The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Effect of Isometric Hand Grip on Blood Pressure in Post Menopausal Hypertension268526915850110.21608/mjcu.2019.58501ENYASMEEN R. AHMED, M.Sc.;HALA M. HANFY, Ph.D.WAFAA M. KAMAL, Ph.D.;MAHMOUD M. FOUAD, M.D.The Departments of Women Health, Faculty of Physical Therapy, Cairo University* and Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University**Journal Article20180112Abstract<br />Background: The rate of hypertension increases after menopause. Whether estrogen and progesterone deficiency associated with menopause play a role in determining a worst blood pressure (BP). Hypertension (HTN) is the leading risk factor for mortality and morbidity. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treat-ment.<br />Aim of Study: This current study was designed to investi-gate the effect of isometric hand grip exercise on blood pressure on postmenopausal hypertension.<br />Subjects and Methods: Forty post menopausal women participated in this study they complained from hypertension (diagnosed clinically byynecologist/physician), confirmed by sphygmomanometer instrument. They were selected randomly from outpatient clinic at Luxor general hospital, their age ranged from 50 to 65 years old, their body mass index were not exceed 35kg/m. and their blood pressure ranged from 140/90 to 180/110mm/Hg. They were divided randomly into two groups equal in numbers, group A consisted of 20 post menopausal women who received antihypertensive drugs and isometric hand grip exercise (4 sessions/week for 6 weeks). While group B consisted of 20 postmenopausal women who received anti hypertensive drugs only. Blood pressure was assessed by stethoscope and mercury sphygmomanometer for all patients in both groups before and after treatment.<br />Results: The result of this study revealed that, there was a statistically highly significant decrease in the mean value of SBP in both group (A&B) with percentage of improvement 12.0% and 8.4%, respectively. There was significant decrease in the mean value of DBP in both group (A&B) with percentage of improvement 16.27% and 9.47%, respectively.<br />Conclusion: It could be concluded that the isometric hand grip exercise is a simple, cost free and non pharmacological method in reducing blood pressure in post menopausal women and can be used as adjunct method in treatment of hypertension in postmenopausal women.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Feasibility of MRI in Early Diagnosis of Musculoskeletal Complications of Sickle Cell Disease in Pediatrics269327065850410.21608/mjcu.2019.58504ENNESREEN MOHEY, M.D.;TAMIR A. HASSAN, M.D.The Department Radiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20190112Abstract<br />Background: Sickle cell disease (SCD) include a group of genetic abnormalities in which there is inheritance of Hb S (sickle hemoglobin) from both parents, or Hb S from one parent and a gene for beta-thalassemia or an abnormal hemo-globin from the other parent. The most common and the most severe form is sickle cell anemia.<br />Aim of Study: To evaluate the feasibility of MRI in early detection of musculoskeletal complications of pediatric sickle cell disease (SCD) aiming to discriminate osteomyelitis from infarction.<br />Patients and Methods: This prospective study included 30 patients (21 boys, 9 girls) with a mean age of 5 years proved to have SCD and suspected to have osteomyelitis. All patients underwent X-ray and different sequences MRI.<br />Results: Persistence of red marrow and multiple bone infarctions were the most common MRI findings followed by osteomyelitis in 8, chondritis in 7, myositis in 4, septic arthritis in 3, subperiosteal and soft tissue abscess each in 2. There was difficulty in discriminating infarction from osteomyelitis<br />Conclusion: MRI is helpful in early identification of musculoskeletal abnormalities in SCD in pediatrics. Early detection is crucial to initiate treatment to avoid the compli-cation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Stem Cells in Management of Experimentally Induced Hypothyroidism in Albino Rat270727235859410.21608/mjcu.2019.58594ENSHADIA E. EL NABARAWY, M.D.;OLFAT A. ABD-EL-ATY, M.D.MONA A.A. ARAFA, M.D.;RASHA K. ELSAID, M.Sc.The Department Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EgyptJournal Article20190113Abstract<br />Background: Hypothyroidism is a common condition with potentially devastating health consequences that spread world-wide. Stems cells (SCs) based therapy had showed promising benefits in treatment of many diseases on animal models and applied on some human clinical issues.<br />Aim of Study: To investigate the effect of bone marrow mesenchymal stem cells (BM-MSCs) on the biochemical and histological structures of the thyroid gland after experimentally induced hypothyroidism in adult male albino rats.<br />Material and Methods: Forty five adult male Sprague-Dawley albino rats were divided into 3 equal groups: Control group (Group I), Hypothyroidism induced group (Group II); received orally carbimazole 45mg/kg of rat/day for 5 days/week for 4 weeks and Induced hypothyroidism treated with BM-MSCs group (Group III); received oral dose of carbimazole 45mg/kg of rat/day for 5 days/week for 4weeks then received single intravenous injection of 1x106 cells of BM-MSCs. This group was subdivided into three equal subgroups according to the time of scarification; Subgroup III6: Scarified at the end of 6th week, Subgroup III8: Scarified at the end of 8th week and Subgroup III10: Scarified at the end of 10th week. At the end of the experiment, the hormones of thyroid function were measured and histological examination of the thyroid tissue were done. In addition to morphometric study and statistical analysis.<br />Results: BM-MSCs injection to the induced hypothy-roidism rats showed that after 6 and 8 weeks, there were highly significant increase (p<0.01) of freeT3 and T4 values and highly significance decrease of TSH compared to the induced hypothyroidism group. On the other hand, after 10 weeks from injection of BM-MSCs, there were insignificant differences (p>0.05) of free T3, T4 and TSH compared to the induced hypothyroidism group. The histological examination of the induced hypothyroidism after 6 weeks of BM-MSCs injection showed variable degree of response. However, after 8 weeks of BM-MSCs injection, there was universal improvement of all examined fields that confirmed statistically by improvement of the heights of follicular cells, area percent of collagen fibers and area percent of colloid. On the other hand, after 10 weeks of BM-MSCs injection, there was marked regression in response to SCs treatment in all examined parameters.<br />Conclusion: BM-MSCs injection almost restored the function and histological structures of the thyroid gland after 8 weeks. However, this improvement was declined after 10 weeks of BM-MSCs injection. So second dose is recommended.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Assessment of Laparoscopically Harvested Omental Flap Used in Immediate Reconstruction in Breast Cancer Cases Eligible for Breast Conservative Surgery272527335919410.21608/mjcu.2019.59194ENMOHAMED S. EL-KOTAMY, M.Sc.;WALID Y. ELSHERPINY, M.D.;AYMAN M. ELSAKKA, M.D.;HOSSAM R. MOUSSA, M.D.MOHAMED A. MELEES, M.D.;AHMED A. DARWISH, M.D.The Department of General Surgery, Faculty of Medicine, Tanta University, EgyptJournal Article20190114Abstract<br />Background and Purpose: Breast conservative surgery is considered a standard surgical modality for treatment of early breast cancer. Omental pedicled flap is used for volume replacement after breast conservative surgery.<br />Aim of Study: The aim of this study was to assess the fate of laparoscopically harvested omental flap used in immediate reconstruction in breast cancer cases eligible for breast con-servative surgery.<br />Patients and Methods: Ten female patients were included in this retrospective study which was conducted at The Surgical Oncology Unit, Department of General Surgery, Tanta Uni-versity Hospitals, from June 2016 to July 2018. Every patient was subjected to mammography with complementary ultra-sonography, Doppler ultrasound and Tru-cut needle biopsy from the omental flap and histopathology with different stains.<br />Results: Nodules were detected in 40% of cases which were proved to be benign in nature by Histopathology. Doppler revealed that two cases had partial infarction and degeneration of the omental flap. Histopathology revealed minimal inflam-matory reaction, extensive fat necrosis and dense fibrosis in 50% of the studied cases. Vasculitis was detected in 30% of the studied cases. No recurrence of malignancy could be detected over the follow-up period. With CD31, various degrees of neovascularization were detected in the omental flap, mild in 20% of cases, moderate in 40% of cases and severe in 40% of cases. With CD8, T-Killer cells were found mild in 50% of cases and moderate in 40% of cases. CD44 detected presence of stem cells in 20% of cases.<br />Conclusion: The laparoscopically harvested omental flap had a promising oncological safety during the follow up. In spite of the fibrosis and nodulation found, no change was observed in the shape or contour of the breast. The inflamma-tory reaction and enhanced local immunity by the omentum is not studied as a possible preventive factor for recurrence. Vasculitis, angiogenesis and the presence of stem cells are not studied as a possible potentiating factor for recurrence of breast cancer. So, long term follow-up is essential to see whether the omental flap could be a barrier against recurrence or it may enhance it.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Platelet Changes Following Partial Splenic Artery Embolization in Cirrhotic Patients with Hypersplenism273527425919510.21608/mjcu.2019.59195ENMAHMOUD M. HEGAZY, M.Sc.;SAMEH M. ABDELWAHAB, M.D.YOSRA A.IBRAHIM, M.D.The Department of Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20190114Abstract<br />Background: Hypersplenism is a common complication of cirrhosis, leading to thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been introduced as an effective alternative to surgical splenectomy, effectively increasing hematologic indices particularly the platelets and lowering risk of bleeding.<br />Aim of Study: To investigate the effect of partial splenic Artery embolization (PSE) on platelet Count in cirrhotic patients with Hypersplenism.<br />Patients and Methods: Fifteen patients with chronic liver disease were included. All patients had Cirrhosis with hyper-splenism and all patients underwent PSE in one session with follow-up after one month.<br />Results: The mean age of the selected patients was about 49 years old.<br />All patients showed significant increase in the platelet count after one session and remained at appropriate levels during the follow-up period.<br />Postembolization syndrome was the most common com-plication and noted in in 14 patients (93.3%). Ascites reported in 3 patients (20%). Portal vein thrombosis reported in 2 patient (13.3%) left sided pleural effusion developed in 1 patient (6.6%). No pancreatitis or splenic abscess reported. None of the patients developed septic shock. No post procedure mortality occurred.<br />Conclusion: Partial splenic artery embolization is not without risks, but proven to be effective treatment for throm-bocytopenia in cirrhotic patients with hypersplenism. It is performed under local anesthesia, thus is suitable in surgically unfit patients. It achieves improvement of hematological status with less complications as well as preservation splenic role in immunity.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Updated Role of Magnetic Resonance Imaging in Assessment of Endometriosis274327495919710.21608/mjcu.2019.59197ENSAFAA K. MOHAMED, M.D.;MARY Y. TADROS, M.D.SHAYAN A.MOHAMED, M.Sc.The Department of Radiodiagnosis and Nuclear Medicine, Faculty of Medicine, Ain Shams UniversityJournal Article20190114Abstract<br />Background: Endometriosis is a common disease, affecting 10% of all women of 'fertile' age. It is defined as the presence of ectopic endometrial glands and stroma outside the en-dometrium. It may vary from microscopic endometriotic implants to large cysts (endometriomas).<br />Aim of Study: The aim of this study is to evaluate the accuracy of the magnetic resonance imaging in diagnosis of endometriosis especially in non-apparent types as tubal and cul de sac endometriosis.<br />Patients and Methods: The studied group included 30 women in childbearing period, all of them referred from Obstetrics and Gynecology Department with clinical suspicion of endometriosis. They were sent to MRI unit at Ain Shams University Hospitals, for evaluation of the disease. The sensitivity, specificity and diagnostic accuracy for MRI were calculated.<br />Results: In our study 16 out of 30 cases were confirmed to have endometriosis by using MRI. MRI finding then com-pared with the results of laparoscope which with done after MRI in all patients to confirm diagnosis. Then we conclude that MRI showed a sensitivity of 93%, specificity of 86% with overall accuracy rate of 90%.<br />Conclusion: Magnetic resonance imaging (MRI) is a non-invasive, non-ionizing radiation method, offering high contrast resolution, which allows multiplanar evaluation of endome-triosis, thus facilitating a preoperative diagnosis of the location and extent of endometriotic lesions.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Knowledge and Practice of Family Caregiver for Clients Using Vacuum Wound Therapy for Infected Limb Surgical Wound275127565919910.21608/mjcu.2019.59199ENSOHEIR ABO ELFOTOUH, M.Sc.;NAGAT SAID, D.N.Sc.ENASHELMY, D.N.Sc.The Department of Community Health Nursing, Faculty of Nursing, Cairo University, Cairo, EgyptJournal Article20190114Abstract<br />Background: Family caregivers had heavy burden and a lot of great responsibilities toward their clients using vacuum wound therapy.<br />Aim of Study: To asses knowledge and practice of family caregiver for clients using vacuum wound therapy for infected limb surgical wound.<br />Material and Methods: Design: A descriptive research design.<br />Setting: Out patient emergency plastic surgical clinic which affiliated to emergency hospital 185 at Cairo university hospital.<br />The Study Sample: A convenient sample of 61 family caregivers and their (61) clients used vacuum wound therapy were included in the study from August 2017 to March 2018. Tool for data collection: One tool "Clients and family caregivers a Structured interview questionnaire" which divided to four parts. Part (I): Demographic characteristics of the family caregivers and clients. Part (II): Medical history of clients and home environment. Part (III): Family caregiver knowledge about vacuum wound therapy part (IV): Family caregiver practice about vacuum wound therapy. The total knowledge and practice scores for questionnaires are 100.<br />Results: 42.6% of family caregivers age from 20 to less than 30 years and 73 .7% of them were male. The result revealed that positive statistically significant relations between total knowledge of family caregivers and their age, p=0.02. And education level, p=0.07. There was a positive statistical significant total practice and their job, p=0.08.<br />Conclusion: The study concluded that, 51% of them had unsatisfactory total knowledge. Total practice 53% of them had satisfactory score while 47% of them had unsatisfactory score of total practices regarding vacuum wound therapy.<br />Recommendations: The study recommended before appli-cation therapy, knowledge should be developed for family caregiver about definition, uses, benefits and initiation of therapy Improve practice of family caregiver to manage therapy through demonstration and training on safe handling of infectious and hazardous waste are critical to prevent cross contamin ation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparative Study Between Appendiceal Base Ligation with Hand-Made Endoloop Knot Pusher Versus Standard Endoloop in Laparoscopic Appendectomy275727665920010.21608/mjcu.2019.59200ENMOHAMMED A. ELBANNA, M.Sc.;OSAMA H. ABDRABOH, M.D.TAHA A. ISMAEL, M.D.;SOLIMAN M. SOLIMAN, M.D.MAHMOUD M.ELSHERIF, M.D.The Department of Gastrointestinal, Liver and Laparoscopic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20190114Abstract<br />Background: Using hand-made (endoloop and knot pusher) technique has the same reliability of the other methods in appendiceal base ligation in addition to the significant lower cost in comparison with standard endoloop.<br />Aim of Study: Is to compare between appendiceal base ligation with hand-made Endoloop knot pusher versus standard endoloop in laparoscopic appendectomy.<br />Patients and Methods: This prospective randomized comparative study was carried out in Gastrointestinal, Liver & Laparoscopic Surgery unit of Tanta University Hospitals from May 2017 till May 2018 on 40 patients with acute appendicitis divided into two equal groups; Group I: Were subjected to ligation of the base of the appendix with standard endoloop (commercial) in laparoscopic appendectomy (20 cases). Group II: Were subjected to ligation of the base of the appendix with hand-made endoloop knot pusher in laparoscopic appendectomy (20 cases).<br />Results: The mean age of group I was 29±5.10 years, compared to 29.33±5.39 in-group II, there were 12 males and 8 females in group I, while there were 10 males and 10 females in group II. Statistically significant difference was present in operative time between both groups; group I had operative time mean of 46.07±11.70 minutes compared to 54.73±11.33 minutes in-group II. A highly statistically significant difference in appendiceal base ligation cost between both groups; group I with Mean 69.10±10.41 USD compared to 7.75±1.77 USD in group II. Superficial wound infection developed in one patient in group I and two patients in group II, also each group had only one patient with postoperative ileus, only one patient in group II developed postoperative abscess in the RIF.<br />Conclusion: Using hand-made endoloop knot pusher technique and standard endoloop were proved safe, as both were not associated with major morbidity. Complications rate, hospital stay were average with other studies, Using hand-made endoloop knot pusher technique has significant lower cost in comparison with standard endoloop as it is reusable. However, hand-made endoloop knot pusher technique consuming a longer operative time.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Pentoxifylline Administration on Hemoglobin Level of Hemodialysis Patients276727735920210.21608/mjcu.2019.59202ENSARAH A. MOHAMED, M.Sc.;ATEF M. TAHA, M.D.SHEREEN A. ABDEL-SALAM, M.D.;MAALY M. MABROUK, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190114Abstract<br />Background: Anemia is a common complication of end-stage renal disease despite sufficient iron stores. That is mainly due to the effect of chronic inflammation.<br />Aim of Study: Our study investigated the effect of using a know drug used in intermittent claudication (named pen-toxifylline) as an adjuvant to ESA to improve anemia of hemodialysis patients.<br />Patients and Method: Fifty hemodialysis anemic patients were included. They were assigned to two groups of equal numbers. Oral Pentoxifylline 400mg once daily was added to the treatment group which was compared to the control group over a six months period regarding hemoglobin, hematocrit, serum albumin and CRP.<br />Results: We found no significant difference in hemoglobin or hematocrit between the two groups at the end of the study. However serum albumin was significantly higher in the treatment group (4.2±0.3) than the control group (3.8±0.4) pConclusion: Pentoxifylline had a significant effect in improving the chronic inflammatory state but its use in improving anemia of hemodialysis patients still needs further research.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Image-Guided Stereotactic Ventricular Catheter Placement for Refractory Idiopathic Intracranial Hypertension: Accuracy and Effectiveness277527825920410.21608/mjcu.2019.59204ENNESREEN MOHEY, M.D.;TAMIR A. HASSAN, M.D.The Department of Neurosurgery, Faculty of Medicine, Tanta UniversityJournal Article20190114Abstract<br />Background: Although lumboperitoneal shunt (LPS) is a common procedure for surgical management of idiopathic intracranial hypertension (IIH). However, many studies doc-umented a high failure and complications rate. Ventricular shunts were not commonly used for surgical management IIH due to the difficulty of inserting a shunt into normal or slit ventricles. Also, stereotactic surgery not available in every hospital.<br />Aim of the Study: This article retrospectively evaluate the accuracy, efficacy, and safety of using stereotactic image-guided insertion of ventricular catheter in patients with IIH.<br />Patients and Methods: The authors reviewed the clinical records of all patients in whom stereotaxy was used to guide the placement of a ventricular catheter for IIH. Stereotactic guided ventricular catheter placements were performed on sixteen patients presenting with clinical manifestation of IHH to target the frontal horn of the lateral ventricle after failure of traditional medical or previous surgical treatment. Results: We had fourteen females and two males. Their age ranged from 20 to 45 years (average 29.7). The mean follow-up period was 43.9 months (ranged from 10 to 84 months). Eleven patients had previous LPS insertion with at least one trial of revision. Five patients subjected to stereotactic VPS as a first procedure. Accurate ventricular catheter place-ment was done from the first trial in all patients which was confirmed on postoperative CT scan. Four patients underwent stereotactic ventriculo-atrial shunts due to decrease CSF absorptive capacity of peritoneal cavity due to multiple lumboperitoneal shunt revision. All patients showed improve-ment or stabilization of their visual manifestation after ven-tricular shunt insertion. Headache improved in fourteen patients whereas two patients still had headache that respond to medical treatment. We had no mortality and two patients required shunt revision.<br />Conclusions: Image-guided stereotactic ventricular cath-eter placement is an effective, safe and durable management option that can help in management of IIH when the ordinary medical and surgical methods fail. Also it may be the first choice in certain selected cases.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Chest Physiotherapy on Pulmonary Functions 4 Children with Cystic Fibrosis: Systematic Review of Randomized Controlled Trials278327905920510.21608/mjcu.2019.59205ENREEM M. ALMARAKBY, M.Sc.;EMAN I. ELHADIDY, Ph.D.MAYA G.ALY, Ph.D.The Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo UniversityJournal Article20190114Abstract<br />Background: Pulmonary disease is the main cause of morbidity and mortality in cystic fibrosis (CF). Children with CF usually received chest physiotherapy as a part of their management.<br />Aim of Study: To systematically review the effect of chest physiotherapy on pulmonary functions in children with CF.<br />Patients and Methods: Articles were identified through literature search using PubMed (MEDLINE), physiotherapy evidence database (PEDro) and Cochrane database from 2000 up to February 2019. Studies were included if they were randomized trials focused on chest physiotherapy in children with CF. Data from included studies was extracted and its methodological quality was assessed using PEDro scale. The modified Sackett scale was used to assess level of evidence of each intervention.<br />Results: Seven trials were identified with fair to good methodological quality. Studies were heterogeneous in regards to intervention techniques; findings were qualitatively ana-lyzed. This review found moderate evidence about the effec-tiveness of postural drainage (PD), autogenic drainage(AD), non-invasive ventilation and independent active cycle of breathing technique(ACBT); limited evidence for the effec-tiveness of modified PD, Positive Expiratory Pressure (PEP) and therapist-assisted ACBT. Moderate evidence was found that Hayek oscillator or chest physiotherapy during anaesthesia preoperatively is ineffective in improving pulmonary functions in children with CF.<br />Conclusion: The present evidence supports the use of different chest physiotherapy interventions for improving pulmonary functions in children with CF.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Radiological Intervention and Imaging Procedures in Management of Patients with Malignant Obstructive Jaundice279128005930810.21608/mjcu.2019.59308ENASHRAF M. DAWOUD, M.Sc.;HAZEM M. OMAR, M.D.MOHAMMED A. AMIN, M.D.;ABDELMONEM NOOMAN, M.D.The Department of Radio-Diagnosis & Medical Imaging, Faculty of Medicine, Tanta University* and Liver Institute, Menofia University**Journal Article20190115Abstract<br />Background: Malignant biliary obstruction has a bad prognosis and adverse effect on the quality of life, with most of those patients are inoperable at time of diagnosis. Patients who underwent whipple operation may develop anastomotic site (choledocho-jujenostomy) stenosis with subsequent ele-vated bilirubin level and related complications.<br />Aim of Study: This prospective study will be conducted to evaluate the efficacy of different modalities of interventional radiological and imaging procedures as Percutaneous Trans hepatic Cholangiography (PTC), Percutaneous Trans hepatic Drainage (PTD) and biliary stenting in management of patients with malignant obstructive jaundice.<br />Patients and Methods: This study was conducted on 30 patients (19 males and 11 females) with mean age of 56 years, 28 of 30 patients (93.3%) are non operable and the other 2 of 30 patients (6.7%) operated patients for choledocho-jujenostomy stenosis were subjected to intervention techniques. 10 of 30 patients (33.3%) underwent percutaneous external biliary drainage, 15 of 30 patients (50%) underwent percuta-neous stent insertion (8 of 30 patients (26.7%) with metallic stents & 7 of 30 patients (23.3%) with plastic stents), 3 of 30 patients (10%) underwent internal external drainage and 2 of 30 patients (6.66%) underwent biliary drainage through combined (randez-voux) technique.<br />Results: High success rate (86.6%) with reduction of total bilirubin level was observed in metallic stenting group of patients.<br />Conclusion: Biliary intervention procedures help to reduce high bilirubin level, bypass obstruction level and help in dilatation of post-operative stenosis site.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Changes of Platelet Indices in Patients with Systemic Lupus Eythematosus and their Correlation with Disease Activity280128085930910.21608/mjcu.2019.59309ENWAFAA M. SHERIF, M.Sc.;RASHA A. ABDEL NOOR, M.D.MOHAMED ATTIA, M.D.;NASHWA NOR EL-DEEN, M.D.Journal Article20190115Abstract<br />Background: Systemic lupus erythematosus (SLE) is autoimmune disease needs continuous assessment of disease activity. There is no single biomarker used for that purpose. Platelet indices have recently been found to be a simple inflammatory marker used in the assessment of systemic inflammation in many diseases like, rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel diseases.<br />Aim of Study: To evaluate platelet indices [mean platelet volume (MPV), platelet distribution width (PDW) and platelet-crit (PCT)] as markers of disease activity in patients with SLE.<br />Patients and Methods: In this cross sectional study we tested 100 subjects; 20 healthy control and 80 SLE patients recruited from rheumatology unit in Internal Medicine De-partment, Tanta University, Tanta, Egypt. Then the lupus patients were divided according to SLEDAI into 20 patients without flare (SELEDAI <4), 17 patients mild flare (SELEDAI 4– <8), 25 patients moderate flare (SELEDAI 8 – <12) and 18 patients severe flare (SELEDAI >_12). Platelet indices (MPV, PDW, PTC) were assessed in all of them and their correlation to SLEDAI score were analyzed.<br />Results: MPV and PDW had no clinical significance in assessing lupus activity, PCT significantly lower with SLE patients with severe flare and it had a significant negative correlation with SELEDAI score with cutoff value equals <_0.173, sensitivity 61.11%, specificity 79.03%, PPV 45.8% and NPV 87.5%. Finally there was no significant difference between lupus nephritis and lupus without nephritis patients in Platelet indices.<br />Conclusion: Plateletcrit (PCT) can be used as a new marker for SLE activity.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Real-World Safety and Efficacy of Directly Acting Antiviral Therapy for the Treatment of Patients with Hepatitis C Infection and Decompensated Cirrhosis280928155931010.21608/mjcu.2019.59310ENNOURA M. GHAREEB, M.Sc.;MAMDOUH A. GABR, M.D.AMAL A.SELIM, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: HCV was considered a major health problem worldwide before the discovery of direct acting antiviral therapy. Patients with chronic HCV and decompensated cirrhosis are not uncommon and represent the greatest thera-peutic challenge.<br />Aim of Study: The primary aim of this study is to assess safety, efficacy and tolerability of all oral DAAs in the treatment of a group of difficult-to-treat population (HCV genotype 4-related decompensated cirrhosis).<br />Patients and Methods: Forty (40) patients with chronic HCV infection and decompensated cirrhosis received different combinations of direct acting antivirals in the form of of sofosbuvir-daclatasvir and sofosbuvir-ledipasvir ± ribavirin for 24wks (for the regimens not containing ribavirin) and 12wks (for the regimens containing ribavirin).<br />All patients in this study were subjected to: History taking regarding demographic data and risk factors predisposing them to HCV infection, full clinical examination, laboratory investigations (CBC, liver functions, PT and INR), CTP scoring before treatment and 12wks after the end of treatment (SVR).<br />Results: Thirty (30) patients complete the duration of treatment and developed Sustained Virological Response (SVR) and those patients showed a significant improvement clinically regarding amount of ascites (p=<0.01), in laboratory findings regarding platelets count (p=<0.05), liver transami-nases (p=Conclusion: Direct acting antivirals are highly effective and showed great improvement in patients with chronic hepatitis C and decompensated cirrhosis clinically and in laboratory findings.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Does Podocyte-Associated Protein Has A Role in Early Detection of Diabetic Nephropathy in Type 2 Diabetes Mellitus?281728255931110.21608/mjcu.2019.59311ENMOHAMED A.R. EL-ZAMAR, M.Sc.;OLA A.F. EL-SHORA, M.D.GHADA M. AL-GHAZALY, M.D.;MOHAMED H. ABO FREIKHA, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta University, EgyptJournal Article20190115Abstract<br />Background: Diabetic nephropathy or Diabetic Kidney Disease (DKD) became a major public health concern world-wide because it is a major cause of end stage renal disease. Early intervention can significantly improve the prognosis. Urinary podocyte-associated protein is elevated in patients with DKD, so it is a promising way in early detection of DKD.<br />Aim of Study: To investigate the role of podocyte associated protein in early detection of diabetic nephropathy in patients with type 2 diabetes mellitus.<br />Patients and Methods: A cross sectional study was done on 90 patients divided equally into three groups (normoalbu-miuria, microalbumiuria and macroalbumiuria) plus 10 healthy individuals as controls.<br />Results: All diabetic patients had a higher level of urinary podocyte-associated protein than control group. Also, there was positive correlation between urinary podocyte-associated protein and the degree of albuminuria. So, it was increased with the severity of renal involvement.<br />Conclusion: This study demonstrated that measurement of urinary podocyte-associated protein is a potential biomarker for the early detection of DKD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Resveratrol Improves Cardiac Functions of the Diabetic Cardiomyopathy Rats Via Modulation of AMP-Activated Protein Kinase and the Phosphorylated Glycogen Synthase Kinase-3(3282728376565710.21608/mjcu.2019.65657ENHEND ASHOUR, M.D.;ASMAA M. SHAMSELDEEN, M.D.HEBA S. SHOUKRY, M.D.;LAILA A. RASHED, M.D.MOHAMED M. EL-SEBAIE, M.D.;MOHAMED H. ELSAYED, M.Sc.SHEREEN ABDELFATTAH, M.D.;SAFINAZ SALAH-ELDIN, M.D.HANIA I.AMMAR, M.D.The Departments of Physiology, Biochemistry, Faculty of Medicine, Cairo University, Pediatrics, Al-Ahrar Teaching Hospital, Zagazig, Histology and Anatomy, Faculty of Medicine, Cairo University, EgyptJournal Article20181220Abstract<br />Background: Resveratrol (RSV) has a wide range of diabetic cardioprotective effects. It is currently recognized as a dietary supplement.<br />Aim of Study: To investigate the impact of RSV on the molecular expression pattern of AMP-activated protein kinase (AMPK) and the glycogen synthase kinase-3(3 serine 9 (GSK-3(3S9) in diabetic cardiomyopathy.<br />Methods: We investigated this point using three groups of Wistar albino rats; control group, diabetic cardiomyopathy rats (DCM) and diabetics treated with RSV (DM-RSV) for 20 weeks. Echocardiography was performed at base line, and every 4 weeks. At the end of the study, Ex-vivo assessment of myocardial contractility was performed. The molecular changes in the cardiac tissues were evaluated in all groups for assessment of the silent information regulator (SIRT1), GSK-3(3S9 and the AMPK levels. Histological assessment was done for all cardiac tissues. Apoptosis was assessed by measuring the modulation in the Bax/Bcl2 ratio and poly (ADP-ribose) polymerase-1 (PARP1) levels, trying to explore the RSV underlying mechanism of action.<br />Results: Marked deterioration in the cardiac functions was detected in the diabetic non treated group. The decreased levels of SIRT1, AMPK and GSK-3(3S9 that was associated with increased apoptotic markers, may be the cause of dete-riorated cardiac functions. Assessment of the myocardial functions showed improvement in the diabetic RSV treated group. RSV aimed to normalize the hyperglycemic state and the disturbed molecular pattern associated with diabetes.<br />Conclusion: Prolonged RSV administration protects the diabetic hearts. This could be explained by the interplay between SIRT1, AMPK and the GSK-3(3S9 levels.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Possible Neuroprotective Effects of Crocin Against Motor and Neurochemical Changes in Rotenone Induced Animal Model of Parkinson's Disease283928475931810.21608/mjcu.2019.59318ENAHMED A. ABD AL-FATTAH, M.D.;ABEER A. ABO ZEID, M.D.The Department of Medical Physiology, Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20190115Abstract<br />Backgropund: Parkinson's Disease (PD) is considered a second most common neurodegenerative disease with slow and irreversible nigrostriatal degeneration with subsequent motor and behavioral deficits. Oxidative stress plays a key role in the pathogenesis of PD. Rotenone is a common pesticide inducing PD by the generation of oxidative stress.<br />Aim of Study: The aim of this study was to investigate the possible neuroprotective effects of crocin (saffron active compound) on rotenone induced Parkinson-like behaviors.<br />Material and Methods: 70 male Wister Albino rats were divided into 7 groups (10) per each. (1) Control group (normal saline); (2) Crocin 40mg/Kg; (3) Polyethylene Glycol (PEG) group (vehicle of Levodopa); (4) Rotenone group; (5) Rotenone + crocin 20mg/Kg; (6) Rotenone + crocin 40mg/Kg; (7) Rotenone + Levodopa 10mg/Kg. All agents were injected intraperitoneally once a day for 4 weeks. The neurobehavioral tests include open field, descent latency time in the bar test (seconds), forepaw stride length (cm) and locomotor activity. In serum, the level of 8-hydroxydeoxyguanosine 8-OHdG was estimated. The level of Malondialdehyde (MDA), reduced glutathione (GSH), tumor necrosis factor alpha TNF-a, dopamine and nitrite/nitrate levels were measured in the brain tissue.<br />Results: Rotenone induced neurobehavioral deficits with elevation of brain MDA, brain TNF-a, Nitrite/nitrate level and serum 8-OHdG and reduction of GSH, brain tissue dopamine. Crocin (20 or 40) improved these neurobehavioral deficits. Crocin (20 or 40) and L-DOPA decreased MDA, serum 8-OHdG, TNF-a and Nitrite/nitrate level and increased GSH and dopamine level. Crocin 40 had achieved potent effect compared with crocin 20.<br />Conclusion: Rotenone induced Parkinson-like behavior in rats. Crocin achieved a protective effect through reducing lipid peroxidation, anti-inflammatory and reducing DNA damage together with improvement of neurobehavioral deficits.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901ATG16L1 Single Nucleotide Polymorphism Confers High Cardiac Artery Disease Risk in H. Pylori Chronic Gastritis Patients284928555931910.21608/mjcu.2019.59319ENSAMIA TAHER ALI, M.D.;HATEM RABIE, M.D.The Departments of Internal Medicine*, Faculty of Medicine for Girls, Al-Azhar University and Clinical Pathology**, National Liver Institute, Menoufia UniversityJournal Article20190115Abstract<br />Background: Chronic Helicobacter pylori (HP) gastritis affects two-thirds of the world's population and is one of the most common chronic inflammatory disorders of humans, the infection clearly results in chronic mucosal inflammation in the stomach and duodenum which in turn might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. The increased inflammatory response related to HP gastroin-testinal disease may also lead to damage in non-gastrointestinal tissues. The damage caused by HP is believed to be associated with increased inflammatory markers resulting from immune response and blood cells activation. Autophagy related gene 16 like 1 single nucleotide polymorphism (ATG16L1 SNP) may be associated with impaired autophagy which predisposes to HP persistence and chronicity. Chronic infection is a suspected risk factor for cardiac artery disease.<br />Aim of Study: The aim of this study is to assess the association between (ATG16L1) SNP and coronary artery disease, pro-inflammatory and atherogenic risk factors in HP patients.<br />Patients and Methods: This study was carried out on 80 patients suffering from dyspepsia and reflux symptoms. According to the urea breath test results, patients were divided into two groups: group I (45 positive H. pylori) patients and group II (35 negative H. pylori) patients as control group. All patients were subjected to full medical history taking, clinical examination and laboratory investigations included urea breath testing for H. pylori infection, complete blood count (CBC), (ATG16L1) SNP, pro-inflammatory HDL assay and high sensitivity CRP (hs-CRP) assay.<br />Results: H. pylori gastritis patients with AG+GG genotypes had statistically higher levels of hs-CRP, N/L, P/L, pro-oxidant HDL-c index when compared to H. pylori gastritis patients with AA genotype and both patient groups had higher levels of these parameters when compared to healthy control subjects<br />Conclusion: The ATG16L1 SNP impairs autophagy and has a role in persistence of H. pylori intracellular infection leading to chronic gastritis and increases the CAD pro-inflammatory pro-atherogenic risk factors; the mutant G allele is accused allele.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Unraveling the Role of Melatonin/Quercetin in Attenuating the Metabolic and Bone Turnover Alternations in Iron Treated-Ovariectomized Female Rats285728705932010.21608/mjcu.2019.59320ENRAMEZ A. BARHOMA, M.D.;ISLAM I. HEGAB, M.D.MARWA M. ATEF, M.D.;AMIRA M. EL-SHAMY, M.D.The Departments of Physiology* and Biochemistry**, Faculty of Medicine, Tanta University, EgyptJournal Article20190115Abstract<br />Background: Iron accumulation is involved in many of postmenopausal associated disorders, like osteoporosis.<br />Aim of Study: This study was designed to evaluate the possible role of iron accumulation in deteriorating the ova-riectomy-induced metabolic and bone remodeling alterations with the possible protective effect of melatonin and quercetin in this respect.<br />Material and Methods: 40 female albino rats were divided into 5 equal groups, 8 rats each; Group 1: Control sham operated group, received intraperitoneal injections of normal saline, 3 times/week after sham operations, Group 2: Ovariec-tomized (OVX) group, received the same saline treatments after bilateral ovariectomy, Group 3: Iron treated-OVX group (F-OVX), received intraperitoneal injections of 0.04g/kg ferric ammonium citrate 3 times a week after bilateral ovariectomy, Group 4: Melatonin + iron treated-OVX group (MF-OVX), received subcutaneous melatonin injections (10mg/kg) daily after bilateral ovariectomy, Group 5: Quercetin + iron treated-OVX group (QF-OVX), received intraperitoneal quercetin injection of 10mg/kg/day after bilateral ovariectomy.<br />At the end of the experimental regimen (4 weeks), blood samples were collected and centrifuged, the obtaining serum was used for determination of iron, ferritin, Malondialdehyde (MDA), Total Antioxidant Capacity (TAC) glucose, insulin and insulin resistance (using HOMA-IR equation). Moreover, the serum Total Cholesterol (TC), High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C) and Triglycerides (TG) were assayed along with bone turnover markers including; serum Osteocalcin (OC), Bone Specific Alkaline Phosphatase (BALP) Cross-linked Carboxy-terminal telopeptide of type I collagen (CTX-I) and tartrate-resistant acid phosphatase 5b (TRACP5b). Further-more, livers were removed for determination of liver iron, MDA and TAC levels.<br />Results: Iron treatment in OVX rats further exacerbated the ovariectomy induced alterations in oxidative status, indi-cated by increased MDA and decreased TAC in both serum and liver tissue, metabolic status, indicated by significantly elevated serum TC, LDL-C, TG, glucose and HOMA-IR levels, and bone turnover status, indicated by significant decrease in serum markers of bone formation (OC, BALP) and increase in those of bone resorption (CTX-I, TRACP5b), in F-OVX group compared to OVX group. On the other hand, treatment of F-OVX rats with either melatonin or quercetin significantly mitigated all these alterations, which was in concomitance with improvement of the iron status indicated by significant decrease in serum and liver iron along with serum ferritin levels, in MF-OVX and QF-OVX groups com-pared to F-OVX group.<br />Conclusion: Melatonin and quercetin improved the met-abolic and bone turnover alternations, induced by iron accu-mulation in treated F-OVX rats, possibly via their iron chelat-ing, antioxidant, insulin sensitizing, hypolipidemic and anti-osteoporotic effects, as recorded in this rat model.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Correlation between Clinical Findings in Patients with Breast Lump and Radiological and Pathological Finding287128765932110.21608/mjcu.2019.59321ENASHRAF E. EL-SHARKAWY, M.D.;RAGHEB A. RAGHEB, M.D.WAFAA Kh.TIR EL-BAR, M.Sc.The Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University* and Faculty of Medicine, Menofia University**Journal Article20190115Abstract<br />Background: Although the diagnosis of breast cancer is suggested on clinical examination, the degree of suspicion is variable. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonog-raphy) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps.<br />Aim of Study: Assessment for how much the clinical finding in patients with breast lumps correlates with radiolog-ical and pathological finding.<br />Patients and Methods: This study was carried out on 50 female patients who presented with breast lump in the outpa-tient clinics of Al-Zahraa University Hospital. Patients with a breast lump were selected irrespective of age. A detailed history, clinical examination, mammosonographic imaging and Fine-Needle Aspiration Cytology (FNAC) were used as diagnostic tools for screening of the patients.