Background: Jaundice is one of the most common conditions confronting neonatologists daily. Phototherapy is generally regarded as a safe method for treating hyperbilirubinemia, but it may also lead to undesired effects, one of these effects that it can affect the function of the immune system of the newborn. Aim of the work: The aim of the work was to study the effect of phototherapy on the serum level of tumor necrosis factor- alpha [TNF-a] in neonates. Patients and methods: A total of 35 cases of term neonates with Neonatal Jaundice and indirect hyperbilirubinemia high to the level that need phototherapy for 72hrs or more according to the guidelines of the American Academy of Pediatrics were included in this study, and 15 healthy matched newborns were selected as controls. TNF-a was measured before exposure and after 72 hours phototherapy and from control group at the time of examination. Serum levels of TNF alpha were measured using enzyme linked immunosorbent assay kits. Results: The results showed that there was no statistically significant in patient group before phototherapy in comparison to control group as regards TNF-a, patient demographics or laboratory data. On the other side, serum TNF-a levels significantly increased after exposure to phototherapy for 72 hours when compared to values before phototherapy (151.49±61.97 vs 61.36±31.96 respectively), indicating the influence of phototherapy on serum level of TNF-a. Conclusion: The results demonstrated increased serum TNF-a level after 72 hours may affect the immune system in neonates.

Background: Atherosclerotic infarction accounts for a sizable proportion of cerebral infarcts whether occurs from extracranial or intracranial atherosclerotic disease. Despite recent studies on stroke risk factors; it is still unclear whether or not single risk factor specifically affect extracranial or intracranial arteries in stroke patients. Aim of the work: To determine the difference between intracranial and extracranial steno-occlusive atherosclerosis and its correlation with risk factors of acute ischemic stroke using Magnetic Resonance Angiogram (MRA) and/or Computed Tomography Angiography (CTA) with Duplex. Patients and methods: All cases diagnosed as acute ischemic stroke were subjected to detailed history, full neurological examination, routine laboratory tests, extracranial vessels assessed by duplex, intracranial vessels assessed by MRA and/or CTA. Results: 61 patients included in the study (38 males and 23 females), with mean age (64.5 ± 11.4). Extracranial stenosis was (57 patients, 93.4%), while intracranial stenosis was (49 patients, 80.3%). But the intracranial significant stenosis was (45 patients, 73.77%), while the extracranial significant stenosis (26 patients, 42.62%). Hypertension (72.1%), obesity (62.3%), diabetes (57.4%), dyslipidemia (54.1%) and smoking (39.3%), were risk factors equally affecting the extracranial and the intracranial systems in the same descending order. There was a higher prevalence of hypertension among patients with intracranial significant stenosis showing a significant P-value of 0.048. Conclusion: Extracranial stenosis was more common than the intracranial stenosis, but the intracranial significant stenosis is more prevalent than the extracranial. Hypertension is a significant risk factor for intracranial significant stenosis

Background: Inside textile mills, pregnant women employees are inevitably exposed to a huge pollution that can result in adverse pregnancy outcomes. Aim of the work: We aimed to evaluate the potential effect of exposure to textile industry induced pollution, among women textile workers, on pregnancy outcome. Patients and methods: A case-control study was carried out at Misr Spinning/Weaving Company, El Mahalla El Kubra, Egypt. The exposed and control group consisted of 142, and 143 eligible participants respectively. All underwent full history taking, clinical examination and ultrasound investigations during first, second and third trimesters. Pregnancy outcome was documented. Results: 64.1% of exposed group’ pregnancies were complicated versus 16.1% of control group. Of which pregnancy induced hypertension (PIH, 19.0%), preterm birth (23.2%), term low birth weight (TLBW, 19.7%), and congenital anomalies (2.1%), in contrast to 4.9%, 7.7%, 2.8%, and 0.7% respectively, in the control group. Conclusion: We concluded from our results that textile induced pollution exposure was significantly associated with adverse pregnancy outcomes (OR=1.652, CI: 1.287-1.954), and this risk was significantly proportional to duration of exposure (OR=2.110, CI: 1.334-3.338).

