in cavitary pulmonary lesions. Patients and Methods: 52 patients with lung cavities were included (29 male and 23 female) with age (mean ± SD) of 56±12.4 years. Sampling of the maximal wall thickness of the lesion. Aspirated specimens were submitted on positively charged glass slides and the remainder fixed in 95% alcohol. A pathologist performed rapid an onsite preliminary diagnosis and material triage. In all 52 cases Fine Needle Aspirations (FNA) for cytology were obtained, Samples for microbiology were obtained in 10 cases. The results categorized into 4 diagnostic groups malignant, Benign specific, Benign nonspe-cific, and non diagnostic. Results: Histological examinations revealed over all sensitivity (39/41) and specificity (9/10), of CT guided FNAB for diagnosing the malignancy. In 6 cases, molecular studies were requested, positively charged glass slides and cell block paraffin-embedded tissue was used in all cases in 66.6% of the cases all requested molecular tests could be done, in 16.7% the material were sufficient for only some studies while in 16.7% there was no sufficient material for any test. In some cases Epidermal Growth Factor Receptor [EGFR], Anaplastic Lymphoma Kinase [ALK] testing were requested and successfully per-formed.<br />Conclusion: CT-guided fine needle biopsy of cavitary lung lesions combined with rapid on site pathological evalu-ation increase the accuracy and bridge the gap between accuracy and adequacy to provide adequate tissue for molecular testing from the small size sample.https://mjcu.journals.ekb.eg/article_116831_ec7ec66a7f4cc07c6ae84b470f1b3c9c.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Value of Functional MRI in Evaluation of Ovarian Lesions1827183711854010.21608/mjcu.2020.118540ENFATMA A. ELSHARAWY, M.D.;NAGLAA A. HUSSEIN, M.D.The Departments of Radio-Diagnosis & Medical Imaging* and Gynecological**, Faculty of Medicine, Tanta University, EgyptJournal Article20200613Abstract Background: Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Magnetic Resonance Imaging (MRI) is currently used to evaluate ovarian tumors. Functional MRI techniques such as Diffusion Weighted MRI (DW-MRI), Dynamic Contrast-Enhanced MRI (DCE-MRI) are currently being evaluated as possible predictive and prognostic biomar-kers in the context of ovarian malignancy. Aim of Study: Differentiation between benign and malig-nant ovarian lesions by conventional MRI and assessing the role of functional MRI (f-MRI) as an advanced MRI technique for better differentiation. Patients and Methods: 30 patients with ovarian masses were included. Evaluation of functional Magnetic Resonance Imaging (f-MRI) in diagnosis of ovarian masses and differ-entiating the benign from malignant lesions in addition to conventional MRI sequences. Results: Our study included 30 patients with different ovarian lesions, 22 benign cases and 8 malignant cases proved by histopathology and laparoscopy, and the mean age was 40.37 years. Imaging all have increased the sensitivity, spe-cificity, positive and negative predictive values and accuracy from 72.7%, 66.7, 57.14%, 80%, 61.5% respectively for conventional MRI to 90.9%, 100%, 90.9%, 94.7%, 95% respectively for f-MRI. Conclusion: Combination of conventional MRI & f-MRI findings are problem-solving tool for confusing ovarian lesions, characterizing benign and malignant ovarian tumors.https://mjcu.journals.ekb.eg/article_118540_b29f6fbe6c0abaadb3ab329e7a772f2f.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Mechanical Effect of Poller Screw in Metaphyseal Fractures of Tibia Fixed by Locking Intra-Medullary Nail1839184811854110.21608/mjcu.2020.118541ENMOAAZ ABD EL-MONAEM, M.Sc.;MOHAMED A. OMAR, M.D.HANYA. SOLIMAN, M.D.The Department of Orthopedic Surgery, Shebeen El-Kom Teaching Hospital* and Faculty of Medicine, Al-Azhar University**, CairoJournal Article20200613Abstract Background: Intramedullary nailing of metaphyseal frac-tures may be associated with deformity as a result instability after fixation. Our aim was to evaluate the clinical use of Poller screws (blocking screws) as a supplement to stability after fixation with statically locked intramedullary nails of small diameter. Aim of Study: To evaluate the mechanical effect and clinical outcome of poller screw in metaphyseal fractures of tibia fixed by locking intramedullary nail. Patients and Methods: 15 men and 5 women (20 fractures) aged 19 to 60 (mean, 36.25) years underwent fixation of tibial metaphysis by locking intramedullary nail and poller screw. The mechanisms of injury included motor car accident in thirteen patients, fall from height in two patients, direct trauma in five patients. Radiological and clinical outcome was eval-uated. Results: Twenty patients were followed-up in the outpatient clinic for assessment of fracture healing or the establishment of a nonunion. Union was defined as the healing of at least 3 of 4 cortices on a biplanar radiograph. All the twenty patients (100%) achieved union at average time twenty weeks (ranging from 16 to 24 weeks). Conclusion: Poller (blocking) screws are an important adjunct for intramedullary nailing; aiding fracture reduction at the metaphysis, and offsetting deforming forces that cause malalignment.https://mjcu.journals.ekb.eg/article_118541_e02c1aaa29d3fd94aa66f7bf75aa058e.