<br />Results: The sensitivity of clinical examination to detect malignant breast mass was 80%, specificity was 100%, Positive Predictive Value (PPV) was 100%, Negative Predictive Value (NPV) 95.24% and with 96% accuracy. The sensitivity of mammosonography to detect malignant breast mass was 70%, specificity was 100%, positive predictive value 100%, negative predictive value was 93.02% & with 94% accuracy. The sensitivity of FNAC to detect malignant breast mass was 71.43%, specificity was 100%, positive predictive value was 100%, negative predictive value was 95.24% & with 95.24% accuracy.<br />Conclusion: This study revealed the accuracy of clinical examination, mammosonography & FNAC in evaluating breast lump especially when applied together.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Meta-Analysis of Clinical Outcomes of Tricuspid Valve Replacement287728835932210.21608/mjcu.2019.59322ENSHERIF NEGM, M.Sc.;AMR A. ARAFAT, M.D.EL-ATAFY M. EL-ATAFY, M.D.;HOSAM F. FAWZY, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, EgyptJournal Article20190115Abstract<br />Background: The long-term results of Tricuspid Valve Replacement (TVR) depend on factors related to the original valve disease more than on the prosthesis type. Tricuspid valve prosthesis; either mechanical or bioprosthetic, should be chosen according to the individual patient's characteristics.<br />Aim of Study: The aim of the study was to analyze the clinical results of tricuspid valve replacement, comparing the different types of tricuspid valve prostheses.<br />Patients and Methods: A meta-analysis study was done to evaluate TVR results in adults in the literature published in the period of 20 years “1995: 2015”, focusing on literature published in English comparing mechanical valves to bio-prosthetic valves. We performed a search over published literature of different databases “Embase, PubMed, Ovid, Justor, Science Direct, and Wiley Blackwell.”<br />Results: The total of 17 studies evaluating 1020 mechanical valve and 1199 bioprosthetic valve patients were included in the meta-analysis. Valve thromboses, and emboli are less reported with bioprosthetic valve (RR=6.52; 95% CI: 3.00, 14. 15; p<0.00001) and (RR=2.25; 95% CI: 1.14, 4.46; p= 0.02) respectively. There was no statistically significant difference between valve types as regards to bleeding, heart block, low cardiac output, valve failure, infective endocarditis, stroke, and renal failure.<br />Conclusion: The type of the tricuspid valve prosthesis should be chosen based on patient's characteristics but occa-sionally it's equivocal, that's when the bioprosthetic valve should be preferred because of its less morbidity.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Non-Neoplastic Femoral Head Lesions: Magnetic Resonance Imaging Value288528985932810.21608/mjcu.2019.59328ENREDA A. AL-ARABAWY, M.D.;ATEF H. TEIMA, M.D.OSAMA A. SELIM, M.D.;MARAM K. EL-GOHARY, M.Sc.The Departments of Radiodiagnosis & Medical Imaging* and Orthopedics**, Faculty of Medicine, Tanta University, EgyptJournal Article20190115Abstract<br />Background: Hip pain is a common problem in patients of all ages, attributed to many causes. MRI combined with recent technologic developmentst plays a crucial role in assessment of epiphyseal disorders in great detail without ionizing radiation.<br />Aim of Study: Was to evaluate the diagnostic value of MRI in assessment of non-neoplastic femoral head lesions.<br />Patients and Methods: This study included 40 patients, 22 females (55%) and 18 males (45%), their ages ranged from 4 to 65 years with a mean age of 35 years complaining of hip pain. The most frequently involved age group was the group >30-40 years in both males and females.<br />All patients were clinically evaluated, and then subjected for radiological examination and medical imaging (MRI) for all patients and ultrasonography for 6 patients (5 developmental dysplasia and 1 septic arthritis).<br />Results: Out of forty patients who had performed MRI were classified to: Avascular necrosis; the commonest disease in our study; as it is seen in 12 (30%) patients, followed by; osteoarthritis in 6 (15%) patients, migratory osteoporosis in 4 (10%) patients, septic arthritis in 4 (10%) patients, devel-opmental dysplasia in 5 (12.5%) patients, Perthe's disease in 4 (10%) patients, slipped capital femoral epiphysis in 3 (7.5%) patients and stress fractures in 2 (5%) patients.<br />The final diagnosis achieved through the MRI findings were confirmed by surgical data in 6 patients with avascular necrosis, histopathology in 5 patients (3 septic arthritis and 2 osteoarthritis) and follow-up by clinical, laboratory and other imaging studies in 29 patients.<br />Conclusion: MRI is highly sensitive imaging modality for diagnosis and characterizing of different non-neoplastic femoral head lesions and accurate for assessing the full extent of osseous, chondral and soft tissue abnormalities of the hip joint.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparison between Intraperitoneal Instillation of Bupivacaine Versus Dexmedetomidine for Post-Operative Analgesia after Laparscopic Cholecystectomy289929055932910.21608/mjcu.2019.59329ENYOMNA M. EL-BAHNASSY, M.Sc.;KAMAL EL-DEIN A. HEIKAL, M.D.NABIL A.M. EL-SHEIKH, M.D.;REHAB S. EL-KALLA, M.D.The Department of Anesthesiology and Surgical ICU, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Optimizing post-operative pain management can be challenging due to surgical factors and intrinsic patient responses to surgery and pain. Intraperitoneal instillation of local anesthetic drugs has become a popular practice for pain relief after laparoscopic surgery which limit the requirements for opioid analgesics and prevent common post-operative side effects such as ileus, nausea and vomiting, thus enables more patients to meet early discharge criteria.<br />Aim of Study: The aim is to compare between the efficacy of intraperitoneal instillation of Bupivavcine versus Dexme-detomedine for pain relief post-operatively after Laparoscopic Cholecystectomy.<br />Patient and Methods: This study was carried out on 75 patients, 18-59 years, ASA I or II scheduled for elective Laparoscopic Cholecystectomy. Patients were randomly as-signed to receive either Dexmedetomidine (DEX ), Bupivacaine (Bup), or normal saline (control group) for post laparoscopic cholecystectomy peritoneal instillation of local anesthetic. All patients were premedicated with IV fentanyl inj. (2μg/kg) 15min before induction of anesthesia. The induction was done with propofol 2mg/kg IV and to facilitate the endotracheal intubation, atracurium (0.5mg/kg) was given intravenously. Throughout the procedure controlled ventilation was main-tained with 100% O2, sevoflurane (1-2%) and atracurium. At the end of the surgery, the study solution was instillated intraperitoneally before removal of trocar in Trendelenberg's position, into the hepato-diaphragmatic space, on gall bladder bed and near and above hepatoduodenal ligament. The neuro-muscular blockade was antagonized with neostigmine 0.05 mg/kg and atropine 0.01mg/kg and trachea was extubated.<br />Recording the demographic data, duration of surgery, intensity of post-operative pain using VAS score, pattern of pain, analgesic requirement, time to the first request of anal-gesia, total dose of analgesia and side effects.<br />Results: VAS score was significantly lower in Group I (DEX) than Group II (Bup) and Group III (Control) at 30min, 1hr, 2 hr and 4hr after extubation (p-value <0.05). The onset of post-operative analgesia was significantly lower in Group II (Bup) and Group III (Control) than Group I (DEX) (p-value <0.05). Total dose of post-operative analgesia requirement was significantly lower in Group I (DEX) and Group II (Bup) than in Group III (Control) (p-value <0.05).<br />Conclusions: Intraperitoneal instillation of dexmedetomi-dine 1μ/kg in elective laparoscopic cholecystectomy signifi-cantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% before removal of trocars at the end of surgery.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Probiotics Mitigates Skeletal Muscle Atrophy in Isoproterenol-Induced Heart Failure Adult Rats; by Increasing IGF-I Gene Expression and Improving Insulin Sensitivity290729245933010.21608/mjcu.2019.59330ENMANAL S. ABD-EL HAMID, M.D.;ABD EL-HAMID A. MOHAMED, M.D.NAYRA S.H.MEHANNA, Ph.D.The Department of Physiology, Faculty of Medicine, Ain Shams University* and The Department of Dairy Science, National Research Centre, Dokki**, Cairo, EgyptJournal Article20190115Abstract<br />Background: Skeletal muscle atrophy is a common com-plication of heart failure that may result from the accompanying neuro-hormonal disturbances. Altered gut microbiome can mediate these neuro-hormonal disturbances. Growing evidenc-es pointed to the health benefits of probiotics.<br />Aim of Study: To evaluate the effects of probiotics on skeletal muscle state in ISO-induced HF and the underlying mechanisms.<br />Material and Methods: 21 male adult rats were divided into: Control group (C), ISO-HF group; rats were injected with isoproterenol (ISO) 5mg/kg/d IP for 7 days and Pro-T group which were given probiotics by oral gavage for 6 weeks after ISO injection. Plasma Ang II, insulin, glucose, skeletal muscle atrogin and cardiac BNP levels were measured. Also relative gene expression of skeletal muscle IGF-1, IRS-1, NADPH oxidase was assessed. Cardiac and skeletal muscle tissues were weighed and histopathologically assessed.<br />Results: In pro T group, cardiac BNP, plasma Ag II, left ventricular weight and LV/BW ratio were significant reduced. Also, skeletal muscle atrogin and NADPH oxidase were significantly decreased with a significant increase in skeletal muscle weight, IGF-1 and IRS-1 relative gene expression. In addition, probiotics decreased insulin resistance, plasma glucose, insulin levels and HOMA-IR score. This was accom-panied by the restoration of normal collagen distribution and cardiac muscle distinct cell borders and skeletal muscle distinct cell borders.<br />Conclusion: Probiotics mitigates muscle atrophy in ISO-HF by lowering Ang II and by their anti-oxidant, anti-fibrotic, anti-hypertrophic and anti-hyperglycemic effects.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Positron Emission Tomography/Computed Tomography (PET/CT) in Assessment of Therapeutic Response in Non-Hodgkin Lymphoma292529255933210.21608/mjcu.2019.59332ENHUSSEIN A. FADHIL, M.Sc.;MOHAMMED A. ALI, M.D.AHMED M.BASSIOUNY, M.D.The Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20190115Abstract<br />Background: Lymphoma is the most common primary hematopoietic malignancy, make up a heterogeneous group of neoplastic diseases of lymphocytes origin broadly divided into Hodgkin Disease (HD) and Non-Hodgkin's Lymphoma (NHL) In the past decade, functional imaging with 18F-FDG PET has been the fastest growing diagnostic modality in oncology, the addition of PET to CT adds sensitivity and specificity in tumor imaging. Thus, PET/CT is a more accurate test than either of its individual components.<br />Aim of Study: This study was undertaken to evaluate the role the PET/CT in assessment of response to chemotherapy and or radio therapy, follow-up and assessment of remissions and relapses in patients with lymphoma.<br />Patients and Methods: Retrospective diagnostic interven-tional study in Ain Shams University Hospitals. Study popu-lation: Non Hodgkin lymphoma patients receiving therapy-presenting to Ain Shams University Hospitals since Jan. 2018- Apr. 2019. Patients included will perform one or more of the following: Initial PET/CT for staging and follow-up PET/CT exams. All exams will be done on the PET/CT scanner. intravenous glucose Fluorodeoxyglucose (FDG) dose depend-ing on the protocol of department. After 60min of 18F-FDG injection MCDT diagnostic nonionic contrast examination for anatomical localization followed by PET images. The whole study took approximately 20-30 minutes.<br />Results: This study included 20 patients with pathologi-cally confirmed non Hodgkin lymphoma (diffuse large B cell) who underwent PET/CT study after they had finished their treatment protocol. The PET/CT exam of each patient was interpreted for the assessment of treatment response after end of treatment. About 65% of patients received 6 cycles of chemotherapy, however only 35% received 8 cycles of chem-otherapy.<br />In our study, 12 patients (60%) had extra-nodal involve-ment and were as follow: 7 patients (55%) had only one extra nodal affection site and 5patients (45%) had more than one extranodal affection site. It had high sensitivity (100%) and specificity (75%) for the evaluation of therapeutic response than contrast enhanced CT and fair agreement (Kappa 0.610) according to the Deauville criteria. We assess therapeutic response in our study using IHP and correlated with visual assessment using (Deauville Criteria-five-point scale).<br />Conclusion: Combined PET/CT using 18F-FDG is the best oncologic imaging modality at present time with indis-pensable role and valuable application in management of lymphoma. According to the Deauville criteria in end of treatment response assessment. We recommend in reporting of PET-CT for response assessment using the Deauville criteria.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prevalence and Risk Factors of Peripheral Neuropathy among Diabetic Patients in Aden Diabetic Center293529445933310.21608/mjcu.2019.59333ENBALQIS A. ABDULLA EBRAHIM, M.D.;LINDA MUSTAFA H. BA ALWI, M.Sc.HANAN Sh.MOHAMMED, M.D.The Departments of Internal Medicine, Faculty of Medicine, Aden University, Yemen* and Assiut University**, EgyptJournal Article20190115Abstract<br />Background: Diabetic Peripheral Neuropathy (DPN) is an important micro-vascular complication of Diabetes Mellitus (DM), considered as a major contributor to foot ulceration and lower limb amputation among diabetic patients and have remarkable negative effect on patient's quality of life.<br />Aim of Study: This study aimed to estimate the prevalence and possible risk factors of DPN among patients attending diabetic center in Aden governorate, Yemen.<br />Patients and Methods: This cross-sectional retrospective study review prevalence of peripheral neuropathy among patients aged 18-70 years with type 1 and 2 DM (T1D, T2D), were 124 patients assessed by neurosymptoms and neurodis-ability scores (NSS and NDS respectively). Descriptive statistic and logistic regression analysis were done.<br />Results: The prevalence of DPN based on NSS and NDS was 60.48%. Risk factors significantly associated with DPN were age (p 0.015), educational level (p 0.013), type 2 diabetes (p 0.022), and duration of diabetes (p 0.001), dyslipidemia (p 0.009), abdominal obesity (p 0.001), body mass index (p 0.036) and retinopathy (p 0.035). Female gender, hypertension, elevated glycated hemoglobin and the presence of albuminuria were associated with higher frequency of DPN although this relation was statistically non-significant. Logistic regression analysis revealed that Illiteracy (OR 8.75, 95% CI 2.23- 34.33), dyslipidemia (OR 1.97, 95% CI 1.04-24.44), long standing of diabetes (OR 1.14, 95% CI 1.05-1.23), and ab-dominal obesity (OR 1.05, 95% CI 1.01-1.09) were signifi-cantlly associated with DPN.<br />Conclusions: A higher prevalence was observed with illiteracy, dyslipidemia, longer duration of diabetes and abdominal obesity.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Hazards of Bisphenol A on the Thyroid Gland of Adult Male Albino Rats and Possibility of Recovery after its Withdrawal294529535933410.21608/mjcu.2019.59334ENIBRAHIM H. IBRAHIM, M.D.;MANAL M. MORSY, M.D.The Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Sharkia, EgyptJournal Article20190115Abstract<br />Background: Bisphenol A (BPA) is a chemical pollutant and one of the endocrinal disrupting factors.<br />Aim of Study: This study was designed to evaluate the possible changes that may occur in thyroid gland of male adult rats following BPA administration and to access the possibility of the thyroid recovery after stoppage of its admin-istration.<br />Materials and Methods: 36 male adult wistar albino rats were divided into 3 equal groups (control, BPA treated and recovery). For 8 weeks, each animal in the treated group received orally BPA 50mg/kg/day, also rats in the recovery group dosed BPA similar to the treated group then held for another 4 weeks without BPA administration. Finally when the experiment was ended, the rats were anesthetized, sacrificed and blood samples were obtained to measure the levels of thyroid hormones. The thyroid gland was processed for his-tological, histochemical and immunohistochemical Bcl2 studies. Also, morphometric studies were accessed.<br />Results: In BPA treated group, there were vacuolated follicular cells, exfoliation of epithelial cells inside the colloid and congested capillaries in the interfollicular spaces. Marked decrease of colloidal PAS reaction and the Bcl2 immunoreac-tion with increase of the amount of collagen fibers were observed. Also, these results were demonstrated morphomet-rically. Significant reduction of triiodo-thyronine (T3), thy-roxine (T4) and significant increase of thyroid stimulating hormone (TSH) were recorded. In the recovery group, partial improvement of the histological, histochemical, biochemical and immunohistochemical changes caused by BPA was re-corded.<br />Conclusion: Exposure to BPA could result in histological and functional changes of thyroid gland that were incompletely improved after stoppage of BPA administration.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Carotid Angioplasty and Stenting for Atherosclerotic Stenosis: Case Series295529625933510.21608/mjcu.2019.59335ENFAROUKHASSAN, M.D.The Department of Radiology, Faculty of Medicine, Cairo UniversityJournal Article20190115Abstract<br />Background: Carotid artery stenting is an alternative to endarterectomy in treatment of carotid artery stenosis. Com-parative studies have shown different results regarding the outcome of both techniques.<br />Aim of Study: The aim of our study is to present our experience in carotid artery stenting and compare our results with the literature.<br />Patients and Methods: A retrospective analysis of our series of patients who underwent carotid artery angioplasty/ stenting, between January 2011 and April 2018, in Kasr Al-Ainy University Hospital and Sheikh Zayed Specialized Hospital was performed. Peri-procedural and delayed, minor and major complications rates as well as the rate of restenosis over the follow-up period were analyzed.<br />Results: A total of 106 patients who underwent 109 procedures of carotid artery angioplasty/stenting were included for analysis. Average age of patients was 63±7 years, with 71 male (67%). Symptomatic stenosis was seen in 81 cases (74.3%) and asymptomatic stenosis was seen in 28 cases (25.7%). Filter protection device was used in 69 cases (63.3%) and 40 cases (36.7%) were done without protective device. Pre-stent dilatation was performed in 21 cases (19.2%). Post-stent dilatation was performed in 75 cases (68.8%). Both pre and post-stent dilatations were done in 9 cases (8.2%). No balloon dilatation was done in 3 cases (2.7%). In one case (0.9%) angioplasty was done without stenting. Minor compli-cations occurred in 4 cases (3.7%) in the form of 3 cases of intra-procedural and 1 case of post-procedural transient ischemic attack. Two major complications (1.8%) occurred in the form of distal showering with middle cerebral artery occlusion in 1 case, and retroperitoneal hematoma in another case. Two cases (1.8%) of intraprocedural adverse events occurred in the form of dissection without clinical sequelae. Two cases of insignificant restenosis were encountered in the follow-up.<br />Conclusion: Carotid artery stenting is an effective and relatively safe alternative to carotid endarterectomy. Further studies assessing the value of embolic protective devices and the best type of stent should be conducted.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Possible Effects of Growth Hormone Therapy on the Eye296329665933610.21608/mjcu.2019.59336ENAHMED FAWZY, M.Sc.;NORA EL-SAID BADAWI, M.D.MOHAMED M. ISMAIL, M.D.;MOATAZ HAMED OSMAN, M.D.The Departments of Pediatrics* and Ophthalmology**, Faculty of Medicine, Cairo UniversityJournal Article20190115Abstract<br />Background: Human growth hormone therapy in children may affect the eye due to its growth promoting properties.<br />Aim of the Study: To detect possible effects of growth hormone therapy on ocular axial length, refraction and posterior segment.<br />Patients and Methods: This study included 30 Growth Hormone (GH) deficient children scheduled for human GH therapy. Before GH treatment patients ocular examination included: Dilated fundus, cycloplegic spherical equivalent and axial length using A-scan ultra sound. All the previous examination items were repeated and documented 6 months after treatment start.<br />Results: 30 GH deficient children were included; 17 (56.7%) males and 13 (43.3%) females of whom 3 had turner syndrome. Mean age was 11 .39±3.64 years. Mean spherical equivalent of cycloplegic refraction was +0.81-}0.85 diopter pre-therapy and +0.26-}0.6 diopter 6 months after therapy (p-value=0.2). Mean axial length was 21.04-}1.33mm pre-therapy and 21.421.39mm 6 months after therapy (p-value=0. 12). Right sided papilledema occurred in 1 patient with turner syndrome (1.66%) 6 months after therapy, while no other retinal complications were found.<br />Conclusion: We found no significant change in ocular axial length and refraction 6 months after GH therapy. One case of pseudotumour cerebri was documented. We recommend routine fundus examination for patients receiving GH therapy and stop of therapy once papilloedema encountered.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Effect of Ultrasound Guided Rectus Sheath Block Versus Transversus Abdominis Plane Block for Pain Relief after Total Abdominal Hysterectomy296729755933910.21608/mjcu.2019.59339ENMOSTAFA M. ELBAGOURY, M.Sc.;MOHAMMAD I. OKAB, M.D.SABRY M. AMIN, M.D.;HESHAM I. ELTATAWY, M.D.The Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Total abdominal hysterectomy (TAH) is associated with substantial postoperative pain and discomfort. Transversus abdominis plane (TAP) block and rectus sheath (RS) block are used to block the sensory nerves of the anterior abdominal wall and thereby contributing in pain relief after lower abdominal surgeries.<br />Aim of Study: The aim of this study is to evaluate the effect of postoperative bilateral US-guided RS block versus postoperative bilateral US-guided TAB on analgesic require-ments and hemodynamic changes after TAH.<br />Patients and Methods: This prospective randomized study was carried out on 60 females, ASA I or II presented for elective TAH under general anesthesia (GA)and randomly classified into 2 equal groups (each of 30 patients); patients in group I received RS block with 40ml bupivacaine 0.25% (20ml each side) before the end of surgery and in group II, patients received TAP block with 40ml bupivacaine 0.25% (20 ml each side) before the end of surgery. HR and MABP were measured as baseline, after induction of GA, every 15 min till end of surgery, immediately after recovery, at 2h, 4h, 6h, 8h and 12h postoperatively. Operative time, the duration of anesthesia and Numeric Rating Scale (NRS) at 2h, 4h, 6h, 8h, and 12h after recovery. Time to first analgesic request, total 24h pethidine consumption and side-effects were meas-ured.<br />Results: HR, MABP, and NRS score showed significant elevation at 6H and 8H postoperatively in group I. First time of analgesic request in group II was prolonged than group I. Pethidine consumption was reduced in group II compared to group I. Postoperative nausea and vomiting (PONV) showed elevation in group I compared to group II.<br />Conclusion: Postoperative bilateral US-guided TAB block was more effective than US-guided RS block in patients undergoing TAH with prolonged postoperative analgesia, less pethidine consumption, and less PONV.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Monitoring of Blood Glucose Level in Surgical Intensive Care Unit Patients with Sepsis297729815934110.21608/mjcu.2019.59341ENABDULLAH N. EL-ORABY, M.Sc.;SOHAIR M. SOLIMAN, M.D.AHMED A. EL-DABA, M.D.;WAIL E. MESBAH, M.D.The Department ofAnesthesiology, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Sepsis now is defined as evidence of infection plus life-threatening organ dysfunction, clinically characterized by an acute changes of 2 points or greater in the SOFA score. The new clinical criteria for septic shock include sepsis with fluid-unresponsive hypotension, serum lactate level greater than 2mmol/L, and the need of vasopressor to maintain mean arterial pressure of 65mmHg or greater. One of the most important metabolic changes in sepsis is hyperglycemia arising from muscle glycolysis and lipolysis, and subsequent gluco-neogenesis and glycolysis in the liver. The other feature of metabolic changes in sepsis is hyperlactatemia due to glycolysis in muscle caused by counter regulatory hormones and cy-tokines. Gcontrol to a moderately tight range (140-200mg/dl) is not inferior to euglycemia and clearly safer in critically ill patients.<br />Aim of Study: The aim of this study is monitoring of blood glucose level in Surgical Intensive Care Unit patients with sepsis.<br />Patients and Methods: This study was carried out in Tanta University Hospitals at Surgical Intensive Care Unit (SICU) for six months (from October 2017 to March 2018) after a written informed consent was obtained from the patients relatives, 100 patients of both sex admitted to SICU suffering from sepsis were enrolled in the study. Everyone had a secret code number.<br />Results: Our results showed that no significant correlation between C-Peptide level & RBS in hyperglycemic patients, –ve significant correlation between C-Peptide level & RBS in hypoglycemic patients, significant decrease in MAP of hypoglycemic cases more than hyperglycemic cases, significant increase in HR of hyperglycemic cases more than hypoglyc-emic, significant increase in mortality in hypoglycemic patients as compared to hyperglycemic patients.<br />Conclusion: We concluded that frequent blood glucose measurement is one element of the routine intensive monitoring that all critically ill patients receive following admission to intensive care units. Transient increase in blood glucose concentration (hyperglycemia) is very common in this patient. Although decrease in blood glucose concentration (hypoglycemia) is rare but has very bad prognosis with significant increase in mortality rate.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Computed Tomography Angiography (CTA) and Color Doppler Ultrasonography in Evaluation of Arterial System in Diabetic Foot298329925934210.21608/mjcu.2019.59342ENAHMED E. SHABAN, M.Sc.;KHALED I. EL-SHAFEY, M.D.HASSAN A. HASSAN, M.D.;HAYTHAM H. EMAM, M.D.The Departments of Radiodiagnosis & Medical Imaging* and Vascular Surgery**, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Objective: The aim of this study was to highlight the role of Computed Tomography Angiography (CTA) and color Doppler Ultrasonography (DUS) in the evaluation of patients with diabetic foot disease.<br />Background: The risk for ulceration and amputation is much higher in diabetics compared with nondiabetics. CTA is more frequently used to assess peripheral vascular disease of the diabetic foot while Doppler ultrasonograpy is a reliable non-invasive method of investigating the lower limb arterial system provides us with hemodynamic data proximal, distal and at the site of obstruction.<br />Patients and Methods: This prospective study included 30 diabetic patients who presented with diabetic foot vascular lesions and referred from outpatient clinics of Vascular Surgery Department to the Radiology and Medical Imaging Department, Tanta University Hospital. The present study was performed in the period between March 2017 and March 2018. Their ages ranged from 40 to 80 years; 17 of them were men and 13 were women. All cases underwent Doppler examination as a rapid, noninvasive complementary diagnostic tool, and the findings were compared with those of CTA.<br />Results: In the present study, the number of segments were 513 for 57 limbs, and each arterial tree of one limb was divided into nine segments (common iliac,external iliac, common femoral, superficial femoral, popliteal, anterior tibial, posterior tibial, peroneal, and dorsalis pedis arteries). In this study, the number of stenotic segments was 30 and 22 on Multidetector Computed Tomography Angiography (MDCTA) and DUS, respectively. The number of segments with total occlusion was 50 and 43 on MDCTA and DUS, respectively.<br />Conclusion: The use of CTA and DUS increases the ability to delineate vascular anatomy, localize the obstruction, assess the severity of stenosis, and detect the presence of collaterals and distal run off.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Immunohistochemical Study of KPNA2 Expression in Correlation to PCNA Expression in Colorectal Carcinoma299330015934410.21608/mjcu.2019.59344ENMARYAM E. ABDO, M.Sc.;HEBA F. HARRAS, M.D.OMNIA K. RIZK, M.D.;KHAIRIA GAWEESH, M.D.The Department of Pathology, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Colorectal cancer is the third most common cancer worldwide. In Egypt, it ranks the 7th most common malignant tumor representing 3.47% of male cancers and 3% of female cancers. The relative frequency of colorectal cancer is about 9-12% with high male predominance 3:1. The prog-nostic value of conventional parameters for the evaluation of patient prognosis is limited. So, a need for novel prognostic markers is being largely considered.<br />Aim of Study: The purpose of this study is to detect the immunohistochemical expression of KPNA and PCNA in colorectal carcinoma and correlate their expression with the available clinicopathological parameters to illustrate their prognostic role. Also correlate the relation between KPNA2 immunohistochemical expression and PCNA immunohisto-chemical expression to evaluate the role of KPNA2 as a proliferative marker.<br />Material and Methods: Sixty cases of colorectal carcinoma were collected retrospectively. They were stained by H & E, KPNA and PCNA for immunohistochemical study. The rela-tions between their expression and the available clinicopatho-logical parameters were evaluated.<br />Results: KPNA2 expression in colorectal carcinoma showed statistically significant relation with tumor grading, staging, vascular invasion and perineural invasion. PCNA expression showed statistically significant relation with histopathological grading, staging, vascular and perineural invasion. This study observed a strong positive correlation between KPNA2 immunohistochemical score and PCNA immunohistochemical staining in the studied cases.<br />Conclusions: KPNA2 and PCNA expression can be used as predictive tumor marker which predicts the poor prognosis in colorectal cancer. KPNA2 may have a potential role in tumor cell proliferation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Efficacy and Safety of Daclatasvir and Sofosbuvir in Egyptian Patients with Chronic Hepatitis C Genotype 4 and Cirrhosis300330085935010.21608/mjcu.2019.59350ENAHMAD E. SHAMS EL-DIN, M.B.B.Ch.;MAMDOUH A. GABR, M.D.AMR M. GAWALY, M.D.;MANAL A. EID, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Hepatitis C virus (HCV) infection is a leading cause of Chronic Liver Disease (CLD) and liver transplantation globally. Currently, oral combinations of Direct Acting Anti-viral agents (DAAs) are the standard of care for treating chronic HCV infection.<br />Aim of Study: To assess the efficacy & safety of combi-nation of Daclatasvir and Sofosbuvir in Egyptian patients with chronic hepatitis C Genotype 4 and Cirrhosis.<br />Patients and Methods: 50 Egyptian, cirrhotic patients with HCV genotype 4 infection were treated with a generic form of sofosbuvir (SOF) 400mg, daclatasvir (DCV) 60mg with or without weight-based ribavirin (RBV) for only 12 weeks. 40 out of the 50 patients enrolled in the study, com-pleted treatment, while the remaining 10 patients were lost for follow-up.<br />Results: The 12 weeks combination of SOF plus DCV achieved SVR in all treated patients (100%) whether treatment-naïve or experienced, with or without ribavirin. A significant improvement was observed in transaminases, while a non-significant improvement was observed in serum albumin, bilirubin, INR and the mean CTP score indicating improvement in liver functions. Regarding safety outcomes, all treatment-related AEs were only minor AEs with no major AEs.<br />Conclusion: The combination of SOF plus DCV with or without RBV for only 12 weeks is highly effective in treating HCV GT4 cirrhotic patients with SVR12 rate of 100%, safe and well tolerated by these cirrhotic patients. Moreover, there was a marginal improvement in liver functions observed 12 weeks after treatment.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Uterine Artery Doppler Velocimetry in Placenta Previa and Placenta Accreta300930135935210.21608/mjcu.2019.59352ENMOHAMED A.M. BOSTAN, M.Sc.;HESHAM M. EL-TOKHY, M.D.RASHA A. EL-SHAFAY, M.D.;NAREMAN M. EL-HAMAMY, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Placenta previa and placenta accreta are common obstetrical problem. Placenta previa is partially or totally implanted placenta in the lower uterine segment, this abnormality in the site occurs with different degrees, placenta previa lateralis, marginalis and centralis either incomplete or complete. Abnormal placental adhesion means that the placenta invades the uterine myometrium with different degree. This morbid adhesion is called “Placenta Accreta”, with different grades according to the degree of the trophoblastic invasion through the myometrium and bladder serosa as placenta accreta vera, placenta increta and placenta percreta. Incidence of placenta accreta is increased over the past years mainly due to increasing rates of cesarean delivery. Placenta accreta may lead to massive obstetric hemorrhage with attempt to remove the placenta leading to several complications up to death. Diagnosis of placenta accreta can be done by different modalities such as Ultrasound Grey scale, Color Doppler, Magnetic Resonance Imaging (MRI). Ultrasonography is usually employed as the primary modality for antenatal diagnosis of invasive placentation. Over recent years, Color Doppler Sonography (CDS) have been started to be used to predict placental abnormalities. CDS, a noninvasive and simple tool, is useful indistinguishing normal and abnormal placentation.<br />Aim of Study: The aim of this work was to study uterine artery doppler velocimeteric changes in patients with placenta previa and placenta accrete.<br />Patients and Methods: 30 pregnant females were included in this comparative prospective clinical study subdivided into two group; Group (A) Includes 15 patients with anterior placenta previa, and Group (B) Include 15 patients with anterior placenta previa accrete. Both groups were diagnosed by trans-abdominal Ultrasonography either from outpatient clinics or inpatient department of Tanta University Hospital seeking for antenatal care from Octorber 2017 to August 2018. All patients underwent uterine artery Doppler velocimetry to measure the mean Resistive Index (RI) and Pulsatility Index (PI) in the third trimester and compared between both groups.<br />Results: the mean uterine artery velocemtric changes including mean Resistive Indices (RI) and mean Pusitility Indices (PI) were significantly lower in the placenta accreta group compared to placenta previa group (with mean for RI 0.41 versus 0.45; p=0.001) and (with mean for PI 0.50 versus 0.56; p=0.001), the uterine artery Doppler values in combina-tion with maternal characteristics, such as previous history of cesarean deliveries, will improve screening accuracy of placenta accrete (p=0.022). Conclustion: This study suggests that the mean PI and RI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. Accuracy of diagnosis can be potentially improved in invasive placentation if uterine artery Doppler values and the history of cesarean delivery are combined.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Multidetector Computed Tomography with Three Dimension Reconstruction in Evaluation of Pelvic Fractures301520195935310.21608/mjcu.2019.59353ENAHMAD A. ABD EL-GALEEL, M.Sc.;MOHAMMAD F. DAWOOD, M.D.ALY A. EL-BARBARY, M.D.;MOHAMMAD M. EL-ASHWAH, M.D.The Department of Radio-Diagnosis & Medical Imaging, Faculty of Medicine, Tanta UniversityJournal Article20191115Abstract<br />Background: Pelvic fracture is a serious injury that may be associated with high morbidity and mortality. MDCT is more frequently used for accurate evaluation of pelvic fractures.<br />Aim of Study: The aim of this work is to evaluate the role of multidetector CT with three dimension reconstruction in diagnosis of pelvic fractures.<br />Patients and Methods: This prospective study included 70 patients who presented with pelvic fractures and referred from outpatient clinics of Orthopedic Department to the Radiology and Medical Imaging Department, Tanta University Hospital. The present study was performed in the period between February 2018 and March 2019. Their ages ranged from 4 to 82 years; 45 of them were males and 25 were females. All cases underwent multidetector computed tomog-raphy as a rapid, noninvasive diagnostic tool, and the findings were compared with those of plain X-ray.<br />Results: According to our results patients with partial unstable pelvic ring fractures (Tile type B) had higher incidence than stable fractures (54.28%), followed by stable Tile A fractures (28.57%). Young Burgess lateral compression frac-tures had significantly higher incidence (68.57%) especially Young Burgess subtype LC1 (54.28%). All sacral fractures were associated with pelvic ring fratures, Denis zone I was the most common (54.28%). The elementary Judet-Letournel acetabular fractures were the most common (58.82%) espe-cially type posterior wall (20.58%). Hip dislocations and femur head fractures were rare, represented only by 4 cases for each. The most common hip dislocation type was the posterior dislocation represented only by 2 cases (50%).<br />Conclusion: MDCT with 3D has numerous advantages and accurate in diagnosis of pelvic fratures.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Subjective Global Assessment for Nutritional Assessment of Patients on Regular Hemodialysis at Dialysis Unit at Tanta University Hospital302330295935510.21608/mjcu.2019.59355ENMAI M. ELBAKARY, M.Sc.;KAMAL M. OKASHA, M.D.AMR M. GAWALY, M.D.;MANAL S. NEGM, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Malnutrition is a major negative prognostic factor in dialysis patients. Simple and reliable estimations of nutritional status may therefore prove of particular value in the follow-up of these patients.<br />Aim of Study: To assess the nutritional status of hemodi-alysis patients using the Subjective Global Assessment (SGA) method and to validate Subjective Global Assessment (SGA) we compared subjective global assessment with objective measurements (anthropometry, biochemical measurements).<br />Patients and Methods: 100 patients aged from (18-65) on regular hemodialysis at Hemodialysis Unit of Tanta Uni-versity Hospitals. All were subjected to history taking, physical and clinical examination, routine laboratory investigation and we used the parameters of Subjective Global Assessment (SGA) for evaluating nutritional status of hemodialyzed patients with anthropometric measurements and laboratory parameters.<br />Results: 100 patient were assessed and about 82 patient were categorized as Group A which represent well-nourished groups and 18 patient were categorized as Group B which represent malnourished groups, there was statistically signif-icant difference as regard to BMI, BMR, Hb, TLC, s.iron, Creat, CRP, albumin, Ca, Na, lipid profile and nutritional status. And there was significant correlation between BMI and albumin, CRP, Hb, cholesterol, TG, and LDL and also there was significant correlation between BMR and CRP, cholesterol, TG, LDL and HDL. And according to multi regression analysis the independent predictors for nutritional assessment in hemodialysis patients were albumin, creatinine and hemoglobin.<br />Conclusion: SGA is an easy-to-use as nutritional assess-ment tool that allows quick identification of malnutrition in hemodialysis patients.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Diagnostic Accuracy of DW MRI in Early Detection of Endometrial Carcinoma303130395935810.21608/mjcu.2019.59358ENRASHA M. KAMAL, M.D.;NAGAT MANSOUR KHALIFA, M.D.AMR KAMAL, M.D.;GHADA F.A. HAMMAD, M.D.The Department of Radiology, Faculty of Medicine, Cairo University*, National Cancer Institute of Cairo** and The Department of Surgery, National Cancer Institute of Cairo***, EgyptJournal Article20190115Abstract<br />Introduction: Endometrial carcinoma is the most common gynecological malignancy and the sixth most common neo-plasm worldwide. The role of MRI in patients with histolog-ically proven endometrial cancer is to evaluate the depth of myometrial and cervical invasion and detect pelvic lymph node involvement pre-operatively thereby helping to determine the need for lymph node dissection. DW-MRI provides im-portant new information noninvasively. This unique modality is helpful in initial staging of known malignancies, differen-tiating benign from malignant lesions, as a biomarker for treatment response and determining the presence of disease recurrence.<br />Aim of Study: The aim of this study is to assess the diagnostic accuracy of diffusion weighted imaging and ADC value in early diagnosis of endometrial cancer in high risk patients decreasing the need for surgical interventions for diagnosis.<br />Patients and Methods: This study included 33 patients, 21 patients had pathologically proven endometrial cancer, and 12 patients had endometrial hyperplasia with control group of 36 patients referred to the Radiology Department from Surgical Department to assess the endometrium. Pelvic DCE-MR was done and DWI was obtained with 3 b-values including 0, 300 and 600mm/sec.<br />Results: There is statistically significant difference between the benign and malignant group with p-value=0.001 in which Sensitivity=90.0% Specificity=83.3% Accuracy=85.2%. The ADC value of benign group ranged from (0.8 to 2), the ADC value of malignant group ranged from (0.5 to 1.3). There was significant overlap between benign and malignant group as regards the ADC value however if we use cut off value of 0.6 for malignant lesions and 1.6 for benign lesions, the specificity will be 77.1% for benign and 100% for hyperplasia. Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group (p 0.06) in which Sensitivity=30.4% Specificity=38.5% Accuracy=33.3%.<br />Conclusion: Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group. The diffusion weighted imaging ADC value improve the efficacy and diagnostic accuracy in early diagnosis of endometrial cancer in high risk patients decrease the need for surgical interventions for diagnosis.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Fused PET/CT in the Follow-up Assessment of the Post-Operative and Post-Therapeutic Cases of Renal Malignancy304130505936010.21608/mjcu.2019.59360ENTALAAT A.HASSAN, M.D.The Department of Radiology, Faculty of Medicine, Cairo UniversityJournal Article20190115Abstract<br />Background: Post-operative and post-therapeutic proper restaging of renal cancer can modify the therapeutic plans. PET-CT as combined anatomical and functional imaging technique and whole body survey is a useful technique for these patients.<br />Aim of Study: To determine the role of fused Positron Emission Tomography/Computed Tomography (PET/CT) in the follow-up assessment of the patients with treated renal malignancy.<br />Subjects and Methods: All data were collected and ana-lyzed in a retrospective pattern; enrolling 33 patients who were cases of treated renal malignancies (9 females and 24 males) (their age range=37-73 years). The patients had been referred to a private imaging center for evaluation of disease recurrence by fused PET/CT.<br />Results: By PET/CT a recurrent malignancy was catego-rized as operative bed recurrence/residual, nodal and distal metastasis.