Background: Miscarriage is the most common adverse pregnancy outcome which has detrimental psychological consequences for the woman and her partner and delays successful childbearing. Normal embryonic heart rate is about [100-200] bpm at 5 weeks gestation then it increases progressively over the subsequent 2-3 weeks. Fetal demise often occurs within one week after the slow embryonic heart rate and always occurs by the end of the first trimester. Aim of the work: The aim of the present study was to investigate the relation between first trimester miscarriage and slow embryonic heart rate at sixth week of gestational age and other risk factors of miscarriage. Patients and methods: A prospective observational cohort study was conducted in the department of Obstetrics and Gynecology, Al-Azhar Faculty of medicine [Damietta] during the period from September 2017 to September 2018 on 90 pregnant women who had slow embryonic heart rate [80-100] bpm at sixth week of gestational age. All were submitted to full history taking, clinical and ultrasound examination and followed up till the end of their pregnancy and outcome was documented. Results: Percentage of aborted cases at the 8th week of gestational age was [38.9%], while, [20%] at the 10th week and [15.4 %] at 13th week. Whom fetus had a heart rate less than 90 were at risk 23.8 times for experiencing abortions more than other females. Conclusion: Slow embryonic heart rate is one of the earliest predictors for the first trimester fetal demise and it is one of the newest studies

Background: Pelvic ring fractures is not uncommon, and represented a challenge in their fixation. Anterior plating of sacroiliac joint seems to have less good outcome and low complications rate when compared to other approaches. Aim of the work: The aim of this work is to assess the results of surgical treatment of unstable pelvic ring fractures with stabilization of sacroiliac joint with anterior plating, the results assessed clinically and radiologically. Patients and methods: Fifteen patients with unstable pelvic ring fractures were included. All underwent full history taking, clinical and radiological evaluations and scheduled for anterior plating of sacroiliac joint. All were followed up for at least 15 months postoperatively. Results: Radiologically, 53.3% had anatomic, 20.0% had moderate and 26.7% had nearly anatomic results. Clinically, satisfaction was reported by 80.0%. The union was achieved in 86.7% and no complications was reported among 80.0%. Complications were significantly associated with non-satisfactory outcome, and radiological outcome was significantly associated with AO-OTA classification. Conclusion: Anterior pelvic plating combined with percutaneous sacroiliac joint screw fixation is effective treatment for unstable pelvic ring fractures with high success rate and low complications.

Background: Relapse is common and causes a high burden in schizophrenic patients. Stress is a main factor in relapse, so stress-resistant factors are proposed to have an important role to prevent it and improve outcomes in schizophrenia. One of these factors is Resilience. Aim of the work: To find the relationship between resilience and frequency of relapse among schizophrenic patients, and to help in developing new therapeutic programs that may lead to decrease the frequency of relapse in schizophrenic patients. Patients and Methods: This is a cross-sectional study. Eighty schizophrenic patients were selected among patients attending Port-Said Mental Health Clinic; 56 were males and 24 were females. Psychotic state was assessed using Positive and Negative Syndrome Scale (PANSS); Medication adherence was assessed using Morisky-8 scale. Resilience was assessed using The Resilience Attitude Scale. Results: There were generally no age, gender, work type, educational or social state differences in relation to frequency of admission. In addition, there was no statistical relation to frequency of admission as regards to education and marital state. On the other side, patients who were admitted less than or equal twice have generally high resilience level than who were admitted more than twice. Conclusion: Resilience is a very important protective factor against relapse in patients with schizophrenia.

