Background: Polymorphic eruption of pregnancy [PEP] is a benign inflammatory dermatosis of pregnancy of unknown etiology developing in the third trimester as an intensely pruritic rash and inflamed striae with peri-umbilical sparing. It is a self-limiting condition which resolves after delivery and has no maternal or fetal adverse effects. There are no specific investigations. Diagnosis is based on history and typical clinical features. Emollients, topical corticosteroids and oral antihistamines provide symptomatic relief, though a few patients with severe symptoms may require a short course of oral or injectable corticosteroids. Autologous hemotherapy is a safe option and can be considered in severe conditions. Case summary: This report describes an unusual patient with singleton pregnancy presenting at 41 weeks gestation with sudden onset intense itching and rash on abdomen, upper part of legs and arms. We have summarized current literature related to PEP and evaluated the variations in clinical presentations, relevant etiopathogenesis and treatment options.

Background: Otitis media with effusion is a prevalent disease of pediatrics. It is usually a self-limiting disease. However, it may be complicated by serious consequences. The early detection and the determination of actual prevalence could help in planning for preventive interventions. Aim of the work: To determine prevalence of otitis media with effusion and the risk factors associated with this disease. Patients and methods: The study included all patients younger than 16 years of age, who attended the outpatient clinic of otorhinolaryngology department (Al-Azhar Faculty of Medicine, New Dameitta), during the period from August 2016 to August 2018. In this work, 2338 patients were included (1351 males and 987 females). For each child, the demographic data were collected and documented. All attended children were submitted to an ear, nose and throat examination; both ears were examined by an otoscope (pneumatic) and tested with tympanometry by the same investigator. Results: The disease was diagnosed in 124 children (5.3%). The mean age of studied children was 9.13±2.83 years (range 4-15). The most common affected age was 4 years (15%) followed by 6 years (13.1%), then 15 years (6.3%). The condition was significantly associated with low socioeconomic class, smoking exposure and past frequent upper respiratory tract infection. Conclusion: The prevalence of OME in 4-15 years old children in Damietta Governorate was 5.3%, elevated to 15% at the age of 4 years. The low social state, exposure to smoking and frequent infections of upper airway were the most common associated risk factors.

Background: Endovascular management of cerebral aneurysms is relatively a new modality of management in Egypt. So, studies are needed to evaluate efficacy, safety, and outcome; especially with this rapid evolution in both materials and equipment. Aim of the work: To asses safety, efficacy, and outcome of our case series with cerebral aneurysm managed by endovascular coiling. Patients and Methods: Here we documented the clinical, treatment, and outcome variables of cerebral aneurysm case series treated by endovascular coiling between May 2018 and December 2019 in a single center in Egypt. Results: In 30 patients, 34 aneurysms were found, 31 aneurysms [91.1%] were treated by coiling, and only 3 aneurysms [2 cases] [8.9%] failed to be treated by coiling. Total occlusion was achieved in 25 aneurysms [80.6%]. Neck remnants were present in 6 aneurysms [19.4%]. Regarding functional outcome, 26 patients had good outcome and 2 patients had poor outcome. Conclusion: Endovascular coiling is safe and effective method for management of cerebral aneurysm and should considered as the first choice in management.

Background: Spondylodiscitis is an inflammation of the vertebral disk space often related to infection. Different treatment modalities were present. However, no full consensus is found about the ideal treatment. Aim of the work: To compare between titanium mesh and autogenous iliac bone graft through anterior approach for treatment of lumbar spondylodiscitis. Patients and Methods: A total of 30 patients with spondylodiscitis were included in the study. They were assigned for surgical intervention. They were allocated into titanium mesh or autogenous iliac bone graft through anterior approach. All underwent full history taking and clinical examination, radiological evaluation and surgical outcome was documented. Results: There was no significant difference between the two studied groups as regard the bony fusion after follow up period and there is no significant difference between the two studied techniques as regard outcome. Favorable outcome was not related to patient gender. But, the favorable outcome was associated with younger age [all patients younger than 40 years had favorable outcome, while 73.7% of those older than 49 years had been improved. Conclusion: Titanium mesh cages were found to be similar to autogenous iliac bone graft for restoring vertebral height when treating single-segment lumbar spondylodiscitis and obtained same clinical efficacy as autogenous iliac bone.