<br />With a reference to the gold standard (the histopathology examination with a correlation to the clinical and the radio-logical follow-up assessments if available), the PET/CT (for the tumor recurrence/residual) had sensitivity, specificity, positive predictive value, negative predictive value and an overall accuracy (94.7%, 100%, 100%, 93.3% & 97%) respec-tively, while the CT (for the tumor recurrence/residual) had had sensitivity, specificity, positive predictive value, negative predictive value and an overall accuracy (68.4%, 92.8%, 92.8%, 68.4%, 78.8%) respectively.<br />Conclusion: PET/CT offered a useful diagnostic tool for detection of the operative bed recurrence and nodal and distant metastases and therapeutic assessment follow-up in patients with renal cancer.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparison between Magnesium Sulphate and Ketorolac Intravenous Infusion on Characteristics of Spinal Anesthesia305130585936210.21608/mjcu.2019.59362ENAHMED R. EL-REWENY, M.Sc.;ABDELRAHEEM M. DOWIDA, M.D.GHADA F. EL-BARADEY, M.D.;REHAB S. EL-KALLA, M.D.The Department of Anesthesiology and Surgical ICU, Faculty of Medicine, Tanta UniversityJournal Article20190115Abstract<br />Background: Spinal anesthesia is used widely for many procedures, many adjuvants had been used to prolong duration of sensory and motor block and improve post-operative pain.<br />Aim of Study: The aim of this study is to compare the effect of magnesium sulphate and ketorolac intravenous infusion on sensory and motor blockage, hemodynamic pa-rameters, duration of analgesia and side effects during spinal anesthesia.<br />Patients and Methods: Patients were classified randomly into three groups (30 patients each) Group M (Magnesium sulphate Group), Group K (Ketorolac Group), Group C (Con-trol Group). Group M patients received a loading dose of magnesium sulphate 40mg/kg IV over 10min followed by 15mg/kg/h IV infusion, Group K patients received a loading dose of ketorolac (0.4mg/kg) (IV) over 10min followed by 0.8mg/kg/h IV infusion. Group C received 50ml of saline (IV) over 10min followed by saline infusion. After ensuring free flow of cerebrospinal fluid, 3mL of bupivacaine (0.5%) injected Pulse rate, electrocardiography, non-invasive blood pressure and SpO2 monitored continuously. Measurements: Demographic data (age, weight, BMI, ASA physical status). Hemodynamic (HR, MAP, SpO2) before giving study drugs, 10min after giving study drugs and after reaching the maximal level of spinal anesthesia and then every 30min till end of surgery. Onset of sensory blockade has been assessed by pinprick method. Onset of motor blockade has been assessed by modified Bromage Scale. Level of sensory and motor blockade has been checked at 3, 5, 10 and 15min after spinal anesthesia and then every 20min throughout the surgery. Time to achieve complete regression from sensory and motor blockade has been noted. All the durations were calculated considering the time of spinal injection as zero time. Post-operatively analgesia has been assessed by the Visual Analog Scale (VAS). The time at which analgesia was first received and total analgesic requirement in 24h was recorded. Patients observed for any adverse effects such as nausea, hypotension.<br />Results: There were insignificant changes between the three groups in HR and MAP but there was significant decrease in HR and MAP in each group at 10min, maximal level and 30min in comparison with base line. <br /> There were insignificant changes in onset and duration of sensory and motor block in the three studied groups.<br />The total dose of analgesic consumption (pethidine (mg)) showed significant decrease in Group M in comparison with Group K & Group C with insignificant change between Group K & Group C.<br />The time of first rescue analgesia showed significant increase in Group M in comparison with Group K & Group C and insignificant changes in Group K in comparison with Group C.<br />Conclusion: Addition of intravenous magnesium sulphate with spinal anaesthesia provides significant decrease in post-operative analgesic requirements and prolongs the time of the first rescue analgesia as compared to intravenous ketorolac with spinal anaesthesia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparative Study between Unilateral Spinal Anesthesia Versus Ultrasound Combined Femoro-Sciatic Nerve Block for Lower Limb Surgery305930685950810.21608/mjcu.2019.59508ENSHIMAA S. AWAD, M.Sc.;AHMED M. SABER, M.D.ASHRAF E. ELZEFTAWI, M.D.;RABAB M. MOHAMED, M.D.The Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta UniversityJournal Article20190116Abstract<br />Background: The advantages of Unilateral Spinal An-esthesia (ULSA) over bilateral spinal anesthesia are less doses, cardiovascular side effects, and hospitalization. Femoral/Sciatic Nerve Block (FSNB) may decrease post-operative pain, nausea and vomiting, length of stay, surgical stress, morbidity and mortality and may improve mobilization and recovery of gastrointestinal function.<br />Aim of Study: The aim of this study is to compare ULSA versus FSNB by Ultrasound (US) guided as anesthetic tech-nique for cases undergoing elective lower limb surgery.<br />Material and Methods: This prospective randomized study was carried out on 60 adult educated patients, aged 18:60, of both sex, ASA I-II and scheduled for lower limb surgery at Tanta University Hospitals. Patients were randomized into 2 equal groups (30 patients in each); Group-I: ULSA and Group-II: US guided FSNB. Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded before block and every 15min intraoperative and at 30, 60min, 2, 3, 4, 6 and 12h post-operative. Onset and duration of both sensory and motor block, the first time for need of rescue analgesia (morphine) and Visual Analogue Scale (VAS) at rest and with activity (at 0, 1, 2, 3, 4, 6 and 12hr) were recorded. Patient and surgeon satisfaction and any post-operative side effect were recorded.<br />Results: Onset of sensory and motor block was signifi-cantly shorter in ULSA, but the duration of sensory and motor block was prolonged in FSNB with delayed first dose of analgesic. Intraoperative HR and MAP showed insignificant difference and post-operative significant increase in ULSA. VAS at activity showed earlier need for rescue analgesic in ULSA. There was no significant difference in surgeon and patient satisfaction with minimal side effects.<br />Conclusion: Both ULSA with 2ml heavy bupivacaine 0.5% given slowly over one minute and US guided FSNB using combination of 0.25% bupivacaine and 1% lidocaine resulted in comparable adequate intraoperative anesthesia, stable hemodynamics and adequate surgeon and patient satis-faction with minimal side effects. US guided FSNB was superior to ULSA in post-operative analgesia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Vitamin D Supplementation Reduces Serum Chemerin Level in Gestational Diabetes Mellitus Rat Model306930805950910.21608/mjcu.2019.59509ENSUZAN M.M. MOURSI, M.D.;ABEER A. SAID, M.D.The Department of Physiology, Faculty of Medicine, Zagazig University, EgyptJournal Article20190116Abstract<br />Background: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder that increases the prenatal morbidity. Data regarding the association between circulating chemerin level and GDM remains controversial. On the other hand, Vitamin D deficiency is common in pregnancy and may increase the frequency of GDM.<br />Aim of Study: This study was conducted to examine the effects of Vitamin D3 supplementation on serum chemerin level and some metabolic parameters in GDM rat model.<br />Material and Methods: Healthy female white albino rats were divided randomly into three groups (n=10 rats): Group I (normal pregnant group); fed on normal diet for five weeks before induction of pregnancy. Group II (GDM-induced); fed High Fat-Sucrose Diet (HFSD) for five weeks before induction of pregnancy then injected Intraperitoneally (I.P) by Strepto-zotocin (STZ) (25mg/kg) on the 7th day of gestation. Group III (GDM-induced group supplemented with Vitamin D3); GDM-induced as before and injected Intramuscularly (I.M) with 20,000IU/kg of cholecalciferol on days 1 and 14 of gestation. On the 19th day of gestation, serum chemerin, estradiol, progesterone, glucose, insulin and Insulin Resistance index (HOMA-IR), Total Cholesterol (TC), Triglycerides (TG), Low Density Lipoprotein-cholesterol (LDL-c), High Density Lipoprotein-cholesterol (HDL-c), Very Low Density Lipoprotein-cholesterol (VLDL-c), Tumor Necrosis Factor alpha (TNF a) and Malondialdehyde (MDA) levels and Serum Superoxide Dismutase (SOD) activity were estimated for all groups.<br />Results: GDM-induced rats showed significantly increased serum glucose, HOMA-IR, TG, TC, LDL-c, VLDL-c, MDA, and TNF a levels while showed significantly decreased serum insulin and HDL-c levels and SOD activity when compared to normal pregnant control rats. GDM-induced rats also showed significantly increased serum chemerin levels that showed significant positive correlations with serum glucose, insulin, HOMA-IR, TG, TC, LDL-c, VLDL-c, MDA, and TNF a levels but showed significant negative correlations with serum HDL-c level and SOD activity. Noteworthy, Vitamin D3 administration significantly improved these pa-rameters in GDM-induced group supplemented with Vitamin D3.<br />Conclusion: Our results denoted the protective effect of Vitamin D3 supplementation on GDM that may be through improving the antioxidant and inflammatory status. Decreasing circulating chemerin level may play a role in this protective effect.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Changes in Autonomic Nervous System in Patients with Multiple Sclerosis308130875951010.21608/mjcu.2019.59510ENAHMED S. ALJEFRI, M.D.YOUNOUS A. BINTALEB, M.D.The Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Aden, YemenJournal Article20190116Abstract<br />Background: Multiple sclerosis (MS) is one of the most disabling neurological disorders, in which autonomic impair-ment is not rare.<br />Aim of Study: To assess the frequency of cardiovascular (CV) autonomic dysfunction in MS patients as well as to relate these autonomic abnormalities to the brainstem dys-functions in thoe patients evidenced by brainstem auditory evoked potential (BAEP) studies.<br />Patients and Methods: We studied 20 patients with clin-ically definite relapsing remitting MS and 20 gender and age matched healthy control. The patients were evaluated clinically using expanded disability status scale (EDSS). Autonomic functions were evaluated with blood pressure response to both standing and static exercise (sympathetic), and 24-hour elec-trocardiographic (ECG) recording, time domain (parasympa-thetic). Brain stem auditory evoked potential was performed to all patients. Data were statistically analyzed using Epi-info software version 6.04.<br />Results: The MS patients included 11 (55%) males and nine (45%) females with a mean age of 29.8-}8.4 years, whereas control group was composed of five (50%) males and five (50%) females with a mean age of 34.2±13.4 years. Regarding tests of CV autonomic functions, 13 (65%) patients had at least one abnormal test. The results showed statistically significant differences in all CV autonomic tests when com-paring MS patients to controls. We found significant correla-tions between autonomic tests with duration of the disease. Significant correlations were detected between autonomic tests and brainstem lesions. BAEP findings were indicative of brainstem affection and there was a significant correlation between autonomic tests and I-V inter peak latency.<br />Conclusion: These results suggest that a significant number of patients with MS show evidence of CV autonomic dysfunc-tion, which is correlated with brainstem function.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Assessing Safety and Efficacy of Uterine Artery Embolization in Symptomatic Uterine Fibroids308930955951110.21608/mjcu.2019.59511ENHAZEM I. KORASHI, M.D.;AHMED H. SOLIMAN, M.D.AHMEDEL SHIMY, M.D.The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20190116Abstract<br />Background: Uterine artery embolization (UAE) is a modality for management of symptomatic uterine leiomyomata. UAE for uterine fibroids in Egypt is a procedure with minimal reported data.<br />Aim of Study: To determine safety and efficacy of UAE in treating uterine leiomyomata in Egyptian population.<br />Patients and Methods: 45 consecutive patients undergoing UAE for uterine leiomyomata management were questioned for fibroid associated manifestation and symptomatic improve-ment at predetermined follow-up clinical visits. Data were obtained via verbal questionnaire.<br />Data collected included early, late procedural related complications and possible gynecological interventions were gathered.<br />Follow-up imaging by MRI at three and six months was carried out in order to measure reduction in uterine, dominant leiomyomata volume post-UAE.<br />Results: Technical success was achieved in 100% of patients. No significant complication took place with no necessary post procedural-related gynecological interventions.<br />Follow-up duration was 6 months. Heavy menstrual bleeding improved in 91.1% of patients at 3 months and in 95.6% at 6 months post treatment. Pressure-related symptoms improved in 84.4% of patients at 3 months and in 95.6% at 6 months after treatment. Convenient control of pain was evident in 55.6% of patients at 3 months and in 73.3% at 6 months post-UAE. MRI showed highly significant reduction in uterine as well as dominant fibroid volumes (24.4, 31.1 % at 3, 6 months), (33.3, 44.4% at 3, 6 months) respectively.<br />Conclusion: Uterine artery embolization is an effective procedure in treatment of symptomatic uterine leiomyomata with reduced post-procedural complications.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparative Study of Output Factors of Small Field Sizes Dosimetry Systems309731045951210.21608/mjcu.2019.59512ENSAMAH K. ELSHAMNDY, M.Sc.;PAOLO FRANCESCON, Ph.D.NINFA SATARIANO, Ph.D.;CHIARA ORLANDI, Ph.D.HASSAN ABOUELENEIN, Ph.D.;AHMED M. AHMED, Ph.D.Journal Article20190116Abstract<br />Background: The use of small fields in radiotherapy techniques has swiftly increased, in detail in stereotactic treatments and large uniform or nonuniform fields, which are composed of small fields such as for intensity-modulated radiation therapy (IMRT).<br />Aim of Study: Compare output factors (OFs) of small fields using various detectors and investigate its suitability for small field relative and absolute dosimetry through explor-ing the measured OFs with implementation to 6 MV photon beams by a Cyber Knife®. Normalization of different detector responses for the same field configuration is accomplished via applying a Monte Carlo derived correction factor.<br />Materials and Methods: Detectors used in the study were PTW60019 MicroDiaond, Exradin W1 Scintillator, and CCO1 IBA ion chamber, and field factors were calculated using Alfonso formula. OFs for a CyberKnife were measured in circular fields with the diameters range from 5mm to 60mm and using water tank at a 1.5cm depth and at 80cm source-to-axis distance.<br />Results: The OFs measured by Micro Diamond and Exra-din W1 (PSD) were within the uncertainties of the M.C. simulations for all the beam cones. While the CCO1 IBA ion chamber was unstable responding.<br />Conclusion: PTW 60019 microdiamond and Exradin W1 provide a useful and possibly superior alternative to existing dosimetry systems for small fields, as they are inherently less susceptible to volume-averaging and perturbation effects than larger, air-filled ionization chambers. Ultimately, they are favorable in small-field dosimetries.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Electrocautery Versus Scalpel Scalp Skin Incisions310531085951310.21608/mjcu.2019.59513ENAYMAN M. ISMAIL, M.D.;MOHAMMAD WAHEED EL-ANWAR, M.D.The Departments of Neurosurgery* and Otorhinolaryngology-Head & Neck Surgery**, Faculty of Medicine, Zagazig University, EgyptJournal Article20190116Abstract<br />Background: Scalp skin incisions have routinely been perfumed with scalpel. Recently, there is a shift to electrocau-tery skin incision. But, questions about bad scars, wound healing and sequels on hair growth limits its popularity.<br />Aim of Study: The aim of current study was to compare the diathermy versus scalpel skin incision for elective cranial incisions with regards to post-operative pain, post-operative wound infection and wound healing and hair regrowth.<br />Patients and Methods: This prospective comparative study was conducted on 42 patients. 21 patients underwent diathermy incision (diathermy group) that was compared with 21 scalpel incision patients (scalpel group). Pain that was assessed by visual analogue scale, feasibility, postoperative infection rate and hair regrowth were assessed at 3 months postoperatively and compared between both groups.<br />Results: Electrocautery incisions were clearly easier with less bleeding and shorter operative time. Electraucautery showed significantly less post-operative pain (p<0.05). Post-operative infection rate, scar and hair regrowth showed com-parable results in both the groups (p>0.05). No complication was reported with both techniques.<br />Conclusion: Diathermy scalp incisions are easier, faster, and less painful than scalpel incision with comparable results as regard scar and hair regrowth.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Assessment of Ocular Tear Film Stability in Subjects with High Total Cholesterol Levels310931165951410.21608/mjcu.2019.59514ENSAUD A.ALANAZI, Ph.D.Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaJournal Article20190116Abstract<br />Background: High cholesterol levels are known to cause multiple complications and the correlations between dry eye disease and high cholesterol levels can be used as an indicator of the need for urgent treatment to prevent severe ocular complications.<br />Aim of Study: This study aimed to assess ocular tear film stability in subjects with high total cholesterol levels by using various dry eye diagnostic tests.<br />Subjects and Methods: Twenty male subjects aged 19-43 years (32.5±7.3 years) with a high total cholesterol level (6.2±0.7mmol/L) and an age-matched control group of twenty male subjects (19-40 years; 31.1±4.6 years) with normal total cholesterol levels (3.9±0.6mmol/L) participated in the study. All subjects completed the ocular surface disease index assessment first, followed by the non-invasive tear break-up time (NITBUT) test. After 10 minutes, the tear meniscus time (TMH) test was performed followed by phenol red thread (PRT) and tear ferning (TF) tests, with a 10-minute gap between the tests.<br />Results: The mean scores (p<0.05) in the NITBUT and TMH tests indicated a dry eye condition in the study group [7.5 (3.3) s and 0.15 (0.12) mm, respectively] and a normal eye condition in the control group [15.3 (4.1) s and 0.27 (0.06) mm, respectively]. The average score for the TF grade (p<0.05) showed eye dryness [2.2 (1.8)] in the study group and a normal eye condition in the control group [0.5 (1.5)]. The cholesterol level showed a medium correlation with age (r=0.473; p=0.035), a strong negative correlation with the PRT score (r=-0.524; p=0.018), and a strong correlation with the TF grade (r=0.530; p=0.016).<br />Conclusion: The total cholesterol level significantly influences ocular tear film stability. Both tear quantity and quality decreased in subjects with high total cholesterol levels, which led to meibomian gland dysfunction and disturbances in lipid production and blood and oxygen supply to eye tissues, thereby causing dry eye symptoms.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Correlation between the Environmental Risk Factors and Typhoid Disease Among Children and their Care Givers, Alqalioubiya Governorate311731255951510.21608/mjcu.2019.59515ENRANDA H. ABDELFATTAH, M.Sc.;ENASS H. ELSHAIR, D.N.Sc.EBTESAM M.ELSAYED, D.N.Sc.The Department of Community Health Nursing, Faculty of Nursing, Cairo UniversityJournal Article20190116Abstract<br />Background: Typhoid disease remains an important pre-ventable public health problem. Typhoid is found all over the world, but the areas of risk include East and Southeast Asia and Africa particularly Egypt, most of typhoid deaths occur in children of school age or younger.<br />Aim of Study: To assess the correlation between the environmental risk factors and typhoid disease among children and their care givers, Alqalioubiya governorate.<br />Material and Methods: A descriptive correlative research design was utilized. Setting; study was conducted in 4 villages at Alqalioubiya governorate. A simple random sample of 313 participants was selected. Two tools were used; 1st tool a structured interviewing questionnaire includes 3 parts demo-graphic data, Knowledge and practices of the caregivers toward typhoid. 2nd tool an observational checklist for the home environment.<br />Results: Reveals that 47.9% of participants were aged 20 to less than 30 years old with mean ± SD=29.76±7.36. All participants had governmental water while 46% found it unsafe for drinking and food preparation. One fifth kept water tanks in bathrooms, moreover; 32% kept it unclean and 9.4% stored it till water turned off. All participants had trenches sewage disposal system. There were a highly statistically significant negative correlation found between the total knowl-edge and the family history toward typhoid (p=0.000). There were a highly statistically significant positive correlation found between the total knowledge and Total practice scores (p=0.000).<br />Conclusion: That risk of typhoid transmission not only affected by sanitation of the environment but also the practices within this environment.<br />Recommendations: Health education program to increase public awareness for typhoid prevention and regular exami-nation of food handlers. Safe water supply program and continuous monitoring to detect any leakage or fecal contam-ination.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Omeprazole as an Adjuvant to Praziquantel in Treatment of Experimental Schistosomiasis Mansoni312731355951610.21608/mjcu.2019.59516ENASMAA R. EL LAKANY, M.Sc.;DINA I. EL GENDY, M.D.HANAN A. ALSHENAWY, M.D.;AMIRA E. ABDEL GHAFFAR, M.D.The Departments of Medical Parasitology* and Pathology**, Faculty of Medicine, Tanta University, EgyptJournal Article20190116Abstract<br />Background: Schistosomiasis is an important parasitic disease. It has a chronic course with noticeable residual effects on health. Praziquantel (PZQ) is recommended by the WHO as the first line in treatment of schistosomiasis. Unfortunately, it has low efficacy against schistosomula and the juveniles stages which can compromise its efficacy. This further needs more research to find new drugs that improve the effectiveness of PZQ. Omeprazole has been found experimentally to have antiparasitic properties against many parasites such as Leish-mania donovani, Plasmodium falciparum, Trichomonas vag-inalis, Entamoeba histolytica and Giardia lamblia.<br />Aim of the Study: The aim of this study was to evaluate the efficacy of omeprazole as an adjuvant with PZQ in mice infected with Schistosoma mansoni (S. mansoni).<br />Material and Methods: For this aim, 100 laboratory bred clean male Swiss albino mice were divided into three groups including group I (Normal), group II (Control), group III infected and treated at 4 weeks post infection (P.I.). Group III was divided into 3 subgroups a (treated with PZQ), b (treated with omeprazole) and c (combined treatment). At 6 weeks P.I., all mice were submitted to the following: Count of juveniles worms, liver egg load, histopathological exami-nation of the liver.<br />Results: The results showed significant reduction of counts of juveniles worms, liver egg loads and improvement of the pathological changes in the liver in combined treatment group at 6 weeks P.I. as compared to PZQ treated group.<br />Conclusions: From these results, it was concluded that combination of omeprazole with PZQ shows synergistic effect in the treatment of S. mansoni-infected mice. Therefore, further studies should be done to establish the mechanisms of action of omeprazole and to examine its beneficial effects.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Serum Magnesium Level Change in Type 2 Diabetic Patients with Cardiovascular Complications313731455951710.21608/mjcu.2019.59517ENMOHAMMED ELGAZZAR, M.Sc.;ABD ELMOTTALEB TAHA EISSA, M.D.AMAL SAID ALBENDARY, M.D.;YASSER MOHAMED ABDELRAOUF, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta University, EgyptJournal Article20190116Abstract<br />Background: Diabetic macrovascular complications remain the main cause of morbidity and mortality in type 2 diabetes patients. Magnesium is a necessary cofactor for several enzymes that play an important role in glucose metabolism.<br />Aim of Study: This work was designed to investigate the relation between serum magnesium and diabetic cardiovascular complications.<br />Patients and Methods: In the present study, 120 patients with type 2 diabetes mellitus were enrolled from Internal Medicine Diabetes and Endocrine Unit Out-patient Clinic, Tanta University Hospitals, Egypt, and 30 individuals as a control within a period of one year. The enrolled individuals were divided into two groups. Group I included 30 healthy non diabetic individuals as control group. Group II included 120 type 2 diabetes patients classified into subgroups;<br />A-30 type 2 diabetic patients without any vascular com-plications.<br />B-30 type 2 diabetic patients with ischemic heart disease.<br />C-30 type 2 diabetic patients with nephropathy.<br />D-30 type 2 diabetic patients with retinopathy.<br />Serum magnesium and other investigations were taken to evaluate the relation between serum magnesium and diabetic macrovascular complications.<br />Result: Serum magnesium level was significantly low in patients with ischemic heart disease 1.28±0.36mg/dl. It was found using recipient characteristic observer curve for mag-nesium as a predictor of diabetic complications that serum magnesium level of 0.9mg/dl was accompanied with 76.4% sensitivity and 72% specificity for prediction of complications. While, HbA1C 7.5% was accompanied with 86.1% sensitivity and 46.2% specificity for prediction of macrovascular com-pilations. Serum magnesium level could be a predictor of occurrence of diabetic complications, but its role in pathogen-esis cannot be well stated as our data did not confirm that hypomagnesaemia is an independent risk factor for diabetes complications.<br />Conclusion: From this study, it can be concluded that that serum magnesium level could be a predictor of occurrence of diabetic complications, but its role in pathogenesis cannot be well stated as our data did not confirm that hypomagnesaemia is an independent risk factor for diabetes complications.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Efficacy of Transarterial Y90 Radioembolization in Management for Unresectable-Intermediate and Locally Advanced-HCC314731565951810.21608/mjcu.2019.59518ENMOHAMED M. HAMED, M.D.;ABDELHAY A. ABDELHAY, M.D.MOHAMED H. ABD ALFATTAH, M.D.;GAMAL AL-DEIN E. GAMEEL, M.D.The Departments of Radiology* and Tropical Medicine**, Faculty of Medicine, Cairo University, EgyptJournal Article20190116Abstract<br />Background: Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Many have adopted the Barcelona Clinic Liver Cancer (BCLC) staging classification, which links the stage of the disease to a specific treatment strategy. More controversial than the prognostic scoring system is the treatment algorithm that is a part of the BCLC. TACE is usually recommended as the standard treatment of BCLC-B patients, yet it is a relatively contraindicated in BCLC-C1 patients. Radioembolization with yttrium-90 (Y90) is a recently introduced liver-directed therapy, it is a is a sort of internal brachytherapy by arterially injected yttrium-90 (Y90) microspheres for the treatment of HCC. Growing data suggest that (Y90) radioembolization has a potent anticancer effect with negligible adverse events if appropriate pretreatment evaluations. It can be used in BCLC-B and BCLC-C1 in an unselective manner. In contrast to<br />TACE, the rate of adverse effects after such "unselective" application, as performed over a lobar branch of the hepatic<br />artery, is not significantly increased as compared to segmental or even subsegmental microsphere application, although the tumor response rate may vary.<br />Aim of Study: This study aims to present and discuss the efficacy and clinical outcome of Y90 radioembolization using Y90 microsphere for management of patients with intermediate and locally advanced (BCLC-B and BCLC-C1) Hepato-Cellular Carcinoma (HCC).<br />Patients and Methods: This is a prospective study carried out between June 2014 and May 2016 for patients with hepatocellular carcinoma and liver restricted disease. All patients underwent treatment by Y90 microsphere radioem-bolization (SIR-Tex). A total number of 20 patients with intermediate and locally hepatocellular carcinoma and liver restricted disease, not eligible for curative treatment.<br />Results: Assessment was done according to RECIST and mRECIST guidelines. We found good therapeutic response in patients treated with Y90 radioembolization. The complete response, partial response, stable disease and disease progres-sion rates for the study sample after 3 months using the conventional RECIST criteria was 0%, 55%, 30% and 10%, while after 6 months it became 0, 50%, 20% and 25% respec-tively.<br />Conclusion: Y90 microspheres radioembolization for patients with intermediate and advanced HCC is an effective treatment which can be utilized even in patients with compro-mised liver function.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Study of Chest Disorders in Non-Smoker Patients Complaining of Gastroesophageal Reflux Disease315731625951910.21608/mjcu.2019.59519ENTAHA A. AWAD, M.D.;ABDULLAH S. AYOUB, M.D.SAYED F. MOHAMMAD, M.D.;MAHMOUD R. EL-NAGGAR, M.B.B.Ch.The Departments of Chest Diseases* and Tropical Medicine**, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20190116Abstract<br />Background: Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis, and aspiration pneumonia. Management of GERD may help in management of these respiratory diseases.<br />Aim of Study: To study the presence of chest diseases in non-smoker patients complaining of GERD.<br />Subjects and Methods: The study was carried out on 100 patients attended to Al-Hussein and Sayed Galal Al-Azhar University Hospitals in the period from September 2017 to May 2018. Patients were categorized into two groups: Group 1: Included 100 patients complaining of heartburn, epigastric pain and respiratory symptoms confirmed to have GERD by upper GI endoscope. Group 2: Include fifty patients apparently healthy (as regard GERD symptoms) confirmed that they were not have GERD by upper GI endoscope. All patients underwent history taking, examination, routine lab investiga-tions, upper GI endoscopy, chest X-ray and spirometry. C.T. chest was done on need according to symptoms and chest X-ray finding.<br />Results: Respiratory disorders occurrence was more in GERD group than in negative group as regard GERD with statistically significant difference between the two groups in chronic laryngitis, bronchial asthma, COPD, and pneumonia, but no significant difference between the two groups wos found as regard ILD.<br />Conclusion: GERD is a considrable risk factor for the development of respiratory disorders. This study proved that pulmonary symptoms was elevated among those with frequent GERD compared to those without GERD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Has Resveratrol a Modulatory Effect on Renal Injury Associating Diabetic Nephropathy in Albino Rats?316331746489810.21608/mjcu.2019.64898ENNERMEEN B. SADEK, M.D.;MOHAMED A. ESHRА, M.D.EFFAT A. KHOWAILED, M.D.;LAILA A. RASHED, M.D.ВАSМА E.ABOULHODA, M.D.The Departments of Physiology*, Biochemistry** and Anatomy, Faculty of Medicine, Cairo University, EgyptJournal Article20190112Abstract<br />Background: The involvement of abnormally stimulated renin angiotensin system, excessive formation of reactive oxygen species, increased glucose metabolite flux and up-regulation of pro-inflammatory and profibrotic cytokines in the pathogenesis of diabetic nephropathy has become an emerging concern. Exploration of novel therapies that specif-ically target such factors is a major goal in diabetes treatment.<br />Aim of Study: Our aim is to explore the potential protective and therapeutic effect of resveratrol on DN progression through its antioxidant, anti-inflammatory and antifibrotic role in comparison with losartan as one of the therapeutic regimens used in diabetic nephropathy.<br />Material and Methods: Forty eight male albino rats were assigned into six groups; control, diabetic nephropathy, pro-phylactic losartan, prophylactic resveratrol, therapeutic losartan and therapeutic resveratrol. Systolіc blood pressure, fasting glucose, glomerular filtration rate, urea, urea albumin excretion, tumor necrosis factor a, tansforming growth factor-(3, inter-leukin-б and superoxide dismutase have been measured. Histopathological assessment of inflammation, glomeruloscle-rosis and fibrosis using hematoxylin and eosin, Masson's trichrome and Periodic acid shift staining and histomorpho-metric analysis for glomerular and tubular parameters have also been performed.<br />Results: Prophylactic resveratrol showed significant regression in inflammation, fibrosis and oxidative stress compared with its therapeutic effect.<br />Conclusion: Resveratrol showed better outcome compared with losartan with significant change in the biochemical parameters.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901A Study of the Impact of Treatment Response to Direct Acting Antivirals on Serum Lipid Profile in Egyptian Patients with Chronic HCV Infection317531806490010.21608/mjcu.2019.64900ENMARIAM N. NAGUIB, M.Sc.;ABDELRAHMAN A. KOBTAN, M.D.AMAL H. ABD ELHAMEED, M.D.;MAHMOUD A. KHEDR, M.D.The Departments of Tropical Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190112Abstract<br />Background: Hepatitis C virus infection is a major etio-logical factor for liver cirrhosis, steatosis, and hepatocellular carcinoma. HCV is known to be closely related and associated with host and lipid metabolism.<br />Aim of Study: This study aimed at studying the changes in serum lipid profile with INF-free treatment regimens in chronic HCV infection.<br />Patients and Methods: This prospective observational cohort study was carried out on 301 chronic HCV-infected patients, who had fulfilled the inclusion & exclusion criteria and treated according to the National Committee of Control of Viral Hepatitis (NCCVH) Treatment Protocol, updated in December 2016, and completed their course of treatment and follow-up. They were divided into two groups. Group I included 264 patients, who achieved SVR and Group II included 37 patients who did not achieve SVR. Patients underwent additional investigations in the form of 12h fasting serum lipids profile (mg/dl) including: Serum cholesterol, serum triglycerides, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL). These tests were done before starting treatment (baseline), at the end of treatment.<br />Results: There was a statistically significant difference between responder and non-responder groups as regard baseline cholesterol (p=0.001), LDL (p=0.001), HDL (p=0.026) and triglycerides levels (p=0.016). These lipid parameters increased significantly over the course of the therapy and continued to be increased after treatment discontinuation in responders; while they showed non-significant changes in non-responders.<br />Conclusions: Viral eradication was associated with in-creased serum cholesterol, TG & LDL levels, which continued to be elevated after discontinuation of therapy.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Association between Neutrophil to Lymphocyte Ratio and Systolic Right Ventricular Dysfunction in Patients with Acute Inferior ST- Segment Elevation Myocardial Infarction318131876490410.21608/mjcu.2019.64904ENMOHAMED S. AMER, M.Sc.;IBTESAM KHAIRAT, M.D.MOHAMED A. ABD ELAAL, M.D.;SEHAM F. BADR, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20190112Abstract<br />Background: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment Elevation Myocardial Infarction (STEMI). Acute inferior STEMI is associated with increased in-hospital morbidity and mortality particularly among patients with coexisting Right Ventricular (RV) involvement. High Neu-trophil to Lymphocyte Ratio (NLR) is an independent predictor of major adverse cardiac events and mortality in patients with myocardial infarction.<br />Aim of Study: To study the relationship between the NLR and RV Dysfunction (RVD) in patients with inferior STEMI who underwent primary Percutaneous Coronary Intervention (PCI) or received fibrinolytic therapy. RVD measured by Tricuspid Annular Plane Systolic Excursion (TAPSE) Patients and Methods: This study was conducted on sixty patients diagnosed with acute inferior STEMI and underwent primary PCI or received fibrinolytic therapy in Tanta University Hospitals, Cardiovascular Department, from December 2017 to June 2018. The cases were divided into two groups according to the presence of RVD or not. The groups were compared according to NLR and Receiver Operating Characteristic (ROC) analysis was performed to access the predictability of high NLR in patients with RVD.<br />Results: The NLR was significantly higher in the group with RVD compared to that without RVD (p=0.002). In ROC analysis, NLR >3.2 predicted RVD with sensitivity of 82.16% and specificity of 89.19%. In a multivariate regression analysis, NLR remained an independent predictor of RVD (95% C.I 0.787-0.976, p=0.002).<br />Conclusion: NLR was an independent predictor of RVD in patients with acute inferior STEMI who underwent primary PCI or received fibrinolytic therapy.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Endoscopic Surgery of Third Ventricular Lesions318931966490510.21608/mjcu.2019.64905ENAHMED A. ABDELKHALEK, M.D.;MOHAMED A. THABIT, M.D.The Department of Neurosurgery, Faculty of Medicine, Cairo UniversityJournal Article20190112Abstract<br />Background: The endoscopic surgery to third ventricular lesions are now widely used as it is less invasive than the traditional microsurgical procedures.<br />Aim of Study: To evaluate endoscopic surgery of third ventricular lesions as regards clinical improvement, compli-cation rate and extent of lesion resection.<br />Patients and Methods: Retrospectively eleven cases of third ventricular lesions (seven cases of colloid cyst, two cases of astrocytoma, one case epidermoid cyst and 1 case of arachnoid cyst) were operated upon through endoscopic route for total excision if feasible, pre-operative assessment in the form of full neurological examination and imaging (CT and MRI) were done for all patients. Incompletely removed lesions were managed by a septostomy and VP shunt, post-operatively CT was performed in the first 24 hours after surgery and another after 48 hours, MRI with contrast was done 6 months post-operatively to detect recurrence, patients with persistent post-operative hydrocephalus had VP shunt insertion.<br />Results: Complete resection was achieved in nine patients (82%), while resection was incomplete in two cases (18%). complications were in one case (9%) in the form of short memory affection improved after one month, post-operative hydrocephalus was in one patient (9%), mean length of hospital stay was three and half days, no recurrence was reported in all patients with complete resection for a follow-up period of 12 months.<br />Conclusion: Endoscopic resection of third ventricular lesions is safe, minimally invasive, technically feasible and with good outcome especially in completely removed lesions.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Corneal Endothelial Cell Changes after Photorefractive Keratectomy for Low to Moderate Myopia With and Without Mitomycin-C319732036490610.21608/mjcu.2019.64906ENKARIM A. NASSAR, M.Sc.;HESHAM A. HASBY, M.D.WALEED A. ALLAM, M.D.;ADEL A. SELIEMA, M.D.The Department of Ophthalmology, Faculty of Medicine, Tanta University, EgyptJournal Article20190112Abstract<br />Background: Mitomycin-C was suggested for application during surface ablation procedures to reduce post-operative haze formation. It can effectively reduce haze formation and hence, improve the predictability of visual outcomes following refractive surgery. Despite these advantages, MMC can po-tentially damage all three main corneal cell types including epithelial (differentiated epithelium and limbal cells), stromal (keratocytes), and endothelial cells.<br />Aim of Study: To investigate the croneal endothelial cell changes after Photorefractive Keratectomy (PRK) with and without Mitomycin-C 0.02% for low to moderate myopia.<br />Patient and Methods: This prospective, randomized, comparative study included 60 eyes of 30 patients who were chosen from Ophthalmology Clinic at Tanta University Hos-pital and Shorouk Laser Vision Correction Centre for 6 month from December 2017 to May 2018 and scheduled for Photo-refractive Keratectomy (PRK) using193nm wavelength exci-mer laser system Allegretto EX500, (Wave Light Technologie., USA). These patients were randomly divided into two groups. Group (A) were scheduled for (PRK) with adjunctive mito-mycin-C 0.02% and patients of Group (B) were scheduled for (PRK) without mitomycin-C. Informed consents were obtained from all study participants.<br />Results: In Group A the mean Endothelial Cell Density (ECD) was 2891.61±272.41 and at three months after surgery was 28 13.04±276.55cells/mm2 (p=0.289), pre-operative mean of Coefficient of Variation (CV) was 34.87±4.37 and post-operatively was 34.70±4.06 (p=0.877), the pre-operative mean of Central Corneal Thickness (CCT) was 523.00±26.14 m and 467.36±40.61 m post-operatively (p=0.001), the mean of hexagonality pre-operatively was 64.26±8.64% and 59.96± 8.15% post-operatively (p=0.059) which was statistically insignificant. In Group B the mean Endothelial Cell Density was (ECD) 2874.50±314.48 and at three months after surgery was 2777.23±302.44cells/mm2 (p=0.227), pre-operative mean of Coefficient of Variation (CV) was 33.49±4.98 and post-operatively 33.55±4.10 (p=0.962), pre-operative mean of central corneal thickness was 538.03±26.03 and 484.50±20.55 post-operatively (p=0.001), the mean of hexagonality pre-operatively was 63.00±7.74 and 61.43±7.29% post-operatively (p=0.423).<br />Conclusions: There's no significant effect on endothelium in patients underwent to PRK in low to moderate myopia with or without mitomycin-C. We can't judge the same results for patients with high myopia because the ablation depth will be more and theoretically the diffusion of mitomycin-C to en-dothelium would affect its function or count.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Glucagon Like Peptide 1| (GLP1) Analogues on Obese Egyptians With and Without Diabetes320532086561310.21608/mjcu.2019.65613ENKHALED A.ELBANA, M.D.The Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20181220Abstract<br />Background: The Glucagon Like Peptide 1 (GLP1) recep-tor agonists are a new class for treatment of both type 2 diabetes and obesity.<br />Aim of Study: To evaluate efficacy of GLP1 analogues in both weight reduction and glycemic control in obese Egyptians with and without diabetes.<br />Patients and Methods: This intervention study was con-ducted from August 2017 to August 2018. Total of 40 patients were divided into 3 groups: Obese group, obese group with diabetes & obese group with diabetes after failure to lose 10% of their initial weight after bariatric surgery. Clinical data were collected, anthropometric measures and laboratory investigation included fasting blood glucose and HbA1c in the beginning and every 3 months for a year were done.<br />Results: This study showed statistically significant body weight and BMI reduction in all groups, there was statistically significant reduction of fasting blood glucose, and HBA1c in the 2nd & 3rd group.