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Volumetric Software Tools Using Artificial Intelligence in Evaluation of Regional Gray and White Matter Volume Changes in Patients Having Migraine Without Aura1849185611854210.21608/mjcu.2020.118542ENAHMAD EL-MORSY, M.D.;SAHER EBRAHIM TAMAN, M.D.TAMER M BELAL, M.D.;MONA MAHMOUD ZAKY, M.D.The Departments of Diagnostic Radiology* and Neurology**, Mansoura Faculty of Medicine, Mansoura University, Mansoura, EgyptJournal Article20200613Abstract Background: Migraine is a predominant headache that features pulsating pain that is mostly unilaterally provoked by regular physical activity and is accompaniedby nausea and/or photophobia and phonophobia. A range of autonomic, cognitive, and emotional disturbances may accompany mi-graine. High prevalence and elevated socioeconomic and personal effect have been recorded by epidemiological studies. Migraine has an incidence of 14% in the overall population for one year. The Global Burden of Disease Survey ranked it as the sixth largest worldwide cause of disability. Aim of Study: The aim of this study is to assess the role of volumetric software tools using artificial intelligence in evaluation of regional gray and white matter volume changes in patients having migraine without aura. Patients and Methods: We enrolled in this prospective study 20 patients, age ranged from 13 to 52 years old (mean =33.65 years, SD=10.68), 1 male and 19 female patients (5% and 95% respectively). Ten patients (50%) suffering from right side migraine, 8 (40%) from left side and two patients (10%) suffering bilaterally. 3D T1-weighted MRI images with dedicated parameters were uploaded to NeuroQuant software which is FDA approved software for segmental brain volu-metric studies. Automated reports for volume changes were obtained. Results: Focal hypertrophy was observed in 14 (70%) patients for cerebellar white matter, 11 (55%) patients for cingulate gyrus, 10 (50%) patients for nucleus accumabens, 10 (50%) patients for Hippocampus, 8 (40%) patients for thalamus, 8 (40%) patients for isthmus cingulate, 7 (35%) patients for posterior superior temporal sulcus, anterior cin-gulate, para hippocampaleach & 6 (30%) patients for cerebral white matter and ventral diencephalon. Less percentage was noted for focal atrophy, 9 (45%) patients for medial orbitof-rontal gyrus, 7 (35%) patients for posterior superior temporal sulcus & 4 (20%) patients for ventricles. Conclusion: Patients having migraine without aura show gray and white matter volume changes in different cerebral and cerebellar areas that could be detected by MRI and improved by using artificial intelligence software programs for accurate, fast, automated volume changes detection.https://mjcu.journals.ekb.eg/article_118542_7f017f2f8a61a4496732ef908051b472.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Meningioma en Plaque: Experience with 22 Cases1857186511854310.21608/mjcu.2020.118543ENMOHAMMED M. ADAWI, M.D.;MAHMOUD M. WAHDAN, M.D.RAMYA. TEAMA, M.D.The Department of Neurosurgery, Faculty of Medicine, Benha UniversityJournal Article20200613Abstract Background: Sphenoid wing meningioma en plaque is a unique subtype of intracranial meningiomas, known as intra osseous meningiomas that specifically grow at the base of the anterior and middle cranial fossa, extending to the sphenoid wing and orbit and associated with a significant hyperostosis. They result in neurosurgical complications by direct pressure of nearby cranial nerves, cavernous sinus and carotid artery. Aim of Study: Present our series of Sphenoid wing men-ingioma en plaque and to try to conclude the best surgical options and promising results. Patients and Methods: Retrospective analysis for our records regarding 22 patients with radiologically and patho-logically proven en plaque meningioma from Jan 2016 to Nov 2019. All patients underwent complete neurological examina-tion with detailed ophthalmic examination was performed. We adopted the pterional approach with its modification for all surgeries. Post operative CT scan was performed to asses degree of excision and possible recurrence. Results: Mean age was 42 years 21 were females and 1 male. The most common presenting symptom was proptosis in 20 (93%) patients and also 6 patients presented with visual affection (27%). 