Background: Otitis media [OM] is the second most common disease of childhood after upper respiratory tract infection. There was no consensus on the ideal treatment modality yet. Aim of the work: To compare the use of trans-tympanic T tube [TTTT] and subannular T tube [SATT] in recurrent otitis media, recurrent otitis media with effusion or tympanic membrane retraction. Patients and Methods: This is a prospective controlled study, which was conducted at Al-Azhar university hospital [Damietta]. It included 40 patients that were randomly divided into two groups A and B: Group A: include 20 patients who were submitted to trans-tympanic T-tube. Group B included 20 patients who were submitted to sub annular T-tube. Patient data and outcome were documented and compared. Results: The duration that TTTTs and SATTs remained in place ranged from 4 to 19 months with a mean of 10.62 and there was a significant decrease of duration in TTTT in comparison to SATT groups [7.28 vs 14.80 respectively]. Besides, in 14 cases in the SATT group, the tube is still in place. Extrusion was reported in 10 cases [8 in the TTTT group and 2 in the SATT group] and finally removal was reported in 6 patients [2 in TTTT group and 4 in the SATT group. Conclusion: The use of SATTs for long term middle ear ventilation is safe and more efficient than V-T Grommet TTTTs for maintaining middle ear ventilation and prevention of recurrent interventions in children with less otorrhea and plugged tubes.

Background: Total knee Replacement proved to be an effective surgery that leads to restoration of joint function, limb alignment, beside elimination of pain in patients with osteoarthritis. Aim of the work: To assess the results of treatment of osteoarthritis of the knee with severe malalignment by total knee arthroplasty. Patient and Methods: 30 patients (12 males & 18 females) aged from 48 - 68 years who had advanced knee arthritis were operated by total knee replacement at Al-Azhar University Hospital [Damietta] and Damietta Specialized Hospital and followed up for average 12 months from December 2016 to March 2019. All patients were assessed by history taking, examination, radiological and laboratory investigations, and all were subjected to a three-phase postoperative rehabilitation protocol. Results: 19 patients (63.3 %) had excellent final result, 8 patients (26.7%) had good result, 2 patients (6.7 %) had fair result and one patient (3.3 %) had poor final result. In addition, there was significant improvement in pain relief and joint function Conclusion: Total Knee Replacement in severe malalignment is a challenging surgery. However, it leads to significant changes in the quality of life in most patients; regarding pain relief, improvement in joint function and early return to daily activities.

Background: Spondylolysthesis represents a particular and relatively frequent mechanism of intervertebral instability. It could cause low back pain due to forward or anterior displacement of one vertebra in relation the adjacent lower vertebra. There are many treatment intervention. However, there was no consensus on the ideal approach. Aim of the work: To assess the outcome of trans-pedicular screw fixation with posterior inter-body fusion in management of lumber and lumbosacral Spondylolysthesis. Patients and methods: This is prospective study, included twenty patients who underwent surgical lumbar laminectomy and disc removal with lumbar pedicle screw fixation with inter body fusion for patients with Spondylolysthesis who failed conservative measures. Results: The mean preoperative visual analogue score (VAS) for pain was 7.75 ± 0.72 that decreased to 1.35 ± 0.59 at the end of postoperative sixth month, with statistically significant decrease. In addition, the majority of cases had no significant complications, although complication rate was 25%. Conclusion: Posterolateral fusion with pedicle Screws fixation minimizes dislocation, achieves adequate decompression, corrects the sagittal axis, and accomplishes fusion. We successfully achieved solid fusion with good mechanical alignment in majority of the patients.

Background: Osteoarthritis (OA) is the most common joint disease, causing disability and reduction of quality of life and participation in social activity. Now considered a whole joint disease, OA is characterized by cartilage loss, subchondral bone changes, synovial inflammation and meniscus degeneration1. Aim and objectives: The evaluation of the role of musculoskeletal ultrasound and MMP-2 serum in the diagnosis of early knee OA. Subjects and methods: The present study was conducted on 50 patients with early knee OA patients attending the Outpatients Clinic of the Rheumatology Department Damietta Faculty of Medicine, Al-Azhar University matched with 25 age and sex healthy volunteers. Musculoskeletal ultrasound (MUS) was performed by experienced radiologist according to the EULAR recommendations by using a 12–5-MHz linear transducer (voluson E6) and Metalloprteinase-2 (MMp2) was detected by Elisa technique. Results: MMP-2 is highly significant and overexpressed in patient group and its early detection is positively correlated with weight and BMI. Our results appear that family history, BMI and weight are the main risk factor for the onset of knee osteoarthritis (KOA) in the patient group. MUS clarifies most patients (88% and 80%) have Medium osteophyte on LT and RT respectively, followed by 44% of participants have Mild osteophyte on RT. Conclusion: MMP-2 is a diagnostic biomarker at the early stage of OA. MSU is an excellent imaging technique to detect early osteoarthritis.