Background: Infertility means a couple in their reproductive age not bearing a child after a year’s unprotected intercourse. It has a global prevalence of 12% to 15%. Aim of the work: The aim of this study is to evaluate the combined effect of several lifestyle behaviors [Exercise, smoking, alcohol, dietary habits and stress] on assisted reproductive techniques [ART] outcomes. Patients and Methods: This study included 700 patients undergoing intracytoplasmic sperm injection. Patients answered a questionnaire [simple life style questionnaire; SLIQ] and analysis examined the relationship between lifestyle with the intracytoplasmic sperm injection cycles outcomes. Comparison of SLIQ scores as measured by the scoring template with scores obtained by the health professionals’ blinded assessment of the questions validated our scoring scheme. We achieved a correlation coefficient of 0.77 [P<0.001] between SLIQ scores and blinded reviewers’ scores. Results: The mean number of oocytes was 6.31±5.5; and [73%] of oocytes were of good quality; the mean number of embryos was 3.22±3.36 and 69.0% were of good quality. Finally, 399 patients [57%] get pregnant. There was significant relation between life style behaviors and results of ART. There was Positive correlation between [total score and each of quality of oocytes, quality of embryos and pregnancy test. Conclusion: This study has highlighted that lifestyle behaviors can adversely affect general health and reproductive performance.

Background: Endoscopic third ventriculostomy (ETV) approach was gaining popularity over shunt placement in obstructive hydrocephalus. Postoperative ETV assessment and patients follow up remains a matter of controversy and challenge to ensure efficiency and patency of ventriculostomy. Aim of the work: To assess whether cerebrospinal fluid (CSF) flow is restored after ETV and similarity to flow in normal aqueduct with patients clinical and ventricular size changes assessment. Patients and Methods: From April 2016 to April 2019, 30 patients with hydrocephalus due to aqueductal stenosis (AS) were treated with ETV. They were followed up for ventriculostomy patency within the 1st, 6th and 9th month after surgery and compared to 22 persons as a control group of normal aqueductal flow with phase contrast magnetic resonance imaging (PC MRI). Results: Twenty-three (23) patients restored pulsatile bidirectional pattern of CSF flow across the ventriculostomy similar to that of aqueductal flow. While one patient had no flow during the 1st follow up and 6 patients showed initial pulsatile flow then developed flow disturbance during the 2nd follow up period. Absolute stroke volume values showed significant statistical difference between ETV and control groups (p value < 0.001). The value of 85 µl showed sensitivity and specificity of 84.3% and 81.7%, respectively as a cutoff value of ETV efficiency. Conclusion: ETV is an efficient technique to restores the physiological pulsatile Cerebrospinal fluid flow. Absolute stroke volume was a good predictor of ETV efficiency.

Background: Hysteropexy is an effective procedure for vault prolapse as abdominal sacrocolpopexy but easier and simple. Right sacrospinous fixation has the same results of bilateral fixation. Aim of the work: To evaluate the value and safety of unilateral or bilateral sacrospinous fixation [SSF]. Patients and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Al-Azhar University, Damietta over a period of two years [July 2017 to June 2019]. A total of 32 patients posted for 16 cases unilateral sacrospinous ligament fixation to vault and 16 cases for bilateral fixation were enrolled after informed consent. Results were recorded under headings of procedure time [min], blood loss [ml], major intro-operative complications and post-operative complications, postoperative pain and duration of hospital stay. Results: The result of unilateral transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal [Pelvic Organ Prolapse stage III and stage IV and vault prolapse] was evaluated as better than bilateral approach with the same efficacy, less time consuming, less blood loss and low post-operative pain. Conclusion: Unilateral transvaginal sacrospinous ligament fixation revealed a significant reduction in intraoperative blood loss, procedure time, immediate post-operative pain, and mean length of hospital stay.