7 patients complained of peri-orbital pain. 5 patients observed solid swelling over the Temple region We could remove the tumors in most of cases totally Up to grade II on Simpson scale. In 5 out of 22 cases, the resection was subtotal. Improved Proptosis in 17 out of 22 patients post operative. Adjuvant radiation therapy was performed in 5 patients. After a mean follow-up of 24 monthes, 4 out of 22 patients presented by tumor recurrence (18,2%) the recurrences were mainly in the areas around the superior orbital fissure due to our inability to resect the tumor completely for fear of complications and exposed to another course of radiotherapy, No patient presented recurrence after radiation therapy. Conclusion: Early diagnosis, prompt surgical intervention with resection of all invaded bone as possible are key factors in improving outcome of spheno-orbital meningioma en plaque. Regular follow-up is mandatory as some cases may have unpredictable behavior.https://mjcu.journals.ekb.eg/article_118543_273173fad9b1a3569c808ae05125d457.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901The Protective Role of Atorvastatin against the Damage Induced by Cyclophosphamide on the Kidney and Testis of Adult Male Albino Rat: Histological, Biochemical and Histomorphmetric Study1867188211854410.21608/mjcu.2020.118544ENHANAN N.GADALLAH, M.D.The Department of Anatomy and Embryology, Faculty of Medicine, Cairo UniversityJournal Article20200613Abstract Background: Cyclophosphamide (CP) is commonly used as chemotherapy for many cancers as well as autoimmune disorders. However, upon treatment, it was found that it had side effect which was the cause of histological and biochemical changes due to its oxidative stress capability. Atorvastatin (ATV) at a therapeutic low dose has been found to have antioxidant and anti-inflammatory properties. Aim of Study: The present work was designed to evaluate the adverse effect of cyclophosphamide on the histology and oxidative markers of the kidneys and testes of adult male albino rats. Moreover, the study evaluated the role of Atorv-astatin in prevention and treatment of the possible renal and testicular histological and biochemical alterations induced by cyclophosphamide. Material and Methods: Twenty-four adult male albino rats were utilized in the present study, six in each group; Group I (control group), Group II receiving Cyclophosph-mideonly, Group III receiving Atorvastatin 10 days after-Cyclophosphmide, Group IV receiving Atorvastatin 5 days before and 5 days after Cyclophosphmide. The kidneys and testes of all rats were dissected and removed for investigation using light microscopic study, biochemical analysis, histomor-phometrical and statistical study. Results: Light microscopic examination of the renal cortex of the kidneys of group II showed shrunken renal glomeruli with subsequent widening of the Bowman's space, and inter-stitial inflammatory cellular infiltration. The proximal and distal convoluted tubules appeared dilated. Examination of the rat testes of group II displayed histological changes in theform of irregular distorted seminiferous tubules with marked degenerative changes of the spermatogenic epithelium. The interstitial spaces were wide containing pyknotic Leydig cells, dilated congested blood vessels and interstitial acidophilic exudate. The renal glomeruli and seminiferous tubules showed increased amount of collagen fibers deposition in the interstitial tissue in Masson's stained sections. Light microscopic exam-ination of the kidneys and testes of group III and IV showed recovery of the histological changes. Conclusion: Atorvastatin intake implicated outstanding structural recovery approaching the structural and biochemical parameters of the control group, but the improvement in group IVwas much better than in group III.https://mjcu.journals.ekb.eg/article_118544_85d34d92a1ccb710a63d83c334de1b4b.