Background: Obesity is a challenging health problem in gynecologic surgery. Laparoscopic has the potential advantages than abdominal hysterectomy of being quicker, efficient with low estimated blood loss. Aim of the work: To compare the safety and effectiveness of laparoscopic and abdominal hysterectomy for benign conditions in obese patients. Patients and Methods: Sixty patients were submitted to history taking, clinical examination, Lab investigations, abdominal ultrasound and biopsy for suspicious pathology. Patients divided into two equal groups. The first for total laparoscopic hysterectomy and the second for trans-abdominal hysterectomy. Patients were followed for six months after surgery. Data collected include operative time, amount of blood loss, complications and duration of hospital stay. Results: BMI was significantly higher among open when compared to laparoscopic group (43.69±3.86 vs 34.5±4.02 respectively), and low parity and low cesarean deliveries were significantly increased in laparoscopic group. The highest indication of hysterectomy in laparoscopic group was adenomyosis (43.3%) followed by fibroid (30.0%), while in open group, the most common indication was fibroid (53.3%) followed by adenomyosis (26.7%). Operative time showed significant decrease in laparoscopic when compared to open hysterectomy groups (56.23±21.5 vs 78.87±8.22 minutes respectively) and blood loss was significantly decreased among laparoscopic group. Finally, the length of hospital stay was significantly decreased in laparoscopic when compared to open groups (the median was 10 versus 24 hours respectively). Conclusion: Laparoscopic hysterectomy is superior to abdominal hysterectomy in obese females with benign conditions in terms of safety and efficacy.

Background: Conservative management for obesity had limited role in treatment of obesity. Otherwise, surgical treatment is effective, But associated with many comorbidities. Aim of the work: To evaluate laparoscopic sleeve gastrectomy, greater curvature plication and gastric bypass in morbidly obese patients. Patients and Methods: Thirty patients were included. They were divided into three groups: A for laparoscopic greater curvature plication, B for laparoscopic sleeve gastrectomy, and C for laparoscopic gastric bypass. All subjects underwent full history taking, clinical examination, laboratory investigations, abdominal ultrasonography, and upper gastrointestinal endoscopy. Follow up carried out at the first two weeks then at 1, 3, 6, 12 months for late postoperative complications, changes in comorbidities (hypertension, diabetes mellitus, arthritis) and percentage of excess weight loss. Results: Studied groups were comparable as regard to patient demographics, preoperative comorbidities, intraoperative bleeding or postoperative complications. Operative time was significantly decreased in group B. EBWL differ significantly between groups at all postoperative follow up visits. For example at the second postoperative week, there was significant increase of EBWL in groups B and C when compared to group A (5.75±3.96 and 8.4±5.54 vs 1.15±0.81 respectively). Failure was 40%, 10% and 0% in groups A, B and C respectively. Only one patients died after operation in the bypass group. Morbidities were improved after surgery. Conclusion: Laparoscopic greater curvature plication, is lower than laparoscopic sleeve gastrectomy and laparoscopic gastric bypass surgery as the procedure for weight loss, despite of its less cost. In addition, it had higher complications, reoperations and weight gains.

Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity for mother and fetus. Preeclampsia is a pregnancy multisystem disorder. Abnormal lipid profile has an effect on endothelial dysfunction. The association of serum lipid profile with preeclampsia is suggested to reflect new diagnostic tools. Pregnancy dyslipidemia is associated with an increased risk of preeclampsia. Compared to healthy pregnancy, women with preeclampsia have an abnormal lipid profile. Aim of the work: The aim of this work is comparison between normotensive women and preeclamptic women by serum lipid profile at third trimester. Patients and Methods: The present study conducted on 70 pregnant women in the Department of Obstetrics and Gynecology, at Al-Azhar University hospital [Damietta], which was conducted during 2019 [from April to December]. A study comprised 35 normotensive pregnant women as controls and 35 preeclampsia cases. The blood samples were analyzed for serum triglycerides [TGs], total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density Lipoprotein-Cholesterol [LDL-C], very low-density Lipoprotein-Cholesterol [VLDL-C], Apo lipoprotein- A1 [Apo-A1] and Apo lipoprotein- B[Apo-B]. Results: There was significant difference between group A and B as regard Apo B/ Apo A1, cholesterol, TGS, LDL and VLDL. They are higher in group B. Conclusion: In the third trimester of pregnancy, preeclamptic women have altered levels of serum lipid profile. The most significant test is Apo B/A1 ratio with accuracy [72.7%].

