Although the perception of surgery in space may appear obscure, it is vital to initiate planning early if new frontiers in space travel are to be accomplished. Conditions necessitating surgery in space are rare, but they are challenging in their management. Telemedicine can allow consultation and instruction at the time of surgical intervention. This may permit optimal guidance for conduction of simple surgical maneuvers by non-medical crew members. Robots could be used for more complex interventions in the absence of a trained crew member. Earth-to-space telesurgery is yet to be attained. However, National Aeronautics and Space Administration [NASA] has successfully did several basic procedures at an underwater facility, simulated the space environment. The communication delay between craft and earth is the main potential issue affecting telesurgery. For example a communication delay of radio signals between 4 and 22 minutes is expected between earth and Mars. Thus, available telesurgical capabilities are not suitable for a Mars mission. In addition, to facilitate endogenous repair of injured structures, the use of absorbable nanoparticulate scaffolds could offer temporary structure support, while eluting drugs stimulate endogenous mesenchymal stem cells to differentiate into osteoblasts. Otherwise, direct delivery of extrinsic mesenchymal stem cells to injured sites via nanoparticulate delivery system provide a reasonable alternative. The use of 3D printing allows fabrication of complex surgical tools from a computer-aided design template from a digital database of nearly each instrument. In addition, 3D-printed surgical tools may be disposable, meaning no requirement for space-occupying sterilization appliances.

ackground: 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: 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: Vitiligo is a common disease of the skin, affecting epidermis and hair follicles. Both genders are affected. The main pathogenic mechanism of the disease is the destruction or inhibition of the epidermal melanocytes which is manifested clinically by presence of variable sized areas of skin depigmentation that can affect any site of the body. Aim of the work: To estimate the prevalence and risk of metabolic syndrome in vitiligo patients. Patients and Methods: This is a case control study that was conducted on 90 patients with vitiligo recruited from outpatient clinic, dermatology department of Al Azhar University Hospital in Damietta, and 60 healthy controls. Full history was taken from all the subjects included in the study. The cases were also subjected to careful general examination and dermatological examination to determine the site and the type of the lesion and the presence of any dermatological diseases, laboratory investigations including HDL, TG and FBS were done. Results: In this study we found that 35.6% of cases have metabolic syndrome while 33.3% of healthy controls have metabolic syndrome. We also found that there is no relation between presence of metabolic syndrome and disease extent, progression or stage. Conclusion: Incidence of metabolic syndrome is slightly higher in cases with vitiligo as compared to the control group. Presence of metabolic syndrome is not associated with disease severity, extent or stage.

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: Psoriasis is a chronic inflammatory skin disease affecting approximately 1-6% of population in the world. Aim of the work: To screen psoriatic patients for psoriatic arthritis [PsA] to improve optimal PsA management and outcome. Patients and Methods: This study included one hundred and tow patients with psoriasis recruited from the dermatology outpatient clinics in Damietta, [Al-Azhar University Hospital, Dermatology and Leprosy Hospital and El-Maasarah Hospital]. Patients should fulfill a Simple Psoriatic Arthritis Screening Questionnaire [SiPAS] to calculate the prevalence of psoriatic arthritis among psoriatic patients in Damietta. Results: The study included 42 [41.2%] females and 60 [58.8%] males with age range between 6 -88 years old with mean age 45 years old. Among the 102 included patients with psoriasis, 36 patients [35.3%] had score [=3]; [63.9%] of them were men and [36.1%] were women with mean age 51 years old, mean age of onset of psoriasis 31 years old and mean duration of psoriasis 19.14 . [77.8%] of them had psoriatic nail lesions. On the other side, 66 patients [64.7%] had score [<3] with mean age 45.19 years old, mean age of onset of psoriasis 32 and mean duration of psoriasis 9 years. Conclusion: Early diagnosis of PsA could prevent permanent joint damage or spinal fusion and could improve long-term patient outcome. The SiPAS questionnaire can be a powerful tool to help dermatologists to quickly screen PsA during their clinical practice. The SiPAS questionnaire is able to quickly screen psoriasis patients for PsA. A SiPAS score =3 is an indication for referral to a rheumatologist.

Background: Lower urinary tract symptoms [LUTS] have a marked impact on the quality of life in patients with neurological ailments. They are also linked to a high risk of serious morbidities. Aim of the work: was to evaluate the LUTS associated with neurological disorders in a sample of Egyptian patients. Patients and Methods: This study conducted on 104 patients treated in our Neurology and urology clinic at Al-Azhar University hospitals from January 2018 to January 2019. Patients divided into several subgroups according to the neurological diagnosis, and the following data were collected: age, sex, irritative symptoms [frequency, urgency, and urge incontinence], obstructive symptoms [straining, slow stream, hesitancy, retention of urine], timing [before or after neurological disease], and finally evolution of symptoms either solved or persistent. Results: We studied 104 patients; 53 were females and 51 males. LUTS were found in 44 out of 104 patients [42.3%]. LUTS were more presented in patients with neurovascular, spinal cord and demyelinating disorders. Urinary urge incontinence was the most common symptom [70.4%]. It was found to be predominant in the neurovascular and demyelinating diseases. In 30 out 44 subjects, the urinary symptoms persist, in 14 out of them the urinary problems were treated. Conclusions: Storage symptoms are more common, mostly urge urinary incontinence. Neurovascular diseases, spinal cord, and demyelinating diseases are the most common neurological disorders associated with LUTS. A multidisciplinary method should be encouraged for the management of these patients including the whole team of rehabilitation.