Background: Gastrointestinal stromal tumor [GIST] is commonest mesenchymal tumor, mainly affects adults. But, 1.5% to 2% GISTs were reported in pediatrics and adolescents. The treatment of GIST is managed as in adult because of lack of information about pediatric GIST. Aim of the work: Here we presented a case report of pediatric GIST. Current literature was reviewed and a summary was formulated to form a base for future optimal treatment of childhood GIST. Case summary: A 14 years Saudi female presented with vague abdominal pain and easy fatigability for 8 months. The pain located in lower abdomen, mild, waning, no aggravation or reliving factor and not radiating. Clinically, there was peri umbilical round, firm and not tender mass extending to right side of the abdomen till right hypochondrium, with no movement with respiratory movements. Investigations demonstrate severe microcytic hypochromic anemia. A computed tomography [CT] abdomen and pelvis showed evidence of soft tissue mass, about 13*11*12cm, of heterogeneous pattern and enhancement with area of hypodensity and cystic degeneration. There was necrosis of mesentery with some calcification seen inside the lesion suggestive of query GIST or Lymphoma. En block resection of the mass done with safety margin, biopsy from lymph node and side-to-side anastomosis done using linear stapler. The histopathological examination revealed ill and well defined fasicles of tumor cells that have spindle, oval and round shape nuclei invading mesentery and small bowel. Mitotic figurer 5-10/50 HPF, reactive lymph node. Immunohistochemistry showed diffused strong positive CD117 and CD34, negative S-100

Background: Diabetes mellitus [DM] is one of the most widespread chronic diseases. It is commonly known by its serious vascular complications including micro-vascular [as retinopathy] and macro-vascular [as ischemic heart diseases] complications. So, a correlation between those complications may be found. Aim of the work: To investigate the correlation between diabetic retinopathy and increased risk of coronary artery diseases. Patients and methods: This study enrolled fifty patients with type 2 diabetes mellitus [DM] who were referred for coronary angiography. Full History, clinical examination, biochemical tests, electrocardiography [ECG], Echocardiography, coronary angiography and fundus examination were carried out. Diabetic retinopathy was detected and classified; patients were classified into two groups: a group [A] with diabetic retinopathy [DR] and a group [B] without diabetic retinopathy. Coronary diseases were assisted by coronary angiography using two different scores. Results: Population characters, including age, risk factors, duration of DM, lipid profile, angiography scores, were comparable between the two study groups. Patients in group [A] had significantly higher number of diseased vessels and higher Gensini score than those of Group [B]. The correlation was significant between the presence of the DR and both the number of diseased vessels [r = 0.532 P < 0.001] and Gensini score [r = 0.881, P < 0.001]. Conclusion: The diabetic retinopathy is a serious risk factor for increasing the severity of coronary artery diseases and can consider as a predictor of CHD in patients with DR

Background: Having an attention deficit hyperactivity disorder (ADHD) child has a disruptive effect on parenting style. As it demands more efforts to be managed and control their behaviors. Insufficient parenting style in childhood can affect the progress of the disorder, worse its signs and symptoms, and increases the risk of development of other behavioral problems, as an oppositional defiant disorder. Aim of the work: We were aiming in this study to assess the relationship between the severity of ADHD and parenting style. Patients and methods: This cross-sectional study was conducted on 100 children who had been attending the psychiatry outpatient clinic from January to June 2019. ADHD was diagnosed with an interview. The ADHD severity and parenting style were assessed by Conner’s Parent Rating Scale (CPRS-R-L) and parenting style scale, respectively. Results: The mean age of the enrolled children was 7.91 ± 2.39 years, and 72% were males. The severity of ADHD was 9% mild, 36% moderate, 32% severe, and 23% very severe. There was a statistically significant relation between “negative” or authoritarian parenting style and severity of ADHD (p <0.001). Conclusion: The results of this study demonstrated that ADHD was more common among males with statistically significant relation with parenting style, and a “positive” parenting style may help in decrease the severity of ADHD symptoms.