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Value of the Uterine Artery Color Doppler Study in Detection of Placenta Accreta1883189211854510.21608/mjcu.2020.118545ENMONA AL SAYED ELKAFRAWY, M.D.;HANAN ABDELMONAEM, M.D.HALAMAGHRABY SHERIEF, M.D.The Departments of Obstetrics & Gynecology and Radiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20200613Abstract Background: Placenta accreta is serious pregnancy com-plication associated with various maternal morbidity and mortality and is currently the major cause of postpartum hysterectomy. Aim of Study: Evaluation of the value of the uterine artery color Doppler ultrasonography in the detection of placenta accrete in pregnant women with previous cesarean section. Patients and Methods: This study was a prospective observational (Cohort) study was done at Al-Zahraa University Hospital (in Obstetric and Gynecology Department) in the period from December 2017 to February 2019. All women were pregnant in a singleton fetus, their gestational age ranged from 28 to 36 weeks, with history of previous cesarean section and all patients presented with anterior low inserted placenta or placenta centralis. The study included sixty pregnant women without risk factors. Patients were recruited from the causality and the antenatal care clinic with suspected placenta previa (anterior low inserted or complete centralis) during the Third trimester of pregnancy which was confirmed by abdominal ultrasound. All the women in this study were subjected to Complete history taking, physical examination, and routine obstetric ultrasound study for detection of the location of the placenta after the 28th week of gestation and Color Doppler ultrasound study of the uterine artery. The intraoperative findings of each case were compared with the preoperative imaging findings. Results: Placenta accreta was found in 41.7% of the studied women. The study reported that the mean RI deter-mined by color Doppler ultrasonography of the uterine artery was significantly low in placenta previa with accreta. As it was 0.656±0.190 for placenta without accreta and 0.557±0.127 for placenta accreta (p < 0.001). The cutoff value of mean uterine artery Doppler PI for placenta accrete obtained from ROCK curve was £0.93, AUROC (0.636), SN (64%), SP (74.3%), PPV (64%), NPV (71.3%), accuracy (70%) and CI (95%). Conclusion: This study concluded that ultrasound and uterine artery Doppler had a role in detection of placenta accreta in cases with previous CS. The mean uterine artery RI was significantly lower in the placenta accreta compared to placenta previa without accreta.https://mjcu.journals.ekb.eg/article_118545_2198ac6ab1c2f72e7158f238a9abec69.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Value of Diffusion-Weighted and Perfusion-Weighted MR Imaging in Differentiation of Recurrent Tongue Carcinoma from Post-Treatment Changes1893190211854610.21608/mjcu.2020.118546ENFATMA MOHAMED SHERIF, M.D.;MAIY ABDEL-RAHEIM ALSHAHAT, M.D.The Departments of Radiology* and Clinical Oncology & Nuclear Medicine**, Faculty of Medicine, Mansoura UniversityJournal Article20200613Abstract Background: Tongue carcinoma is characterized by high recurrence rate. Thus, post-treatment follow-up imaging is critically important. Advanced Magnetic Resonance Imaging (MRI) techniques can be employed for this purpose due to the limited accuracy of conventional MRI. Aim of Study: Evaluation of the value of Diffusion Weight-ed (DW) and perfusion weighted MRI implementation in the post-treatment follow-up of tongue carcinoma. Patients and Methods: This study was conducted on 23 patients on post-treatment follow-up of tongue carcinoma. They underwent DW-MRI and Dynamic Contrast Enhanced (DCE) perfusion T1-weighted MRI to differentiate between recurrent tumor and post-treatment changes. Apparent Diffu-sion Coefficient (ADC) was estimated, perfusion MR quali-tative and semiquantitative assessment was performed. Re-sulting data were compared to histopathologic characterization (n=18) and further clinical and radiological follow-up (n=5) which were considered as the reference standards. Results: The mean ADC value of recurrent tongue carci-noma (1.029±0.207 X 10–3mm2/s) was significantly lower (p < 0.001) than the mean ADC value of post-treatment changes (1.425±0.238 X 10–3mm2/s). The ADC threshold used for differentiating recurrent tumor from post-treatment changes was 1.175 X 10–3mm2/s with Area Under the Curve (AUC) of 0.938 and diagnostic accuracy of 82.6%. Among the DCE perfusion weighted MR parameters, the wash in rate and Area Under Gadolinium Curve (AUGC) displayed the highest diagnostic accuracy (73.9%) with thresholds of 18.65a.u/s and 126826.7m.M.s respectively. The combined use of both DW-MRI and perfusion weighted MRI showed the highest diagnostic accuracy. Conclusion: The DW MRI is a non-invasive technique providing accurate post-treatment follow-up assessment of tongue carcinoma. The perfusion weighted MRI provides lower diagnostic accuracy than DWI. The combined use of both techniques provides superior differentiation of tumor recurrence from post-treatment changes.https://mjcu.journals.ekb.eg/article_118546_bf3791d57e9efca626dd8374b301f79d.