<br />Conclusion: GLP1 analogues are effective in treatment of obese patients with and without diabetes.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparative Study between Oral Pregabalin versus Intravenous Low Dose Ketamine for Post-Operative Pain Management in Laminectomy320932176561410.21608/mjcu.2019.65614ENAHMED G. ARAKEEB, M.Sc.;ABDEL AZIZ H. EL BADAWY, M.D.HODA A.A. EZZ, M.D.;ASMAA F. AMER, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Lumbar laminectomy is accompanied with significant post-operative pain. Preemptive analgesia is effec-tive to reduce the magnitude and duration of post-operative pain.<br />Aim of Study: The aim of this study is to compare the efficacy of oral pregabalin versus IV low dose ketamine for postoperative pain management in patients undergoing elective single level lumbar laminectomy.<br />Material and Methods: This prospective double blind randomized controlled study was carried out on 105 patients of both sexes, 18-60y, American Society of Anesthesiologist I or II and scheduled for elective single level lumbar laminec-tomy under general anaesthesia. All patients are randomly allocated into 3 equal groups: Control group (received a placebo capsule orally 1h before induction of anesthesia and 5ml normal saline Intravenous (IV) before induction of an-esthesia). Pregabalin group: Received a 150mg pregabalin capsule orally 1h before induction of anesthesia and 5ml normal saline IV before induction of anesthesia and ketamine group: Received a placebo capsule orally 1h before induction of anesthesia and 0.3mg/kg ketamine in 5ml of normal saline syringe IV before induction of anesthesia. Visual Analogue Scale (VAS), Heart Rate (HR) & Mean Arterial Pressure (MAP) were recorded at 30min, 2h, 4h, 6h, 12h, 18h and 24h post-operative, the time (h) to first analgesic requirement, total dose of rescue analgesia (morphine) were recorded. Sedation scores & complications were measured.<br />Results: Our results showed no significant difference as regard to age, sex, weight & ASA physical status, but there was significant decrease in VAS. 1st analgesic requirements & total dose of rescue analgesia in pregabalin group & keta-mine group as compared to control group with (p<0.05) & pregabalin group was superior to both groups as regard sedation score.<br />Conclusion: Pre-operative administration of oral pregab-alin (1 50mg) 1h before surgery or IV ketamine at dose (0.3mg/kg) at induction in patients undergoing elective single-level lumbar laminectomy significantly decreased post-operative pain, total opioid consumption as compared with control group without significant side effects.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Cyanoacrylate Glue in Mesh Fixation in Non-Incisional Ventral Hernia321932266561510.21608/mjcu.2019.65615ENMAHMOUD K. ATLAM, M.Sc.;HOSSAM R. MOUSSA, M.D.MOHAMED A. MLEES, M.D.;AYMAN A. ELNEMR, M.D.The Department of General Surgery, Faculty of Medicine, Tanta University, EgyptJournal Article20181220Abstract<br />Background: The occurrence of post-operative chronic pain after mesh hernioplasty in nonincisional ventral hernia is especially disturbing as it is felt by 0-43% of patients, 11% on average. Post-operative pain is the consequence of tissue dissection and post-operative local inflammation. As a result, the surrounding nerves become damaged and painful stimu-lation occurs. The cyanoacrylate glue, the characteristic of histoacryl such as efficacy, excellent local tolerability, and less of adverse effects makes it an optimal choice for the atraumatic mesh fixation. It has been used in a variety of surgical fields for its effectiveness, excellent local tolerability and relative lack of adverse effects and contraindications. However, the hospital costs were increased by the use of cyanoacrylate glue instead of the sutures.<br />Aim of Study: The aim of this study is to evaluate the feasibility, efficacy of cyanoacrylate glue in mesh fixation in non-incisional ventral hernia repair as regard the operative time, the post-operative pain, the occurrence of wound seroma and recurrence rate.<br />Patients and Methods: This prospective study was carried out on 20 patients of different ages in either sex presented with nonincisional ventral hernia who were subjected to mesh hernioplasty with cyanoacrylate glue. They were followed-up for chronic pain, seroma, recurrence.<br />Results: The post-operative pain was evaluated in 1st month and at 6 months by visual analogue score, 8 out of 20 patients (40%) had mild pain and 2 out of 20 patients (10%) had moderate pain. Shrinkage of the mesh reported in 2 out of 20 patients (10%) and 5 out of 20 patients (25%) developed seroma over the mesh that resolved on conservative treatment. No recurrence of the hernia during the follow-up period by clinical examination and by abdominal ultrasound.<br />Conclusion: The mesh fixation with cyanoacrylate glue in nonincisional ventral hernia is more expensive than using sutures in mesh fixation but, it can reduce the need for analgesics and improve life style by decreasing incidence of chronic post-operative pain. We recommend performing further studies with larger population.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Prevalence and Types of Hypertensive Diseases in Pregnant Women Admitted to Department of Obstetrics and Gynecology in Tanta University Hospitals323932456561610.21608/mjcu.2019.65616ENAHMED A. ATTALLA, M.Sc.;GAMAL EL DEEN Y. EL KHOLI, M.D.TAYMOUR M. ABDALLA, M.D.;ABD EL GHAFFAR S. DAWOUD, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, EgyptJournal Article20181220Abstract<br />Background: Hypertensive disorders of pregnancy are used as an umbrella term that includes chronic and gestational hypertension, preeclampsia and eclampsia, representing a major cause of maternal and perinatal morbidity and mortality, considered to be the most common medical problem encoun-tered during pregnancy, and so this study was done to find the prevalence and types and the proper methods of treatment of each type of hypertension in pregnant women admitted to Department of Obstetrics, Tanta University Hospital.<br />Aim of Study: The aim of this study is to find the prevalence and types of hypertension in pregnant women admitted to Department of Obstetrics, Tanta University Hospital.<br />Patients and Methods: This prospective, randomized, comparative study included Seven hundred and fifty (750) pregnant women in the Department of Obstetrics and Gyne-cology in Tanta University Hospital during the period between December 2016 and December 2017. In this study, hypertensive pregnant females were categorized in to 4 major groups: Chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia and no cases of superimposed pre-eclampsia on top of chronic hypertension were encountered. Informed consents were obtained from all study participants.<br />Results: Number of patients examined in this study was 750 pregnant women, 179 were hypertensive (23.86%). Chron-ic hypertension 15 cases (8.37%), gestational hypertension 61 cases (34.07%), pre-eclampsia 90 cases (50.27%) and eclampsia 13 cases (7.26%), according to the clinical charac-teristics, the mean age was significally higher in chronic hypertensive group (40.53±5.3 years), and was significally lower in eclamptic patients (23.31±4.33 years), the highest gravidity was recorded in chronic hypertension (3.20±0). The body mass index was similar in all the studied groups. Blood pressure was highest in preeclampsia, according to methods of delivery in different studied groups, assisted and spontaneous vaginal delivery were highest in gestational hypertension (23%) and (13.1%) respectively and Caesarian section was highest in eclampsia (84.6%) and lowest in chronic hyperten-sion (60%), the gestational age of the studied groups was showing that prematurity was encountered in 61.54% of cases of eclampsia and was lowest (0%) in chronic hypertension; this was due to induction of labor, the main cause of death in this study is prematurity. The mean APGAR score in the present study was highest in chronic hypertension group (7.40 ±1.88) and lowest in eclamptic group (5.08±1.19) after one minute of delivery and after 5 minutes APGAR score was highest in pre-eclamptic (8.80±1.52) and lowest in eclamptic group (7.23±1.88). The respiratory distress syndrome, Neonatal Intensive Care Unit and neonatal mortality were highest in eclampsia group (3 8.5%, 30.8% and 23.1% respectively) and lowest in chronic hypertension group (0% in all), a comparison between 2 forms of pre-eclampsia (mild and severe) showed that all the parameters including blood pressure, hematocrit value, creatinine, uric acid levels and liver enzymes were higher in severe preeclampsia compared to the mild form. C.S was 100% in severe pre-eclampcia and 73.01% in mild pre-eclampcia, the respiratory distress syndrome, Neonatal Intensive Care Unit and neonatal mortality were significally higher in severe pre-eclampcia than mild pre-eclampcia, gestational age and birth weight were significally higher in severe pre-eclampcia than mild pre-eclampcia, Intra Uterine Growth Restrictions (I.U.G.R) were found only among the severe pre-eclampcia group (18.52%).<br />Conclusions: From this study we can reach the following conclusions:<br />1-High blood pressure complicates 23.9% of all pregnant women.<br />2-The incidence of chronic hypertension in the present study is 8.37%, gestational hypertension is 34.1%, pre-eclampsia is 50.3% and eclampsia is 7.3%.<br />3-The worst prognosis was found among the eclamptic group.<br />4-Chronic hypertension when perfectly managed doesn't develop into superimposed pre-eclampsia.<br />5-No cases of secondary chronic hypertension were encoun-tered in the study denoting that it is rare with pregnancy. The cause of secondary hypertension may compromise her fertility.<br />6-Neonatal complications were most common with pre-eclampsia and eclampsia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901CHADS2-VASC Score as a Predictor for Contrast Induced Nephropathy in Patient with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention324732556561710.21608/mjcu.2019.65617ENAHMED F. ABO EGELA, M.Sc.;MAI M. SALAMA, M.D.SUZAN B. EL HEFNAWY, M.D.;MOHAMED N. HUSSIEN, M.D.The Department of Cardiology, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Ischaemic heart disease is the single most common cause of death and its frequency is increasing. Acute ST-Elevation Myocardial Infarction (STEMI) results from the sudden obstruction of a coronary artry. Acute kidney injury is a frequent complication among patients who undergo Primary Percutaneous Intervention (PCI) shown to be associ-ated with adverse outcomes. CHADS2 and the more recent CHA2DS2-VASc are two validated scores for predicting embolic/stroke risk in patients with non-valvular Atrial Fibril-lation (AF). The CHADS2-VASC score has been reported as risk factors for CIN and adverse cardiac events.<br />Aim of the Study: The aim of this work is to evaluate CHA2DS2-VASC score as a predictor for Contrast-Induced Nephropathy (CIN) in patient with acute myocardial infarction treated with primary Percutaneous Coronary Intervention (PCI).<br />Patient and Methods: The study included 100 patients presenting to Cardiology Department, Tanta University Hos-pital, diagnosed with as first time STEMI and underwent primary PCI. CHADS2-VASC score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for all patients. Serum creatinin level and effective Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PPCI.<br />They were divided into into two groups: Group I: Those who developed CIN 48h after primary PCI (36%) and Group II: Those who did not (64%).<br />Results: Patient who developed CIN had higher CHADS2- VASC score than who did not, mean ± SD value was 3.53±1.11 vs. 0.72±0.83, p-value <0.001.<br />Conclusion: CHA2DS2-VASC score >3 was independently associated with CIN development in patients with acute STEMI who were treated by PPCI. The more CHADS2-VASC score, the more risk for developing CIN after PPCI.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Toll Like Receptor 2 Genotypes and Intra-Coronary Stent Restenosis325732606561810.21608/mjcu.2019.65618ENTAREK ABDELAZIZ, M.D.;RANDA HUSSINY, M.D.MARWA GAD, M.D.;MOHAMED GAMEL, M.Sc.The Departments of Cardiology* and Medical Biochemistry**, Faculty of Medicine, Zagazig UniversityJournal Article20180120Abstract<br />Background: Intra-coronary Stent Restenosis (ISR) is a common complication after Percutaneous Coronary Interven-tion (PCI). There is an association between many genes such as Toll Like Receptor 2 (TLR2), Adrenergic B2 Receptor (ADRB2), platelet glycoprotein IIIa, Nitric Oxide Synthase3 (NOS3), P2Y12 receptor (P2Y12), cyclin-dependent kinase inhibitor (p27kip1) and the process of intra-coronary stent restenosis. Study of the genetic polymorphisms of these genes is very important to detect which is protective against intra-coronary stent restenosis, and which is risky for development of this problem. Our study selected TLR2 gene to detect its different genotypes involved in the problem of ISR.<br />Aim of Study: To find the association between TLR2 genotypes, polymorphisms and Intra-coronary Stent Restenosis (ISR) complication after PCI procedures.<br />Patients and Methods: The study included 200 patients with previous coronary revascularization by stent implantation. All patients were re-admitted to coronary angiography because of objective evidence of myocardial ischemia. The patients were classified into two groups: Group (A) included 100 patients who developed ISR and Group (B) included 100 patients who did not develop ISR. The two groups were compared regarding distribution of TLR2 genotypes and alleles.<br />Results: 78% of patients with (GG) genotype, 14% of patients with (GA) genotype and 7% of patients with (AA) genotype developed ISR. There was no association between TLR2 (GA), (AA) genotypes and risk of ISR when compared by (GG) wild homozygous genotype (p>0.05, OR=1.2). We also did not find any association between TLR2 gene alleles and risk of ISR complication (p>0.05, OR=0.9).<br />Conclusion: There was no association between different TLR2 genotypes, alleles and risk of ISR development.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Sonographic Evaluation of the Yolk Sac and its Relationship to the Pregnancy Outcome326132666561910.21608/mjcu.2019.65619ENRASHA A. EL-SHEIKH ALI, M.Sc.;AHMED M. AWARA, M.D.EMAD M. MASHALY, M.D.;NAREMAN M. EL HAMAMY, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: The yolk sac is the first anatomical structure identified ultrasonographically within the gestational sac and acts as the primary route of exchange between the human embryo and the mother before the placental circulation is established.<br />Aim of Study: To determine whether yolk sacs with an abnormal sonographic appearance in pregnancies at 5-10 weeks gestation, are associated with adverse pregnancy out-comes or not.<br />Patients and Methods: This study included one hundred pregnant women who are between 5-10 weeks of gestation at Tanta University Hospitals. They were prospectively evaluated concerning for sonographic characteristics of the yolk sacs and perinatal outcomes.<br />Results: An abnormal yolk sac was found in 42 pregnan-cies. In pregnancies with enlarged yolk sacs, a miscarriage occurred in 71.4% of cases (5/7). The pregnancies with a yolk sac diameter ³6mm had a significantly higher risk of miscar-riage (p=0.001). Miscarriage occurred in 29.4% of pregnancies with irregular yolk sacs (5/17) and 30.8% of pregnancies with echogenic yolk sacs (4/13).<br />Conclusions: An enlarged yolk sac is strongly associated with a significantly increased risk for miscarriage. The presence of an echogenic or irregular yolk sac appears to be unrelated to adverse perinatal outcome.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Thyroid Function in Obese Adults with Non-Alcoholic Fatty Liver Disease Attending Tanta University Hospital326732756562010.21608/mjcu.2019.65620ENASMAA M. EMARA, M.S.Ch.;YASSER M. HAFEZ, M.D.HOSSAM A. HOUDIB, M.D.;LOAI M. ELAHWAL, M.D.FOUAD Kh.HARRAS, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is considered, most common cause of end stage Liver disorder needing liver transplantation worldwide. NAFLD is considered the hepatic presentation of metabolic syndrome. The associa-tion between thyroid dysfunction and NAFLD has increasingly become a focus of research.<br />Aim of Study: Evaluation of thyroid function in obese adults with non-alcoholic fatty liver disease attending at Tanta University Hospitals from July 2017 to February 2018.<br />Patients and Method: In our study patients were classified into 2 groups first included 60 obese with Non-Alcoholic Fatty Liver (NAFLD) patients, second group included 60 obese non NAFLD patients recruited from endocrinology, diabetology and metabolism outpatient clinics and inpatient wards, Internal Medicine Department at Tanta University Hospitals. Serum Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Free Tri-iodiothyronine (FT3) by ELISA, Anti thyroid peroxidase (ANTI-TPO), Anti thyroglobulin (Tg Ab) and thyroid ultrasound were done for both groups for evaluation of thyroid function in obese adults with non-alcoholic fatty liver disease attending at Tanta University Hospitals from July 2017 to February 2018.<br />Results: TSH levels showed statistically significant dif-ference being higher within obese NAFLD group p=0.001 with mean values 2.72±0.77 in obese NAFLD group, 1.93± 0.66 in obese non-NAFLD group. Also FT4 levels showed statistically significant difference lower in obese NAFLD group p=0.006 with mean values 1.08±0.22 in obese NAFLD group, 1.25±0.42 in obese non-NAFLD group. As regard FT3 levels, ANTI-TPO levels, Tg Ab levels and thyroid ultrasound characters did not show statistically significant difference between the two groups.<br />Conclusion: We concluded that there was elevation in levels of TSH within the normal range in obese NAFLD group over obese non-NAFLD group. Also FT4 results was within normal range 0.8-1.8ng/dl with lower levels in obese NAFLD group than obese non-NAFLD we still need further research on large scale.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Magnetic Resonance Imaging (MRI) in Diagnosis of Hip Joint Disability in Adults322732386565810.21608/mjcu.2019.65658ENMOHAMMED A. HAMMAD, M.Sc.;HANAN A. NAGY, M.D.DINA MOGHAZY MOHAMED, M.D.;MOHAMMED F. DAWOUD, MD.The Department of Radio-Diagnosis and Medical Imaging, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Painful hip is a common problem in absence of a known acute trauma. MRI is a method of choice in detection of different causes of hip pain causing hip joint disability in adults including osseous, chondral and soft tissue abnormalities.<br />Aim of Study: This prospective study was conducted to evaluate the role of Magnetic Resonance Imaging (MRI) in diagnosis of different causes of hip joint disability in adults.<br />Patients and Methods: This study was conducted on 42 patients (22 females and 20 males) with age ranged from 18- 68 years (mean of 41 years). All patients was subjected to plain X-ray and MRI of hip joint in different sequences, with additional post contrast (axial and coronal T1 WI) in 6 patents. Patient history, clinical examination of the diseased hip, and laboratory investigations were performed.<br />Results: According to final results: 12 patients (28.6% of 42 patients) presented clinically with hip pain but had negative plain X-ray and MRI findings, while other 30 patients of them (71.4%) their MRI diagnoses were as follows: Avascular necrosis in 10 (33.3%), transient osteoporosis in 4 (13%), osteoarthritis in 3 (10%), inflammatory arthritis in 2 (6.7%), traumatic condition in 3 (10%) and bone tumors in 8 (27%).<br />Conclusion: MRI of the hip joint is an essential imaging modality in detection of different hip joint pathologies espe-cially in patients presented clinically with hip pain but with negative conventional radiography.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Venous Sinus Thrombosis Following Repair of Compound Depressed Fractures Overlying Sinuses327732826562110.21608/mjcu.2019.65621ENAHMED A. ABD ELKHALEK, M.D.;MOHAMED A. THABIT, M.D.The Department of Neurosurgery, Faculty of Medicine, Cairo UniversityJournal Article20180120Abstract<br />Background: Traumatic dural venous sinus injury associ-ated with depressed skull fracture is one of the most dangerous complications of traumatic brain injury, because it may be complicated during repair by fatal venous bleeding or post-operatively with venous sinus thrombosis.<br />Aim of Study: In this research we will evaluate the inci-dence and management of venous sinus thrombosis following repair of cases of traumatic compound depressed skull fractures overlying venous sinuses.<br />Patients and Methods: This is a retrospective study of 40 cases of compound depressed fractures overlying dural venous sinuses, operated in the period between May 2015 to May 2016, all cases subjected to surgery for elevation of depressed skull fracture, follow-up ranged from 3 to 6 months.<br />Results: In 22 cases (55%) the bleeding was controlled by direct gelfoam compression, in 10 cases (25%) the bleeding was controlled by direct stitching of the dural tear followed by gelfoam compression, in 6 cases (15%) the bleeding was controlled by pericranium duroplasty, 2 cases (5%) bleeding was controlled by free muscle duroplasty.<br />Two cases (5%) developed complete obstruction of the venous sinus, the 2 cases were operated by pericranium duroplasty, both were early managed with anticoagulants, one of them later in the follow-up developed benign intracranial hypertension.<br />Conclusion: Venous sinus thrombosis uncommonly occur after repair of compound depressed skull fractures overlying venous sinuses, early management with anticoagulation will result in good outcome, thrombi in sinuses frequently recanalize with time due to fibrinolysis.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Ultrasound Imaging in Ankle Impingement328332886562210.21608/mjcu.2019.65622ENRANIA ZEITOUN, M.D., F.R.C.R.;LAMIAA I.A. METWALLY, M.D.MOHAMEDEL-AZAB, M.D.The Department of Diagnostic and Interventional Radiology, Faculty of Medicine* and
The Department of Diagnostic Radiology, National Cancer Institute**, Cairo University, EgyptJournal Article20181220Abstract<br />Background: Ankle impingement is a clinical condition of chronic and painful limited range of joint movement. It presents a significant clinical concern athletes and young population.<br />Aim of Study: To study the value of US in the diagnosis of soft tissue and bony ankle impingement, using combined plain radiography and MRI as a reference for diagnosis.<br />Patients and Methods: The study included 20 patients (8 male and 12 female), mean age: 35. 1 years, suspected to have ankle impingement by clinical examination. The included patients underwent US ankle examination. The diagnosis of impingement was classified according to the anatomical compartments and categorized according to the underlying impinging factor as bony or soft tissue impingement. We calculated a p-value to evaluate the role of US in diagnosis of bone and soft tissue impingement.<br />Results: Eight patients had single compartment impinge-ment and 12 patients (60%) had multi-compartments impinge-ment with a total number of 40 compartments impingement. The observed impingements were categorized into 22 soft tissue and 18 bone impingements. Ultrasound could detect 11 out of 18 bone impingements (p-value=0.011) and 21 out of 22 soft tissue impingements (p-value=0.005).<br />Conclusion: Ultrasound is a helpful diagnostic tool in cases of bone and soft tissue ankle impingement.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Combined Diagnostic Value of Both CT and MRI in Pre-Operative Evaluation of Cochlear Implant Patients328932966562310.21608/mjcu.2019.65623ENAYA M. ADLY GABR, M.Sc.;MOHAMMED M. DAWOUD, M.D.MOHAMAD H.A. HAMAD, M.D.;MOHAMAD F. SHERIF, M.D.The Departments of Radio-Diagnosis & Medical Imaging* and Otorhinolaryngology**, Faculty of Medicine, Tanta UniversityJournal Article20180120Abstract<br />Background: Cochlear implantation is considered an acceptable treatment for severe to profound sensorineural hearing loss with normal cochlea and cochlear nerve. CT is the best modality for evaluation of bony labyrinth and MRI is the best modality to evaluate membranous labyrinth so combined CT and MRI is mandatory for preoperative evalu-ation for cochlear implantation, radiologist should be familial with absolute and relative contraindication of cochlear im-plantation.<br />Aim of Study: The aim of this study is to evaluate the role of HRCT and MRI in pre-operative assessment of cochlear implantation candidates.<br />Patients and Methods: Our study included 60 patients (120 ears) 39 of them were males while 21 were females. The age of our selected patents ranged from 2 to 60 years with a mean of 15.8 years most of them were in pediatric age group 2-10 years representing 60%. The present study included patients with bilateral profound sensory neural hearing loss, minimum age of eligibility is 1 year, both sexes will be included. We excluded pediatric age group >1 year. All patients were subjected to the clinical evaluation. Computed Tomog-raphy (CT), all CT studies (60 figs) were obtained using a 320-row multidetector CT scanner (Aquilion One Toshiba Medical Systems, Otawara, Japan) installed in Tanta University Educational Hospital.Magnetic Resonance Imaging (MRI), all MRI studies (60 figs) were obtained using a closed MRI machine (General Electric SIGNA) HS (high speed) with magnets of intensity field 1.5T.<br />Results: Combined HRCT and MRI revealed a normal appearance of the labyrinth and internal auditory canal in 44 (88 ears) patients (73%). In 16 (32 ears) patients (26%) had abnormalities of the labyrinth; 10 patients (16%) of them had congenital anomalies and 6 patients (10%) had acquired Sensoneural Hearing Loss (SNHL). Ten patients (16%) had congenital abnormalities of inner ear bilaterally; absent cochlea (n=3) represented 5%, IP type I (n=2) represented 3%, IP type II (n=4) represented 6%, common cavity (n=1) represent about 2%, absent vestibule (n=3) represented 5%, dilated vestibule (n=6) represented 10%, dilated vestibular aqueduct (n=5) represented 8% and dysplastic semicircular canals (n=4) represented 7%. The cochlear nerve was normal in 57 figs (95%), while two patients (3%) had absent nerve, and one patient (2%) presented with atrophied cochlear nerve. Nar-rowed internal auditory canal (n=3) represented 5%. Six patients (10%) had acquired sensoneural hearing loss after meningitis, labyrinthitis, otitis media, trauma and sequalae of old age. Calcifications within the cochlea and in the semicircular canals caused by labyrinthitis ossificans (n=3) represented 5% and otosclerosis (n=1) represented about 2%. In current study, we found 4 ears with narrow IAC and absent vestibulocochlear nerve, 2 ears with narrowed IAC and atro-phied small sized vestibulocochlear nerve. In all of them the assessment of VCN were done using 3D MRI.<br />Conclusion: Combined HRCT and MRI studies are man-datory for evaluation of inner ear, the radiologist must be familiar with imaging findings that absolutely contraindicate implantation (Cochlear aplasia, cochlear nerve aplasia and labyrinthine aplasia), and with those that relatively contrain-dicate implantation (labyrinthitis ossificans, other inner ear dysplasia) and with other findings that could significantly alter or complicate surgery (hypoplastic mastoid process, facial nerve dehiscence, oto-mastoiditis).The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Plasma C-Terminal Agrin Fragment (CAF) as an Early Marker for Kidney Function in Patients with Chronic Kidney Disease329733056562410.21608/mjcu.2019.65624ENNARDIN S. SOLIMAN, M.Sc.;GEHAN F. ATTIA, M.D.SHERIF E. EZAT, M.D.;MAHA M. HAGRAS, M.D.The Departments of Clinical Pathology* and Internal Medicine**, Faculty of Medicine, Tanta UniversityJournal Article20180120Abstract<br />Background: CKD is defined by the presence of renal damage or impaired renal function for three or more months, irrespective of the cause. The presence of the damage or impaired function for at least three months is important to distinguish CKD from AKI. C-terminal Agrin Fragment (CAF) was found in the basement membrane of the kidney and cleared from circulation by glomerular filtration.<br />Aim of Study: To evaluate plasma level of C-terminal agrin fragment as an early detector of renal function impairment in patients with chronic kidney disease.<br />Methods: The study was carried on two groups Group (I): 20 healthy persons as a control group and Group (II): 60 CKD patients. Patients were selected from Internal Medicine Department, Tanta University Hospital. We excluded patients suffered from inflammatory, autoimmune, infectious disorders and malignant diseases, also patients with acute underlying illness were excluded from the study. Informed consents were taken from all participants and the privacy of the data were greatly considered. Complete clinical examination including: Body Mass Index (BMI) calculation and routine laboratory investigations including Complete Blood Count (CBC), blood urea, serum creatinine, eGFR, 24h proteinuria, sodium and potassium, CRP and specific investigation: Plasma level of C-terminal Agrin Fragment (CAF) measurements by ELISA technique was done.<br />Results: Plasma CAF showed statistical significance increase in patients group than control healthy groups (p<.001) with gradual increase in its level in progressive CKD stages. There was significant positive correlation between plasma CAF, serum creatinine and blood urea (p<.001) while there was significant negative correlation between plasma CAF and eGFR (p<.001). There was significant increase in CAF in early stage 1 CKD group compared to control group (p<.001). Plasma CAF wasn't affected by age, sex and muscle mass in contrast to creatinine which was affected by them.<br />Conclusion: The results of this study showed that plasma CAF was increasing with the progression of CKD stages and it was more sensitive and specific than serum creatinine, blood urea and eGFR in estimation of staging CKD. Plasma CAF also can differentiate between healthy individuals and stage 1 CKD patients, so measurement of plasma level of CAF may represent a promising bio-marker of early kidney damage detection and progression to ESKD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Multidetector Computed Tomography with Three Dimension Reconstruction in Evaluation of Pelvic Fractures.330733146562510.21608/mjcu.2019.65625ENAHMAD A. ABD EL GALEEL, M.Sc.;MOHAMMAD F. DAWOOD, M.D.ALY A. EL BARBARY, M.D.;MOHAMMAD M. EL ASHWAH, M.D.Journal Article20180120Abstract<br />Background: Pelvic fracture is a serious injury that may be associated with high morbidity and mortality. MDCT is more frequently used for accurate evaluation of pelvic fractures.<br />Aim of Study: The aim of this work is to evaluate the role of multidetector CT with three dimension reconstruction in diagnosis of pelvic fractures.<br />Patients and Methods: This prospective study included 70 patients who presented with pelvic fractures and referred from outpatient clinics of Orthopedic Department to the Radiology and Medical Imaging Department, Tanta University Hospital. The present study was performed in the period between February 2018 and March 2019. Their ages ranged from 4 to 82 years; 45 of them were males and 25 were females. All cases underwent multidetector computed tomog-raphy as a rapid, noninvasive diagnostic tool, and the findings were compared with those of plain X-ray.<br />Results: According to our results patients with partial stable pelvic ring fractures (Tile type B) had higher incidence than stable fractures (54.28%), followed by stable Tile A fractures (28.57%). Young Burgess lateral compression frac-tures had significantly higher incidence (68.57%) especially Young Burgess subtype LC1 (54.28%). All sacral fractures were associated with pelvic ring fratures, Denis zone I was the most common (54.28%). The elementary Judet-Letournel acetabular fractures were the most common (58.82%) espe-cially type posterior wall (20.58%). Hip dislocations and femur head fractures were rare, represented only by 4 cases for each. The most common hip dislocation type was the posterior dislocation represented only by 2 cases (50%).<br />Conclusion: MDCT with 3D has numerous advantages and accurate in diagnosis of pelvic fratures.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Association between Serum Lipoxin A4 Level and Lupus Nephritis331533246562610.21608/mjcu.2019.65626ENHANAN A. TAHA, M.D.;MAHMOUD FARID, M.D.MOHAMED A. ELFIKI, M.D.;KHALED S. MOHAMED, M.D.AYMAN S. SOLIMAN, M.D.;HANAN M. FARHAN, M.D.The Departments of Internal Medicine*, Physiology** and Clinical Pathology***, Faculty of Medicine, Beni-Suef University, EgyptJournal Article20180120Abstract<br />Background: Systemic Lupus Erythematosus (SLE) is an autoimmune connective tissue disorder with a wide range of clinical features, which predominantly affects females. Glomer-ulonephritis (GN) is a major determinant of the course and prognosis of SLE and is clinically evident in 40-83% of patients. Lupus Nephritis (LN) affects from one-third to one-half of lupus patients and accounts for significant morbidity and mortality. Lipoxins are produced locally at sites of in-flammation by transcellular routes. Lipoxin biosynthesis has been described in many human and experimental diseases associated with cell contact, including glomerulonephritis, asthma, and rheumatoid arthritis. Yet, there is no gold standard for assessment of lupus nephritis up till now.<br />Aim of Study: The aim of this study is to assess the level of serum lipoxin A4 as a diagnostic biomarker in cases of SLE complicated with lupus nephritis and to evaluate its relation to pathogenesis of lupus nephritis and renal disease activity.<br />Patients and Methods: This study was conducted on fifty Egyptian patients with Lupus Nephritis (LN) and 10 healthy subjects as a control. Disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and renal SLEDAI. Complete blood picture (CBC), ESR, Anti deoxyribonucleic acid (Anti-dsDNA) antibodies, Antinuclear Antibodies (ANA), quantitative determination of serum complements levels (C3, C4), complete urine analysis, 24 hours urinary proteins, serum creatinine, blood urea and Serum Lipoxin A4 (LXA4) level by (ELISA) were done for all samples of the study groups. Renal biopsy, microscopic examination and pathological classification was performed for all patients.<br />Results: SLE patients with lupus nephritis showed a lower median level of serum LXA4 compared with the control group (7.7 Vs. 25.8ng/ml), with highly significant statistical differ-ence (p<0.001). Total SLEDAI and the renal SLEDAI, also were correlated with lipoxin A4 level and showed no significant statistical correlation. No correlation was found between serum lipoxin A4 and, age, sex, disease duration, anti-dsDNA, C3 and C4, ESR, 24 urinary proteins, ANA and CBC param-eters. The levels of serum lipoxin A4 did not show significant statistical difference among all SLE patients and the drug history.<br />Conclusion: Serum LXA4 deficiency could be used as a noninvasive diagnostic biomarker for renal involvement in SLE patients.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Reoperative Urethroplasty after Failed Hypospadias Repair332533326562710.21608/mjcu.2019.65627ENMOHAMMED A. ZEDAN, M.Sc.;TAREK A. GAMEEL, M.D.MOHAMMED A. GHALWASH, M.D.;OSAMA M. EL-GAMAL, M.D.The Department of Urology, Faculty of Medicine, Tanta University, EgyptJournal Article20180120Abstract<br />Background: Reported reoperation rates after primary hypospadias repair can exceed 50%. Failed hypospadias occurs when the primary surgery does not achieve the cosmetic and functional goals of a straight penis with glanular meatus that enables normal urinary and sexual function. Treatment of patients with failed hypospadias repair can be a challenging task in the majority of cases and the selection of the most appropriate technique for this repair is the corner stone for success in these cases.<br />Aim of Study: Is to evaluate the results and success rate of some common techniques for redo urethroplasty in cases with failed hypospadias repair.<br />Patients and Methods: The study included forty two patients with recurrent hypospadias and their ages ranged from 2-15 years. The final position of the external urethral meatus after release of chordee, was subcoronal (13 cases), distal penile (13 cases), mid-penile (13 cases) and penoscrotal (3 cases). TIP technique was applied in 12 cases, Mathieu technique in 10 cases, transverse dorsal preputial onlay flap in 10 cases and two-stage repair with buccal mucosa graft in 10 cases. The operative technique was selected according to the status of the urethral plate and the nearby penile skin.<br />Results: Our overall results showed that 24 patients (57.14%) had successful repair while failed repair was reported in 8 patients (19.04%). Minor complications were also reported in 10 cases (23.80%) which included urethrocutaneous fistula, meatal stenosis and urethral diverticulum. The success rates of TIP, Mathieu, transverse dorsal preputial onlay flap and the two-stage repair were 58.33%, 50%, 50% and 70% respec-tively.<br />Conclusion: TIP urethroplasty is an effective technique for redo hypospadias repair if the patient has a non-scarred and wide urethral plate. Similar results can also be achieved by Mathieu's repair or transverse onlay flap in patients with narrow and non-scarred urethral plate. However, patient with scarred unhealthy urethral plate should have a two stage repair with buccal mucosa graft.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Extra-Periosteal Plate Fixation of Ankle Fractures333333396562810.21608/mjcu.2019.65628ENHOSSAM A. ELSOUDANY, M.Sc.;ELSAYED M. ELFORS, M.D.WALID MOHAMED EWIS, M.D.;EMAD ABDEL-FATTAH ELMEHY, M.D.The Department of Orthopedic, Faculty of Medicine, Tanta UniversityJournal Article20180120Abstract<br />Background: Open reduction and internal fixation with plate and screws is the standard operative treatment for displaced or unstable malleolar fractures, as it allows for a stable mechanical environment for healing. However, extensive surgical dissection can lead to devitalization of the fracture fragments and their soft tissue attachments, resulting in delayed union, non-union, and infection. Hence, a balance is necessary between anatomic reduction and soft tissue devitalization.<br />Aim of Study: Was to evaluate the results of extra-periosteal plate fixation in ankle fractures.<br />Patients and Methods: This study was done on 21 patients with closed ankle fractures who were admitted to Department of Orthopaedics, Tanta University Hospitals. The distribution of patients was according to age, sex, side, mode of trauma, lauge hansen classification type of fracture, medical history, smoking, time lag and associated injuries. Fixation was done by extra-periosteal plating technique. Clinical evaluation was according to Baird and Jackson scoring system. Results: There were significant statistical correlation between the time of union and mode of trauma, associated injuries, associated medical condition and Time lag.<br />Conclusion: Extra-periosteal plating of ankle fractures is an effective method of stabilization that leads to predictable union of the fibular fracture. The results of this procedure are at least as good as those of other techniques of open reduction and internal fixation of the ankle.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Acute Type A Aortic Dissection: Pre-Operative Clinical and Radiological Predictors of Outcome334133466562910.21608/mjcu.2019.65629ENAHMEDELSHARKAWY, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo UniversityJournal Article20180120Abstract<br />Background: Acute type A aortic dissection is a surgical emergency associated with high morbidity and mortality and is still a surgical challenge. The aim of our work is to evaluate the impact of pre-operative clinical status of different malp-erfusion symptoms (according to Penn classification) and radiological findings on surgical outcome of acute type A dissection patients.<br />Aim of Study: Is to report our experience in surgical management of acute type A dissection patients and to deter-mine the impact of pre-operative ischaemia (by Penn class) on post-operative outcome.<br />Patients and Methods: Between January 2012 and De-cember 2014, 30 patients (23 males, 7 females) with acute type A aortic dissection were operated upon at Kasr Al-Aini Cardiac Surgery Unit, Cairo University. All patients presented with severe chest pain and pulse deficit. Their age ranged from 30 to 70 years. 2 patients had bicuspid aortic valve and 8 patients had Marfan syndrome. 3 patients had acute lower limb ischemia, 6 had renal malperfusion and 4 had massive pericardial effusion. All patients had pre-operative multislice CT aortography with 4 patients showing extensive arch tears and 4 patients had dissected coronary arteries on multislice CT of the coronaries. 13 patients had supracoronary conduit replacement of ascending aorta, 13 had modified Bentall operation, and 4 had valve-sparing (David) operation. All patients had circulatory arrest at moderate hypothermia and cerebral protection for open repair of the dissected aortic arch.<br />Results: The mean cross clamp time was 145±25minutes, and total circulatory arrest time was 25±10 minutes. Patients with pre-operative malperfusion had more prolonged and complicated post-operative stay. There was 5 (17%) post-operative mortality: 1 due to massive bleeding, 2 due to prolonged ventilation following stroke, 1 due to hepato-renal failure and 1 due to myocardial failure.<br />Conclusion: Surgical treatment of acute type A aortic dissection is challenging and requires a well-planned strategy to get optimum outcome.<br />Dissection patients with malperfusion syndromes, circum-ferential arch tears, and dissected coronaries carry higher risk of mortality.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Anterolateral Ligament Tear in Acute Anterior Cruciate Ligament Rupture: Diagnostic Accuracy of MRI334733526563010.21608/mjcu.2019.65630ENABDELMONEM M.MOURAD, M.D.The Department of Radiodiagnosis, Saudi German Hospital, Riyadh, Saudi Arabia and The Department of Radiology, Faculty of Medicine, Assiut University, EgyptJournal Article20180120Abstract<br />Background: The anterolateral ligament is a special ligamentous structure traversing the knee joint along its anterolateral part, originating from the lateral femoral epi-condyle, with an oblique course through the joint capsule to be inserted at the anterolateral tibial surface just posterior to Gerdy's tubercle. Evaluation of anterolateral ligament has been done by MRI. The rate of its visualization is by MRI is varying from 50 to 100%. There is a significant increase in the incidence of association between the anterolateral ligament and ACL lesions as detected by MRI.<br />Aim of Study: The present study was aimed to give a comprehensive evaluatation for the ability of MRI to diagnose anterolateral ligaments injuries in patients with acute tears of the anterior cruciate ligaments.<br />Material and Methods: A retrospective study on ninety six patients underwent ACL reconstruction was done. The MRI knee studies of those patients were done within two months after the initial injury and the anterolateral ligament pattern was evaluated; either non-detectable, normal or path-ological. Two expert musculoskeletal radiologists evaluated the images.<br />Results: The present study revealed that 20 (21%) cases of the 96 ACL injured cases, Anterolateral Ligament (ALL) could not be detected (21 %), while 76 (79%) could be detected with MRIs. Twenty cases of the visualized ALLs were seen intact (26%), on the other hand, 56 knees (74%) showed imaging abnormalities. The site of injury of the ALL was involving mainly the distal segment (tibial part) in 34 cases (61%), the proximal segment (femoral part) was less common in 14 cases (25%) and both parts were injured in 8 cases (14%).