Background: The most common cause of hospital admission in the first month of life is the neonatal jaundice. Some factors [e.g., prenatal, neonatal factors, maternal factors, and environmental factors (such as zinc) influence the frequency of neonatal jaundice. In terms of neonates, it is proposed that there is a correlation between serum zinc quality and hyperbilirubinemia. Aim of the work: To evaluate the level of serum zinc in term neonates with indirect hyperbilirubinemia. Patients and Methods: A case control study carried out at the neonatal intensive care unit (NICU) and pediatric outpatient clinic of New Damietta, Al-Azhar University Hospital, from June 2018 to February 2019. It included 75 neonates with neonatal jaundice as cases group and 75 healthy neonates of matched age and sex as a control group. All were assessed clinically and serum zinc levels were determined and documented. Results: Level of serum zinc in neonates with non-hemolytic hyperbilirubinemia (103.3±36.56 ug/dl) was significantly lower than healthy neonates without jaundice (128.62 ± 40.83 ug/dl) and zinc deficiency in jaundiced neonates (25.3%) was statistically significant more than healthy neonates) 6.7%). There was no significant relation between the level of serum zinc and other factors like the maternal age, parity, pattern of feeding, gender and weight, but there was significant correlation with maternal zinc intake during pregnancy. Conclusion: We concluded that serum zinc level in term neonates with neonatal jaundice was statistically significant decreased than healthy term neonates.

Background: Epilepsy is one of the most common neurological disorders in children. It often requires long-term antiepileptic drug (AED) therapy. AEDs are frequently associated with cognitive and behavioral dysfunctions. Also, there is a relationship between AEDs use and homocysteine levels. Elevated homocysteine has been associated with cognitive dysfunction. However, such effect among epileptic children has not been well-studied. Aim of the work: To study plasma homocysteine level in children under treatment with AEDs and its relation to intelligence quotient (IQ). Patients and Methods: A case control study included 56 epileptic children on AED therapy for at least 6 months, and 36 healthy children (Controls). Study was conducted at Al-Azhar University Hospital (Damietta) from June 2016 to June 2018. Plasma homocysteine was measured using Enzymatic Recycling (Biotecnica Instruments SpA). IQ testing was conducted using Stanford-Binet Intelligence Scales, Fifth Edition. Results: Epileptic children exhibited significant elevation of Homocysteine level (P=0.005), and significant affection of all IQ parameters. There was significant negative correlation between homocysteine level with total working memory, total verbal IQ and total IQ. Multivariate regression analysis revealed that homocysteine showed a significant and independent association with total working memory, total verbal IQ and total IQ. None of the other studied factors revealed such association. Conclusion: Homocysteine was a significant and independent risk factor for low total working memory score, low total Verbal IQ and low total IQ scores. Further studies are required to confirm these results, and to evaluate the effect of homocysteine-lowering treatment on cognitive function in epileptic children.

Background: Epilepsy is one of the most common neurological disorders in children. It often requires long-term antiepileptic drug (AED) therapy. AEDs are frequently associated with cognitive and behavioral dysfunctions. Also, there is a relationship between AEDs use and homocysteine levels. Elevated homocysteine has been associated with cognitive dysfunction. However, such effect among epileptic children has not been well-studied. Aim of the work: To study plasma homocysteine level in children under treatment with AEDs and its relation to intelligence quotient (IQ). Patients and Methods: A case control study included 56 epileptic children on AED therapy for at least 6 months, and 36 healthy children (Controls). Study was conducted at Al-Azhar University Hospital (Damietta) from June 2016 to June 2018. Plasma homocysteine was measured using Enzymatic Recycling (Biotecnica Instruments SpA). IQ testing was conducted using Stanford-Binet Intelligence Scales, Fifth Edition. Results: Epileptic children exhibited significant elevation of Homocysteine level (P=0.005), and significant affection of all IQ parameters. There was significant negative correlation between homocysteine level with total working memory, total verbal IQ and total IQ. Multivariate regression analysis revealed that homocysteine showed a significant and independent association with total working memory, total verbal IQ and total IQ. None of the other studied factors revealed such association. Conclusion: Homocysteine was a significant and independent risk factor for low total working memory score, low total Verbal IQ and low total IQ scores. Further studies are required to confirm these results, and to evaluate the effect of homocysteine-lowering treatment on cognitive function in epileptic children.

