Background: Incisional hernias are common after abdominal surgery. Laparoscopic repair has advantages over open repair. Traditionally, laparoscopic ventral repair of hernia has been done as a bridged repair to accomplish circumferential overlap of the fascial defect. More recently, there has been a growing trend to do primary fascial closure to reapproximate the fascia before mesh insertion. Aim of the work: to present our experience with laparoscopic ventral and incisional repair of hernia to determine outcomes and different results of fascial defects closure and non-closure. Patient and methods: From January 2016 to April 2018, 68 patients suffering from ventral and incisional hernias were treated in New Damietta University Hospital. Laparoscopic repair was decided for all patients. Results: Operative time for group A ranged from 50-120 minutes (average 96.8 min), 30-90 minutes (average 66 min) for group B. Chronic postoperative pain reported in 12.9% in group A and 6.6% in group B. 16.1% from group A had seroma lasting 4 weeks, while it was reported in 36.7% from group B, which remain for 6 weeks. There were 7 patients from group A complaint of post-operative respiratory embarrassment which resolved conservatively except for one patient, who necessitated ICU admission for two days. No one from group B complaint of post-operative respiratory complications. Conclusion: Although there were no major statistical differences between fascial closure and non-closure groups, the seroma and recurrence were less in fascial closure group.

Background: Metabolic syndrome is a multiorgan disease and it could aggravate other diseases. Its effect on chronic obstructive pulmonary disease needs to be addressed. Aim of the work: to examine if metabolic syndrome increases the frequency, duration and severity of acute exacerbations of chronic obstructive pulmonary disease. Patients and methods: 60 patients who admitted with COPD exacerbation were included and were divided into two groups: Group 1 (COPD without metabolic syndrome). Group 2 (COPD with metabolic syndrome). All submitted to full history taking, clinical examination, laboratory and radiological examination. Results: COPD severity was GOLD class II in 25.0%, class III in 51.7% and class IV in 23.3%; and disease severity was significantly higher in patients with metabolic syndrome. The frequency of COPD exacerbations showed significant increase in group 2 when compared to group 1 (2.17±0.65 vs 1.43±0.57 respectively). In addition, the duration of hospital stay increased significantly in group 2 when compared to group 1 (4.33±0.80 vs 3.37±0.61). Conclusion: metabolic syndrome could play a role in pathogenesis- or may be a consequence of- COPD. Thus, metabolic syndrome had a harmful effect on the outcome of COPD exacerbations.

Background: Bedside echochocardiography is a useful tool in critical care setting. Several studies support the performance of echocardiography by non-cardiologist. Aim of the work: To evaluate if bedside transthoracic echocardiography (done by intensivist) is useful to provide diagnosis of cardiovascular pathologies of patients with acute respiratory failure in respiratory intensive care, and to assess the interobserver variability between measurements done by intensivist and expert echocardiographer. Methods: Sixty patients with acute respiratory failure admitted to respiratory critical care unit were evaluated by echocardiography by an intensivist and expert echo cardiographer. Interobserver agreement for both readings was done. Results: results of the present work revealed that, there was strong agreement between the reading of both the intensivist and echocardiographer. In addition, significant abnormalities were present in the examined cases especially diastolic dysfunction. conclusions: The intensivist detected most abnormalities detected by the expert echocardiographer. The bedside echocardiography is a useful instrument in respiratory critical care unit.

Background: Difficult intubation is usually encountered in daily work of anesthesia and intensive care. Different inventions and techniques were tried to deal with difficult intubation. Aim of the work: To investigate the difference between awake fiberoptic and awake videolaryngoscopy in difficult intubation Methods: A two-years, randomized comparative study was conducted and included patients with ASA classes I to III, who were scheduled for elective surgical procedures with anticipated difficult intubation. Patient randomly allocated to fiberoptic intubation (FI) and videolaryngoscopy (VL) intubation. The outcome measures were time to tracheal intubation, intubation success, number of attempts and operator evaluation of the procedure. Results: Both groups were comparable as regard to patient demographics, ASA classifications, number of attempts and number of patients who experienced desaturation. The time to intubate was significantly shorter in VL when compared to FI group. The sedation score and ease scores were significantly lower in VL when compared to FI groups. Conclusions: Videolaryngoscopy-guided intubation in difficult cases was associated with better outcome than fiberoptic intubation. However, no failure was reported in both groups