Background: Vitamin D is a group of fat-soluble corticosteroid responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects. In humans, the most important compounds in this group are vitamin D3 [also known as cholecalciferol] and vitamin D2 [ergocalciferol]. Aim of the work: The aim of this thesis is to assess Vitamin D3 [VD3] level in patients with sino-nasal polypi in comparison with normal individuals. Patients and Methods: This prospective comparative [case-control] study conducted by the Department of ENT, Al-Azhar University Hospitals in the period from March 2019 to September 2019 and included 40 individuals who were selected by inclusion and exclusion criteria, both genders, all patients had been counseled about the nature of the study and informed written consent has been obtained. Results: Serum level of VD3 in patients with chronic rhinosinusitis with sinonasal polyps [CRSwNP] and allergic fungal rhinosinusitis [AFRS] was significantly lower than that of control subjects. Vitamin D levels ranged from 8.74 to 39 ng/ml, and there was statistically significant decrease of serum vitamin D levels in patient group when compared to control group [16.20±4.29 vs 30.56±4.83 respectively]. In addition, there was significant increase of patients with deficient and insufficient vitamin D levels in patient group when compared to control group. Conclusion: VD3 may constitute an inexpensive prophylactic and cost effective option in the therapeutic armamentarium in reducing inflammation either by itself or as a synergistic agent to traditional agents in patients suffering from sino-nasal polypi.

Background: Myomectomy is the best procedure for treatment of uterine fibroids. However, post-myomectomy adhesions represent a major problem. The introduction of hysteroscopic myomectomy thought to reduce these adhesions. However, the incidence is not determined after different shavers. Aim of the work: To assess the prevalence of adhesions in women undergoing IBS-myomectomy for uterine fibroids. Patients and methods: The study included 70 women indicated for IBS myomectomy. Eligible females were submitted to full history taking, clinical examination and routine laboratory investigations. In addition, all patients underwent transvaginal ultrasonography. Fibroid grade was defined and hysteroscopic myomectomy. Then office hysteroscopy was done after 3 months of the procedure, and any pathology especially intrauterine adhesions was reported. Patients were classified into two groups; with adhesions and without adhesions. Results: The incidence of adhesions was 5.7%. The development of adhesion was usually associated with multiple myomas present in posterior position who need long resection time and usually the resection is incomplete. The adhesions were usually mild [75%] and there was no complications were reported after hysteroscopic myomectomy. Conclusion: The incidence of intrauterine adhesion after the hysteroscopic myomectomy by IBS is low

Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established. Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA]. Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery. Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was non-significant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA. Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.

Background: Upper gastrointestinal endoscopy [either diagnostic or therapeutic] is widely practiced under conscious sedation. However, the standard sedative agent or drug combination is not yet well established. Aim of the work: Comparison between propofol-fentanyl and midazolam-fentanyl for sedation in upper gastrointestinal endoscopy. Patients and methods: Sixty patients from those scheduled to undergo upper gastrointestinal endoscopy at the Gastrointestinal Endoscopy Unit were included. Patients were divided into two equal groups: propofol-fentanyl and midazolam fentanyl. The Anesthetist scheduled to perform the procedures was oriented by the drug, while patients did not know the sedating drug. Prior to the procedure, a clinical history and physical examination was carried out, and throughout the procedure the patient was monitored for blood pressure, heart rate, respiratory rate, and oxygen saturation. Both groups were compared regarding time to recovery, patient satisfaction, physician satisfaction and adverse events. Results: Recovery time was significantly shorter, patient and physician satisfaction scores were significantly higher among propofol group. On the other side, systolic blood pressure was significantly lower in propofol group at midpoint and recovery times, while oxygen saturation was significantly reduced in midazolam group at intermediate point of the procedure. Finally, hypoxia was significantly higher among midazolam group [reported in 20.0%], versus [none] in propofol group. No other adverse events were encountered. Conclusion: Propofol is better sedative than midazolam for upper gastrointestinal endoscopy. Thus, it should be used as a first-line drug in sedation in our endoscopy units.

Background: Ocular complications are one of the well-recognized extra-articular complications of rheumatoid arthritis [RA]. The most common ocular complications of RA are Keratoconjunctivitis sicca, episcleritis, scleritis, marginal thinning of the cornea with keratolysis, stromal corneal opacities with peripheral vascularization, and iridocyclitis. The ocular complications were found to be significantly higher in patients with long duration of RA. Aim of the work: This study was conducted to determine the common ocular complications that occur with RA and to determine the correlation of this complications with age, gender, duration, and activity of RA. Patients and methods: Tow hundred eyes of one hundred patients [males and females] with symptomatic evidence of RA were studied. All patients subjected to full clinical evaluation, laboratory assessment, plain X-ray hand and detailed ocular examination [visual acuity, slit lamp, fundus examination and Schirmer’s test]. Results: Our research showed that 47.0% of the studied cases were aged from 41 to 60 years old, 93.0% of them were females, 57.0 % of them had RA more than 2 years [longstanding RA] and 40.0 % of them had ocular complications. The most common eye complications among the studied cases were dry eye, episcleritis, and scleritis [28.5 %, 4.0 %, and 3.0 % respectively]. Conclusion: RA patients have a higher risk of ocular complications. Eye examination should be included as a routin for RA patients to facilitate early diagnosis and management of ocular complications.