Background: Epilepsy is one of the most common neurological disorders in children. It often requires long-term antiepileptic drug (AED) therapy. AEDs are frequently associated with cognitive and behavioral dysfunctions. Also, there is a relationship between AEDs use and homocysteine levels. Elevated homocysteine has been associated with cognitive dysfunction. However, such effect among epileptic children has not been well-studied. Aim of the work: To study plasma homocysteine level in children under treatment with AEDs and its relation to intelligence quotient (IQ). Patients and Methods: A case control study included 56 epileptic children on AED therapy for at least 6 months, and 36 healthy children (Controls). Study was conducted at Al-Azhar University Hospital (Damietta) from June 2016 to June 2018. Plasma homocysteine was measured using Enzymatic Recycling (Biotecnica Instruments SpA). IQ testing was conducted using Stanford-Binet Intelligence Scales, Fifth Edition. Results: Epileptic children exhibited significant elevation of Homocysteine level (P=0.005), and significant affection of all IQ parameters. There was significant negative correlation between homocysteine level with total working memory, total verbal IQ and total IQ. Multivariate regression analysis revealed that homocysteine showed a significant and independent association with total working memory, total verbal IQ and total IQ. None of the other studied factors revealed such association. Conclusion: Homocysteine was a significant and independent risk factor for low total working memory score, low total Verbal IQ and low total IQ scores. Further studies are required to confirm these results, and to evaluate the effect of homocysteine-lowering treatment on cognitive function in epileptic children.

Background: Occupational noise-induced hearing loss (ONIHL) is a major health issue with high prevalence globally and has major social, economic and psychological effects. Aim of the work: Assessment of noise induced hearing loss (NIHL) prevalence among employees at wood industry in Damietta governorate. Patients and methods: The present cross-sectional study was carried out in New Damietta city, Damietta governorate, Egypt. Ten workplaces were selected through convenience sampling. From these ten workplaces, one hundred fifty (150) employees agreed to participate in the study. Pure-tone audiometry between 500 and 8000Hz frequencies determined the hearing condition of the participants and noise readings were conducted at the selected workplaces. Results: Among all study participants, the prevalence of noise induced hearing loss (NIHL) was 39% of carpenters and 44.4% of sawyers with no statistically significant difference (P?=?0.253) between both groups. Noise levels ranged from 73 to 91.5 dBA in the various furniture factories and from 74.9 to 94.1 dBA in the different saw mills. Conclusion: Occupational noise induced hearing loss (ONIHL) is highly prevalent in Damietta governorate among wood workers, which might be due to lack of knowledge, awareness about NIHL among employers, workers, and health care workers along with absence and or implementation of hearing conservation programs in the work places.

Background: Spondylotic cervical myelopathy is defined as spinal cord dysfunction secondary to extrinsic compression of the spinal cord and/or its vascular supply so it is the commonest cause of cord dysfunction in patients over 55 years. Main Surgery target is to prevent the progression of symptoms also to improve existing symptoms. Aim of the work: To determine prognostic factors of patients with spondylotic cervical myelopathy that surgically managed through anterior approach in relation to outcome clinically and radiologically. Patients and methods: From July 2015 till December 2018, forty patients with cervical myelopathy were operated by anterior surgical approach (anterior cervical discectomy with fusion and/or corpectomy with fusion. Only patients with confirmed spondylotic myelopathy were included; we exclude those with an infectious, inflammatory or neoplastic etiology. Results: Patients ages were ranged from (40-67) years, with a mean age 53.2 years. Duration of myelopathy ranged from 2-18 months with a mean duration of 8.55 months. 72.5% patients were treated by discectomy with fusion and 27.5%cases were treated by combined discectomy and corpectomy with fusion. Excellent outcome was reported in 22.5%, while 62.5% cases had good outcome,15% patients had fair outcome. Patient age, disease severity, duration, bowel & bladder manifestations and affection of dorsa column were the prognostic factors in studied patients. Conclusion: Our study reveals that the significant prognostic factors are: age of patient, severity of myelopathy, duration of myelopathy, presence of bowel or bladder symptoms, dorsal column affection and high signal intensity of T2 weighted MRI.