<br />Conclusion: Anterolateral Ligament (ALL) are commonly associated with acutely ruptured Anterior Cruciate Ligament (ACL). Therefore, MRI findings together with clinical corre-lations are still essential factors in the surgical decision reconstruction of ALL avoiding unsatisfactory results post ACL reconstruction alone.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Role of Magnetic Resonance Spectroscopic Imaging in Recategorization of BIRADS 4 Breast Lesions335333646563110.21608/mjcu.2019.65631ENDALIA BAYOUMI, M.D.;MONA ZAKY, M.D.AHMED ABDALLAH, M.D.;DINA ABDALLAH IBRAHIM, M.D.The Departments of Radio-Diagnosis*, Surgical Oncology** and Pathology***, Faculty of Medicine, Mansoura UniversityJournal Article20180120Abstract<br />Background: Breast cancer is one of the major causes of death among females, its early diagnosis allow better prognosis and prolonged survival rates of the patients. Post contrast dynamic MRI is the most sensitive method for breast cancer detection which has also good diagnostic performance for evaluation of different breast pathological lesions. Magnetic Resonance (MR) spectroscopy is a functional MRI technique which is used to study the metabolic profile of different breast lesions to improve the diagnostic accuracy of MRI especially in BIRADS 4 breast lesions in order to reduce the unnecessary biopsies.<br />Aim of Study: Evaluation of the role of multi-voxel MR spectroscopy in the recategorization of BIRADS 4 breast lesions when combined with Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI).<br />Material and Methods: This study included 63 patients, their ages ranged from 28 to 73 years old with mean age 46.7 years old. All the patients included in this study were subjected to history, clinical examination, MRI examination and his-topathology. Initially the included breast lesions were catego-rized as BIRADS 4 by conventional post contrast dynamic MRI techniques, and then we added the results of the magnetic resonance spectroscopic imaging to detect whether the spec-troscopic data can improve the diagnostic accuracy of the MRI study. Finally the reported diagnosis was confirmed by histopathological specimens obtained after excision biopsy and core needle biopsy. We used 1.5 T MRI system and the sequences performed included T1 & T2 pulse sequences, STIR and dynamic contrast enhanced MRI followed by MRS for the suspected lesions. For statistical analysis we used T-test and ROC curve.<br />Results: This study included 63 female patients, their ages ranged from 28 to 73 years old with mean age 46.7 years old. All the breast lesion were categorized as BI-RADS 4 breast lesions based on the Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) then after magnetic resonance spectroscopy the breast lesions were re-categorized into BIRADS 3, 4 and 5 categories. Finally the results were compared to the histopathological results. The most common clinical presentation is palpable mass. We had 33 pathologically proven benign lesions and 30 pathologically proven malignant lesions. The diagnosis was downgraded into BIRADS 3 in 29 cases and upgraded into BIRADS 5 in 28 cases and in 6 cases there was no change in the BIRADS 4 categorization after MRS. During MRS examination the choline resonance peak was detected at a frequency of 3.23ppm, and the choline SNR was measured at cut off value of 2. There were statistically significant differences between malignant and benign breast lesions, the choline SNR measured 6.31±0.99 (mean ± SD) in the malignant lesions and it measured 1.902±0.47 (mean ± SD) in the benign lesions. The sensitivity, specificity, PPV, NPV and accuracy measured 81.3%, 62.6%, 76.5%, 67.1% and 73.4% for the DCE-MRI and measured 87.9%, 89.1%, 85.2%, 88.9% and 94.8% for combined assessment by MRS and DCE-MRI.<br />Conclusion: Magnetic resonance spectroscopic imaging can be problem solving method for BIRADS 4 breast lesions when combined with dynamic contrast enhanced MRI to improve its diagnostic accuracy.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Luteolin Attenuates Dexamethasone-Induced Skeletal Muscle Atrophy in Male Albino Rats336533746563210.21608/mjcu.2019.65632ENNADIA HAWILA, M.Sc.;SABEHA HEDYA, M.D.MAALY ABD ELMAABOUD, M.D.;AMANY ABDIN, M.D.The Department of Pharmacology, Faculty of Medicine, Tanta University, EgyptJournal Article20180120Abstract<br />Background: Glucocorticoid-induced skeletal muscle atrophy is the most common type of drug-induced myopathy.<br />Aim of Study: This study was designated to investigate the effect of luteolin (Lut) on dexamethasone (Dex)-induced skeletal muscle atrophy in rats and the possible mechanisms of this effect.<br />Material and Methods: Forty male Wistar rats divided into; control group, Dex group, and 3 other groups that were treated by Lut 25mg, 50mg and 100mg/kg/day; respectively for 14 days concomitantly with Dex. Body mass and muscle strength were recorded. Serum creatine kinase (CK) activity was assessed. Gastrocnemius muscle was weighed and proc-essed for assay of tissue reduced glutathione (GSH), malond-ialdehyde (MDA) levels. Histopathological and immunohis-tochemical studies were carried out.<br />Results: Lut dose-dependently increased GSH, and cross-sectional area (CSA), and decreased MDA and caspases-3 immunoreactivity. Lut in a dose 50mg/kg/day improved the muscle mass and strength.<br />Conclusion: This study demonstrates that luteolin is a protective agent against glucocorticoid-induced atrophy through antioxidant and anti-apoptotic properties.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparison between Induction of Labor and Expectant Management in Post-Date Pregnancy337533806563310.21608/mjcu.2019.65633ENMOHAMMED A. MOHAMMED, M.Sc.;FARID I. HASSAN, M.D.WAEL S. TAHA, M.D.;RAGHDAA M. ALI, M.D.The Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University* and The Department of Neonatology, Ahmed Maher Teaching Hospital, GOTHI**Journal Article20180120Abstract<br />Background: Post-date pregnancy is associated with increased perinatal morbidity and mortality. Therefore post-date pregnancy is considered as a high-risk condition which requires specialist surveillance and induction of labor at some stage. The aim of this work is to evaluate if a policy of induction of labor at 41 GW is superior, in terms of neonatal and maternal outcomes, as compared to expectant management in healthy women with a low risk singleton pregnancy.<br />Aim of Study: The aim with this study is to evaluate if a policy of induction of labor at 41 GW is superior, in terms of neonatal and maternal outcomes, as compared to expectant management in healthy women with a low risk singleton pregnancy.<br />Patients and Methods: A prospective case control study A total number of 100 pregnant women will be included in the study divided into 2 groups: Group (1): Consists of 50 pregnant women who undergo induction of labor at 41 + 0 or 41 + 1 weeks. Group (2): Consists of 50 women who undergo expectant management await spontaneous onset of labor until 42 weeks.<br />Results: This study shows that Meconium Aspiration Syndrome (MAS) was significantly associated with expectant group as 14% of this group had it in their children while only 2% in the induction group, also shows that there are no significant difference between the two groups regarding other perinatal outcomes also shows that rate of CS was significantly associated with induction group 34% while the rate of CS in expectant group only 16%, also the rate of using analgesia was significantly associated with induction group 44% while only 22% in expectant group.<br />Conclusion: Labor induction at 41 completed weeks should be offered to low risk women. The message from this review is that such a policy is associated with fewer deaths although the absolute risk is small. However, this policy may increase the rate of CS or need of analgesia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Microsurgical Treatment of Parasagittal Meningiomas: Trying to Define the Prognostic Factors for Early Post-Operative Outcome at Benha Neurosurgery Department338133856563410.21608/mjcu.2019.65634ENMOATAZ A. ELAWADY, M.D.;MOHAMED E. ELHAWARY, M.D.The Department of Neurosurgery, Faculty of Medicine, Benha UniversityJournal Article20180120Abstract<br />Background: Maximizing the removal of parasagittal meningiomas and reducing the incidence of surgical compli-cations and tumor recurrence rates have always been the goal for neurosurgeons.<br />Aim of Study: We aim at trying to define the pre-operative and operative prognostic factors for early post-operative outcome at Benha Neurosurgery Department.<br />Patients and Methods: A number of 26 cases, 16 females and 10 males with age ranging between 35 and 65 years have parasagittal meningiomas operated between 2010 and 2018 at the Benha Neurosurgery Department and were retrospec-tively reviewed.<br />Results: Nine patients (34.6%) showed deteriorated motor function. Seven of them (26.9%) also showed deteriorated conscious level.<br />Conclusions: The following factors are associated with good early post-operative outcome: Middle age, no pre-operative peritumoral edema and grade I or II resection.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Human Platelet Alloantigens (HPA-3) Polymorphism in Sickle Cell Disease Patients with Vaso-Occlusive Crisis338733926563510.21608/mjcu.2019.65635ENIMAN R. EL-MAHGOUB, M.D.;AZZA A. ALI, M.D.AMIRA S.A. FARHAN, M.Sc.;MONA K. EL-GHAMRAWY, M.D.HEBATULLLA FAROUK, M.D.;SOHA ATEF, M.D.GEHAN H. SHAHIN, M.D.;RANIA SOLIMAN, M.Sc.The Department of Clinical & Chemical Pathology, Faculty of Medicine Cairo University*, National Research Centre** and Pediatric Department, Faculty of Medicine Cairo University***Journal Article20180120Abstract<br />Background: Vaso-occlusive crisis (VOC) is a significant cause of morbidity and mortality in sickle cell disease (SCD) patients. As polymorphisms in human platelet antigens (HPA) exhibit a prothrombotic nature, we hypothesized that specific HPA polymorphisms could have a role in the pathogenesis of VOC in SCD.<br />Aim of Study: This study investigated HPA-3 T2622G among Egyptian SCD patients.<br />Patients and Methods: This study included 100 SCD patients and 50 controls. Patients were divided into, VOC group (n=60), and steady-state group (n=40). Genotyping was done using PCR-based Restriction Fragment Length Polymor-phism (RFLP) technique.<br />Results: The HPA-3 mutant genotypes were significantly associated with SCD compared to controls (p=0.001), while no significant difference was observed between VOC and steady-state groups (p=0.169). Regarding the frequency of VOC episodes, the HPA-3 homozygous mutant genotypes showed significant differences (p=0.001). The HPA-3 mutant genotypes were significantly correlated with generalized type of VOC (p=0.006) and need for hospitalization (p=0.003). Regarding VOC complications, the HPA-3b/3b genotype was significantly associated with acute chest syndrome (p=0.008) and stroke (p=0.012).<br />Conclusion: The HPA-3 T2622G is common among SCD patients. Although it is not a major determinant of vasculo-cclusion in SCD, it is significantly associated with VOC complications and may alter their outcome.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Intra-Arterial Chemotherapy in the Manegment of Advanced Retinoblastoma; Group D & E339334006563610.21608/mjcu.2019.65636ENGEORGE YASSA, M.Sc.;FAROUK HASSAN, M.D.AYMAN ZAKARIA, M.D.;AMR A. NASSEF, M.D.The Department of Interventional and Diagnostic Radiology, Faculty of Medicine, Cairo UniversityJournal Article20180120Abstract<br />Background: The treatment modalities for managing retinoblastoma have evolved in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stages D and E that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation.<br />Aim of the Study: To evaluate the effectiveness and com-plications of intra-arterial chemotherapy (IAC) for treating advanced refractory group D and E retinoblastoma (RB).<br />Material and Methods: 30 intro-ocular advanced refractory retinoblastoma of 26 consecutive patients who received IAC were included in the study during the period between Novem-ber 2013 and January 2017. These patients failed to respond adequately to a standard systemic chemotherapy (i.e., carbo-platin, vincristine, and etoposide) with or without local therapy. Clinical outcomes and complications of these patients were reviewed.<br />Results: All our patients received IAC with injection of melphalan. The mean follow-up period was 14.2 months after final IAC (ranged from 6 to 20 months). The rate of overall globe salvage was 95% in Group D and 30% in Group E of this study. Short-term ocular adverse events included eyelid edema (n=15, 50%), bulbar conjunctiva congestion (n=7, 23.3%), mild ptosis (n=5, 16.7%) and long-term complications included ophthalmic artery spasm with reperfusion (n=2, 6.7%) retinal atrophy (n=1, 3.3%). Fever was observed after IAC in 10 patients and transient vomiting was observed in 16 patients.<br />Conclusion: IAC can be an evolving optional treatment to save Group D RB that failed in systemic chemotherapy and were destined for enucleation. However, it should be cautioned for Group E. Both the ocular and systemic toxicities of IAC were within tolerance.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Carotid Artery Doppler Ultrasound and Coronary Calcium Score in Assessment of Atherosclerosis in Patients with Suspected Coronary Artery Disease340134166563710.21608/mjcu.2019.65637ENAMINA A. ELBEHERY, M.Sc.;MANAL E. BADAWY, M.D.NOHA M. ABD EL MAEBOD, M.D.;IBRAHIM A. NASSAR, M.D.The Department of Radio-Diagnosis & Medical Imaging, Faculty of Medicine, Tanta UniversityJournal Article20180120Abstract<br />Background: Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality in both industrialized and low income to middle-income countries. As atherosclerosis is the underlying cause for most of CAD, so identification of subclinical disease in the asymptomatic phase has emerged as a public health and economic imperative.<br />Aim of Study: The aim of the study was to evaluate the ability of carotid artery Doppler ultrasound and coronary artery calcium score as screening tools for atherosclerosis in patients who underwent CT coronary angiography for suspect-ed coronary artery disease.<br />Patients and Methods: This study was conducted on 30 patients (17 males and 13 females) with mean age of 58 years with atypical chest pain underwent Cardiac CT (CCT) and carotid Ultrasound (US) on the same day. Carotid artery atherosclerosis was evaluated by detection of Carotid Intimal Thickness (CIMT) & Carotid Plaque Score (CPS) then coro-nary arteries were evaluated by CCT. Coronary artery calcium score was obtained from axial non contrast cardiac CT and finally Coronary Artery Disease (CAD) was evaluated by Gensini score. The relation between both carotid artery Doppler findings & CACS and severity of coronary artery disease were detected.<br />Results: There were significant association between carotid artery disease that was estimated by CIMT, CPS and Gensini score (p=0.045 & 0.004). There was also a significant associ-ation between CACS and Gensini score (p=0.039).<br />Conclusion: Subclinical atherosclerosis as defined by CIMT, CPS and CACs can be simple, non-invasive yet sensi-tive risk-prediction tools to promptly identify those individuals at risk of CVD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Outcomes of Unstable Trochanteric Fractures Treated with Short Proximal Femoral Nail341734256563810.21608/mjcu.2019.65638ENABDEL RAHMAN S. HAROUN, M.Sc.;MOHAMED O. RAMADAN, M.D.OSAMA A. SELEEM, M.D.;OSAMA A. AMIN, M.D.The Department of Orthopedic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20180120Abstract<br />Background: Hip fractures are considered one of the major health problems in aging populations. These fractures are associated with increased disability and mortality and decreased quality of life. Nowadays, most hip fractures are treated by extramedullary or intramedullary implants, which allow a stable fixation in the majority of cases.<br />Aim of Study: Is to evaluate clinical, radiological and functional outcomes of short proximal femoral nail in treatment of unstable trochanteric femoral fractures.<br />Patients and Methods: 21 patients with unstable trochanter-ic fractures underwent fixation with proximal femoral nail, assessment was done using Harris hip score.<br />Results: 15 patients achieved satisfactory results (seven excellent-eight good), four cases had fair outcome and two cases had poor outcome, one case had deep wound infection that led to backing out of screws and fixation failure.<br />Conclusion: The proximal femoral nail provides a stable construct for fixation of unstable trochanteric fractures that allows early post-operative weight bearing with minimal incidence of implant related failures.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Fixation of Middle Third Humeral Shaft Fractures by Anteromedial Plate Through Anterolateral Approach342734346563910.21608/mjcu.2019.65639ENMOHAMMED A. REZK, M.Sc.;AYMAN E. KHALIL, M.D.ASHRAF A. MAHMOUD, M.D.;MOHAMMED A. ROMEIH, M.D.The Department of Orthopaedic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in antero-medial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.<br />Aim of Study: The aim of this study is evaluation of results of fixation of middle third of humeral shaft fractures by anteromedial plate osteosynthesis through an anterolateral approach.<br />Patients and Methods: In this prospective study, 21 cases with middle third humeral shaft fractures were treated with anteromedial plate through anterolateral approach. Clinical and radiological data were analyzed.<br />Results: These cases were assessed according to Murphy scoring systems for middle third humerus fracture the clinical results were graded as excellent in 14 patients (66.6%), good in4 patients (19%), fair in 3 patients (14.3%) & poor in no patients (0%). The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 18 patients (85.7%), and the unsatisfactory results were found in 3 patients (14.3%).<br />Conclusion: This study proves that anteromedial plating of middle shaft humerus through anterolateral approach is safe, effective and avoids release of deltoid tendon insertion and also avoids radial nerve dissection and its injury.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Fixation of Distal Tibial Fractures by Intramedullary Nail with Multidirectional Distal Locking Screws343534426564010.21608/mjcu.2019.65640ENMOHAMED E. TAHA, M.Sc.;ALI M. EMRAN, M.D.KAMAL M. HAHEZ, M.D.;NABIL O. GHARBO, M.D.The Department of Orthopaedic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Fractures of the distal tibia involve the diaphyseo-metaphyseal area of the bone, and may be either extra-articular or intrarticular. Several methods have been described for the treatment of these fractures, including casting, external and internal fixation.<br />Aim of Study: The aim of the work was to evaluate the results of fixation of distal tibial fractures by intramedullary nail with multidirectional distal locking screws (Expert tibial nail).<br />Methods: This study included 21 patients with distal tibial fractures treated between October 2017 and October 2018 (including follow-up period) at Tanta University Hospital with intramedullary nail with multidirectional distal locking screws (Expert tibial nail). Clinical and radiological data were analyzed.<br />Results: According to Tenny & Wiss scoring systems for distal tibial fractures the clinical results were graded as excellent in six patients (28.6%), good in nine patients (38.1 %), fair in four patients (19%) & poor in two patients (9.5%).The excellent and good results were considered as satisfactory results while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 15 patients (71.43%), and the unsatisfactory results were found in six patients (28.57%).<br />Conclusion: Treatment of distal tibial fractures using intramedullary nail with multidirectional distal locking screws (Expert nail) is a safe and accepted method alternative to conventional nail and plating technique. It provides additional biomechanical stability than the conventional nails and plate osteosynthesis.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Endovascular Management of Paragangliomas344334496564110.21608/mjcu.2019.65641ENMOHAMED SHADAD, M.D., Ph.D.;AHMED ELSHARKAWY, M.D., Ph.D.The Department of Neurosurgery, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Paragangliomas of head and neck are highly vascular tumors, which coupled their surgical excision with high morbidity. Pre-operative transarterial super selective embolization markedly improved safety of their surgical excision.<br />Patients and Methods: This is a retrospective non-randomized clinical and angiographic study of all ten patients with paragangliomas who undergone pre-operative emboliza-tion in Department of Neurosurgery-Tanta University between 2010 and 2016.<br />Results: The ten patients had 11 paragangliomas. 80% of patients were females. The average age of patients was 47 years. All patients had pain and pulsatile tinnitus at diagnosis. Paragangliomas subtypes comprised 8 temporal, 2 carotid body and one vagale tumors. The average reduction of para-ganglioma vascularity after embolization was 80%.<br />Conclusions: Pre-operative transarterial embolization of head and neck paragangliomas is a very safe and effective adjuvant to surgical excision.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Surgical Resection of Haglund's Deformity by Achilles Tendon Splitting Approach345134586564210.21608/mjcu.2019.65642ENMAHMOUD T. ALLAM, M.Sc.;MOHEB EL-DEEN A. FADEL, M.D.MOHAMED A. QUOLQUELA, M.D.;AHMED M. SAMY, M.D.The Department of Orthopaedic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Haglund's deformity was first described by Patrick Haglund in 1927 [1]. It is also known as retro-calcaneal exostosis. It is one of the causes of posterior heel pain. Several methods have been described for treatment including conserv-ative measures and surgical measures.<br />Aim of Study: The aim of this study is to evaluate results of surgical resection of Haglund's deformity by Achilles tendon splitting approach.<br />Patients and Methods: In this prospective study, 21 cases with were Haglund's deformity treated with surgical resection through Achilles tendon splitting approach.<br />Results: These cases were assessed according to AOFAS score [2], the functional results were graded as excellent in twelve patients (57.1%), good in eight patients (38.1%), fair in one patient (4.8%), with no poor results. The excellent and good results were considered as satisfactory ones while the unsatisfactory included the fair results. Thus, satisfactory results were found in 20 patients (95.2%), and the unsatisfac-tory ones were found in 1 patient (4.8%).<br />Conclusion: This study proves that central splitting tech-nique for the surgical treatment of Haglund's deformity is an effective treatment with good exposure of retrocalcaneal space, with decrease risk of vascular and nerve injury, and acceptable outcome.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Safety of Transarterial Y90 Radioembolization in Management for Unresectable-Intermediate and Locally Advanced-HCC345934676564310.21608/mjcu.2019.65643ENMOHAMED M. HAMED, M.D.;ABDELHAY A. ABDELHAY, M.D.MOHAMED H. ABD ALFATTAH, M.D.;GAMAL AL-DEIN E. GAMEEL, M.D.The Departments of Radiology* and Tropical Medicine**, Faculty of Medicine, Cairo University, EgyptJournal Article20181220Abstract<br />Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. However, most patients present with either unresectable (intermediate or advanced) tumors, cirrhosis, or both, eliminating these surgical treatment choices. Many institutions have adopted the Barcelona Clinic Liver Cancer (BCLC) staging classification, which links the stage of the disease to a specific treatment strategy. Current guidelines recommend transarterial chemoembolization (TA-CE) as the standard treatment of Barcelona-Clinic Liver Cancer (BCLC)-B patients, however, the long-term survival outcomes of patients managed with this technique do not appear fully satisfactory. In addition, HCC has traditionally been regarded as a radioresistant tumor due to the limited ability to deliver lethal doses using external beam tech-niques.Radioembolization with yttrium-90 (Y90) is a recently introduced liver-directed therapy. It is brachy therapy by arterially injected Y90 microspheres for the treatment of malignancies. Growing data suggest that Y90 radioembolization has a potent anticancer effect with negligible adverse events.<br />Aim of Study: This study aims to present and discuss the safety and adverse effects of Y90 radioembolization for management of patients with intermediate and locally advanced (BCLC-B and BCLC-C1) Hepato-Cellular Carcinoma (HCC).<br />Patients and Methods: This is a prospective study carried out between June 2014 and May 2016 for patients with hepatocellular carcinoma and liver restricted disease. All patients underwent treatment by Y90 microsphere radioem-bolization (SIR-Tex).<br />A total number of 20 patients with intermediate and locally hepatocellular carcinoma and liver restricted disease, not eligible for curative treatment.<br />Results: Follow-up was done using laboratory tests and clinical assessment. We found accepted toxicity profile in patients treated with Y90 radioembolization. The most frequent symptoms we encountered were the transient fatigue, abdom-inal pain and post embolization syndrome. The sever adverse effects (pneumonitis and GI ulceration) were not encountered in our study due to careful selection and pretreatment diagnostic preparation angiograph. <br />Conclusion: Y90 microspheres radioembolization is safe therapeutic option for patients with intermediate and advanced HCC which can be utilized even in patients with compromised liver function.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Zinc Oxide Nanoparticles on the Structure of Testis of Adult Albino Rats and the Possible Protective Role of Naringenin346934836564410.21608/mjcu.2019.65644ENAMIRA F. A. AHMED, M.Sc.;IBRAHIM A. IBRAHIM, M.D.HANAN E.L. MOKHTAR, M.D.;MANAL M. MORSY, M.D.The Department of Anatomy & Embryology, Faculty of Medicine, Zagazig UniversityJournal Article20181220Abstract<br />Background: Zinc oxide (ZnO) nanoparticles have been used as a source of zinc, in food industry and are applied in cosmetic products, but their accumulation in the tissues causes a hazard toxic effect. Naringenin (Nar) is a member of fla-vanones groups that play an important role in body health in terms of antioxidant and anti-inflammatory.<br />Aim of Study: The aim of this study is to evaluate the possible structural changes that occur in the testicular tissue of adult albino rat after single injection of zinc oxide nano-particles and to clarify possible protective role of Naringenin against this toxicity.<br />Material and Methods: 28 adult male albino rats have been used in this work. These animals were divided into three groups. Group Ia (Control –ve): Animals received no chemi-cals. Group Ib (control +ve) rats received oral Naringenin 20mg/kg once daily for two weeks. Group II (Treated group) received single intraperitoneal injection (IP) of Zno-NPs (700mg/kg) (as a single toxic dose in the experiment). Group III (Protective group) rats received Zno NPs (as same previous dose and route) in addition to Naringenin (20mg/kg) orally once daily for 2 weeks. 24 hours after the last administration, rat were sacrificed, carful dissection was performed for gentle removal of both testicles from all groups then processed for light and electron microscopic studies, morphometric exam-ination and statistical analysis. Epididymal sperm was collected for estimation of percentage of sperm Viability and abnormality.<br />Results: By light microscopy, zinc oxide nanoparticles caused massive histopathological changes in rat testes in the form of disorganization of seminiferous tubules, thickening, detachment and separation of basement membranes, widening of interstitial tissues, thickening and congestion blood vessels and pyknosis of sertoli and germ cells. Ultrastructural results confirmed these histopathological changes and revealed the degeneration of Sertoli cells, all germ cells and interstitial cells as well. The statistical analysis of this study supported the results. Administration of Naringenin to treated group provided mild improvement to the testicular tissues against Zno-NPs toxicity.<br />Conclusion: Zinc oxide nanoparticles could result in hazards to the structure of testes. Fortunately co-administration of Naringenin is suggested to reduce such hazards.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Ketamine as an Adjuvant to Lidocaine in Intravenous Regional Anesthesia for Upper Limb Surgery348534906564510.21608/mjcu.2019.65645ENASMAA B. OPODA, M.Sc.;MOHAMMAD I. OKAB, M.D.NABIL A. EL-SHEIKH, M.D.;SAMEH MOHAMMAD F. SADEK, M.D.The Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique but tourniquet pain is a limitation. Ketamine in subanesthetic dose is used as an adjuvant to IVRA to improve analgesia and to impair tourniquet pain.<br />Aim of Study: Is to illustrate the effect of ketamine as adjuvant to lidocaine used for IVRA in patients undergoing upper limb surgery.<br />Patients and Methods: This double-blind randomized controlled study was carried out on 60 patient, ASA I and II, 20-40 years, scheduled for elective minor upper limb surgery. Patients were classified into 2 groups (30 each): Group I (IVRA with lidocaine only) received 3mg/kg lidocaine 0.5% diluted with saline to 40ml and group II (IVRA with lidocaine and ketamine) received 3mg/kg lidocaine0.5% plus 50mg ketamine diluted with saline to 40ml. MAP, HR and SpO2 were measured before, after tourniquet application, during the surgery every 15 minute, and every 30 minutes after deflating the tourniquet. Type & duration of the operation, onset & duration of sensory & motor block were measured. VAS was recorded at 1, 2, 3, 6, 12, 18 and 24h after operation, time of first rescue analgesia, total analgesic given and any undesirable side effects.<br />Results: Demographic data, duration of operation and hemodynamic changes (MAP, HR and SpO2) were comparable. Onset of sensory and motor block were shorter in Group II than in Group I, but the duration of sensory and motor block was prolonged. In Group II, first dose of IV analgesic was delayed and the amount of pethidine was significantly de-creased. VAS and severity of tourniquet pain in group II were significantly decreased.<br />Conclusion: Adding ketamine 50mg to lidocaine for IVRA has faster and prolonged sensory and motor block and delayed tourniquet pain with better quality of postoperative analgesia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Possible Protective Effect of Onion Supplementation on Hepatic Functional and Structural Alterations Induced by Cholestasis349134996564610.21608/mjcu.2019.65646ENABD EL-HAMID A. MOHAMED, M.D.;DALIA A. SAAD, M.D.MARIAN MAGED FRANCIS, M.Sc.;FATMA AHMED MOHAMED, M.D.The Department of Physiology, Faculty of Medicine, Ain Shams UniversityJournal Article20181220Abstract<br />Background: Cholestasis is the obstruction or the reduction in bile flow that results in intrahepatic accumulation of bile constituents, which progresses to develop liver pathology. Common bile duct ligation (BDL) in rodents is an experimental model of cholestasis that has been carried out in research for many years. BDL model of cholestatic liver injury involves other mechanisms, including oxidative stress, inflammation, and fibrogenesis. Antioxidant, anti-inflammatory or antiapop-totic properties gained much interest for the amelioration of liver dysfunction.<br />Aim of Study: The aim of this study is to assess the possible protective effects of onion supplementation on hepatic struc-tural and functional alterations induced by BDL in rats, which reflect the effects of cholestasis resulting from intrahepatic accumulation of bile.<br />Material and Methods: Thirty adult female Wistar albino rats were randomly and equally allocated into three groups: (1) Control group, (2) BDL group; subjected to ligation of the common bile duct and (3) Onion-supplemented BDL groups (O-BDL). Both control and BDL groups received distilled water (solvent for onion powder) daily by gavage for 4 weeks. Onion-supplemented BDL group (O-BDL); subjected to ligation of the common bile duct and then received 500mg/kg of onion powder dissolved in distilled water, daily by gavage for 4 weeks. At the end of the experimental period, plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), direct bilirubin, total proteins, total antioxidant capacity (TAC), tumor necrosis factor-a (TNF-a), and hepatic tissue level of malondialdehyde (MDA) and transforming growth factor-b1 (TGF-b1) were measured for all groups. In addition, his-topathological examination of liver tissue samples was per-formed for the three groups.<br />Results: Plasma levels of ALT, AST, ALP, direct bilirubin, TNF-a and hepatic tissue levels of MDA and TGF-b1 were significantly increased and TAC was significantly decreased in the BDL group compared to the control group. In addition, altered architecture was detected in hepatic tissue samples of BDL group. Onion supplementation significantly decreased the plasma levels of ALT, AST, ALP, direct bilirubin, TNF-a and hepatic tissue levels of MDA and TGF-b1 in the O-BDL group when compared to the BDL group. Total proteins level was not significantly different among all the studied groups. In addition in O-BDL group, histopathological exam-ination of liver revealed near normal structure of hepatic tissue.<br />Conclusion: BDL induces hepatic structural alterations and functional disturbances. Onion supplementation inhibits inflammation and oxidative insults that associate BDL, and subsequently protects against BDL-induced liver injury.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Human Platelet Alloantigen (HPA-5) Polymorphism in Sickle Cell Disease Patients with Vaso-Occlusive Crisis350135066564710.21608/mjcu.2019.65647ENIMAN R. EL-MAHGOUB, M.D.;AZZA A. ALI, M.D.AMIRA S.A. FARHAN, M.Sc.;MONA K. EL-GHAMRAWY, M.D.HEBATULLLA FAROUK, M.D.;SOHA ATEF, M.D.GEHAN H. SHAHIN, M.D.;RANIA SOLIMAN, M.Sc.The Department of Clinical & Chemical Pathology, Faculty of Medicine, Cairo University*, National Research Centre** and Pediatric Department, Faculty of Medicine Cairo University***Journal Article20181220Abstract<br />Background: Vaso-occlusive crisis (VOC) is a significant cause of morbidity and mortality in sickle cell disease (SCD) patients. As polymorphisms in human platelet antigens (HPA) exhibit a prothrombotic nature, we hypothesized that specific HPA polymorphisms could have a role in the pathogenesis of VOC in SCD.<br />Aim of Study: This study investigated HPA-5 G1648A polymorphism among Egyptian SCD patients.<br />Patients and Methods: This study included 100 SCD patients and 50 controls. Patients were divided into, VOC group (n=60), and steady-state group (n=40). Genotyping was done using PCR-based Restriction Fragment Length Polymor-phism (RFLP) technique.<br />Results: The HPA-5 mutant genotypes were significantly associated with SCD compared to controls (p=0.003), while no significant difference was observed between VOC and steady-state groups (p=0.179). Regarding the frequency of VOC episodes, the HPA-5 homozygous mutant genotypes showed significant differences (p=0.003). Regarding VOC complications, the HPA-5b/5b genotype was significantly associated with acute chest syndrome only (p=0.021).<br />Conclusion: The HPA-5 G1648A polymorphism is common among SCD patients. Although neither of them is a major determinant of vasculo-cclusion in SCD, they are significantly associated with VOC complications and may alter their outcome.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Intra-Arterial Chemotherapy in the Manegment of Retinoblastoma in Comparison with Other Modalities350735176564810.21608/mjcu.2019.65648ENGEORGE YASSA, M.Sc.;FAROUK HASSAN, M.D.AYMAN ZAKARIA, M.D.;AMR A. NASSEF, M.D.The Department of Interventional and Diagnostic Radiology, Faculty of Medicine, Cairo UniversityJournal Article20181220Abstract<br />Background: Retinoblastoma often presents with advanced intraocular disease and despite conventional treatment with intravenous chemotherapy (IVC) and external beam radiation therapy, may still require enucleation.<br />Aim of Study: To assess the efficacy of intra-arterial chemotherapy (IAC) in comparison with other modalities in the management of intraocular retinoblastoma.<br />Material and Methods: Twenty one patients with thirty intra ocular retinoblastomas were included in the study from November 2013 to September 2016. Chemo reduction followed by adjuvant consolidative treatment has replaced external beam radiotherapy as the primary modality of treatment for intraocular retinoblastoma. Patients failed to respond ade-quately to a standard systemic chemotherapy (i.e., carboplatin, vincristine, and etoposide) with or without other local therapies, are referred for intra-arterial chemotherapy (IAC) to avoid enucleation. The intervention was selective catheterization of the ophthalmic artery and injection of chemotherapy.<br />Results: The current commonly used treatments for retin-oblastoma in our study were IVC and IAC, along with con-solidated therapy based on tumor staging. For international classification of retinoblastoma (ICRB) grading, we found a significantly higher success rates for RTB cases treated with IAC as primary or adjuvant therapy compared to other treat-ment modalities which achieved 90% versus 73.6% for globe salvage, 80% vs 52.6 % for solid tumor control, 75% vs 66.6% for subretinal seeds control, 66.7% vs 62.5% for vitreous seeds control respectively.<br />Conclusion: IAC may be superior to IVC for the treatment of retinoblastoma, with a higher overall success rate and higher globe salvage especially in group D retinoblastoma that failed to respond to systemic chemotherapy and destined for enucleation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Laryngeal Disorders in Egyptian Patients with Gastroesophageal Reflux Disease351935246564910.21608/mjcu.2019.65649ENSABRY ABDEL FATAH EBRAЮM, M.D.;SAYED GABER, M.D.SAYED FAROUK MOHAMED, M.D.;MOHAMED ABDEL MENAEM, M.D.The Departments of Tropical Medicine* and E.N.T**, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20181220Abstract<br />Background: Gastroesophageal reflux disease (GERD) is chronic illness caused by reflux of gastric acidic contents back up into the esophagus causing wide range of symptoms. Laryngeal reflux is caused by A mechanism which seem identical to GERD some researchers think there is correlation between the prevalence of the two diseases.<br />Aim of Study: The study aimed to evaluate the prevalence of laryngeal reflux in cases of gastroesophageal reflux disease.<br />Methods: In this Prospective study evaluation of the prevalence of Laryngeal reflux symptom in cases of GERD was done in 200 patients by applying Reflux Finding Score (RFS) and Reflux Symptoms Index (RSI). They were divided into two groups Group-I; included 100 patients with Lartngeal reflux symptoms, Group-II; included 100 patients without Laryngeal reflux symptoms and this group was subdivided by laryngoscopic finding into Group-IIA; Laryngeal reflux free and Group-IIB; silent laryngeal reflux according to RFS.<br />Results: GERD was found in all 200 (100%) patients included in the study Group I included 100 patients all of them had symptoms and signs of Laryngeal reflux, Group II included 100 patients didn't have symptoms of Laryngeal reflux of them 92 (92%) patients (Group IIA) were found to be free of Laryngeal reflux signs and 8 (8%) patients (Group IIB) were found to have signs of laryngeal reflux (silent laryngeal reflux).<br />Conclusion: Manifest Laryngeal reflux was found in 100 (50%) of GERD patients, silent Laryngeal reflux was found in 8 (8%) of GERD patients not complaining of Laryngeal reflux symptoms.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Upregulation of Tissue Transglutaminase in Transforming Growth Factor-b Induced Epithelial Mesenchymal TG2Transdifferentiation In Rat Tubular Epithelial Cells352535346565010.21608/mjcu.2019.65650ENSANAA FADEL, Ph.D.;RACHEL EMMA, M.D.Sheffield Kidney Institute, University of Sheffield, Sheffield* and The Department of Microbiology, Faculty of Pharmacy, Cairo University, Cairo, Egypt**Journal Article20181220Abstract<br />Background: Epithelial-Mesenchymal Transdifferentiation (EMT) is believed to be a key step in the course of glomerular and tubulointerstitial fibrosis. Many of the regulators of this process have been identified and Transforming Growth Factor-b (TGF-b) plays a central role. Tissue transglutaminase (TG2) has a crucial role in extracellular matrix formation and stabi-lization.<br />Aim of Study: This study was designed to explore whether TG2 is essential in EMT induced by TGF-b in renal tubular epithelial cells.<br />Material and Methods: EMT was achieved by treating NRK52-E renal tubular epithelial cells with high concentration of rhTGF-b (10ng/ml) for 24, 48 and 72h. Development of mesenchymal cell markers Fibroblast Specific Protein (FSP-1) and a Smooth Muscle Actin (a-SMA) and decrease in tubular epithelial cell surface marker E-Cadherin were used to confirm EMT. The NTU283; TG2 inhibitor was used for the inhibition assays. TG2 activity was quantified using a 14C putrescine incorporation assay. Protein expression and localisation of different markers were assessed by western blot and immunofluorescent dual immunofluorescent staining. Phase analysis was used to quantify the amount of staining for each of the markers used.<br />Results: A significant increase in TG2 activity and protein expression were both observed with TGF-b induced transdif-ferentiation at 48h. This observation was associated with loss of epithelial cell marker E-Cadherin and appearance of intra-cellular a-SMA and FSP-1, characteristic of myofibroblasts. Dual staining showed high TG2 levels in cells (0.254±0.07), compared to the control (0.02±0.008). This also showed loss of epithelial phenotype, decrease of E-cadherin and acquisition of myofibroblast characteristics a-SMA (0.671±0.13) com-pared to the control (0.076±0.016) and FSP-1 (0.492±0.017) compared to control (0.03±0.017). Cells also demonstrated high degree of co-localization of Collagen I (ColI) and a-SMA with TG2. The NTU283; TG2 inhibitor ameliorated TGF-b induced EMT. This was also associated with changed pattern of collagen I and a-SMA co-localization.<br />Conclusion: This data demonstrated upregulation of TG2 during the process of TGF-b induced EMT. TG2 inhibitor showed non-significant reduction of both TG2 and mesenchy-mal markers but demonstrated changes in the molecular configuration of mesenchymal markers a-SMA and Col I, raising the possibility of a role of TG2 in EMT.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Efficacy of Duloxetine on the Duration of Spinal Anesthesia and Acute Post-Operative Pain after Hip Surgery Prospective Randomized Controlled Study353535406565110.21608/mjcu.2019.65651ENMOHAMED S. EL-BEHAIRY, M.Sc.;SALAMA I. EL-HAWARY, M.D.NABIL A. EL-SHEIKH, M.D.;SAMEH M. SADEK, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: Prevention and treatment of post-operative pain continue to be a major challenge in post-operative care. Preemptive analgesia has been shown to be effective in reducing the severity of post-operative pain. Serotonin and norepinephrine are involved in the modulation of endogenous analgesic mechanisms, Duloxetine is a selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) mainly used in the treatment of depression, anxiety and chronic pain. The analgesic effect of duloxetine is believed to result from increased activity of serotonin (5-HT) and Norepinephrine (NE) within the CNS.<br />Aim of Study: The aim of this study was to evaluate the efficacy of pre-operative duloxetine on the duration of spinal anesthesia, severity of post-operative pain, and total analgesic consumption.