Background: Obesity reaches the epidemic situation. Obstructive sleep apnoea is a major concern in obese patients. Aim of the work:To analyse apnoea hypopnea index and to evaluate changes in pulmonary functions before and after bariatric surgery in obese patients. Patients and Methods: We identify 160 patients who met our inclusion criteria. However, 121 patients returned for follow up evaluation. They were 98 women and 23 men. 84 had Raux-en-Y gastric bypass and 37 had sleeve gastrectomy. They were subjected to full history taking, clinical examination, objective measures of obstructive sleep apnoea [apnoea hypopnea index, body mass index, mean oxygen saturation, low oxygen saturation, nasal continuous positive airway pressure and Pulmonary function tests]. In addition, all patients were submitted to a sleep study. Results:Statistically significant improvement was obtained postoperative for apnoea hypopnea index, body mass index, nasal continuous positive airway pressure requirement, mean oxygen saturation and low oxygen saturation. The spirometry and lung volume finding showed statistically significant improvement in lung function parameters after surgery. There was a significant positive correlation between body mass index and apnoea hypopnea index, with significant negative correlation between body mass index and forced vital capacity. Conclusion: Bariatric surgery is associated with significant improvement in pulmonary functions and obstructive sleep apnoea indices

Background: Hepatocellular carcinoma [HCC] is one of the leading causes of cancer-related deaths worldwide. A major problem with HCC surveillance is the lack of reliable biomarkers. Serum transthyretin [TTR] may be a sensitive marker for the diagnosis of patients with liver cell damage, liver cirrhosis or hepatocellular carcinoma. Aim of the work: This study aimed to evaluate the potentiality of serum transthyretin [TTR] as a novel biomarker for detection of HCC in cirrhotic patients. Patients and Methods:This Current study was conducted on 70 patients with chronic liver disease. Also, 20 healthy person matched for age and sex were included as a control group. Patients were classified into 2 groups [30 cirrhotic patients with newly diagnosed HCC & 40 cirrhotic patients without HCC]. Serum TTR levels were measured using enzyme linked immunosorbent assay technique. Results: Serum levels of TTR were significantly much lower in HCC patients when compared to cirrhotic patients without HCC or control group [p<0.0001]. Significant decrease of serum TTR in HCC patients, with portal vein invasion or nodal invasion than in HCC without vascular or nodal invasion. The diagnostic accuracy of TTR was higher than that of AFP regarding sensitivity [83.3%] and negative predictive value [81.4%] in diagnosis of HCC. Conclusion: detection of lower level of TTR alone or in combination with other validated markers may be potentially informative biomarker for detection of HCC among cirrhotic patients at early noninvasive stage where curative treatment can be applied.

Background: Chronic obstructive pulmonary disease [COPD] is a chronic lung disease affecting other body systems, like musculoskeletal system causing weakness. Muscle weakness is a major problem, causing poor functional lung capacity; and a negative impact on daily life activity. Muscle weakness in COPD may be a form of disuse and/or a form of myopathy is a question need answer. Exercise is a basic unit of pulmonary rehabilitation causing increased quality of life. So, PR regarded as effective non-pharmacological treatments in COPD. Aim of the work: Whole-body vibration [WBV] is a type of exercise that improve muscle function specially in debilitated patients like COPD,WBV not yet studied in Egyptian patients with COPD. Patients and Methods:Fifty patients with COPD were assessed for an 18-weeks in outpatient rehabilitation center, the patients were randomly assigned into: Group 1, using dynamic exercise on a side alternating vibration platform at 25–30 Hz three times per week [WBV], and group 2 as a control group [CON] with the same amount of exercise without WBV. Results: Pulmonary function tests results: showing FEV1 pred. 39.8 ± 12.2 and 41.3±4.6 before and after intervention respectively. PaO2: 49.60 ± 80and 82±90 before and after intervention respectively; PaCO2: 65 ± 70and 33±50before and after intervention respectively the difference was significant in intervention group than in control. The distance walked [DW] increased after the WBV period [397±133m] compared with the control period [359±111m]. Conclusion: WBV was good complementary training exercise which could be an effective new modality for COPD patients.