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Utility of Linear Scalp Incision in Various Cranial Surgeries1903190811854710.21608/mjcu.2020.118547ENNASSER MOSAAD, M.D.;MOHAMMED ADAWI, M.D.RAMITEAMA, M.D.The Department of Neurosurgery, Faculty of Medicine, Banha UniversityJournal Article20200613Abstract Background: The linear incision and its modifications are the most commonly used incisionsbecause of being simple and having good outcome. Linear incisions have the advantage of easier upward and downward extension. Layers of the scalp can be arranged as the mnemonic SCALP: S (Skin), C (Connective tissue), A (Aponeurosis), L (Loose areolar tissue), and P (Pericranium). Aim of Study: Is to evaluate thesufficiency of linear scalp incisions, and its resultant scar. Patients and Methods: This is a prospective study per-formed on 43 cases with different pathologies all of them were operated using linear scalp incision between January 2017 and December 2019 in Neurosurgery Department at Benha University Hospitals. Results: Forty three cases were operated using linear scalp incision in the period from January 2017 to December 2019 at Neurosurgery Department at Benha University Hospitals. The age of patients in this study ranged from 5 years to 66 years with a mean age of 29 years. The patients in this study were composed of 24 females and 19 males. The follow-up period ranged from 6 months to three years. Conclusion: Linear scalp incision has a very great safety and efficacy in different types of craniotomies. We found the disadvantages to be present in few cases and can also occur in other types of scars that may be worse than linear incisions and can be minimized by taking care of langers lines and vascular territories of the scalp and minimizing the use of artery forceps.https://mjcu.journals.ekb.eg/article_118547_e37fb492c245e3e083a18e23037389a4.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Role of Magnetic Resonance Imaging in Breast Cancer: Detection of Tumor Response Post Neoadjuvant Chemotherapy1909191611854810.21608/mjcu.2020.118548ENTALAL A. AMER, M.D.;MOHAMED A. HEGAZY, M.D.GHADA H. ABDELRAOUF, M.Sc.;FATMA M. SHERIF, M.D.The Departments of Diagnostic Radiology* and Surgical Oncology**, Faculty of Medicine, Mansoura UniversityJournal Article20200613Abstract Background: This study aimed at assessment of the role of magnetic resonance imaging (MRI) in evaluating residual disease, and its ability to detect response after neoadjuvant chemotherapy (NAC) for locally advanced breast cancer cases. Aim of Study: The aim of this study was to assess the role of MRI in evaluating response to NAC for locally advanced breast cancer cases. Patients and Methods: This prospective study included 40 female patients with pathologically proven locally advanced breast cancer, with mean age of 43.1 years. They underwent dynamic MRI with diffusion study after neoadjuvant chemo-therapy (NAC) to assess the response after the NAC, results were compared to the histopathological results after surgery following NAC as the gold standard. The study was done at Radiology Department, Mansoura University, Egypt. This study was carried out in the period between February 2017, and September 2019. Results: MRI showed sensitivity of 91.2%, specificity 66.7%, PPV 93.9%, NPV 57.1%, and accuracy 87.5% in assessment of the response to NAC. In (17.5%) of cases MRI showed overestimation compared to the pathological results. In (5%) of cases MRI showed underestimation compared to the pathological results. Conclusion: MRI proved to be highly beneficial in assess-ment of response of locally advanced breast cancer to NAC. However, it may overestimate or underestimate residual disease in some patients. Further studies to improve the specificity of MRI may be of benefit.https://mjcu.journals.ekb.eg/article_118548_7796e1391a322038b86fb15cf070ef62.