Background: Bedside echochocardiography is a useful tool in critical care setting. Several studies support the performance of echocardiography by non-cardiologist. Aim of the work: To evaluate if bedside transthoracic echocardiography (done by intensivist) is useful to provide diagnosis of cardiovascular pathologies of patients with acute respiratory failure in respiratory intensive care, and to assess the interobserver variability between measurements done by intensivist and expert echocardiographer. Methods: Sixty patients with acute respiratory failure admitted to respiratory critical care unit were evaluated by echocardiography by an intensivist and expert echo cardiographer. Interobserver agreement for both readings was done. Results: results of the present work revealed that, there was strong agreement between the reading of both the intensivist and echocardiographer. In addition, significant abnormalities were present in the examined cases especially diastolic dysfunction. conclusions: The intensivist detected most abnormalities detected by the expert echocardiographer. The bedside echocardiography is a useful instrument in respiratory critical care unit.

Background: many other studies were done to evaluate the effect of oral lactoferrin administration on iron deficiency anemia. Objective: This study was designed to assess the effects of lactoferrin supplementation on primary school children having iron deficiency anemia. Patients and Methods: Prospective cohort study was conducted on 94 patients with iron deficiency anemia. They were 58 females and 36 males. Their ages range from 6 years to 12 years with mean age of 8.4 years. In the period between October 2018 and January 2019. Each child was submitted to full history taking, complete clinical examination and laboratory investigations including complete blood count, Serum ferritin, serum iron and total iron binding capacity. Results: oral administration of bovine lactoferrin (BLf) significantly increases the number of red blood cells, hemoglobin, serum ferritin and total iron after thirty days of the treatment. BLf is a more effective and safe alternative than elemental iron for treating iron deficiency and iron deficiency anemia. Conclusion: lactoferrin is a better substitute for elementary iron in treatment of iron deficiency.

Background: Vitiligo is a depigmenting disorder characterized by the appearance of circumscribed white macules in the skin. The aetiology of vitiligo is not clear, and although various hypotheses have been proposed. It has been suggested that autoimmunity plays an important role in the pathogenesis of vitiligo. Objective: To evaluate the serum levels of S100B as it could be used as biomarker of disease activity in vitiligo patients. Patients and Methods: The current study included 45 patients with vitiligo and 45 healthy controls. Patients were divided into two groups, segmental vitiligo (group I) including 4 patients and generalized vitiligo (group II) including 41 patients. All participants were recruited from the outpatient clinic of Al-Azhar University hospital (Damietta) and Dermatology, Venereology, Leprosy in June 2018. Results: S100B serum levels were high in patients with vitiligo as compared to the control subjects. S100B were significantly higher in non segmental vitiligo. S100B serum levels were higher in active vitiligo patients as compared to inactive vitiligo patients. There was no significant difference between the studied groups regarding age, gender, duration of the disease and Fitzpatrick skin phototype. Conclusion: Vitiligo patients have been associated with high levels of S100B, indicating its possible involvement in its pathogenesis. Levels of S100B may be a potential target for treatment. It is needed to perform further studies with larger sample size including patients and controls and follow up monitoring of activity in needed to evaluate of S100B.

Objective: The aim of the present study was to evaluate the effects of ondansetron for prevention of postoperative shivering. Patients and Methods: The study was carried out on 40 patient ASA I or II scheduled for lower abdominal surgery. They were categorized into two equal groups Group I (Group P): Patients were receiving intravenous pethidine in a dose of 0.5 mg/kg. Group II (Group O): Patients were received intravenous ondansetron in a dose of 4 mg. just before induction of spinal block. Results: The studied groups showed no significant difference regarding demographic data, or postoperative shivering. However, postoperative nausea, vomiting and sedation were significantly increased in pethidine when compared to ondansetron group. Conclusion: Ondansetron is effective as Pethidine for prevention of postoperative shivering. However, side effects postoperative nausea & vomiting were significantly higher in pethidine group. Thus, ondansetron could be used as a safe and effective alternative for pethidine for postoperative shivering.