<br />Methods and Material: Sixty patients aged 18-60 years, ASA I-II, scheduled for elective hip surgery were randomized into two equal groups: Duloxetine group (Group D): 30 patients received duloxetine 60mg on two divided doses 30mg every 12h for three days before the operation, 2h pre-operative and 12h after the surgery. Control group (Group C): 30 patients received placebo capsules by the same way as duloxetine group.<br />Measurements: Demographic data (age, Body Mass Index (BMI), sex), Hemodynamic (HR, MAP), duration of surgery, duration of spinal anesthesia, post-operative pain was assessed by the Visual Analog Scale (VAS) at 0, 2, 6, 12, 24 and 48h after the surgery, the time at which rescue analgesia was given and total analgesic consumption in 48h was recorded.<br />Results: There was no significant difference between both groups as regards to demographic data, hemodynamics (HR & MAP), duration of surgery and duration of spinal anesthesia. VAS score was significantly lower in in Group D than Group C. Time till administration of first rescue analgesia was significantly prolonger in Group D than Group C.<br />Conclusions: We conclude from this study that pre-operative administration of oral duloxetine 60mg daily divided into two doses 30mg every 12hr for 3 days significantly decreases post-operative pain and total analgesic consumption and improve patient psychology with a significant reduction in associated side effects but has no effect on the duration of spinal anesthesia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Anatomical Variations of the Circle of Willis: Computed Tomography Angiography Study354135486565210.21608/mjcu.2019.65652ENMOHAMMED HAMDNALLAHA GHOBASHY, M.D.;AMANY E. MOHAMMED HAMOUD, M.D.The Departments of Diagnostic Imaging & Interventional Radiology* and Anatomy & Embryology**, Faculty of Medicine, Cairo University, EgyptJournal Article20181220Abstract<br />Background: Circle of Willis (COW) main function is the brain protection from ischemia, as it ensures a constant and regular blood flow to the brain. The anatomy of Circle of Willis (COW) showed a wide variations in different individuals as regard age and sex.<br />Aim of Study: The current study was designed to elucidate the prevelance of COW variations in its anterior and posterior parts regarding age and sex, as well as the differences in the mean diameter of vessels forming the circle using Computed Tomography Angiography (CTA).<br />Material and Methods: The study was conducted on one hundred patients using cerebral CTA, Maximum Intensity Projections (MIP) and 3D reformatted images were assesed to determine the COW configuration and exclude the presence of any pathology. Frequency of variations in its two parts as regard age and sex. The diameters of arteries were measured and the mean difference were calculated.<br />Results: The study was designed on 100 patients (52% male and 48% female) in two different age young group _40. The mean diameters of arteries were higher in younger age group 56% compared to 44% in old age. Complete circle was encountered in 70% of cases, while 30% were incomplete. The variations recorded were 55% of cases in anterior part of the circle (Ant V) and 45% of cases in its posterior part (Post V) that showed statistically sig difference in anterior part than posterior part in the mean arteries diameters.<br />Conclusion: The circle of Willis showed different ana-tomical variations. Knowledge of the frequency of these variations is very important especially for surgery in cerebrov-ascular disease and in interventional procedures as a guide for entry in these procedures.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Laparoscopic Management of Incarcerated Congenital Inguinal Hernia354935546565310.21608/mjcu.2019.65653ENMAHMOUD E. BADAWY, M.D.;HISHAM A. ALMETAHER, M.D.ABDEL MOTTALEB E. EBEID, M.D.;MOHAMED A. SHEHATA, M.D.ESSAM A.ELHALABY, M.D.The Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta UniversityJournal Article20181220Abstract<br />Background: The laparoscopic management of incarcerated congenital inguinal Hernia in children is challenging and may be not devoid of risk. Controversies are still present about its management. Some surgeons prefer immediate repair as emergency even for successfully reduced hernias, others delay the repair for some days.<br />Aim of Study: The aim of this work is to evaluate the safety and efficacy of emergency laparoscopic management of incarcerated congenital inguinal hernia in children.<br />Methods: Eleven patients underwent emergency laparo-scopic repair of incarcerated inguinal hernia using burse string sutures around internal inguinal ring.<br />Results: From August 2017 to January 2019, 11 patients were operated (9 males and 2 females) with a mean age of 8.81±4.26 month. 8 right-sided and 3 left-sided hernias. Two patients with contralateral PPV were diagnosed and operated. All hernias were successfully reduced. The hernia content was: Bowel loops 8 (73%), adnexa/ovary 2 (18%), and appen-dix 1 (9%). The mean operative time was 37.73±6.17 minutes. There were no serious complications except that one patient had port site infection and another patient had ipsilateral hydrocele. No recurrence occurred during the follow-up period.<br />Conclusion: Emergency laparoscopic repair of congenital inguinal hernia provide an alternative procedure in pediatric patients presenting with incarcerated hernia. It appears to be feasible, safe and effective with few complications.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Minimally Invasive Management of Post Hepatectomy Localized Bile Leak355535606565410.21608/mjcu.2019.65654ENHAYTHAM MOHAMED NASSER, M.D.;HATEM SAYED, M.D.AHMED SAMIRALLAM, M.D.The Departments of Radiology*, General Surgery** and Internal Medicine***, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20181220Abstract<br />Background: Bilomas (localized bile leak) are localized post-operative collections of bile. Bile leakage is a common complication after hepatectomy with an occurrence rate of 2.9%-17%. Bile leak is always correlated to increased mor-bidity and mortality due to risk of serious biliary infection. Previously, biloma usually required reoperation. Yet surgical solution for bile leakage usually increases the incidence of patient morbidity and mortality especially in early post-operative period.<br />Aim of Study: The purpose of this study is evaluate non-surgical minimal invasive strategies as an effective choice in management of biloma (localized bile leak) and these include different strategies as minimally invasive US or CT guided percutaneous drainage with or without ERCP.<br />Patients and Methods: 20 patients were enrolled in our descriptive study (13 males, 7 females; mean age 49.40±9.30 years; range, 30 to 62 years) with biliary collections after open hepatectomy non of them had biliary reconstruction were treated using non-surgical methods between October 2017 and March 2019 at Al-Demerdash Hospital and Ain Shams University Specialized Hospitals and they were fol-lowed-up for at least 3 month. Percutaneous drainage using a 10Fr drainage catheter using US or CT guidance with/without (ERCP) were performed for management of those collections.<br />Results: Minimally invasive intervention could be suc-cessfully applied in all 20 cases. In all the cases, a pigtail was inserted for drainage, 17 cases (85%) were successfully drained and 3 cases (15%) weren't drained adequately due to extensive septations and they needed surgical intervention for drainage.<br />Conclusion: Non surgical (minimal invasive) management is an effective way in treating biloma (localized bile leak).The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparison of Prophylactic Intravenous Pethidine versus Intravenous Ondansetron in Prevention Post Spinal Shivering in Hysterectomy356135666565510.21608/mjcu.2019.65655ENMANAL F. ABD-ELMONIEM, M.D.;RASHEDA AZZAM, M.D.The Department of Anaesthiology, Intensive Care and Pain Management, Faculty of Medicine for Girls, Al-Azhar UniversityJournal Article20181220Abstract<br />Background: Spinal anesthesia is known to significantly impair thermoregulation; shivering associated with spinal anesthesia is reported up to 55%. Pethidine probably acts directly on the thermoregulatory center or via opioid receptors. Mechanism of action of 5HT antagonist as anti-shivering is thought to be related to inhibition of serotonin reuptake on the preoptic anterior hypothalamic region.<br />Aim of Study: This study was designed to compare the effectiveness of intravenous Pethidine versus intravenous Ondansetron for prevention of post-spinal shivering (primary outcome), hemodynamic changes, side effects of both groups were also evaluated (secondary outcome).<br />Material and Methods: Patients were randomly assigned allocated into two groups (Group P n=30 patients) received pethidine 0.4mg/kg and (Group O n=30 patients) received Ondansetron 4mg as premedication (each drug was mixed into 10ml isotonic saline and given to the patient, slowly IV).<br />Results: Non-significant differences between two groups as regards episodes of shivering, grading of shivering and tympanic temperature, but there is delayed onset of shivering episodes in pethdine group. There was statistically significant decrease in patients had nausea and vomiting in O group. While there was no statistically significant difference as regard sedation in both groups.<br />Conclusion: The use of Prophylactic 4mg Ondansetron (5HT3 antagonist) is equally effective as 0.4mg/kg pethidine in the prevention of perioperative shivering following spinal anesthesia, maintains core temperature and Prophylactic Ondansetron also reduces the need of antiemetics.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Feasibility of Low Intensity Pulsed Ultrasound to Improve Cartilaginous Thickness in Osteoarthritic Knee356735716565610.21608/mjcu.2019.65656ENFATMA A. HANAFY, M.Sc.;SALWA F. ABDEL-MAJID, Ph.D.MOHAMED F. ABDEL-LATIF, Ph.D.;HATEM MOHAMED AL-AZIZI, M.D.The Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo and MUST Universities and The Department of Radiology, Faculty of Medicine, Cairo University, Giza, EgyptJournal Article20181220Abstract<br />Background: It is clear that OA is a complex multifactorial disease process involving cartilage catabolism and anabolism. LIPUS may play a potential chondroprotective role in chondro-cyte metabolism; enhance cell proliferation and matrix pro-duction.<br />Aim of Study: Is to investigate the effect of Low Intensity Pulsed Ultrasound (LIPUS) therapy on cartilage repaire in patient with grade 2 or 3 osteoarthritis of the knee.<br />Methods: Subjects were assigned in one pre and post study groupand receive 20 minutes of LIPUS with power 60 mw/cm and frequency 100Hz over the medial tibiofemoral compartment of the knee of both lower limbs and that was 3 times per week for successive three months. The clinical measures were obtained before the first session and after 36th session, using the Musculoskeletal Ultrasound (MSUS) to assess cartilage thickness.<br />Results: There was a significant difference between MSUS before and after LIPUS treatment in left knee with p-value= 0.01. The mean MSUS increased from 1.81 to 2.27 with a difference 0.45 and in right knee with p-value=0.001. The mean MSUS increased from 2.09 to 2.44 with a difference 0.34.<br />Conclusion: LIPUS has a statistical difference over in-creasing cartilage thickness measured by M.S.U.S in patient with mild to moderate knee osteoarthritis.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Interplay between Exercise and SIRT1 in Skeletal Muscle of Diabetic Male Rats357335796989410.21608/mjcu.2019.69894ENASMAA S. MOHAMMED, M.D.;NERMEEN B. SADEK, M.D.MONA M. MOHAMMED, M.D.;EFFAT A. KHOWAILED, M.D.LAILA A.RASHED, M.D.The Departments of Medical Physiology* and Biochemistry**, Faculty of Medicine, Cairo UniversityJournal Article20181204Abstract<br />Background: Great evidences support the promising effect of physical exercise on pathophysiological changes associating diabetes. Several molecular mechanisms of the beneficial outcome of physical training have been suggested. The role of silent information regulator one (SIRT 1) in diabetes after exercise training is still obscure.<br />Aim of Study: To evaluate wheather re-establishing SIRT 1 activity after exercise training can improve diabetic outcome or not.<br />Patients and Methods: Forty male Wistar albino rats (n=10 per group) were randomized to control, diabetic (STZ; 60mg/kg i.p.), diabetes + exercise (D+EX) and exercise + diabetes (EX+D) (swimming 1h/day, 5days/week before diabetes). After the end of the study, body mass index (BMI), serum glucose, triglyceride, HDL, SIRT1 expression and activity were measured.<br />Results: Both exercised groups showed significant decrease in serum glucose and triglycerides, significant increase in serum HDL, SIRT1level and activity and insignificant change in BMI compared with control group. There was no significant difference between exercised groups, approaching to normal levels in EX+D group. Correlation studies showed SIRT1 level and activity negatively correlated with glucose and TG levels, positively correlated with HDL level among all groups.<br />Conclusion: Exercise training before or after diabetes improved glycemic control and lipid profile, SIRT upregulation may have a role in this improvement.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prognostic Significance of Concurrent MYC, BCL2 and/or BCL6 Expression in Diffuse Large B-Cell Lymphoma358135886989610.21608/mjcu.2019.69896ENMOHEBAT H. GOUDA, M.D.;MOSTAFA M. AMER, M.D.MOHAMMEDABD ELMONEM, M.D.The Departments of Pathology, Faculty of Medicine-Benha University*, Clinical Pathology, Faculty of Medicine, Al-Azher University, Assuit** and General Surgery, Faculty of Medicine, Benha University***Journal Article20180204Abstract<br />Background: DLCL with aberrations in MYC, BCL2 and/or BCL6 due to genetic alterations or protein expression is a high grade B-cell lymphomas with poor prognosis if received standard RCHOP chemotherapy. So that, different regimens are needed for better prognosis.<br />Aim of the Study: Identify the association of protein, genetic expression of MYC, BCL2, and/or BCL-6 in cases of DLBCL, if MYC IHC could be used as a screening test to determine DHL or THL status, and to determine if the DHL or THL biology are related to any clinic-pathological features.<br />Material and Methods: Thirty patients who were diagnosed with primary DLBCL from July 2015 to July 2018. The cases were collected from General surgery department-Faculty of medicine- Benha University and Assiut faculty of medicine-Al-Azhar University were identified after applying exclusion and inclusion criteria. Clinico-pathological data was obtained by review of medical records and biopsy specimens for IHC and FISH were obtained from the Departments of general surgery. The FISH test (for MYC, BCL2, and BCL-6) and IHC (for CD10, KI 67, MYC, BCL2, and BCL-6) were per-formed. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 16 (p-valueResults: Double hit gene rearrangements by FISH were detected in 3/30 (10%) patients. MYC IHC was positive in 6/30 (20%) cases, and 3 of these 6 cases (50%) were FISH positive. Sensitivity, specificity and concordance of MYC IHC as a screening tool were 100%, 73.6% and 50%, respec-tively. BCL2 staining was positive in 14/30 (46.6%) cases, and only 3 of the 14 cases (21.4%) were FISH positive. 6/30 (20%) cases were positive for both MYC and BCL2 by IHC (double protein expresser status) and 3 of these 6 (50%) cases were positive by FISH. DHL biology showed an association with many clinico-pathological parameters including elevated serum Lactate dehydrogenase, stage III,IV, Bone marrow infiltration, extranodal involvement, and overall survival.<br />Conclusion: The association between MYC IHC and FISH in the current study was statistically significant. The sensitivity of MYC in our study was 100%, we can propose that it can be used as an effective screening test if similar results can be validated in larger studies. The current study supports the practice of routinely testing for MYC and BCL2 status in all cases of DLBCL, irrespective of clinical features of the disease, to identify the high-risk DHL subset of patients, who can be candidates for more intense newer chemotherapy regimens and for prognostic purposes.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Doppler Ultrasound of Hepatic Artery and Portal Vein: Relationship with Clinical Severity of Hepatitis C Virus Liver Cirrhosis358935956989910.21608/mjcu.2019.69899ENMEDHAT I.M.AHMAD, M.D.The Department of Radiology, Sohag University Hospital, Sohag, EgyptJournal Article20180204Abstract<br />Background: Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within cirrhotic patients. Differences in haemodynamics exhibited in hepatic vasculature has been appeared in previous reports to associate with the clinical severity of cirrhosis. In any case, the degree of changes in Doppler ultrasound flow parameters in foreseeing the clinical severity of liver cirrhosis stays uncertain.<br />Aim of Study: The purpose of this study was to evaluate the contribution of Doppler ultrasound of Hepatic Artery (HA) and Portal Vein (PV) with Child-Pugh (CP) score to assess the advancement of Hepatitis C Virus (HCV)-related liver cirrhosis.<br />Patients and Methods: One hundred patients with HCV-related liver cirrhosis divided according to CP score were included. Doppler ultrasound variables including Portal Vein (PV) diameter, Maximum Portal Vein Velocity (MPVV), and resistance index of the hepatic artery (HARI) were measured.<br />Results: There was significant association between the diameter of PV and the increase in CP score, which was statistically significant (p=0.000). A choice of 12mm as a cutoff point of PV diameter between CP, A and B revealed sensitivity of 96.9%, and specificity of 97.9%. The mean MPVV was statistically significantly higher with Child A (mean 17.1±1.6 cm/sec), compared to Child B and C (p= 0.000), and Child B (mean 14.1±1.9cm/sec) compared to Child C (mean 11.3±1.4cm/sec) (p=0.000). The mean HARI was statistically significantly lower with Child A and B (0.8cm/sec), compared to Child C (0.9cm/sec) (p=0.000). There was a strong negative correlation between HARI and MPVV which was statistically significant (p=0.000). There was a strong positive correlation between HARI and Child class and diameter of PV which was statistically significant (p=0.000).<br />Conclusion: PV diameter is a useful predictor of advance-ment of liver cirrhosis. Doppler measurements of MPVV, and HARI are useful in differentiating patients with CP, A and B from C.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Evaluation of Diabetes Mellitus as an Independent Risk Factor for Gastroesphageal Variceal Bleeding in Cirrhotic Patients359736056990110.21608/mjcu.2019.69901ENDINA A. LABIB, M.Sc.;HEGAZY M. HEGAZY, M.D.DESOUKY E. ABOAMMO, M.D.;GHADA M. ELGHAZALY, M.D.The Departments of Internal Medicine* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190204Abstract<br />Background: Diabetes mellitus has been reported to increase the risk of complications of liver cirrhosis and subsequent survival. Varices constitute the most common lethal cause of mortality in cirrhotic patients, consequently the association between DM and gastro-esophageal variceal bleeding becomes the focus of attention.<br />Aim of Study: Is to elucidate whether DM is an independent risk factor for gastro-esophageal variceal bleeding in cirrhotic patients.<br />Patients and Methods: This cross-sectional study was conducted in Internal Medicine Department, Faculty of Med-icine, Tanta University Emergency Hospital at Gastro-endoscopy Unit from September 2017 to July 2018 and included 120 patients. Group (A): Diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. Group (B): Non-diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. The patients were subjected to history taking, laboratory investigations including: CBC, AST, ALT, bilirubin, albumin, blood urea, serum creatinine, Pa, INR, HBVs Ag, anti HCV Ab, RBG, HbA1c and gastrointestinal endoscope.<br />Results: Of the 120 patients, there were 67 (55.8%) diabetics, 53 (44.2%) were non-diabetics, they were 47 (39.2%) child A, 73 (60.8%) child B & C. GEVB incidence was higher in child B & C than child A, also as regard sub grouping in child A, the diabetic patients were 32 (68.1%) while non-diabetics were 15 (31.9%) and in child B & C diabetics were 35 (47.9%) and non-diabetics were 38 (52.1%) with p-value (0.030), there was significant higher ratio of ascites, enceph-alopathy and recurrence of attacks of GEVB in child B & C than child A, there was significant higher ratio of ascites, previous attacks of encephalopathy and recurrence of attacks of GEVB in diabetics than non-diabetics and there was statis-tically significant higher incidence of recurrence of attacks of GEVB with HBA1c >7.<br />Conclusion: The incidence of GEVB was significantly associated with DM in cirrhotic patients, especially in patients with Child-Pugh Class A.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Functional Lumial Imaging Probe (ENDO-FLIP) for Assessment of Continence after Abdomino-Perineal Resection for Carcinoma of the Rectum Patients360736176990410.21608/mjcu.2019.69904ENMAMDOUH MOUNIR, M.Sc.;MOUNIR ABOUL ELA, M.D.MOHAMED GAMIL, M.D.;GAMAL AMIRA, M.D.AHMED FARAG, M.D.;TAREK KHAIRY, M.D.The Department of Surgical Oncology, National Cancer Institute, Cairo UniversityJournal Article20190204Abstract<br />Background: Twenty per cent of patients with carcinoma of the rectum are surgically treated with Abdomino-perineal Resection even after the recent advances in surgical techniques and the introduction of staplers. Permanent iliac Colostomy impairs the quality of life of patients after APR which raised the issue for creation of Perineal colostomy as a method of total Perineal reconstruction after APR. Which later raised the issue of objective Assessment of function as regards Continence of these patients.<br />Aim of the Study: This work is aiming at assessment of degree of Continence of patients suffering carcinoma of the rectum previously treated with APR followed by TPR and Perineal colostomy. An objective Assessment using the Endo-FLIP was used in addition to their subjective assessment.<br />Material and Methods: Twenty patients with low rectal cancer previously treated with APR followed by a perineal colostomy were included. Patients were objectively evaluated using the Endo-FLIP system with correlation to their quality after life as regards continece.<br />Results: Considerable degree of distensibility was noted during coughing with a mean of 22.1mm at the proximal segment of the colon versus 11.2 at the neo-sphincter level. Our patients were as well able to evacuate the catheter volun-tarily with a mean of 3.2 seconds.<br />Conclusion: In conclusion, this new technique proved to be valuable in improving the QOL of patients with rectal cancer after APR. The procedure achieved 94% patient satis-faction.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Ankle Weight during Gait Training on Dorsiflexors Strength in Hemiparetic Children361936246990510.21608/mjcu.2019.69905ENHEBA I. AHMED, M.Sc.;EL-NEGMY E.H, Ph.D.KHALED A. OLAMA, Ph.D.;AMINA S. HENDAWY, M.D.The Departments of Physical Therapy for Pediatrics, Faculty of Physical Therapy* and Neuropediatrics, Faculty of Medicine**, Cairo UniversityJournal Article20190204Abstract<br />Background: Affected side toe walking is a common problem in hemiparetic cerebral palsy children, that may occur due to spasticity of planter flexors muscles and inhibition of anterior tibial muscles, walking with equines foot lead to abnormal gait pattern, frequent falling down, pain at the metatarsal heads and compensatory reaction that affects hip and trunk and may cause contracture of calf muscle which may need surgery. Using ankle weight during gait training may be an effective treatment tool in hemiparetic children.<br />Aim of Study: The current study was conducted to inves-tigate the effect of using ankle weight during gait training in hemiparetic children.<br />Subjects and Methods: Thirty hemiparetic children par-ticipated in this study, their ages range from 3 to 6 years, all subjects were recruited from the outpatient clinic at the Faculty of Physical Therapy, Cairo University. They were assigned randomly in to two group of equal number; Group A control group received a specific physical therapy program and Group B study group received the same specific physical therapy program as in Group A in addition to weight started 1/2kg placed above ankle of the affected side during gait training. Hand held dynamometer was used to measure ankle dorsiflex-ors muscle strength and Kinovea software was used to measure dorsiflexion angle during initial foot contact.<br />Results: There was a significant increase in ankle dorsi-flexors muscle strength and a significant decrease of dorsi-flexion angle during initial contact in the study group compared to the control group.<br />Conclusion: Ankle weight during gait training can be an effective treatment tool in improving dorsiflexors muscle strength in hemiparetic children.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Comparative Study of Sacroiliac Joint Dysfunction and Lumbar Flexibility between Normal Subjects and Sacroiliac Joint Dysfunction Patients362536326990710.21608/mjcu.2019.69907ENAHMED M.A. SHADY, M.Sc.;HAMED M. EL-KHOZAMY, Ph.D.SALWA F. ABDEL MEGID, Ph.D.;WALID ABD EL BAKY, M.D.The Department of Musculoskeletal Disorders & their Surgeries Physical Therapy, Public Hospital, Menofyia*,Journal Article20190204Abstract<br />Background: Low Back Pain (LBP) is a symptom rather than a disease diagnosis. Pathology in the low back might affect the pattern of movement rather than only the range of movement ROM. Approximately 10% with LBP do not respond to treatment and develop chronic LBP. The cause for this non-response to treatment is lack of specific diagnosis and inability to distinguish, in some people, pain arising from the Sacroiliac Joints (SIJs) or the lumbar spine.<br />Aim of Study: This study was conducted to identify the relationship between Sacroiliac joint dysfunction SIJD and lumbar spine movement in sagittal and frontal plan.<br />Subjects and Methods: Forty participants aging 20:40 years divided into 2 groups. Group (A) consisted of 20 healthy participants, Group (B) SIJD consisted of 20 subjects were positive of at least 3 SIJ provocative test. All the participants on the study, pelvic asymmetry was measured by PALM device also spinal flexibilityof lumbar spine was assessed in sagittal and frontal plan.<br />Results: There was negative weak significant correlation between mean difference of pelvic inclination and Extension-Flexion E-F of lumbar (r=–0.405, p=0.014*). While, no significant correlation between mean difference of pelvic inclination and lumbar flexion, left side bending, right side bending, and over all side bending L-R of lumbar.<br />Conclusion: There was change of lumbar spine mobility in sagittal plan on extension and overall sagittal ROM with SIJD patients, though in comparison between groups it showed that patient with SIJD had less overall frontal plan ROM.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Acupressure versus Aerobic Exercise on Depression in Postmenopausal Women363336376990810.21608/mjcu.2019.69908ENHALA M. EMARA, Ph.D.;WAFAA M. KAMAL, Ph.D.HOSSAM E.D. HUSSEIN, M.D.;NERMEEN S. ABD ELAZEIM, M.Sc.The Department of Physical Therapy for Woman’s Health, Faculty of Physical Therapy, Cairo University*, The Department of Gynecology and Obstetrics, Faculty of Medicine, Al-Azhar University**Journal Article20190204Abstract<br />Background: The effect of acupressure and aerobic exer-cise on depression was a hot topic in physical therapy in the past decades. The results of the research available to date showed that acupressure and exercise training might be a promising, additional, safe and economical method to help in improving depression.<br />Aim of Study: This study was conducted to compare the effect of acupressure versus aerobic exercise on depression in postmenopausal women.<br />Material and Methods: A sample of 40 postmenopausal women diagnosed with depression by gynecologist and con-firmed by Zung self-rating depression scale, their ages ranged from 45 to 55 years with body mass index not exceeded 30kg/m2 participated in this study from the outpatient clinic of Kasr Al-Ainy University Hospital, Cairo University. They were distributed into two groups; each consisted of 20 post-menopausal women, Group (A) received acupressure by wearing wrist band for four weeks for 24 hours and Group (B) performing aerobic exercises on treadmill 3 sessions per week for four weeks for a duration 40mins (10mins warming up, 20mins running and 10mins cooling down).<br />Results: Showed that there was a statistically significant decrease in the value of Zung self-rating depression scale measured at post-treatment compared with the pre-treatment in both study Groups (A) and (B) (p=0.001).<br />On the other hand at post-treatment, there was a statistical significant decrease in value of Zung self-rating depression scale in Group B (38.80±3.02) when compared with its cor-responding value in Group A (46.90±3.82) with Z-value= –4.903 and p-value=0.001.<br />Conclusion: Both acupressure and aerobic exercise have significant effect on depression in postmenopausal women but, patients may get additional benefit in improving the depression level through aerobic training program more than the acupressure.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prediction of Return to Work after Mild Traumatic Brain Injury by Different Assessment Scales363936476991010.21608/mjcu.2019.69910ENAMANY S. HASSAN, M.Sc.;EMAN S.M. FAYEZ, Ph.D.AHMED EL FIKI, Ph.D.;AHMED S. ALI, M.D.The Department of Physical Therapy Emergency Hospital, Faculty of Medicine, Cairo UniversityJournal Article20190204Abstract<br />Background: Mild Traumatic Brain Injury (m-TBI) based on a score of 15 on the Glasgow Coma Scale; a score of 13 or 14 is due to confusion and will be associated with a long duration of posttraumatic amnesia. Identifying factors that increase the risk of m-BTI is necessary to develop public health programs and reduce the risk of being unable to return to work. Therefore, early detection of disability and interven-tion training is a very important treatment strategy to enable the injured patients to return to their works.<br />Aim of Study: Is to predict disability effect on Return to Work (RTW) by assessment scales for patients with mild traumatic brain injury during hospital stay and eight to twelve weeks follow-up.<br />Material and Methods: Different assessment scales in-cluding; Glasgow Coma Scale (GCS), the Montreal Cognitive Assessment (MOCA) Arabic Version, Disability Rating Scale (DRS) and Post Traumatic Amnesia Time (PTAT) were re-ported a detailed understanding of patients temporally changes in physical and mental statues and its impact on successful RTW and community integration. A prospective cohort study of sixty-one patients with mild traumatic brain injury (m-TBI) admitted consecutively to Neurotrauma Departments at Emergency Hospital, in El-Kasr El-Aini Hospital.<br />Results: The results revealed that return to work and recovery from m-TBI occurred after hospital discharging between eight to twelve weeks in 6 patients (9.8%), six to eight weeks in 28 patients (45.9%), two to four weeks in 9 patients (14.8%) and one week in 18 patients (29.5%) and this was supported by using GCS, MOCA [highly predicted (94.86%)] and DRS [highly predicted (96.03%)] scales to predict and develop a suitable work plan according to patient disability.<br />Conclusion: Return to work and recovery from mild traumatic brain injury occurred mainly between six and eight weeks and were followed for twelve weeks post-traumatic, indicating a high rate of predictability using GCS, MOCA, DRS and PTAT and helped to develop a remedial plan suitable for disability reasons.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Subjective Assessment of an Innovative Technique for Perineal Colostomy after Abdomino-Perineal Resection for Carcinoma of the Rectum: Towards a Better Quality of Life364936566991110.21608/mjcu.2019.69911ENMAMDOUH MOUNIR, M.Sc.;MOUNIR ABOUL ELA, M.D.MOHAMED GAMIL, M.D.;GAMAL AMIRA, M.D.AHMED FARAG, M.D.;TAREK KHAIRY, M.D.The Department of Surgical Oncology, National Cancer Institute, Cairo UniversityJournal Article20190204Abstract<br />Background: Abdomino-perineal resection is still a pro-cedure of choice in the management of rectal cancer. A left iliac permanent colostomy has a great impact on the quality of life of the patients. Many procedures and techniques have been introduced for the creation of a perineal colostomy aiming at improving the QOL of these patients.<br />Aim of Study: This work is a scientific practical contribu-tion to improve the quality of life of patients after APR for carcinoma of the rectum. To achieve this, a subjective evalu-ation of an innovative unprecedented technique for a continent perineal colostomy instead of the left iliac colostomy was done.<br />Material and Methods: A prospective observational study included 20 patients with low rectal cancer treated surgically with APR followed by a perineal colostomy using an innovative technique of a circular smooth muscle cuff. An immediate (Synchronous) reconstruction after APR was done in 14. In 6 patients the operation as a delayed (Metachronous) step 2- 4 years after APR. Patients were subjectively evaluated using Kirwan's scoring system.<br />Results: Thirteen patients (72%) were continent; 2 normal continence for gas and stool and 11 patients were continent only for stool. Four patients had minor soiling. Seventeen patients (94.5%) were satisfied. Only one patient suffered incontinence.<br />Conclusion: This new technique proved to be valuable in improving the QOL of patients with rectal cancer after APR. The procedure achieved 94% patient satisfaction.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Ultrasound Assessment in Achilles Tendon Pathology365736636991410.21608/mjcu.2019.69914ENHOSSAM SAKR, M.D.;MENNATALLAH HATEM SHALABY, M.D.HUDA ABDELHADYABDELHAMEED, M.D.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20190204Abstract<br />Background: Tendons are connective tissues that transmit the force produced by muscle to bone and also prevent muscle damage by acting as shock absorbers. The Achilles tendon is the single largest, thickest and strongest tendon in the human body that transmit the force of powerful calf muscles to foot facilitating walking and running. This has long been known as a site susceptible to disabling injury. Forces up to 12 times bodyweight may arise during sporting activity. US performed with high-resolution linear-array probes has become increas-ingly important in the assessment of ligaments and tendons around the ankle because it is low cost, fast, readily available, and free of ionizing radiation.<br />Aim of the Work: To provide an overview of clinical applications of ultrasound in assessment of pathological Achilles tendons. And to demonstrate the role of ultrasound in diagnosis of Achilles tendon pathology after clinical diag-nosis.<br />Patients and Methods: This study is a prospective study, it was conducted in Radiology Department at Ain-Shams University Hospitals (El-Demerdash) from September 2018 till March 2019. It included 20 patients who were referred from the orthopedics, sports medicine and physical medicine outpatients.<br />Results: In our study US was capable of detecting almost all Achilles tendon abnormalities with high accuracy. The main noticeable limitation was the assessment of the bone marrow. In our study, the sensitivity, specificity and accuracy for US for Achilles tendon were 100%, 75% and 95% respec-tively. Both US and MRI are used in the evaluation of super-ficial structures, such as tendons and ligaments. The choice between US and MRI in such evaluations is determined by availability, referring physician preference, and the experience of the radiologist because in many settings accuracies can be similar.<br />Conclusion: Ultrasonography is an accurate and sensitive modality in evaluation of the Achilles tendon, it and can be used either as primary tool of investigation or as complemen-tary tool with MRI and even in some cases may be used as a final method of diagnosis without need for further correlation with any other imaging techniques.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Effect of Magnesium Sulphate on Intubating Condition for Rapid-Sequence Induction; Comparative Study of Magnesium Sulphate versus Ketamine in Rapid Sequence Induction366536726991510.21608/mjcu.2019.69915ENMOHAMED S. ABDEL AZIZ, M.D.;HEBA B. EL-SERWI, M.D.DINA GALALABO-DIEF, M.Sc.The Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams UniversityJournal Article20190204Abstract<br />Background: Rapid sequence induction is the preferred method of endotracheal intubation in the emergency setting. The rapid sequence intubation technique involves the prompt sequential administration of a predetermined dose of hypnotic agent and muscle relaxant followed by tracheal intubation within 1min of giving the muscle relaxant.<br />Aim of Study: Test the efficacy of magnesium sulphate (MgSo4) versus ketamine to assess intubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) for rapid sequence induction.<br />Patients and Methods: We compared magnesium sulphate with control, ketamine with regard to intubation conditions during rapid-sequence induction.<br />Design: This is a prospective, randomized, double-blinded study.<br />Setting: The setting is at an operating room in Ain Shams University Hospital.<br />Patients: 75 patients scheduled for general anesthesia were randomly allocated to the following 3 groups in equal numbers.<br />Interventions: The control received rocuronium 0.6mg/kg; the ketamine group was given 0.5mg/kg ketamine 2 minutes before 0.6mg/kg rocuronium; and the magnesium group received 50mg/kg magnesium sulphate. Intubation was initiated 50 seconds after the rocuronium injection.<br />Measurements: Intubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) were recorded.<br />Results: The excellent intubating condition was more frequent in the magnesium group (p b.05). Onset of neuromus-cular block was shorter in the magnesium group than in the control, ketamine, (p b.05).<br />Conclusions: Magnesium sulphate pre-treatment was most likely to provide excellent intubating condition for rapidsequence intubation compared with the control, ketamine. However, magnesium sulphate administration is associated with a burning or heat sensation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Vit D3 versus L Carnitine Supplement in Alleviating Age-Related Insulin Resistance in A Naturally Aging Rat Model367336856991610.21608/mjcu.2019.69916ENISLAM I. HEGAB, M.D.;MARWA M. ATEF, M.D.The Departments of Physiology* and Biochemistry**, Faculty of Medicine, Tanta University, EgyptJournal Article20190204Abstract<br />Background: Insulin Resistance (IR) has long been rec-ognized as a characteristic of aging. Many studies recorded beneficial roles of Vitamin D3 (VD3) and L-Carnitine (LC) in obesity and type 2 diabetes.<br />Aim of Study: To evaluate the role of VD3 versus LC in attenuating the age-related IR in a naturally aging rat model, clarifying their possible underlying mechanisms.<br />Material and methods: Rats were divided into 4 groups; Young Control (YC), aged group, VD3-treated aged group (VD3-aged) and LC-treated aged group (LC-aged). Experi-mental procedures included measurement of body weight, Body Mass Index (BMI) and Oral Glucose Tolerance Tests (OGTT). The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index was also calculated. Assays of fasting serum glucose and insulin levels as well as serum tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) and adiponectin levels were performed. Moreover, skeletal muscle Sirtuin-1 (SIRT-1), Triglycerides (TGs) and TNF-a levels alongside with the glucose transporter-4 (GLUt4) mRNA expression were assessed.<br />Results: Compared to YC rats, aged rats exhibited signif-icant increase in fasting serum insulin and HOMA-IR as well as an abnormal OGTT. Serum TNF-a and IL-6 levels were significantly increased, whereas serum adiponectin level was significantly decreased in old rats. Furthermore, the SIRT1 levels and GLUT 4 mRNA expression were significantly lower, whereas the TGs and TNF-a were significantly higher in skeletal muscle of aged rats compared to YC ones. On the other hand, these parameters, were equally and significantly attenuated in VD3 and LC supplemented rats compared to non-treated age matched group, except for the skeletal muscle SIRT-1 level which could be elevated only by VD3, while the anti-inflammatory and TGs lowering effects of LC were more prominent than VD3. Nevertheless, the overall effect of VD3 and LC on IR-related parameters were nearly equal.<br />Conclusion: Both VD3 or LC administrations were equally effective in alleviating the age-related IR, thus may provide a possible therapeutic intervention in the aging population.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prevalence and Characteristics of Traumatic Spinal Cord Injuries for Educational Hospitals in Cairo368736906991810.21608/mjcu.2019.69918ENHEBA G. SAYED, M.Sc.;EMAN S. FAYEZ, Ph.D.AHMED A. SOLIMAN, M.D.;AMINA AWAD, Ph.D.The Department of Physical Therapy Emergency Hospital, Cairo University HospitalsJournal Article20190204Abstract<br />Background: Traumatic Spinal Cord Injury (SCI) is a catastrophic event that is sudden and unexpected and can results in disturbances to normal sensory, motor, or autonomic function all of which can be devastating for the individual, both socially and economically. To our knowledge, local epidemiological study of traumatic SCI has not been carried out previously in Cairo.<br />Aim of Study: To identify the prevalence of common causes and characteristics of traumatic SCI among the popu-lation of Cairo.<br />Patients and Methods: Medical records of patients with traumatic SCI from Neurosurgery Department at Kaser Al-Aini Educational Hospital in Cairo, Egypt, were reviewed from the first of January 2017 to 31 December 2018. Demo-graphic characteristics, etiology, neurological level were analyzed.<br />Results: A total of 65 medical record of patients with traumatic SCI were reviewed during the mentioned period. The male to female ratio was 4.40:1. The mean age at injury was 32.18 years. The most frequent cause of traumatic SCI was falls (49.2%), followed by traffic accidents (43.1%). The neurological level of injury was 52.3% in cervical region, 30.8% in lumbar region and finally 16.9% in thoracic region.<br />Conclusion: Falls were the main causes of traumatic SCI among people living in Cairo with higher incidence to cervical lesion. Concerning gender, men have significantly higher rate of injury compared to women especially the young adult population. These information pose a challenge to the society health system to develop preventive strategies to SCI, improve the services and quality of life to Egyptian people living with SCI.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of Magnetic Resonance Imaging in Assessing Instability After Anterior Cruciate Ligament Reconstructive Surgery in Males369136976992010.21608/mjcu.2019.69920ENHANAN M. EISA, M.D.;RASHA S. HUSSEIN, M.D.HOSAM M.AHMED EID, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine, Ain Shams UniversityJournal Article20190204Abstract<br />Background: The most commonly reconstructed ligament in the knee is the anterior cruciate ligament. Clinical evaluation of ACL reconstructions can be difficult, and MR imaging plays an important role in assessing instability of the knee joint after ACL reconstruction.<br />Aim of Study: To determine the value of magnetic reso-nance imaging in assessing instability after anterior cruciate ligament reconstructive surgery in males.