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Prevalence and Risk Factors for Irritable Bowel Syndrome among Male Secondary School Saudi Students in Najran City, Saudi Arabia1917192111854910.21608/mjcu.2020.118549ENABDULAZIZSAAD ALSHAHRANI, M.D.The Department of Internal Medicine, College of Medicine, Najran University, Najran, Saudi ArabiaJournal Article20200613Abstract Background: Patients with IBS have higher healthcare resource utilization than non-IBS patients in terms of more frequent physician visits, more tests, greater medication use, and increased rates of unnecessary surgery. Aim of Study: This study aimed to assess prevalence, types, and risk factors of irritable bowel syndrome among Saudi Male Secondary School Students in Najran City, Saudi Arabia. Patients and Methods: A cross-sectional study design was followed during February 2020. The study included 400 Male Secondary School Saudi students in Najran City, Saudi Arabia. Aself-administeredquestionnaire was used for data collection. It included personal characteristics, and the IBS questionnaire. A total of 159 male secondary school students (39.8%) expressed symptoms suggestive of IBS. Alternating diarrhea and constipation (i.e., IBS-M) was the most common type (26.3%), followed by those with diarrhea (i.e., IBS-D), (7.3%), and those with constipation (i.e., IBS-C), (6.3%). Some variables were associated with significantly higher prevalence of IBS among male secondary school students, i.e., positive family history of IBS, and diabetes mellitus. Conclusions: Prevalence of IBS symptoms among male-secondary school students in Najran City is high. IBS-Mis the most common type, followed by IBS-D. Positive family history of IBS, and diabetes mellitus are associated with significantly higher prevalence of IBS among students. There-fore, it is recommended to provide health education for secondary school students on how to manage and alleviate symptoms of IBS.https://mjcu.journals.ekb.eg/article_118549_598706b89246750a7604ece9189908c5.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Comparative Study of Esophageal Varices Grading by Multi-Detector Computed Tomography and Endoscopy1923193111855010.21608/mjcu.2020.118550ENFATMA A. EL-SHARAWY, M.D.;MOHAMED M. MABROUK, M.D.The Departments of Radio-Diagnosis & Medical Imaging* and Internal Medicine**, Faculty of Medicine, Tanta University, EgyptJournal Article20200613Abstract Background: Cirrhosis is often complicated by Esophageal Varices (EV) and portal hypertension. The use of upper GI endoscopy (GIE) as a screening method is limited regarding invasiveness, expensive, needs sedation as well as patient's poor acceptance of the procedure. In contrast; Multidetector Computed Tomography (MDCT) imaging is non-invasive, does not necessitate sedation, and allows accurate assessment of variceal site and size, also better tolerated by patients than upper GI Endoscopy (GIE). Aim of Study: To prove that MDCT is a non-invasive alternative diagnostic tool to EGD in grading of Esophageal Varices. Patients and Methods: 50 patients with liver cirrhosis were included. Evaluation of Multidetector Computed Tom-ography (MDCT) in the diagnosis of esophageal varices and its grading was done by comparing the grades of Esophageal Varices at Multidetector Computed Tomography (MDCT) and upper GI endoscopy independently. Extra-esophageal findings were also assessed by Multidetector Computed Tomography (MDCT) that cannot by (GIE). Results: At upper GI endoscopy, 3 patients had grade 0 Esophageal Varices, 25 patients had grade 1, 16 patients had grade 2 and 6 had grade 3. The sensitivity, specificity, positive and negative predictive values and accuracy of Multidetector Computed Tomography (MDCT) for defining Esophageal Varices in all grades were 99.5%, 99.6%, 99.4%, 99.5% and 99.5% respectively. Important extra-esophageal findings were determined by Multi-Detector Computed Tomography (MD-CT) only. The acceptance of patients for Multidetector Com-puted Tomography (MDCT) was significantly more than that for upper GI Endoscopy (GIE). Conclusion: Multi-Detector Computed Tomography (MD-CT) is a fast, non-invasive procedure for diagnosis and grading of Esophageal Varices.https://mjcu.journals.ekb.eg/article_118550_b16d1799bc253fe0e8df858226d5cc5a.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Breast Lesion Elastography Region of Interest Selection and Quantitative Heterogeneity: A Systematic Review and Meta-Analysis1933194211855110.21608/mjcu.2020.118551ENHANAA A. ABDELHAMEED, M.D.;KHALED A. ALY, M.D.NOHAH. SAKR, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20200613Abstract Background: Breast cancer is one of the most common causes of death among women worldwide. Early detection and diagnosis will be helpful to reduce mortality and improve prognosis. It is urgent to develop efficient detection technology for breast cancer. Mammographic screening is a valuable tool for early detection of breast cancer. However, the increased density of breast tissue significantly reduces the diagnostic accuracy. Aim of Study: To provide an overview of the different reported elasticities of specific breast