Background: Neonatal sepsis a major health challenge associated with major morbidity and mortality. Neonatal care improved recently. However, different challenges regarding management still exist. Vitamin D deficiencies was proposed as a predictor of neonatal sepsis. Objective: To highlight the impact of vitamin D levels on early onset sepsis in full term neonates. Methodology: It is a case control which carried out at the neonatal intensive care unit of Al-Azhar university hospital (Damietta), from March to April 2019. It included 50 full-term neonates with probable sepsis and 50 healthy controls of matched age and sex with no signs of sepsis. Results: vitamin D level showed significant negative correlation with sepsis, C-reactive protein (CRP), positive blood cultures; and significant positive correlations with Apgar score, hemoglobin concentration and platelets count. Regression analysis revealed that, higher CRP and lower vitamin D were associated risks of neonatal sepsis in univariate analysis. Multivariable regression analysis revealed that only lower vitamin D level is the predictor for early neonatal sepsis. Conclusion: Vitamin D levels were significantly lower in septic neonates with high sensitivity and specificity. Vitamin D supplementation to mothers during pregnancy could prevent early onset neonatal sepsis.

Background: Echocardiography increasingly used for diagnosis of right atrial dilatation. Three dimensional is superior than two dimensional echocardiography. However, advances and new windows continues to emerge to increase its accuracy Aim of the work: to show the feasibility and accuracy of right parasternal approach and its usefulness in qualitative and quantitative assessments of right atrium in patients with right atrial dilatation in comparison with transesophageal approach. Patients and Methods: The study included thirty patients with right atrial dilatation. All patients underwent full history taking, clinical, 12-lead electro-cardiography and echocardiography. Transesophageal Echocardio-graphy was used as a gold standard for the accuracy of the right parasternal approach. Results: The study includes 30 patients with right atrial dilatation the right parasternal (RPS) view obtained in 18 patients (60%), and not obtained in 12 patients (40%). There was significant decrease of SVC anteroposterior minimal diameter (Min AP), crista terminalis (CT) width, CT length, right atrial appendage (RAA) base Maximum diameter and RAA base Minimum diameter, in 2D Echocardiography when compared to 3D Echocardiography. On the other side, there was no statistically significant difference in Right parasternal approach (3D) and Transesophageal approach. Conclusions: Parasternal approach is feasible in imaging right heart structures. In addition, three dimensional TTE had an incremental value over two dimensional TTE in the assessment of these structures

Background: Scabies is a common parasitic infestation of the skin. Signs and symptoms of scabies are the result of a hypersensitivity reaction to proteins released by the mites. Diagnosing scabies is problematic and confirmed by direct tests showing the presence of mites or their eggs. Dermoscopy is viewed as a sensitive and valuable tool in diagnosing scabies in vivo Objective: to assess the validity of dermoscopic findings in diagnosis of scabies. Patients and methods: This study included 40 patients complaining of generalized itching or multiple localized itching. All the patients were subjected to full history taking and clinical examination including general examination, dermatological examination and photography of any lesions in the suspected sites. These lesions were examined by the dermoscope. Results: The results of the study revealed that dermoscope had 87.5 % sensitivity and 100% specificity in the diagnosis of scabies as compared to clinical examination. The overall accuracy of dermoscope in diagnosis of clinically suspected cases was 90%. Conclusion: Scabies is a common skin disease that affects both genders mainly in the middle age group. Dermoscope has been shown to be as an effective and non-invasive technique in diagnosis of scabies