<br />Patients and Methods: This prospective study included 30 male patients with reconstructed and repaired anterior cruciate ligaments of the knee, all of them were males. Their ages ranged from 19 to 58 years old with mean age of 30 years old.<br />Results: MRI is ideally suited for the evaluation of insta-bility in the post-operative ACL patient. Graft integrity and position can be determined, and clinically challenging diag-noses such as graft impingement or hardware failure are readily diagnosed with MRI. With the increasing prevalence of arthroscopic repair of the ACL, the importance of MRI in the evaluation of this patient population will increase.<br />Conclusion: We conclude that MRI of the knee is valuable in assessing instability of the knee joint of the post-operative ACL reconstruction patient. MRI provides a non-invasive modality for evaluation of ACL graft fiber integrity and post-operative complications. ACL graft complications such as abnormal tunnel positioning, roof impingement, partial and complete graft tears, arthrofibrosis and tunnel synovial cysts, are reliably assessed by MRI.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Pelvic Floor Exercises on Post-Prostatectomy Urinary Incontinence: A Systematic Review369937056992710.21608/mjcu.2019.69927ENSAMAH HOSNY, Ph.D.;MARWA ABD-ELMOTELB, Ph.D.HODA ABO-TALEB, Ph.D.;HOSAM EL-DEEN GAMAL, M.Sc.The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University and The Department of Applied Statistics and Econometrics, Institute of Statistical and Search, Giza, EgyptJournal Article20190204Abstract<br />Background: Urinary incontinence is a common and costly complication after radical prostatectomy often adversely affecting the quality of life.<br />Aim of Study: The aim of this systematic review was to examine the effectiveness of pelvic floor exercises on quality of life in post-prostatectomy patients.<br />Material and Methods: Systematic review of randomized controlled trials, data bases searched were made in PubMed, Pedro, Google scholar and Cochrane, all studies were post 1980 to 2015. Limits were English language.<br />Intervention: Four relevant randomized controlled trials included the exercise and its effects on quality of life in patients with urinary continence.<br />Results: Four studies were selected, included in meta-analysis for the primary outcomes as quality of life and secondary outcomes as depression.<br />Conclusions: There was strong evidence supporting that pelvic floor exercises decrease the frequency of urine leakage. Exercise can be an effective strategy to improve quality of life in patients having post-prostatectomy urinary incontinence.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Soluble Form of Transferrin Receptor as A Biomarker of Ineffective Erythropoiesis and Iron Overload in Pediatric Egyptian Patients with b-Thalassemia370737156993110.21608/mjcu.2019.69931ENMOHAMED H. MEABED, M.D.;AYMAN S. SOLIMAN, M.D.DINA A. EZZAT, M.D.;SAHAR S. ABD-ELHALIM, M.D.DINAH. EL-DAHSHAN, M.D.The Departments of Pediatrics*, Physiology** and Clinical Pathology***, Faculty of Medicine, Beni Suef University, EgyptJournal Article20190204Abstract<br />Background: Beta-thalassemias (b-thalassemias) are a group of inherited blood disorders caused by reduced or absent synthesis of the beta chains of hemoglobin resulting in variable phenotypes ranging from severe anemia to clinically asymp-tomatic individuals. Thalassemia is the commonest hereditary hemolytic anemia in Egypt. Iron overload is a major compli-cation of repeated blood transfusion in patients with thalassem-ia. Soluble Transferrin Receptor (sTfR), one of the main regulators of cellular iron homeostasis, is the truncated form of the tissue receptor.<br />Aim of Study: This work was conducted to study the pathophysiology of iron overload in children with b-thalassemia intermedia and thalassemia major and explore the possible utility of Soluble Transferrin Receptor (sTfR) for the evaluation of iron overload and ineffective erythropoi-esis in pediatric Egyptian patients with ß thalassemia major, b-thalassemia intermedia and comparing this with the controls.<br />Patients and Methods: This study was conducted on sixty b-thalassemia patients (30 b-thalassemia major and 30 b-thalassemia intermedia) together with 30 age and sex matched controls. Patients were selected from the outpatient clinics of the Pediatric Hematology Unit and the Inpatients of Pediatric Department; Faculty of Medicine, Beni Suef University Hospital during the year 2017. Patients and control were subjected to clinical evaluation and complete blood count along with serum ferritin and sTfR levels by Enzyme-Linked Immunosorbent Assay (ELIZA) technique.<br />Results: Both serum ferritin and sTfR levels were signif-icantly higher in patients compared with controls and in patients with thalassemia major compared with those with thalassemia intermedia. Serum ferritin and sTfR levels were significantly positively correlated with patients' age and with each other. Each of them was negatively correlated with age of disease onset, frequency of blood transfusions and with hemoglobin level.<br />Conclusion: Serum levels of ferritin and soluble transferrin receptor were significantly higher in both thalassemic groups in comparison to control group.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Reoperation on the Aortic Root after Previous Cardiac Surgery: Predictors of Outcome371737226993210.21608/mjcu.2019.69932ENAHMEDELSHARKAWY, M.D.The Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo UniversityJournal Article20190204Abstract<br />Background: Reoperations on the aortic root and the ascending aorta are being performed with increasing frequency and remain a challenging problem. The aim of our work is to study the surgical strategy, results and predictors of outcome of aortic root surgery in patients with previous cardiac operations.<br />Aim of Study: Is to report our experience with patients undergoing re-operation on the proximal thoracic aorta after previous cardiac surgery, to highlight special surgical consid-erations needed in this particular entity and to identify pre-dictors of outcome.<br />Patients and Methods: Between 2008 and 2016, 35 patients had reoperation on the aortic root after previous Cardiac Surgery at Kasr Al-Aini Cardiac Surgery Unit, Cairo Univer-sity. Their age ranged from 9 to 58 years. 4 patients had bicuspid aortic valve and 5 patients had Marfan syndrome. The main indication for reoperation was ascending aortic aneurysm (45.7%), followed by aortic valve pathology (22.9%), infective endocarditis involving the aortic root (17.1%) and type A aortic dissection (14.3%). 13 patients had modified Bentall procedure, 9 had supra coronary conduit replacement of ascending aorta, 5 had aortic valve replacement, 4 patients had supra coronary conduit and aortic valve replacement, 2 patients had biological root replacement with homograft, one patient had David procedure, and one patient had Bentall with Elephant trunk procedure.<br />Results: The mean cardio-pulmonary bypass time was 163±10min and the mean cross clamp time 134±9min. Re-exploration for bleeding was needed in 2 patients. There was 5 in hospital mortality (14.3%): 3 due to multi organ failure due to sepsis of active endocarditis, 1 due to myocardial failure and 1 due to major uncontrollable bleeding.<br />Conclusion: Short-term survival following aortic root reoperation is good for patients with degenerative aneurysms and healed infection, acceptable in cases of dissection, poor in patients with active endocarditis.<br />Long bypass time, active infection, time interval between surgeries less than one year were independent predictors of mortality.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Percutaneous Transforaminal Endoscopic Lumbar Discectomy: Early Experience of the First Fifty 50 Cases372337296993310.21608/mjcu.2019.69933ENAYMAN M. ISMAIL, M.D.;ESAM ABDELHAMID DAOUD, M.D.IHABALY MOHAMED HOSNY, M.D.The Departments of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt* and Orthopedics, Egyptian Military Medical Academy**Journal Article20190204Abstract<br />Background: Many kinds of surgical approaches from standard discectomy, microdiscectomy, percutaneous inter-laminar and transforaminal endoscopic discectomy have been in use for treatment of prolapsed intervertebral disc. Transfo-raminal endoscopic discectomy through a safe triangle (Kambin triangle) is a stitchless minimal invasive approach, doesn't require muscle splitting, can be done under local anaethesia with short hospital stay and minimal complication.<br />Aim of Study: The aim of this study is evaluation of early experience of transforaminal endoscopic lumbar discectomy, surgical technique, complications, overall results in single and multilevel lumbar disc herniation.<br />Patients and Methods: A retrospective study involved fifty patients with low back pain and unilateral sciatica due to prolapsed intervertebral disc were treated with endoscopic transforaminal discectomy at Zagazig University Hospitals, Al-Helmia and Al-Agoza Military Hospitals from Jan 2016 to June 2017 (35 patient under local, 15 patients under general anesthesia). Preoperative clinical assessment of the patients has done using visual analogue score (VAS) and Oswestry Disability Index (ODI) and follow-up was done at 1, 6, 12, months postoperatively. Surgery done by surgeons have never practicing endoscopic transforaminal approach before.<br />Results: Using Modified MacNab's criteria, good to excellent outcome was noted (45 patients, 90), fair outcome (2 patients, 4%) and poor results (3 patients, 6%). No major complications were noted, discitis in (2 patients, 4%), dysae-thesia (3 patients, 6%), recurrent disc prolapsed (3 patients, 6%), dural tear in (2 patients, 4%), no wound infection reported, mean operative time 55 minutes, mean hospital stay (12 hours, 4 days), mean return to work.<br />Conclusion: Since the introduction of percutaneous pos-terolateral approach by Kambin in the year of 1973, for treatment of herniated LDP, the procedure has advanced over the last decades and becoming more popular as the treatment of choice for treatment of herniated lumbar disc in selected cases.<br />Percutaneous transforaminal discectomy is a relatively safe and successful alternative approach for treatment of lumbar disc prolapse and associated sciatica, although micro-discectomy still remains the gold standard approach.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Can We Rely on mDixon Technique on Quantification of Hepatic Steatosis?373137386993510.21608/mjcu.2019.69935ENMONA ZAKY, M.D.;HATEM ELALFY, M.D.The Departments of Diagnostic Radiology* and Gastroenterology & Hepatology**, Faculty of Medicine, Mansoura UniversityJournal Article20190204Abstract<br />Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the outstanding cause of chronic liver disease. Magnetic Resonance (MR) is widely used in clinical trials to noninvasively quantify liver fat content.<br />Aim of Study: To determine the accuracy of mDixon MR technique in quantification of liver fat and correlate the results with liver biopsy.<br />Material and Methods: A prospective study was conducted at Mansoura University Hospitals between March 2017 to November 2018. This study included forty two patients who were referred from gastroenterology clinic for non-hepatic complaints. Clinical examination and estimation of body mass index was recorded in all patients. Abdominal ultrasonography was done to all patients only to exclude focal lesions and gross morphological changes, then MRI evaluation of the upper abdomen using the mDixon protocol. Within a week interval period, patients had liver biopsy.<br />Results: There was good correlation between the MR estimation of liver fat and histological grading, yielding sensitivity of 83.3% and specificity of 85.7% with accuracy of 84.62% at cut off point of 14.545.<br />Conclusion: MR estimation of the liver using mDixon technique provided specific information about liver fat, correlated well with the histological grading. Non invasive technique, does not require ionising radiation hence recom-mended as method of choice of liver fat quantification.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Measurements of Qf СйП, fmsr by Using Different Detectors in Radiation Qclin, Qmse Therapy Systems373937476994210.21608/mjcu.2019.69942ENSAMAH K. ELSHAMNDY, M.Sc.;PAOLO FRANCESCON, Ph.D.NINFA SATARIANO, Ph.D.;CHIARA ORLANDI, Ph.D.HASSAN ABOUELENEIN, Ph.D.;AHMED M. AHMED, Ph.D.The Department of Radiotherapy and Nuclear Medicine, Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20190204Abstract<br />Background: It worth to be mentioned that the use of small size photon beam is frequently used in modern radio-therapy to treat brain tumors and functional disorders.<br />Aim of Study: To measure output factors (OFs) and cal-culate the field factor ( ƒclin, ƒmsr ) of small fields and<br />V clin, Qmse<br />study its suitability for small field relative dosimetry.<br />Material and Methods: Numerous detectors were used for measuring the output factors for 6 MV photon beams by a CyberKnife®. To normalize different detector responses for the same field configuration, a correction factor was calculated for each detector by simulating the radiation delivery using Monte Carlo (MC) methods. Detectors used in the study were PTW60019 MicroDiaond, PTW 60018 Silicon diode, PTW31018 MicroLion, and Exradin W1 Scintillator. Field factors were calculated using Alfonso formula. Output factors for a CyberKnife were measured in circular fields with the diameters range from 5mm to 60mm. Measurements were made in a water tank at a 1.5cm in term of depth and at 80 cm for source-to-axis distance.<br />Results: The results of the current study show that the output measured by the detectors Micro Diamond and Exradin W1 Scintillator (PSD) were within the uncertainties of the Monte Carlo simulations for all the beam cones. The silicon diode detector was over-responding, while the MicroLion was under-responding. We found that an accurate dosimeter could be the MicroDiamond and Exradin W1 Scintillators in small field dosimetry.<br />Conclusion: We found that at small collimator settings only the synthetic microdiamond (PTW60019) and Exradin W1 scintillation detectors can be used as relative dosimeters without applying any correction factor.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Mechano-Chemical Endo-Venous Ablation of Varicose Veins with Flebogrif Occlusion Catheter374937546994310.21608/mjcu.2019.69943ENAHMED H.SOLIMAN, M.D.The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20190204Abstract<br />Background: Varicose veins may present a major health problem nowadays, as it has been detected in about 70% of population worldwide. This created a sense of urgency to develop less invasive techniques to manage such a condition.<br />Aim of Study: The aim of this study was to evaluate the effectiveness and safety of mechano-chemical ablation tech-nique in management of varicose veins using the flebogrif endo-venous occlusion catheter.<br />Patients and Methods: A total of 30 patients (35 lower limbs) had mechan-ochemical ablation for their varicose veins using the flebogrif endo-venous catheter; 22 for great saphe-nous vein (GSV) incompetence, 9 bilateral GSV, 3 shorts saphenous vein (SSV), one bilateral SSV and 2 combined unilateral great saphenous vein and SSV. Patients came back for follow-up one week, one month and 3 months post proce-dure having ultrasound duplex done. Recanalization, pigmen-tation, intra and post procedural pain were recorded, as post-operative complications.<br />Results: All 35 procedures were under local anaesthesia. Complete occlusion of the treated vein was initially achieved in all the patients, but at 3 months' follow-up, there was only partial recanalization in 2 from 35 (6%) of the veins. Those two were successfully treated with additional complementary ultrasound guided foam sclerotherapy. No significant compli-cations were reported.<br />Conclusions: Flebogrif is an effective treatment for chronic venous insufficiency of the long and short saphenous veins. Bilateral procedures can be successfully performed and toler-ated as can multiple veins in the same setting and same leg.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Analgesic Effect of Dexmedetomidine or Magnesium Sulphate Added to Bupivacaine in Interscalene Brachial Plexus Block During Shoulder Arthroscopy375537636994510.21608/mjcu.2019.69945ENDOAA A. ELZEFTAWY, M.Sc.;MOHAMAD A. EL-HARTY, M.D.AHMED S. ELGEBALY, M.D.;MONA B. FAYAD, M.D.The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta UniversityJournal Article20190204Abstract<br />Background: Shoulder surgery is accompanied with sig-nificant post-operative pain. Interscalene block is one of regional techniques which is effective and safe to control this pain. Magnesium Sulphate (MgSO4) & dexmedetomidine as adjuvants to bupivacaine is expected to prolong the block with minimal undesirable systemic effects.<br />Aim of Study: The aim of this work was to evaluate the post-operative analgesic effects of ultrasound guided intersca-lene brachial plexus block in elective shoulder surgeries under general anesthesia using either bupivacaine, bupivacaine-magnesium sulphate or bupivacaine-dexmedetomidine.<br />Material and Methods: This double blind RCT was carried out on 45 patients of both sexes, 18-60y, ASA I or II and scheduled for elective arthroscopic shoulder surgeries under GA. US guided interscalene block with total volume 20ml was done to all patients who randomly allocated into 3 equal groups: Group I (control group): 0.25% bupivacaine 18ml, Group II (Mg group): 0.25% bupivacaine 18ml + 2ml 10% MgSO4 200mg and Group III (Dex group): 0.25% bupivacaine 18ml + 2ml dexmedetomidine (100m g). HR & MAP at baseline, skin incision, 30, 60, 90 & 120min after skin incision and at 2h, 4h, 6h & 8h post-operative, onset & duration of sensory block, (VAS & sedation score) at 2, 4, 6, 8 & 12hrs post-operative, onset of 1st and total dose of meperidine and complications were measured.<br />Results: Our results showed no significant difference as regard to age, sex, ASA, duration & type of surgery, sedation score but there was significant decrease in HR, MAP, VAS, onset of sensory block & 1st analgesic requirements, total dose of rescue analgesic and prolongation in sensory block in Mg group & Dex group as compared to control group & also Dex group was superior to Mg group.<br />Conclusion: Dexmedetomidine 100μg was better than MgSO4 200mg when they added to bupivacaine 0.25% in US guided interscalene brachial plexus block as evidenced by prolongation of sensory block, improved quality of post-operative analgesia, decreased requirements of rescue analge-sics and providing desirable sedation without side effects.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of Subclinical Myocardial Dysfunction Using Tissue Doppler Imaging Echocardiography in Children with Non-Alcoholic Fatty Liver Disease376537766995010.21608/mjcu.2019.69950ENESSAM M.E. ELGENDY, M.Sc.;MOHIEE EL-DEEN A. AWAD, M.D.OSAMA A. TOLBA, M.D.;AMAL S. ELBENDARY, M.D.The Departments of Pediatric* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190204Abstract<br />Background: Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD) is a global health problem worldwide and is con-sidered the most common cause of chronic liver disease in pediatrics. Both NAFLD and heart failure are obesity-related conditions with high cardiovascular morbidity and mortality that have reached epidemic proportions.<br />Aim of Study: Evaluate subclinical myocardial dysfunc-tion using Tissue Doppler imaging Echocardiography in a group of overweight/obese children and adolescents with NAFLD.<br />Patients and Methods: This prospective case-control study was carried out upon 80 children (40 cases with NAFLD, 20 cases obese without NAFLD and 20 healthy controls). Diag-nosis of NAFLD was based on the finding of hepatic steatosis detected by abdominal ultrasonography. These children un-derwent full examination, lab investigations and TDI echocar-diography.<br />Results: Using conventional echocardiography mean value of LV mass was significantly higher in patients with NAFLD compared to controls. Using TDI mean values of MPI was significantly higher in patients compared to controls, whereas other parameter showed no significant difference. Left ven-tricular mass by echo showed significant increase as the hepatic steatosis was advancing in severity.<br />Conclusion: Patients with NAFLD have evidence of subclinical myocardial dysfunction using TDI echocardi-ography. Although the TDI provides new insight into alter-ations in LV structure and function related to IR in NAFLD patients, it cannot be used for differentiation of steatosis grading.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Pharmacodynamic Changes in Penile Color-Doppler Ultrasound of Diabetic Patients377737876995510.21608/mjcu.2019.69955ENSAMEH M. SARSIK, M.Sc.;TAREK A. AMIN, M.D.NAEIM M. ABD EL-NABY, M.D.;MOHAMED M. HEFEDA, M.D.The Departments of Dermatology, Venereology and Andrology* and Diagnostic Radiology**, Faculty of Medicine, Tanta UniversityJournal Article20190204Abstract<br />Background: Erectile dysfunction in diabetic patients leads to changes of intima, media, and Lumina of arteries resulting in atherosclerosis.<br />Aims of Study: To determine the association between diabetes mellitus and penile Doppler ultrasonography changes in patients with erectile dysfunction. Also, the influence of duration, control of diabetes and diabetes complications on Doppler parameters.<br />Settings and Design: Prospective cohort study, Andrology Unit of Dermatology, Venereology and Andrology Department, Tanta University Hospital.<br />Material and Methods: Thirty diabetic patients with ED and 10 age matched healthy controls were enrolled. Patients underwent assessment with international index of erectile function score, cavernosal artery ultrasonography during flaccid state for measurement of internal diameter, intima media thickness and arterial wall mass index. Followed by ICI to measure peak systolic velocity, end diastolic velocity and resistive index.<br />Statistical Analysis Used: Mean, standard deviation and Chi-square test by SPSS V.16.<br />Results: Diabetic patients with ED showed statistically significant decrease in IIEF score and PSV, increase in IMT and AWMI compared to controls. Positive correlation between duration of diabetes, blood glucose level and IMT and AWMI, Negative correlation between duration of diabetes and IIEF, PSV and erectile response. Negative correlation between blood glucose level and IIEF, PSV. Negative correlation between IMT, AWMI with IIEF.<br />Conclusions: Diabetic patients with ED have a higher prevalence of atherosclerosis represented as increased IMT and AWMI compared with controls. Diabetes was an inde-pendent risk factor associated with atherosclerosis. Cavernosal artery IMT and AWMI interpreted clinically as negative correlation with erectile function domain of IIEF. These new parameters give good prediction for atherosclerosis and could replace more invasive ICI.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Thyroid Imaging Reporting and Data System (TIRADS) Versus Thyroid Scan for Solitary Thyroid Nodules378937946995810.21608/mjcu.2019.69958ENHAYTHAM M. NASSER, M.D.;MOHAMMED ALEEM, M.D.The Departments of Radiology* and Otorhinolaryngology**, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20190204Abstract<br />Background: Solitary Thyroid nodules are a common finding which is defined as localized thyroid enlargement within an otherwise apparently normal gland. It is more common in females. Most of them are asymptomatic usually accidently discovered in neck US or carotid Doppler. Solitary thyroid nodule has a higher risk for malignancy than multiple nodules as reported in literature. Previously Radioactive Isotope scanning was first line for characterization before FNAC which is the gold standard to exclude malignancy. The availability and safety of US in addition to marvelous technological advances that yields high diagnostic power made it a prefect tool for the initial characterization of thyroid nodules. Recently TI-RADS (Thyroid Imaging Reporting and Data System) were proposed on the basis of ultrasound features for initial Solitary thyroid nodule characterization.<br />Aim of Study: To compare between Thyroid Imaging Reporting and Data System and thyroid scan to evaluate the malignant potentiality of the solitary thyroid nodule with taking reference the results of fine needle aspiration cytology (FNAC) and histopathology as gold standard.<br />Material and Methods: Thirty patients were enrolled in our cross section study with solitary thyroid nodule referred from the Otolaryngology Department to Radiology Department at Ain Shams University Hospitals. All patients underwent full thyroid ultasound examination with full comment on the nodules as regarde shape, echogenicity, margins, internal components and echogenic foci and classified according to the Americal college of radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) Classification guideline, then thyroid scan was done to all cases. Results of both ultrasound and thyroid scan are compared with histopatholog-ical results of Fine needle aspiration cytology (FNAC).<br />Results: The sensitivity and specificity of TIRADS on considering TR4 and TR5 lesions positive ( suspiciuos) when compared with histopathological findings were 100% and 79.2% respectively with PPV of 54.5%, NPV of 100% and accuracy of 83.3%. While isotope sensitivity when considering a cold nodule to be positive (suspiciuos) was 66.7% with specificity of 16.7%, PPV of 20%, NPV of 66.7% and accuracy of 26.7%.<br />Conclusion: Our results suggest that ACR TIRADS clas-sification is superior to thyroid scan as regarde charchterization of solitary thyroid noude and considered reliable in predicting thyroid malignancy.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Nasal Tip Remodeling by Non-Destructive Techniques379537996996310.21608/mjcu.2019.69963ENAMGD S.A. MADY, M.Sc.;MOHAMED A. RASHAD, M.D.HEBA A. ABO EL-NAGA, M.D.;KARIMA A. MOHAMED, M.D.The Department of Otolaryngology, Faculties of Medicine, Banha*, Al-Azhar (Girls)** and Menoufia*** UniversitiesJournal Article20190204Abstract<br />Background: Nasal tip surgery is regarded as the most challenging aspect of plastic surgery. Control of nasal tip contour has always been a key component of a successful rhinoplasty. Creating a natural-appearing nasal tip contour is a complex task and requires a 3-dimensional approach.<br />Aim of Study: In this study we aimed to study and imple-ment the different non-destructive surgical techniques for the management of the various nasal tip deformities.<br />Patients and Methods: Fifty patients with various tip deformities were operated by an open approach either by sutures, various grafts or both.<br />Results: Decreased need for irreversible techniques, with a concurrent increase in conservative techniques as sutures and grafts techniques that had been done in most of our patients for each.<br />Conclusion: We concluded that management of nasal tip deformities with both suture and grafting provides best results.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Serum Bilirubin Levels Can be Used as a Potential Biomarker in the Progression of Diabetic Nephropathy in Rats380138117009410.21608/mjcu.2019.70094ENSOHAIR A. SALEH, M.D.;ASMAA G. ABDOU, M.D.ESRAA A. SALEM, M.Sc.;SUZAN M. HAZZAA, M.D.The Departments of Physiology* and Pathology**, Faculty of Medicine, Menoufia University, EgyptJournal Article20190205Abstract<br />Background: Diabetes mellitus is a widespread syndrome and a major cause of morbidity and mortality all over the world. Diabetic nephropathy is a progressive and irreversible renal affection that may end by renal failure in sever conditions. Bilirubin is the end product of heme catabolism. It has been recognized as a strong antioxidant. Many studies relate bilirubin to diabetes.<br />Aim of Study: The present investigation aimed to study the changes in serum billirubin level in diabetic nephropathy and to know whether there is a correlation between its level and the stages of nephropathy in diabetic rats.<br />Material and Methods: Sixty male albino rats were used and divided into the following groups; non-diabetic control group, diabetic nephropathy group and insulin-treated diabetic nephropathy group. By the end of the experimental period, 24 hours urine samples were collected to measure urine volume & urinary creatinine concentration and calculation of creatinine clearance. Then systolic blood pressure (SBP) was measured using rat tail sphygmomanometer technique. Fasting blood samples were collected for estimation of glycemic state, liver function tests and renal function tests. Finally both kidneys were fixed in 10% formalin solution for histopathology by using H&E & periodic acid schiffe (PAS).<br />Results: Our data showed that streptozotocin injection significantly elevated glycemic state, aspartate transaminase (AST), alanine transaminase (ALT), serum urea, serum creat-inin, SBP and significantly decreased seum albumin, creatinin clearance, total and direct bilirubin. Alkaline phosphatase (ALP) and serum albumin showed insignificant change. Histopathological examination of the same group showed slight thickening of the basement membrane, arterioles, few inflammatory cells and hydropic changes in renal tubules. Insulin treatment significantly decreased glycemic state, AST, ALT, serum urea, serum creatinin, SBP and significantly elevated seum albumin, creatinin clearance, total and direct bilirubin. Histopathological examination of the same group showed some healthy glomeruli but still hydropic changes in renal tubules.<br />Conclusion: Regular monitoring of bilirubin in diabetic patients is essential marker for progression and prognosis of diabetic nephropathy and effect of treatment.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901A Study of the Role of Nigella Sativa Oil in the Eradication of H.Pylori Infection in Symptomatic Children381338217012710.21608/mjcu.2019.70127ENNOHA S.A. HAMED ESMAIL, M.Sc.;RASHA M.G. EL-SHAFIEY, M.D.AHMAD M. NAIEM ABD ELAL, M.D.;AMAL S. ELBENDARY, M.D.The Departments of Pediatrics* and Clinical Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190205Abstract<br />Background: Helicobacter pylori (H.pylori) is a gram-negative flagellated spiral bacterium which is usually acquired during childhood, and the infection persists throughout life unless specifically treated. Resistance against H.pylori is increasing, and it is necessary to find new effective agents. Nigella sativa has possible role of N. sativa oil in eradication of H.pylori infection in symptomatic children.<br />Aim of Study: The aim as present work was to study the possible role of N.sativa oil in eradication of H.pylori infection in symptomatic children.<br />Subjects and Methods: This randomized clinical trial was carried out on 60 symptomatic children with being proven positive for H.pylori stool antigen test from those attending the Diarrheal Diseases and Nutrition Unit of Pediatric Depart-ment at Tanta University. The patients were randomly assigned to one of the following three groups: Group 1: Included 20 patients who received triple therapy for two weeks including clarithromycin 15mg/kg/day divided into two doses + metri-nodazole 15-20mg/kg/day divided into two doses + omeprazole 1mg/kg/day, for two weeks. Group 2: Included 20 patients who received 2g Nigella sativa oil two capsules (each of 450mg) twice daily after meals and omeprazole 1mg/kg/day for two weeks. Group 3: Included 20 patients who received triple therapy combined with Nigella sativa oil for two weeks. All patients had a full sheet, complete clinical examination and routine laboratory investigations (CBC, ALT, AST, BUN, S.creatinine, ESR), occult blood in stool, H.pylori antigen in stool before and after treatment and assessment of severity of dyspepsia using "Modified Glasgow Dyspepsia Severity Score" before and after treatment.<br />Results: There was statistically significant differences between the three studied groups as regard H.pylori antigen in stool after treatment. The difference was evident on com-paring either Group I or Group III versus Group II. Signifi-cantly more cases in Group I (65%) and in Group III (75%) became negative to H.pylori antigen in stool in comparison to only (30%) of the patients in Group II.<br />Conclusion: Addition of N.sativa to the traditional triple therapy increased the probability of H.pylori eradication more than that achieved through triple therapy alone.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Added Value of Dynamic Contrast Enhanced MRI Semiquantitative Parameter in Discrimination of Ovarian Lesions382338327012810.21608/mjcu.2019.70128ENAHMED S. ABDELRAHMAN, M.D.;AHMED M. BASSIOUNY, M.D.The Department of Radiology, Faculty of Medicine, Ain Shams UniversityJournal Article20190205Abstract<br />Background: Ovarian tumors are one of the most common women cancers. The high vascularity of malignant ovarian tumors can be assessed by the dynamic contrast enhanced MRI allowing preoperative characterization of ovarian lesions which help for planning the proper surgical management.<br />Aim of Study: To evaluate the role of semiquantitative parameters of the dynamic contrast enhanced MRI in differ-entiation of ovarian lesions.<br />Material and Methods: 25 patients with complex or solid ovarian lesions underwent dynamic contrast enhanced MRI (DCE MRI). The semiquantitative parameters including max-imum relative enhancement percentage (MRE%) and time to peak (Tmax) as well as the type of time intensity curve (TIC) were analyzed and compared to the histopathological results.<br />Results: The MRE% was higher for malignant ovarian tumors than for benign (p<0.001) and for borderline lesions (p 0.002). The Tmax was earlier in malignant ovarian tumors than in benign (p<0.001) and in borderline ovarian masses (p 0.019). TIC Type III was specific for invasive malignant tumors. The DCE MRI maximal accuracy was 88.2.<br />Conclusion: The semiquantitative parameters of DCE MRI had increased the accuracy and sensitivity of MRI for discrimination between malignant, borderline and benign ovarian lesions.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Nicotine Response to Interval Training in Male Smokers383338377012910.21608/mjcu.2019.70129ENMAHA M. AZZAM, M.Sc.;SAMAH M. ISMAIL, Ph.D.ZAHRAA M. HASSAN, Ph.D.;MAHA H. SABRY, M.D.The Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, New Cairo Hospital*,
Faculty of Physical Therapy, Cairo University** and The Depatment of Copmlementary Medicine, National Research Center***Journal Article20190205Abstract<br />Background: Tobacco overtaking, sedentary lifestyle and low fitness considered as the main risk factors for diseases that leads to death, such as, coronary heart disease, stroke, obesity and hypertension which are the most common causes of morbidity and mortality.<br />Aim of Study: The purpose of this study was to find out the effect of interval training on nicotine in male smokers.<br />Subject and Methods: The study was conducted on thirty smokers in New Cairo Hospital started at August 2017 and had been finished at December 2018, their age ranged from 20 to 40 years their BMI ranged from 25 to 29.9kg/m2 all subjects were thoroughly evaluated before and after the exercise protocol application. Initial assessment were included measurements of body weight, body height, and nicotine blood levels, all were free from musculoskeletal disorders or cardiovascular disorders, then subjects started treatment program as following, performing a supervised running on treadmill in pattern of high intensity interval training for 30 minutes, 3 sessions per week for 8 weeks. Each training session was consisted of 5 minutes of warming-up walking, 10 minutes of high intensity interval training consist of 2 repeats of (1min running at 85-95% of MHR then followed by 4min recovery at 60-70% of MHR), and ended with 5 minutes of cool-down walking.<br />Results: Statistical analysis showed a significant improve-ment (decrease) in cotinine level (nicotine) by 39.94%.<br />Conclusion: It is recommended for smokers to participate in high intensity interval training to decrease smoking craving, and then smoking cessation.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Predicting the Outcome of Microsurgical Resection of Olfactory Groove Meningiomas (OGMs): Experience at Benha University Hospital383938447013110.21608/mjcu.2019.70131ENMOATAZ A. ELAWADY, M.D.;MAHMOUD M. WAHDAN, M.D.MOHAMMEDE. ELHAWARY, M.D.The Department of Neurosurgery, Faculty of Medicine, Benha UniversityJournal Article20190205Abstract<br />Background: Radical excision of olfactory groove men-ingioma is the goal of microsurgery but faces some challenges such as the hypersostotic bone and paranasal sinus invasion with resulting Cerebrospinal Fluid (CSF) leak and infection making high recurrence rate.<br />Aim of Study: The aim of the present study was to identify factors predicting the outcome for patients with a diagnosis of OGMs undergoing microsurgical resection and to examine whether there is a general benefit of such microsurgery.<br />Patients and Methods: A total number of 28 patients were microsurgically operated for OGMs at the Neurosurgery Department of Benha University Hospital between January 2012 and December 2018.<br />Results: No patient characteristics, such as age, sex or presenting symptoms could be considered predictive for the post-operative outcome. Of the tumor-related characteristics only the presence of skull base invasion and the Simpson grading of removal were considered negative predictors for the outcome.<br />Conclusions: Microsurgical removal of the OGMs is effective and save with very little morbidity and low risk of post-operative recurrence provided that it is done totally with complete reconstruction of the skull base.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Apocynin on Testicular Ischemia/Reperfusion Injury in Male Albino Rats384538537013510.21608/mjcu.2019.70135ENNEHAL M. GABR, M.Sc.;ROMYSAA A. ELSHRBINY, M.D.GHADA M. ESMAIL, M.D.;HOSSAM EL-DEEN M. ABODA, M.D.The Department of Physiology, Faculty of Medicine, Tanta UniversityJournal Article20190205Abstract<br />Background: Apocynin, obtained from the roots of the Apocynum cannabinum plant, is a substance that has the effect of a NOX inhibitor. Apocynin (4-hydroxy-3- methoxyace-tophenone) plays a role in the production of superoxide inhibitors. Many pervious studies demonstrated the positive effects of apocynin on renal Ischemia Reperfusion (I/R) in a rat model.<br />Aim of Study: The aim of this work is to study the effect of apocynin on testicular ischemia/reperfusion injury in male albino rats.<br />Material and Methods: The present work was carried on 30 male albino rats. The rats were divided into three groups, (10 rats for each). Sham operated group (Group I): Delivery of the left testis without twisting and the testis was relocated into the scrotum. Ischemia/reperfusion group (Group II): Testicular torsion was done by rotating the left testis 720º in anticlockwise direction, these rats were injected intraperito-neally by a single dose of 10ml normal saline solution. Apocynin treated group (Group III): The same surgical pro-cedure was done as in Group II; these rats were injected intraperitoneally by a single dose of apocynin at a dose of 20 mg/Kg 1/2 an hour before the detorsion. At the end of the experiment, the animals were anesthetized, then the animals were sacrificed by cervical decapitation. The blood samples were collected.<br />Results: The results of the present work revealed that the 4 hours torsion group showed significant increase in testicular malondialdehyde, serum FSH and LH and multiple apoptotic cells showed by immunohistochemical examination of testic-ular caspase-3, however it produces significant decrease in testicular GPX level and serum free testosterone level when these results compared to sham operated group, these results were confirmed by histopathological examination which showed thick basement membrane, loss of cohesions of spermatocytes, congested interstitial vessels, oedema, seques-tration of spermatocytes and spermatogonia in lumen of tubule and separation of basement membrane. The apocynin treated torsion detorsion group showed significant decrease in testic-ular malondialdehyde, serum FSH, LH and less apoptotic cells showed by immunohistochemical examination of testicular caspase-3, however it produce significant increase in testicular GPX level and serum free testosterone level when these results were compared to torsion detorsion group, these results were confirmed by histopathological examination which showed mild thickening of basement membrane and mild loss of cohesion of spermatogenic cells. Interstitial tissue showed mild congestion of vessels with minimal oedema.<br />Conclusion: We concluded that there is a significant role of Apocynin on testicular ischemia/reperfusion shown from its effect on MDA, GPX, caspase-3, testosterone, serum FSH, LH in addition to its role in improvement of histopathological picture.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prognostic Impact of Telomere Maintenance Gene Polymorphisms on Hepatocellular Carcinoma Patients with Chronic Hepatitis C385538587013610.21608/mjcu.2019.70136ENHEBAT ALLAH M. SHARAF EL-DEEN, M.D.;ENAS H. MAHMOUD, M.D.AHMED A.E. HEKEL, M.D.;ALAA A. ABDEL RAUOF, M.D.SUZAN E. MAHROUS, M.D.;ASMAA E.A. NASR ELDIN, M.Sc.The Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo UniversityJournal Article20190205Abstract<br />Background: Telomere length and telomerase activity are crucial for cancer initiation and the survival of tumors. Tel-omere length is maintained by telomerase in 90% of human cancers, while 10% of cancers use an alternative mechanism of telomere lengthening termed (ALT). Another mechanism for Cancer cells is through activating or up-regulating the normally silent human TERT gene (hTERT) that encodes telomerase.<br />Aim of Study: The aim of the present study was to assess the effect of a SNP in TERT gene rs13167280 on telomere length, furthermore, a study was conducted to investigate whether the changes of median values of Relative Telomere Length (RTL) is related to a SNP genotype.<br />Patients and Methods: The study was conducted on a total number of 100 patients, subdivided into two groups HCC and HCV groups. SNP was measuring using Taqman probe on step-one real time PCR.<br />Results: It was found that HCC patients had high frequency of heterozygous AG genotype than HCV patients 30% versus 22% and both groups had no homozygous AA genotype. Moreover, the frequency of G allele comparing to A allele in SNP rs13167280 was higher in HCV than HCC 90% versus 85% respectively.<br />Conclusion: There was no statistical significant difference observed on comparing a SNP rs13167280 in HCC and HCV groups and there was no statistically significant association was found (p=0.34) when we investigated whether the changes of median values of RTL is related to a SNP genotype.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Ultrasound Guided Radiofrequency Ablation of the Suprascapular Nerve Versus Injection Block Technique: A Comparative Study in Patients with Chronic Shoulder Pain385938647013710.21608/mjcu.2019.70137ENAHMED M. BASSIOUNY, M.D.;AHMED S. ABDELRAHMAN, M.D.The Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptJournal Article20190205Abstract<br />Background: Chronic shoulder pain affects the quality of life and limits daily activities. Suprascapular nerve block is an effective technique in management of chronic shoulder pain. Suprascapular injection technique had several drawbacks particularly repeated injections that may affect the patients' outcomes. RFA is considered a safe technique especially with ultrasound guidance, having a long duration of action with absence of any complications or organ damage.<br />Aim of Study: This study aimed to examine the effective-ness of radiofrequency ablation (RFA) of the suprascapular nerve in comparison to the injection of lidocaine and hydro-cortisone mixture under ultrasound guidance.