pathologies based on ultrasound elastography. Material and Methods: A total of 35 articles including 8316 patients and 9057 breast lesions were included in the pooled analysis of which 3060 malignant lesions were included from 40 studies. The median incidence of malignant breast lesion is 37.1% calculated from the incidence of malignant lesions of all included studies. Seven of the included studies assessed VTIQ. Mean age varied along all included studies. Results: The sensitivity and specificity of Emax, Emean and Eratio for the diagnosis of breast cancer varied according to the interpretative criteria used to define a test as positive. The summary estimates of sensitivity and specificity were 82.58% (95% CI 78.32% to 86.16%) and 84.12% (95% CI 79.07% to 87.07%) for Emean, 86.19% (95% CI 81.60% to 89.77%) and 88.56% (95% CI 88.56% to 91.54%) for Emax, and 87.50% (95% CI 77.47% to 93.44%) and 79.30% (95% CI 68.21% to 87.24%) for Eratio respectively. Regarding DOR, Emax achieved the highest value 48.32 (95% CI 28.7 to 67.8) which means there are 48 times the odds of obtaining an Emax positive result in a diseased rather than a non-diseased person. Meta-regression analysis was conducted to assess the impact of two covaries; Emean and Emax using Likelihood ratio test and revealed significant difference existed with higher summary sensitivity (x2=35.04, p < 001) and specificity (x2=18.65, p < 001) in Emax than Emean. SROC curves were used to show the distribution of sensitivity and specificity of Emax, Emean and Eratio in the Roc space as well as the prediction region. Conclusion: Our meta-analysis demonstrates that SWE is an accurate and reliable diagnostic tool in discriminating malignant and benign breast lesions. With wide application, SWE may significantly improve the early diagnostic of breast cancer. SWE can provide additional information on predicting breast cancer prognosis. However, the possibility of false-positive and false-negative results should be considered during interpretation.https://mjcu.journals.ekb.eg/article_118551_b17efd5adf4c7fa9382efc0664438ff3.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Comparative Study between Ultrasound-Guided Foam Sclerotherapy, Radiofrequency Ablation & Endo-Venous Laser Ablation in Treatment of Great Saphenous Vein Reflux1943195711855210.21608/mjcu.2020.118552ENAYMAN A. SALEM, M.D.;WAEL M. ELSHEMY, M.D.WALEED A. SOROUR, M.D.;AHMED M. ABDULKARIM, M.Sc.The Department of Vascular Surgery, Faculty of Medicine, ZagazigUniversity* and Medical Services Sector, Ministry of Interior**, EgyptJournal Article20200613Abstract Background: The main goal in the treatment of varicose veins is to reduce the symptoms and complications of chronic venous insufficiency and to improve health related quality of life (QoL) of patients. Surgery has been the standard of care in the treatment of saphenous varicose veins for more than a century. Aim of Study: The aim of this work is to compare between the outcome after UGFS, RFA & EVLA concerning the treat-ment of great saphenous vein reflux, regarding success rate, recurrence rate and complications rate. Subjects and Methods: This study was carried out at the Vascular Surgery Department, Zagazig University Hospitals during the period from August 2016 to August 2018, included a total of 51 treated lower limbs in 39 patients were divided into three different groups: Endovenous Laser Ablation (EVLA group) (n=18 legs in 13 patients; 1470nm, continuous mode, radial fiber), Radiofrequency Ablation (RFA group) (n=16 legs in 13 patients) and Ultrasound Guided Foam Sclerotherapy (UGFS group) (n=17 legs in 13 patients). All patients were subjected to complete clinical examination and laboratory investigations. Post procedure follow-up was done after one week, three month, six months & one year following treatment and all limbs were assessed clinically and by using DUS. Results: All the three treatment modalities significantly improved VCSS and QoL as reflected by significant improve-ments in VCSS and CIVIQ; with no significant differences in the outcome between the groups. The improvements per-sisted throughout the 2 years and showed that EVLA, RFA and UGFS are efficient treatments with longerterm beneficial effects in patients with GSV varicose veins. This is true even though some patients in the UGFS group developed recanal-ization of the GSV. UGFS group was significantly longer regarding duration to return to work (p < 0.01) than EVLA and RFA group which both had non-significant difference between them. <br />Conclusion: Our study demonstrated that EVLA & RFA are efficient modalities for the treatment of GSV varicose veins in the medium term. Notinga moderate rate of recanal-ization after UGFS, it appears that EVLA & RFA are superior to UGFS regarding clinical recurrence, VCSS and QoL. Post-operative patient comfort and the outcome of EVLA & RFA in short & medium-terms are superior to those after UGFS in terms of recanalization & effective ablation.https://mjcu.journals.ekb.eg/article_118552_d24ca820a75b2c8766dce14417dca3ba.