Background: Shunt migration after Lumboperitoneal [LP] shunt procedures can occur upward into the spinal subarachnoid space and downward into the abdominal cavity. Cranial migrations are less common than downward migration into the abdominal cavity. Defects of the fixation devices in the shunt system are considered the main cause. Aim of the work: To evaluate fixed node maneuver, a new technique to avoid shunt migration. Patients and methods: Among many cases of shunt installations, we selected 30 patients who received a first-time shunt installation for different causes [pseudotumor cerebri [24 cases], primary cerebrospinal fluid [CSF] rhinorrhea [5 cases] and one case for persistent postoperative lumbar CSF leak]. All cases underwent LP shunt with fixed node in group [A; 15 patients] and the traditional mode of fixation in group [B; 15 patients], with evaluation of postoperative clinical improvement and shunt migration. Results: Clinical improvement occurred in 27 [90%] patients. However, shunt migration was recorded in 2 [13.3%] patients of the second group [B], while in group [A], no recorded shunt migration. Conclusion: We advocated clinical efficacy of fixed node maneuver of lumboperitoneal shunt to avoid shunt migration.

Background: Mesenchymal stem cells have delivered new approaches to the management of burn healing in severe skin injuries. Aim of the work: To evaluate the effect of bone marrow-derived mesenchymal stem cells (BMSCs) on healing of induced deep 2nd degree skin burns in albino rats. Methodology: 55 male albino rats weighed 200gm were divided into 5 groups, 5 animals in group I (control) and group II (burn model), 15 animals in group III (untreated), group IV and group V (MSCs treated). Groups III, IV and V were subdivided into 3 subgroups that were sacrificed after 7, 14 and 21 days respectively. Deep 2nd degree burn wounds were induced on a 4 cm2 area on the back of rats in groups II, III, IV and V by brass probes stabilized at 88–90°C and contacted to the shaved dorsal skin of rats for 20 seconds without exerting any external pressure. Mesenchymal stem cells were isolated from the bone marrow of 5 young rats, weighed 100gm then intra-dermally and intraperitoneally injected. Results: By the end of the third week, the wounds of BMSCs-treated groups showed full regeneration of epidermis, re-organization of collagen and decrease in VEGF immunopositive cells. Delayed wound healing was seen in 20% of systemically treated rats. Significant increase in the mean area percent of collagen fibers was detected in topically treated group. Conclusion: Both methods of BMSCs injection were effective in healing of full thickness skin wound but topical method was more effective.

Background: Peri-operative shivering a challenging discomfort faced in anesthesiologists’ daily practice. Many drugs were used as a prophylaxis, but there was no consensus on ideal or standard drug yet. Aim of the work: To compare the effectiveness and safety of pethidine, granisetron and tramadol in prophylaxis against perioperative shivering after spinal anesthesia. Patients and methods: Sixty adult patients, who underwent spinal anesthesia, were included. They were randomly assigned to granisetron, pethidine or tramadol (20 in each group), and submitted to standard intraoperative monitoring and follow up for postoperative 4 hours. Monitoring included electrocardiography, oxygen saturation, respiratory rate, temperature, non-invasive blood level, conscious level and sedation score. Side effects were documented. Results: Intra- and post-operatively, there was significant reduction of heart rate in granisetron and tramadol groups. Mean arterial pressure significantly decreased in granisetron group at the time from 30 minutes to the end of surgery and during the first two postoperative hours. Respiratory rate significantly decreased in pethidine group during the complete intra- and post-operative period. Granisetron had no sedative effect at all, but sedation was significantly increased among pethidine group. Finally, perioperative shivering was reported in 25%, 15% and 15% of pethidine, granisetron and tramadol groups respectively. Nausea/vomiting was reported in 20%, 10.0%, and 0% of pethidine, tramadol and granisetron groups respectively. Pruritus was confined to 30% pethidine group with significant difference. Conclusion: Granisetron, tramadol and pethidine, all are effective as a prophylaxis against perioperative shivering after spinal anesthesia. However, granisetron seems to be the most suitable drug.