Background: Arteriovenous fistula (AVF) is a significant procedure for patients in need for hemodialysis. Failure of maturation due to stenosis is a challenge, which need further intervention. Aim of the work: To present our experience in therapeutic intervention for non-mature arteriovenous fistula caused by stenosis using balloon angioplasty. Patients and Methods: 25 patients who had stenosis of primary AVF were included. The mean age was 57.28±6.97 years and patients were 16 males and 9 females. Patients were Followed-up every three months up to 1 year. Collected data included patient demographics, cause of renal failure, characters of primary AVF, and variables of balloon angioplasty (e.g., clinical success and complications), primary patency and recurrence of stenosis. Results: AVF type was radiocephalic (60.0%), brachiobasilic (24.0%) and brachiocephalic (16.0%). The fistula segment was juxta-anastomotic (44%), anastomosis (36.0%) and efferent in 20.0%. Technical success was 100%; the patency rate at 6 months was 80.0%, at 9 months was 64.0% and at 12 months was 56.0%. There was puncture site hematoma in 2 patients (8.0%) that were treated conservatively. The recurrence was reported in 9 patients (36.0%) (8 cases due to re-occlusion and one patient due to thrombus formation). Recurrence was significantly associated with older age and high coronary artery disease. Conclusions: Balloon angioplasty is effective and safe procedure for treatment of AVF non-maturation due to stenosis.

Background: Previous studies revealed that right ventricle apex pacing with different modes may yield abnormal electrical activity and left ventricle dyssynchrony. Aim of the work: To evaluate systolic function of left ventricle and mechanical dyssynchrony with different modes of pacing using real time three dimensional echocardiography [the RT3DE] and tissue Doppler imaging [TDI]. Patients and Methods: The study included thirty-five individuals with permanent dual chamber pacemaker with atrial leads placed in right atrial appendage and right ventricular leads placed in right ventricular apex, the pacemakers were programmed to different modes. Imaging parameters were obtained following pacing for 24 hours in each mode. Results: The results revealed that the RT3DE and TDI-derived dyssynchrony indices in the atrial demand pacing [AAI] mode were significantly lower than those in the dual chamber demand pacing [DDD] and ventricular demand pacing [VVI] modes; however, there was no significant difference between the DDD and VVI modes. Also, left ventricular ejection fraction [LVEF] during AAI and DDD modes was significantly higher than that during VVI mode; however, there was no significant difference between the DDD and AAI modes. There were negative correlations between LVEF and Ts-MD and Ts-SD, and there was positive strong correlation between RT3DE and TDI-derived dyssynchrony indices. Conclusions: Left ventricular systolic synchronicity in AAI mode was superior to that in DDD and VVI modes. Left ventricular ejection fraction in the AAI and DDD pacing modes are superior to that in the VVI mode.

Background: in neuroaxial anesthesia, there was many adjuvants used with the purpose of increasing anesthesia duration and reduction of postoperative analgesia. Objective: comparison between dexmedetomidine and fentanyl when added to 0.5% hyperbaric bupivacaine, for lower limb amputation on early stump and phantom pain after spinal anaesthesia. Patients and Methods: Ninety patient arranged for lower limb amputation surgery were randomly allocated into three groups (each 30 patients). Each patient received 2 ml of hyperbaric bupivacaine (0.5%) plus 0.5 ml normal saline in control group (Group B) or 5µ dexmedetomidine diluted in 0.5 ml normal saline in BD group or 25 µ fentanyl diluted in 0.5 ml normal saline in BF group. Anesthesia, analgesia, sedation, hemodynamic changes, adverse effects and post-operative pain up to one month were recorded. Results: The studied groups showed no significant differences regarding demographic characteristics and hemodynamic (heart rate and mean arterial pressure). Patients in group BD had significant increase of sensory and motor block time compared to BF B groups. Post-operatively, there was a significant decrease of pain in BD group in the first 24 hours when compared to control or BF group. The postoperative mean total consumption of analgesics during the first day was significantly decreased in BD when compared to BF and control groups. Conclusions: dexmedetomidine (5µg) represents a good alternative to fentanyl (25µg) as a spinal adjuvant to bupivacaine in surgery for the lower limb.