<br />Patients and Methods: 20 patients with chronic shoulder pain were divided in to two equal groups one group was submitted to RFA of the suprascapular nerve using the Cool-Tip RF system and an internally cooled electrode (group A) and the other group had lidocaine and hydrocortisone mixture injection (group B) of the same nerve, both groups were followed-up over a period of 6 months with pre and post interventional assessment of the pain though visual analogue score for pain (VAS).<br />Results: All patients had chronic shoulder pain not re-sponding to medical treatment and physiotherapy, after RFA, 6 patients were pain free, 4 cases had mild pain that responded to conservative treatment, regarding those of the injection group all cases had relief for 3 months, at 6 months, only 3 had no complain while 4 patients had recurrence and 3 had stationary course of pain relief.<br />Conclusion: RFA proved to be a superior technique com-pared to the injection method in management of chronic shoulder pain.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901hTERT rs2736098 Genetic Variants and Susceptibility of Hepatocellular Carcinoma with Chronic Hepatitis C in the Egyptian Patients386538697013810.21608/mjcu.2019.70138ENHEBAT ALLAH M. SHARAF EL-DEEN, M.D.;ENAS H. MAHMOUD, M.D.AHMED A.E. HEKEL, M.D.;ALAA A. ABDEL RAUOF, M.D.SUZAN E. MAHROUS, M.D.;ASMAA E.A. NASR ELDIN, M.Sc.The Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo UniversityJournal Article20190205Abstract<br />Background: Telomere length and telomerase activity are crucial for cancer initiation and the survival of tumors. Tel-omere length is maintained by telomerase in 90% of human cancers, while 10% of cancers use an alternative mechanism of telomere lengthening termed (ALT). Another mechanism for Cancer cells is through activating or up-regulating the normally silent human TERT gene (hTERT) that encodes telomerase.<br />Aim of Study: The aim of the present study was to assess the effect of a SNP in TERT gene rs2736098 on telomere length, furthermore, a study was conducted to investigate whether the changes of median values of Relative Telomere Length (RTL) is related to a SNP genotype.<br />Patients and Methods: The study was conducted on a total number of 100 patients, subdivided into two groups HCC and HCV groups. SNP was measuring using Taqman probe on step-one real time PCR.<br />Results: It was found that homozygous GG genotype in SNPrs2736098 was high in both HCC and HCV comparing to heterozygous GA genotype and variant AA genotype. Moreover, the frequency of the SNP rs2736098 G allele compare to A allele was higher in HCV than HCC 82% versus 76% respectively.<br />Conclusion: There was no statistical significant difference observed on comparing a SNP rs2736098 in HCC and HCV groups and there was no statistically significant association was found (p=0.69) when we investigated whether the changes of median values of RTL is related to a SNP genotype.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Effect of Energy Drinks on Rat Hippocampus and the Possible Neuroprotective Role of Sesame Oil: Histological, Immunohistochemical and Molecular Study387138817013910.21608/mjcu.2019.70139ENDOAA M.SHUAIB, M.D.The Department of Anatomy & Embryology, Faculty of Medicine, Cairo UniversityJournal Article20190205Abstract<br />Background: Energy drinks (EDs) consumption has in-creased dramatically over the past years and several adverse effects have been reported. Sesame oil (SO) is a potent antioxidant and anti-inflammatory dietary source for human health.<br />Aim of Study: The present study was assigned to investigate the possible neuroptotecive role of SO on energy drinks-induced hippocampal damage.<br />Material and Methods: Twenty adult male albino rats were divided into four groups; five rats in each (control, SO, EDs and EDs+SO). Routine histological examination was done, together with toluidine blue stain for dark neurons (DN) and glial fibrillary acidic protein (GFAP) immunostaining for astrocytes. Gene expression of catalase and tumor necrosis factor alpha (TNF-a) was analyzed using real-time polymerase chain reaction (PCR) and histomorphometric analysis was done.<br />Results: Histological examination of the hippocampus from EDs group showed shrunken pyramidal and granule cells, vacuolation and large pericellular spaces. There was significant decrease in neuronal thickness, increase in the number of DN and GFAP area percent compared to control group. Significant decrease in catalase gene expression was observed along with increase in TNF-a gene expression. Concomitant SO administration significantly improved the previously mentioned changes.<br />Conclusion: Energy drinks administration induced mor-phological and morphometric changes, deficient antioxidant capacity and inflammatory response in rat hippocampus. Sesame oil administration alleviated these adverse changes possibly due to its antioxidant and anti-inflammatory prop-erties.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Efficacy of Radiofrequency in Facial Rejuvenation388338907014010.21608/mjcu.2019.70140ENMAI A.A.R. MOHAMMED, M.Sc.;GHADA F. REZK, M.D.SAMIA OTHMAN NASSAR, M.D.;DAREEN A. MOHAMMED, M.D.The Departments of Dermatology & Venereolog* and Pathology**, Faculty of Medicine, Tanta UniversityJournal Article20190205Abstract<br />Background: The process of skin aging may be classified into intrinsic and extrinsic aging or photoaging. The first is a natural and gradual process. The second is triggered by environmental factors such as excess sun exposure. There are many therapeutic modalities that can improve skin aging. These modalities may be divided into topical agents and procedural agents. Radiofrequency (RF) is one of good pro-cedural modalities to improve skin aging.<br />Aim of Study: The aim of this study was to evaluate the efficacy and safety of radiofrequency in facial rejuvenation.<br />Settings and Design: Prospective study.<br />Patients and Methods: This study included ten patients presented with facial wrinkles. All patients received four RF sessions with three to four weeks interval and followed-up after three month after end of treatment. Patients were assessed by digital photographing and skin biopsies before and after treatment.<br />Results: Radiofrequency showed favorable results with 40-50% improvement. There was a significant difference in degree of improvement according to doctors' opinion ad patients' satisfaction after than before treatment.<br />Conclusion: RF is a safe, acceptable, effective and non-invasive tool for skin rejuvenation that produces favorable results. RF could act as an alternative but not equivalent to other invasive modalities. These results were confirmed by immunohistochemical expression of Matrix Metalloproteinase 1 (MMP1).The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Value of Hystersocopy; Ultrasonogrphy and Histopathology in Diagnosis of Chronic Endometritis in Patients with Unexplained Recurrent Spontaneous Abortion389138957014110.21608/mjcu.2019.70141ENIBRAHEEM M. KANDIL, M.D.;ASEM A. MOUSA, M.D.MOHAMED A. MOHAMED, M.D.;SAYED A. SAYED, M.D.RASHAS. GHORAB, M.Sc.The Departments of Obstetrics and Gynecology* and Histopathology**, Faculty of Medicine, Al-Azhar UniversityJournal Article20190205Abstract<br />Background: Recurrent Spontaneous Abortion (RSA) defined as the loss of three or more consecutive pregnancies before the 20 weeks of gestation or a fetal weight of less than 500 grams.<br />Aim of Study: To investigate the role of Chronic En-dometritis (CE) in unexplained RSA and to determine the correlation between hysteroscopic, Doppler ultrasonography and histologic findings of CE in patients with unexplained RSA.<br />Patients and Methods: This prospective controlled study was conducted in Al-Hussein University Hospital, Al-Azhar University. Forty consecutive patients with unexplained RSA referring to the infertility clinic (from May 2016 till January 2019) were enrolled in this study to investigate the role of CE in RSA. A control group of other twenty fertile women who underwent hysteroscopy due to vaginal bleeding or causes other than RSA and infertility were also included.<br />Results: Suggested that the measurement of previous hormone levels, blood flow by color Doppler can discriminate endometritis from potentially normal women. The data in our study also suggested that there were significant differences as regards luteal phase disorders.<br />Conclusion: Chronic endometritis was not incriminated as a cause for repeated first trimestric abortion in patients with repeated unexplained spontaneous abortionThe Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Ankle Brachial Index As A Monitor of Diabetes Type 2 Microvascular Complications389739037014210.21608/mjcu.2019.70142ENJEHAN SAEED, M.D.;AMIRA AHMED MAHMOUD, M.D.ABEER A. SAEED, M.D.;NAGLAA A. AHMED, M.D.The Departments of Internal Medicine* and Physiology**, Faculty of Medicine, Zagazig UniversityJournal Article20190205Abstract<br />Background: Peripheral Artery Disease (PAD) has been linked with diabetic microvascular complications. However, many patients do not show typical symptoms. Ankle-Brachial Index (ABI) is reported to be a simple and useful method to estimate cardiovascular risks.<br />Aim of Study: To determine whether Ankle-brachial index could be a useful monitor of development of micro vascular complications in type 2 diabetes.<br />Patients and Methods: A cross sectional study included 93 patients, classified into two groups: Group I (control group) consistsed of 10 healthy individuals. Group II (patient group): Consisted of 83 diabetes type 2 patients diagnosed according to ADA criteria; who were further subdivided according to presence or absence of microvascular complications into two groups: Group IIA: 10 diabetics without microangiopathy and Group IIB: 73 Diabetics with microangiopathy. All the study members were subjected to clinical evaluation, fundus exam-ination, serial measurement of blood pressure, fasting & postprandial blood glucose, HbA1c, serum creatinine, urinary albumin and ABI.<br />Results: Our results showed significant higher BMI and lower ABI in diabetic groups compared to control (p<0.05); where fasting blood glucose, postbrandial blood glucose, HbA1c and serum creatinine were significantly elevated diabetic groups compared to control (p<0.05). A significant negative correlations (p<0.000) between BMI, HbA1c and duration of DM with ABI. The incidance of microvacular complications (retinopathy, nephropathy & neuropathy) was significantly higher (p 0.00) in complicated diabetic group (Group IIB) compared to control and IIA groups. The average ABI was significantly lower (p<0.05) among complicated diabetic group (Group IIB) regarding retinopathy (proliferative & non proliferative), nephropathy (micro & macroalbuminria) and neuropathy (mild, moderate & sever).<br />Conclusion: Low ABI is common in patients with T2D. The ABI is a simple, reproducible, and cost-effective screening test for diagnosing microvascular complications in diabetes type 2 patients. ABI screening should be performed in diabetic population for early evaluate of microvascular complications.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Therapeutic Plasma Exchange in Tanta University Hospitals, Single Center Experience390539127014310.21608/mjcu.2019.70143ENHANAA I. OKDA, M.D.;SHIMAA H. EL-ATTAR, M.D.ALZAHRAAA. ALLAM, M.D.The Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20190205Abstract<br />Background: Therapeutic Plasma Exchange (TPE) is effective therapeutic procedure in treating diverse diseases.<br />Aim of Study: To evaluate the outcomes of TPE in different diseases in our department.<br />Patients and Methods: Retrospective study of patients referred for TPE during last five years period. We reviewed the demographic, clinical indications, number of sessions, volume of exchanged plasma, patient response and complica-tions during or after the procedure and descriptive statistica-lanalysis was performed.<br />Results: The study included 109 patients recorded during the last 5 years period. The indications for TPE were Gullian-Baree in 28 patients with response in (21/28 pateints), throm-botic microangiopathy in 27 patients with response in (19/27) patients, SLE in 22 patients with response in (16/22), Cry-oglobinemia in 12 patients with response in (10/12), RPGN<br />in 5 patients with response in (4/5) patients, hyperviscosity<br />in 6 patients, mythenia gravis in 4 patients, renal transplantation in 3 patients, dermatomyocitis in one patient and autoimmune hemolytic anemia in one patient with complete response in all patients of these later diseases. The main complications of the procedure were muscle cramps induced by hypocalcemia (n=10, 9%), allergic reactions (n=9, 8%), hypotension (n=7, 6%), fever (n=4, 3.6%), loss of consciousness (n=2, 1.8%), convulsions (n=2, 1.8%), catheter related hematoma (n=1, 0.9%), bleeding from AV fistula (n=1, 0.9%).<br />Conclusion: Our experience in therapeutic plasma ex-change showed favorable results in different immunological and non-immunological diseases.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Placenta Accreta: Diagnostic Accuracy of Ultrasonography Versus MRI391339217033710.21608/mjcu.2019.70337ENABDELMONEM M. MOURAD, M.D.;REEM A. ASHRY, M.D.SOHIRIBRAHIM, M.Sc.The Department of Radiodiagnosis, Saudi German Hospital, Riyadh, Saudi ArabiaJournal Article20190206Abstract<br />Background: Placenta accreta is an aberrant attachment of the placenta within the myometrium due to the absence of decidua basalis with subsequent infiltration of the myometrium by chorionic villi.<br />Aim of Study: The present study aimed to construct the basic criteria of both sonographic and MRI for the diagnosis of placenta accrete and figuring out the accuracy of those criteria parallel with the definition of the most peculiar features in clinical practice.<br />Material and Methods: 84 pregnant women at high risk of placenta accrete occurrence from two Obstetric Centers; Saudi German and Sulaiman Alhabib Hospitals, Riyadh, KSA, have been disgnosed in the period from January 2015 to May 2017. All patients did abdominal ultrasonography and MRI to evaluate the suspected diagnosis of placenta accreta. A comparison was made between the results of both procedures and the final diagnosis that was confirmed by clinical findings at delivery and pathologic examination of specimens.<br />Results: No significant difference in the sensitivity and specificity of ultrasonography and MRI (sensitivity: Ultra-sonography, 100% versus MRI, 76.9%, specificity: Ultra-sonography, 37%, versus MRI, 50%). Incongruence was found in 28 of 84 cases between ultrasonography and MRI. In these, ultrasonography was correct in 16 cases, and MRI was correct in 12 cases. This was statistically non-significant.<br />Conclusion: Both modalities have nearly the same diag-nostic accuracy. Ultrasonography is the commonly used and the most sensitive imaging method. Moreover, MRI acts as a perfect complement method to ultrasonography in case of the presence of few inconclusive ultrasound findings.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901The Role of PET/CT in Evaluation of Recently Diagnosed Breast Cancer392339327033910.21608/mjcu.2019.70339ENEMAN G. AL-SAADAWY, M.D.;LOBNA K. SAKR, M.D.REEMP. MOHAMED, M.Sc.The Department of Radiodiagnosis, Faculty of Medicine for Girls, Al-Azhar UniversityJournal Article20190206Abstract<br />Background: Breast cancer is the most common non-skin cancer and the second leading cause of cancer related death in women. Breast cancer strikes women of all ages, races, ethnicities, socioeconomic strata, and geographic locales. Once breast cancer is diagnosed, the tumor stage has to be accurately determined before therapy chosen and the prognosis known.<br />Aim of Study: To investigate the ability of 18F-FDG PET/CT to be used as a pre-operative assessment, staging and metastatic work up tool in patients with recently diagnosed breast cancer which is subsequently reflected in the manage-ment of breast cancer patients.<br />Patients and Methods: This study was carried out in Dokki Scan Radiology Center from April 2016 to October 2018 on a total number of 50 female patients with biopsy proved to have cancer breast. The age of the patients ranged from 27 to 78 years, and the average was 56.98. All exams were done on the PET/CT scanner Phillips Gemini & Siemens time of flight 64 & 20 machines respectively.<br />Results: Whole-body 18F-FDG PET/CT plays an important role in the assessment of breast cancer patients particularly as it helps detection of the extent of the disease in the body, improves staging of breast cancer patients which significantly changes the therapeutic management of these patients.<br />Conclusion: PET/CT proved to be an efficient, accurate and non-invasive imaging technique in detecting metastatic disease with subsequent modification of the initial patient staging management planes.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Psychological Factors and Family Troubles among Adolescents with Drug Use Disorders393339437034110.21608/mjcu.2019.70341ENNORHAN A. EL-FALLAH, M.Sc.;EL-SAYED A. GAD, M.D.ADEL A. BADAWY, M.D.;SHEREEN D. ABO HAMAR, M.D.The Department of Neuropsychiatry, Faculty of Medicine, Tanta UniversityJournal Article20190206Abstract<br />Background: Substance use among adolescents is a com-plex and multidimensional problem. Parental substance use, family conflict, poor family management practices and affil-iation with peers using illicit drugs are important risk factors for addiction.<br />Aim of Study: The aim of this study is to assess impulsivity, peer relationships and parent relationship among adolescents with substance use disorders.<br />Subjects and Methods: Eighty adolescents were included in this study, 40 patients with substance use disorder and 40 healthy adolescents as a control group. All subjects of the study were subjected to: Drug abuse history, Arabic Version of (MINI-KID), IQ assessment, Substance Use Risk Profile Scale (SURPS), Socioeconomic Status Scale for Health Re-search in Egypt, questionnaire of parental attitudes as realized by adolescents and Inventory of Parents and Peer Attachment.<br />Results: There was no statistically significant difference between both groups as regards age, sex and residency. Forty-five percent of adolescents with substance abuse came from single parent families. The patients had significantly more positive family history of substance use disorders (p=0.012) and more family history (p=0.013) of psychiatric disorders. Tramadol is the most common abused substance 37.5%. The most common psychiatric co-morbidities in patients group were conduct disorder (22.5%) and major depressive disorder (15%). Impulsivity, anxiety sensitivity and hopelessness were significantly increased among patients group than control group (p=0.001), (p=0.006) & (p=0.001) respectively. Fathers of patients showed significantly higher consistency with their sons (p=0.021) as well as higher rejection (p=0.002), while the mothers of patients showed significantly higher independ-ency (p=0.005) than control group. Adolescent with substance use disorders had significant less trust and communication with their friends (p=0.009), (p=0.001). Patients has signifi-cantly more friend with history of substance use disorders (p=0.011).<br />Conclusions: Poor family management practices and relationships to peers using illicit drugs are important risk factors for addiction. There are certain psychiatric disorders associated with substance use such as conduct disorder and depression. There are also some psychological factors associ-ated with substance use disorder such as impulsivity, hope-lessness and sensation seeking.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Prognostic Value of CD45 Surface Antigen in Children with Acute Lymphoblastic Leukemia Treated according to Total XV Protocol394539527034410.21608/mjcu.2019.70344ENSHEBL S. SHEBL, M.D.;MOHAMED A. SAAD, M.D.IBRAHIM M. BADRAIA, M.D.;AMIRA M. ABO ELELA, M.Sc.The Departments of Pediatric Hematology & Oncology* and Clinical Pathology**, Faculty of Medicine, Tanta University, EgyptJournal Article20190206Abstract<br />Background: Acute Lymphoblastic Leukemia (ALL) is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Further improvement of outcome in childhood acute lymphoblastic leukemia could be achieved by identifying additional high-risk patients who may benefit from intensified treatment. CD45 cell surface antigen is a transmembrane protein with tyrosine phosphatase activity, expressed by all nucleated cells of hematopoietic origin, except erythrocytes and platelets.<br />Aim of Study: To assess the prognostic value of CD45 surface antigen in children with acute lymphoblastic leukemia who treated according to TOTAL XV protocol.<br />Subjects and Methods: This study was conducted on 25 patients with acute lymphoblastic leukemia who treated according to Total XV protocol. CD45 expression was meas-ured by flowcytometry and cut-off value for CD45 expression is set on 90% to distinguish a CD45-high from a CD45-low group.<br />Results: There was significant correlation between CD45 expression and age. There was no statistically significant differences between low and high CD45 groups as regard initial total leucocytic count, bone marrow blast cells percent-age, leukemic phenotype, DNA index, t (9, 22) or CNS status. There was statistically significant difference between the two groups regarding early treatment response, risk stratification, incidence of relapse and event free survival.<br />Conclusion: Measuring the intensity of expression of CD45 surface antigen has a prognostic value in childhood acute lymphoblastic leukemia. So consideration of CD45 expression may serve as an additional stratification tool.<br />Recommendations: Multicenter study on large number of patients with follow-up for longer duration is recommended to prove the prognostic value of CD45 expression in childhood acute lymphoblastic leukemia.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Clinical Value of Serum Fibrosis Biomarkers in Prediction of Esophageal Varices in Cirrhotic Patients395339607034710.21608/mjcu.2019.70347ENGHADA M. GALAL, M.D.;SAFAA KHALAF, M.D.MARIUMAMIR, M.Sc.The Department of Tropical Medicine and Gastroentrology, Faculty of Medicine, Sohag UniversityJournal Article20190206Abstract<br />Background: Esophageal varices is one of the major com-plications of portal hypertension, occur in approximately 30%-70% of cirrhotic patients. As portal hypertension is a consequence of liver fibrosis, serum fibrosis biomarkers could serve as non invasive predictors for esophageal varices and their grades.<br />Aim of Study: Determine the frequency and grading of esophageal varices in a group of cirrhotic patients with no history of upper gastrointestinal bleeding, and also evaluate and compare the predictive value of APRI, AAR, FIB-4, FI, and king scores in predicting the presence of varices and their grade.<br />Patients and Methods: One hundred and one cirrhotic patients were included in the study. The diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic data. An upper GIT endoscopic examination was performed for all patients for the diagnosis of presence or absence of esophageal varices. Serum fibrosis biomarkers were calculated from data available on the first day hospital admission and used as prognostic indicators for presence and grade of esophageal varices.<br />Results: Patients with esophageal varices had significantly lower mean values of platelet counts and albumin levels than those without esophageal varices (p=0.015, p=0.045; respec-tively). Also there was a significant difference between patients with and without esophageal varices as regard FI score (p= 0.016). Patients with medium to large esophageal varices had significantly lower mean values of platelet counts than those with no to mild esophageal varices. Also there was a significant difference between patients with medium to large esophageal varices and those with no to mild esophageal varices as regard FI, FI B-4 and King scores (p=0.003, p=0.001, p=0.017; respectively). The FI score was accurate in predicting presence of esophageal varices in cirrhotic patients. Using 3.52 cut-off value, a prediction of presence or absence of EV could be made in 62.4% of cirrhotic patients. FIB-4 (cut off value 3.64), FI (cut off value 3.65) and King (cut off value 26.65) scores may perform better in prediction of high grade esopha-geal varices than in prediction of presence of esophageal varices.<br />Conclusion: Fibrosis index prediction score at cut off value 3.52 is a moderately sensitive noninvasive tool that can predict the presence of esophageal varices in cirrhotic patients with acceptable accuracy. Thus can reduce the burden and make screening for esophageal varices less stressful for the patients. The combination of FI score (cut off value 3.64), FIB-4 score (cut off value 3.65) and King's score (cut off value 26.65) could be used as an initial screening tests to detect patients with high risk EV for whom endoscopy may be more beneficial. Hence the benefit of doing upper endoscopy overweight the burden of this maneuver.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Cytochrome 2J2 (CYP2J2) Gene Polymorphism in Coronary Artery Disease396139687034910.21608/mjcu.2019.70349ENGHADA S. SABBOUR, M.D.;NERMINE H. MAHMOUD, M.D.SOMIA A. BAWADY, M.D.;LAMYAA E. ALLAM, M.D.DOAAM.A. ELZOGHBY, M.D.The Departments of Clinical Pathology* and Cardiology**, Faculty of Medicine, Ain Shams University, EgyptJournal Article20190206Abstract<br />Background: Coronary artery disease is a multifactorial disease where genetic risk factors are targeted by the environ-mental risk factors leads to disease pathogenesis. CYP2J2 is a monooxygenase which metabolize arachidonic acid into cardioprotective compounds. Genetic polymorphisms in CYP2J2 are common especially CYP2J2*7 (rs890293) which reduce CYP2J2 gene expression and subsequently its cardio-protective effects.<br />Aim of Study: The aim of the present case control study to investigate the relation between CYP2J2*7 (G-50T) (rs890293) gene polymorphism and coronary artery disease (CAD) susceptibility and severity in a cohort of Egyptian individuals.<br />Patients and Methods: The study was conducted on 50 CAD patients and 50 age and sex-matched apparently healthy individuals. Assay of CYP2J2*7 gene SNP (rs890293) was performed by PCR amplification and Restriction Fragment Length Polymorphism (PCR-RFLP) technique.<br />Results: Our results revealed that the genotypic and allelic frequencies of G-50T didn't show any statistically significant association neither with the susceptibility of coronary artery disease or with the number of significantly diseased coronaries. Also no statistically significant difference between GG gen-otypes patients and GT genotypes patients as regard risk factors for CAD.<br />Conclusions: There was no significant association between CYP2J2*7 gene polymorphism (G-50T) (rs890293) and risk of coronary artery disease and also no association between this gene polymorphism and the severity of CAD in the sample of Egyptian population included in this study.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Clinical Significance of Platelet Antigen 1/Platelet Antigen 2 (PlA1/A2) Polymorphism of Integrin b3 (ITGB3) Gene in Coronary Artery Disease396939757035010.21608/mjcu.2019.70350ENHALA ABDEL AL, M.D.;SOMIA A. BAWADY, M.D.AZZA A. SAAB, M.D.;WAEL EL KILANY, M.D.AHMED S. ALLAM, M.D.;SHAIMAA S. METWALLY, M.Sc.The Departments of Clinical Pathology*, Cardiology** and Internal Medicine***, Faculty of Medicine, Ain Shams University, EgyptJournal Article20190206Abstract<br />Background: Coronary Artery disease (CAD) is the leading cause of death worldwide. Platelet activation and aggregation play a crucial role in the process of arterial thrombosis; the main pathogenesis of the disease. The major membrane protein on platelet is integrin aIIbb3 which mediates this response by rapidly transiting from its resting to an activated state in which it serves as a receptor for ligands that can bridge platelets together.<br />Aim of Study: The aim of the present study was to assess the relationship between Platelet Antigen 1/Platelet Antigen 2 (PlA1/A2) polymorphism of ITGB3 gene and CAD.<br />Patients and Methods: The study was conducted on 55 CAD patients in addition to 55 age-and sex-matched healthy subjects serving as a healthy control group. Patients were subdivided into three subgroups according to the degree of disease severity based on the number of occluded coronary blood vessels as seen by the coronary angiography (subgroup Ia: Patients with one-vessel occlusion, subgroup Ib: Patients with two-vessel occlusion and subgroup Ic: Patients with three-or more-vessel occlusion). Determination of the PlA1/A2 polymorphism of ITGB3 gene was carried out using Restriction Fragment Length Polymorphis-Polymerase Chain Reaction (RFLP-PCR).<br />Results: The results of the present study revealed that PlA1/PlA2 genotype and PlA2 allele were more frequent in CAD patients as compared to controls; however such difference in frequency was not statistically significant. No significant difference was detected between the genotype distributions among the different degrees of CAD severity. Moreover, no significant difference was found between both genotypes as regards the presence of risk factors. Finally, the heterozygous genotype PlA1/PlA2 was associated with male sex and in-creased total cholesterol level.<br />Conclusion: PlA1/PlA2 polymorphism of ITGB3 gene failed to prove any association with CAD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Factors Influencing Aphasia Outcome in Patients with Occlusive Stroke397739837035110.21608/mjcu.2019.70351ENESAM M. ELSHAZLY, M.Sc.;OSAMA A. RAGAB, M.D.AYMAN M. ALMALT, M.D.;DINA M. MOHAMED, M.D.AHMED M. ELSHAMY, M.D.;EHAB S. MOHAMMED, M.D.The Departments of Neuropsychiatry* and Radiology**, Faculty of Medicine, Tanta UniversityJournal Article20190206Abstract<br />Background: Aphasia related to ischemic stroke is a major health problem affecting the quality of life profoundly.<br />Aim of Study: Is to assess factors influencing aphasia outcome in patients with occlusive stroke and the role of functional magnetic resonance imaging in detection the patterns of post-stroke language recovery.<br />Patients and Methods: This was a prospective cohort study done at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Diagnostic Radiol-ogy, Tanta University, from January 2017 to January 2018. Aphasia Rapid Test (ART) at day 1 and follow-up at day 8 which is a bed side clinical test to assess aphasia severity, Diffusion Tensor Imaging (DTI) and fMRI were done at day 8 to assess aphasia severity. A total of 34 cases were finally included in this study after fulfilling the inclusion and exclusion criteria, 12 patients who had receptive or global aphasia, were not suitable for fMRI, their native language Arabic, age Results: The total number of the studied patients was 34 of them 18 patients (52.9%) were males and 16 patients were females (47.1%). The age of the studied patients ranged from 28-79 years. The older group of patients had severe language disability also those with global aphasia and perisylvian lesion, risk factors as HTN, DM, Cardiac Disease, Dyslipidemia had worse prognosis, those with no reconstruction of the Arcuate Fasiculus in DTI and fMRI data analysis showed negative effect of the site contralateral to lesion.<br />Conclusion: Age was a significant factor with the higher age group had the worst prognosis regarding aphasia. Large lesion sizes and those with damage to strategic language areas had a bad prognosis. fMRI and DTI were the cornerstone of our study and they were a highly reliable tools in the prognosis of language outcome, with those who had activity in the perilesional and bilateral activity (perilesional and contralateral homotopic) in fMRI to have better outcome than those with only contralateral activity, also DTI to delineate the AF and the degree of its integrity and reconstitution.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Reversed Hemisoleus Flap for Traumatic Wound Coverage in the Distal Third of the Leg398539927035210.21608/mjcu.2019.70352ENAHMED A. FISAL, M.Sc.;LOTFY M. YOUNES, M.D.MUHAMMAD A. QUOLQUELA, M.D.;MUHAMMAD A. ROMEIH, M.D.The Department of Orthopaedic Surgery, Faculty of Medicine, Tanta UniversityJournal Article20190206Abstract<br />Background: Reconstruction of soft tissue defects of the distal third leg are common challenging therapeutic problems with significant long-term morbidity. Treatment options include cross leg flaps, local flaps (as muscle flaps and fasciocutaneous flaps) and the free vascularized flaps.<br />Aim of Study: The aim of this study is to evaluate the clinical outcome of reversed hemisoleus muscle flap in cov-erage of traumatic soft tissue defects in the distal third of the leg.<br />Patients and Methods: In this prospective study, we present 21 patients with traumatic soft tissue defects in the distal third leg with exposure of bone, tendons and neurovas-cular structures, managed by reversed medial hemisoleus muscle flap. Clinical and radiological data were analyzed.<br />Results: The outcome of the flap surgery was evaluated after at least 6 months follow-up on the basis of flap survival, graft intake, functional gain and donor site morbidity [1]. Clinical results were graded as excellent, good, fair as follows: 13 showed excellent results (61.9%), 7 showed good survival (33.3%) and 1 flap was graded as fair (4.8%) with no poor results. The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Accordingly, satisfactory results were found in 20 patients (95.2%), and the unsatisfactory results were found in 1 patient (4.8%) with reliable soft-tissue cov-erage and complete wound healing in all patients.<br />Conclusion: This study shows that reversed medial hem-isoleus muscle flap is a reliable reconstructive option for traumatic soft tissue defects on the medial side of the distal tibia in selected cases.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Frequency of Beta-Hemolytic Streptococci Group A, C and G in The Tonsillopharyngeal Flora of Individuals of Families with a Case of Rheumatic Fever and/or Rheumatic Heart Disease399339977035410.21608/mjcu.2019.70354ENSALAH A. SHOHEIB, M.D.;AHMED O.A. SHALMA, M.Sc.AMAL S. EL-BENDARY, M.D.;WALID A.N. EL-SHEHABY, M.D.AHMED S. SHOHEIB, M.D.;AHMED H. SHABANA, M.D.The Department of Pediatric, Faculty of Medicine, Tanta University1, Al-Mabara Hospital, Ministry of Health2, The Departments of Clinical Pathology3 and Cardiology4, Faculty of Medicine, Tanta UniversityJournal Article20190206Abstract<br />Background: Rheumatic fever is an inflammatory reaction that can develop as a complication of a Group A streptococcal infection. The role of Group C (GCS) and Group G (GGS) in disease burden is under recognized the present study is carried out to find the prevalence of GAS, GCS and GCS in throat of rheumatic families.<br />Aim of Study: Isto explore the frequency of beta-hemolytic streptococci Group A, C and G in the tonsillopharyngeal flora of individuals of families with a case of rheumatic fever and/ or rheumatic heart disease.<br />Patients and Methods: This study was carried out on 20 families of children with rheumatic fever and/or rheumatic heart disease chosen from children attending to Pediatric Clinic at Tanta University Hospital and El-Menshawe General Hospital in Gharbia governorate ten families have animals (cattle and/or birds) and ten families have not. Ten healthy families enrolled as controls five families have animals (cattle and/or birds) and five families have not.<br />Results: In our study (20%) of children in rheumatic families (cases and siblings) less than 18 years and (15.63%) of children of controls in the same age group were GAS positive and GCS was present in (1.67%) and it is absent in children of controls. As regarding GGS (5%) of children in rheumatic families and (3.13%) of children of controls in the same age group were GGS positive.<br />Conclusion: Our study concluded that Group A beta hemolytic streptococci is the most prevalent type of beta hemolytic streptococci compared to Group C and G strepto-cocci in throat of children with ARF/RHD as well as their siblings.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Subthalamic Nucleus (STN) Deep-Brain Stimulation (DBS) in the Management of Idiopathic Parkinson's Disease: Results of our First 20 Cases399940117035710.21608/mjcu.2019.70357ENESAM MOKBEL, M.D.;ESAM MOUNIR, M.D.The Department of Neurosurgery, Faculty of Medicine, Tanta UniversityJournal Article20190206Abstract<br />Background: Idiopathic Parkinson's Disease (iPD) is one of the most disabling chronic neurologic diseases and leads to a significant loss of quality of life. Interest in surgical therapy for PD was renewed in the early 1990s. The most common functional stereotactic procedures that are performed worldwide for PD are lesioning and Deep-Brain Stimulation (DBS).<br />Aim of Study: Is to review and evaluate the results of STN-DBS in management of iPD in our first 20 patients.<br />Patients and Methods: This study was conducted in Department of Neurosurgery, Tanta University from January 2007 to March 2014. It included 20 patients with iPD, they must had positive L-dopa challenge test with at least a 33% decrease in the UPDRS III score. All patients were assessed by UPDRS in off and on phases. Stereotactic STN-DBS was done. The total off UPDRS III score was considered the primary outcome measurement.<br />Results: We had 14 males and 6 females with a mean age at PD onset of 46.5 years, a mean age at implant of 54.5 years with mean duration of symptoms of 10 years. 14 patients had moderate PD while 6 patients had severe PD. The post-operative OFF and ON UPDRS III score improved by 45.5%, and 63.9% respectively. The post-operative OFF and ON bradykinesia score improved by 55.5%, and 62.9% respec-tively. The post-operative OFF and ON tremor score was improved by 68.01% and 76.5% respectively. The post-operative OFF and ON rigidity score was improved by 71.81% and 78.8%. The post-operative OFF and ON postural instability and gait score was improved by 45.42% and 61.9% respec-tively. 60% of patients had good outcome and 40% had fair outcome. We reported one transient post-operative confusion, one infection, one lead displacement, and one lead fracture. Dyskinesia occurred in two patients, speech problems in two patients and emotional lability in one patient.<br />Conclusion: Bilateral STN-DBS provides significant symptom relief for the majority of well-screened patients with iPD.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluation of the Macula, Retinal Nerve Fiber Layer and Choroid Thickness in Women Using Oral Contraceptive Pills401340197035810.21608/mjcu.2019.70358ENMAGDA M.M. SAMY, M.D.;MOUAMEN M. MOSTAFA, M.D.NASHWA M. EZZAT, M.D.;EMAN M.G. EL-SAID, M.Sc.The Department of Ophthalmology, Faculty of Medicine, Ain Shams UniversityJournal Article20190206Abstract<br />Background: Oral Contraceptive Pills (OCP) have some risks and side effects with regard to several organs, one of which is the eye. Estrogen & progesterone receptors have been shown to be present in various eye structures, such as the choroid, retina, conjunctiva, cornea, Meibomian glands, and lens.<br />Aim of Study: The purpose of this study is to assess the macula, Retinal Nerve Fiber Layer (RNFL), and choroid thickness, in addition to evaluation of macular Ganglion Cell Complex (GCC) by using spectral-domain OCT system (3D OCT-2000 FA; Topcon Crop., Tokyo, Japan) in 20 women using Oral Contraceptive Pills (OCP) for more than one year and to compare them with 20 healthy reproductive age women volunteers.<br />Patients and Methods: This is cross sectional study in-cluded 20 women using oral contraceptive pills in comparison to 20 normal females between April 2018 till July 2018 at Giza memorial Institute of Ophthalmic Research. Optical Coherence Tomography (OCT) is used to evaluate the posterior ocular segments, and measurements have been taken in the follicular phase (day 3) of the cycle in all women.<br />Results: The mean age of the OCP group was 31.7±3.76 years and the mean age of the control group was 31.3±5.031 years. Both groups are homogenous in terms of age (p=0.7773). Most of the macular layer thickness and the foveal center are significantly thinner in OCP group. The macular volume is thinner in OCP study group. Retinal nerve fiber layers are thicker in OCP study group a part from Superior RNFL which is thinner in OCP study group, while temporal RNFL zone is with no significant changes. Choroid thickness values, is thicker in OCP study group. Ganglion cell complex is with no significant difference.<br />Conclusion: We found that women who had received combined oral contraceptive pills more than one year have changes in posterior ocular segment.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Evaluating Effectiveness of Intravenous Magnesium Sulfate As a Treatment in Acute Renal Colic Patients Attending Suez Canal University Hospital Emergency Department402140257036010.21608/mjcu.2019.70360ENZAYNAB M. EL SAYED, M.D.;AHMED E. ABOUZEID, M.D.AMLI. ABU EL SOOD, M.Sc.The Department of Emergency, Faculty of Medicine, Suez Canal UniversityJournal Article20190206Abstract<br />Background: Renal colic is one of the most sever forms of pain in humans. Renal colic affects nearly 1.2 million people each year and accounts for nearly 1% of all hospital admissions. Having a family member with a history of stones doubles there rates.<br />Aim of Study: To evaluate the effectiveness of intravenous magnesium sulfate as an adjunct treatment in acute renal colic pain in patients who are not responding to conventional treatment (NSAIDs or Opioids) at the Emergency Department and to evaluate the role of I.V magnesium sulfate in dimin-ishing the need for additional doses of NSAIDs or opioids in treatment of acute renal colic.<br />Material and Methods: This study designed as a rand-omized clinical trial. Patients (18-60 years) having acute renal colic pain attending E.R and not responding to traditional treatment (30mg of intravenous ketorolac added to 10ml saline) and they are divided into two groups including 96 subjects: First Group included (48 patients) is the standard treatment group using NSAIDs, second group included (48 subjects) is the intervention group using Mg Sulphate. Vital signs to all patients including pulse rate, blood pressure (systolic/diastolic), respiratory rate, O2 saturation%, temper-ature (Celsius) and Severity of patient's pain by visual analogue scale (VAS) was measured twice to each group in the study periods 30 minutes after beginning of treatment and 60 minutes later.<br />Results: 96 cases were randomly allocated to intervention or control group. There was a significant statistical difference in between study groups regarding pain severity at 30 and 60 minutes; the intervention group showed much better pain relief on VAS than the control group.The Clinical Society of Cairo UniversityThe Medical Journal of Cairo University0045-380387September20190901Case Report: Congenital Thymic Cyst in an Iraqi Child402740307036110.21608/mjcu.2019.70361ENNADIM HADDAD, M.D.;SUHAILA SHAMSE-ELDEN TAHIR, DIM, M.Sc.IMANHASSAN, M.D.The Department of Thoracic & Vascular Surgeon, College of Medicine, Kirkuk University*, Directory of Health** and The Department of Pediatric, Azadi Teaching Hospital***, Kirkuk-IraqJournal Article20190206Abstract<br />Background: A nine months female child presented with dyspnea was diagnosed by third author applying echocardi-ography who discovered a large thymic cyst. The diagnosis was confirmed by CT scan; the patient was operated on by the first author applying median sternotomy with smooth post operative recovery and complete absence of symptoms.<br />Aim of Study: We intended to report this rare case world-wide so that to throw light on every case with mediastinal cyst to include it in the differential diagnosis, and to be kept in mind always during investigating such a case.