Background: Bronchial asthma Affecting 1-18% of children in different countries, it widely distributed chronic respiratory disease. vitamin-D increase calcium absorption from the gastrointestinal tract, determines bone health and regulates neuromuscular function. In addition, vitamin-D is a potent immune system regulator, and it has a potential role in various allergic diseases. Aim of the work: To estimate the association between asthma and Vitamin-D in pediatrics. Patients and methods: The present work is a case control study included 150 (100 asthmatic children and 50 healthy control) children aged between 5 and 12 years. Serum 25- hydroxy vitamin-D levels were evaluated and compared between two groups. Association between vitamin-D and pulmonary function was studied in asthmatic children. Results: Cases had significantly lower values of FEV1%, FEV1/FVC ratio and vitamin-D levels when compared to controls (53.20±6.27, 68.64±4.42, 24.44±20.92 vs 126.44±10.15, 107.20±5.05 and 84.25±41.79 successively). In addition, vitamin-D was positively and significantly correlated with pulmonary function tests (FEV1% and FEV1/FVC ratio). Conclusion: Children with bronchial asthma suffered from marked reduction of vitamin-D which correlated with asthma severity.

Background: Hepatitis C virus (HCV) infection is associated with more significant morbidity and mortality among dialysis patients than in healthy populations. The fixed-dose tablet (ombitasvir/ paritaprevir/ritonavir) in combination with ribavirin was effective and generally well tolerated in treatment of chronic HCV infected patients with end stage renal disease (ESRD) on hemodialysis. However, limited published data are known about the usefulness of this regimen for treatment of HCV patients with ESRD on hemodialysis. Aim of the work: The aim of this study was to evaluate the safety and efficacy of treatment regimen of ombitasvir (OBV) 25 mg /paritaprevir (PTV) 150 mg /ritonavir (RTV) 100 mg plus generic ribavirin (RBV) 200 mg in Egyptian HCV-infected naive patients with ESRD on regular hemodialysis. Patients and methods: A prospective cohort study involved 40 chronic HCV on regular hemodialysis patients, who were eligible for treatment with combined oral antiviral therapy. Results: The results showed that thirty-five patients [35/40(87.5%)] completed 12 weeks of HCV therapy; they had a virological response at end of therapy and sustained virological response. Anemia was the main observed side effect which lead to discontinuation of the treatment in five patients (12.2%). As these patients were not responding to anemia correction measures (blood transfusion, erythropoietin-stimulating agents, and modification of RBV dose). Conclusion: OBV/PTV/RTV plus Ribavirin can be used in treatment of chronic HCV patients with ESRD on regular hemodialysis.

Background: Atherosclerotic infarction accounts for a sizable proportion of cerebral infarcts whether occurs from extracranial or intracranial atherosclerotic disease. Despite recent studies on stroke risk factors; it is still unclear whether or not single risk factor specifically affect extracranial or intracranial arteries in stroke patients. Aim of the work: To determine the difference between intracranial and extracranial steno-occlusive atherosclerosis and its correlation with risk factors of acute ischemic stroke using Magnetic Resonance Angiogram (MRA) and/or Computed Tomography Angiography (CTA) with Duplex. Patients and methods: All cases diagnosed as acute ischemic stroke were subjected to detailed history, full neurological examination, routine laboratory tests, extracranial vessels assessed by duplex, intracranial vessels assessed by MRA and/or CTA. Results: 61 patients included in the study (38 males and 23 females), with mean age (64.5 ± 11.4). Extracranial stenosis was (57 patients, 93.4%), while intracranial stenosis was (49 patients, 80.3%). But the intracranial significant stenosis was (45 patients, 73.77%), while the extracranial significant stenosis (26 patients, 42.62%). Hypertension (72.1%), obesity (62.3%), diabetes (57.4%), dyslipidemia (54.1%) and smoking (39.3%), were risk factors equally affecting the extracranial and the intracranial systems in the same descending order. There was a higher prevalence of hypertension among patients with intracranial significant stenosis showing a significant P-value of 0.048. Conclusion: Extracranial stenosis was more common than the intracranial stenosis, but the intracranial significant stenosis is more prevalent than the extracranial. Hypertension is a significant risk factor for intracranial significant stenosis.