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Predictive Factors for Postoperative Visual Recovery in Surgically Treated Suprasellar Meningioma: A Retrospective Analysis1959196611855310.21608/mjcu.2020.118553ENMOHAMMED F.A. ALI, M.D.;HIDER AL-SHAMI, M.R.C.S., E.F.N.S.MOHAMEDF. ALSAWY, M.D.The Departments of Neurosurgery, Faculty of Medicine, Cairo University* and Bank Al-Ahly Hospital**Journal Article20200613Abstract Background: Post-operative visual outcome in surgically treated suprasellar meningiomas is a great concern for surgeon, patient and of course for the health system. Certain reports were published before questioning about the aim of treating such tumors in which visual recovery cannot be guaranteed. It is important to classify the possible factors that may predict the prognosis thereafter. Aim of Study: Assessment of the visual function periop-eratively and to delineate the factors of visual recovery in surgically treated suprasellar meningioma. Patients and Methods: This was a retrospective analysis of 24 patients who were operated for suprasellar meningioma in Kasr Al-Ainy University Hospital from January 2018 to July 2020. The following predictive factors were tested: Age, duration of symptoms, pre-operative visual function damage, and radiological criteria of the tumor. Results: An overall improvement in visual function was seen in 14/24 patients (58.3%) in our study. The mean and standard deviation of symptoms' duration in months were 12.36±5.11 (3-23 months). Gross total resection was achieved in 19 cases (79.1%). Gross total resection achieved improve-ment of overall visual function in 73.7% of cases with statis-tically significant difference versus subtotal resection (p-value =0.03). It has been found that duration of symptoms (less than 12 months), mild pre-operative visual symptoms, tumor size less than 3cm, absence of optic nerve extension and gross total resection are related to post-operative improvement in visual outcome. Conclusion: Visual recovery of surgically treated supra-sellar meningiomas is greatly dependent on duration of symp-toms, pre-operative visual status, tumor size, adherence to strategic neurovascular structures and gross total resection.https://mjcu.journals.ekb.eg/article_118553_91c56990dfc0440599ef6f89129abefa.pdfThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380388September20200901Metformin versus Insulin in Treatment of Gestational Diabetes1967197411855410.21608/mjcu.2020.118554ENAHLAM NASIRABOUD AL HAYANI, M.D.The Department of Obstetrics and Gynecology, Ministry of Health, Faculty of Medicine, El Anbar University, IraqJournal Article20200613Abstract Background: GDM affects both mother and baby during pregnancy and in the long term. Metformin was associated with a lower risk of neonatal hypoglycemia; however, met-formin may slightly increase the risk of prematurity. Aim of Study: The aim of the present study was to compare the safety and efficacy of metformin as an oral anti-diabetic drug with insulin as oral hypoglycemic drugs for management of gestational diabetes mellitus. Patients and Methods: 120 pregnant women with gesta-tional diabetes mellitus were included in this randomized controlled trial. Patients were randomly allocated into 2 groups as follows: Group I: Insulin group (n=64) and Group M: Metformin group (n=56). Follow-up was done every week by measuring fasting and post prandial blood glucose level. Maternal outcomes and neonatal outcomes were recorded. Results: There were statistically significant differences as regard mean fasting and post prandial blood glucose level and mean birth weight in insulin and metformin group. Also, increased CS rate between insulin and metformin group. There were statistically significant differences between insulin group and metformin sub-groups patients as regards birth weight, Apgar score and serum glucose level. Conclusion: We concluded that metformin is an effective and safe treatment option for women with GDM. Metformin is comparable with insulin in glycemic control, providing additional evidence for the use of metformin in GDM.https://mjcu.journals.ekb.eg/article_118554_f9908771c4e9dcfa39f36a6460cc0f76.pdf