Background: The fundamental impact of dexmedetomidine on the cardiovascular framework obstruction is the extra component of narcotic saving impact. Similarly, fundamental Lidocaine that is utilized as a consistent mixture during the operation period has pain-relieving, antihyperalgesic, and calming chattels. Aim of the work: To analyze the effectiveness of lidocaine given intravenously with that of dexmedetomidine as an adjuvant to general anesthesia for candidates listed for elective abdominal and pelvic surgery. Patients and Methods:120 patients of both sexes undergoing elective pelviabdominal procedures were enlisted. Patients were assigned randomly to one of three equal groups: group 1 received a loading lidocaine 1.5 mg/kg, followed by an infusion of 2 mg/kg/h, group 2 received a loading dexmedetomidine1 µg/kg, followed by 0.5 µg/kg/h, and group 3 received normal saline 0.9% in the same design as previous medicines. Hemodynamics, consumption of anesthetic agents, induction and recovery times, and time to the first postoperative analgesic request were reported. Results: The hemodynamics after intubation and in the next records, were significantly lower in groups 1 and 2 when compared with group 3 with no significant variance between groups 2 and 1. The induction dosage of propofol, mean end-tidal sevoflurane concentration and the consumption of fentanyl intraoperatively were significantly lower in group 2 when compared with group 1. The time through anesthesia induction was significantly lower in group 1 and 2 when compared with group 3. The time to the first analgesic demand postoperatively was significantly longer in group 2 when compared with group 1. Conclusion: Both lidocaine and dexmedetomidine could be a beneficial adjuvant to general anesthesia. Though, dexmedetomidine has a much economic effect on intraoperative anesthetic agent consumption and more extended time to the first postoperative analgesic request.

Background: Alteration of the female sexual functions after hysterectomy have a great concern to patients and clinicians. The introduction of many assessment tools as the Female Sexual Function Index (FSFI) allowed researchers to assess the sexual functions in a more standardized method. Aim of the work: to assess the consequence of abdominal and laparoscopic hysterectomy on sexual functions. Methods: 60 women aged between 30 to 60 years who underwent hysterectomy (abdominal or laparoscopic) for benign reasons were included in this study, and divided into two groups, total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH). Using FSFI questionnaire, the sexual functions were assessed 1 day preoperatively and six months postoperatively. Results: The score for Desire was 5.08+0.62 for TAH, 5.06+0.60 for TLH preoperatively; and 5.12+0.58 for TAH, 5.20+0.62 for TLH postoperatively. Arousal was 5.14+0.42 for TAH, 5.19+0.42 for TLH preoperatively and 5.15+0.53 for TAH, 5.22+0.46 for TLH postoperatively. Lubrication was 5.05+0.49 for TAH, 5.15+0.52 for TLH preoperatively and 5.23+0.48 for TAH, 5.23+0.53 for TLH postoperatively. Orgasm was 5.01+0.62 for TAH, 5.00+0.57 for TLH preoperatively and 5.04+0.59 for TAH, 5.13+0.59 for TLH postoperatively. Satisfaction was 4.89+0.63 for TAH &4.89+0.60 for TLH preoperatively and 5.00+0.66 for TAH, 5.20+0.60 for TLH postoperatively. Pain was 4.95+0.48 for TAH, 4.95+0.51 for TLH preoperatively and 5.12+0.53 for TAH, 5.01+0.51 for TLH postoperatively. Conclusion: there was a significant improvement in the female sexual functions after laparoscopic hysterectomy, but after abdominal hysterectomy, there was no improvement. Keywords: Female Sexual Function Index, Arousal, hysterectomy.

Background: early pregnancy loss is a challenging health problem and the prediction of exposed females is mandatory to permit early intervention and prevention. Aim of the work: to assess utility of ultrasound in detection of threatened abortion in early pregnancy. Patients and methods: one hundred females with history of threatened abortion were included. A written consent was obtained from each participant. Patients were divided into two groups: Group (I): 85 Cases who continued their pregnancy. Group (II): 15 Cases ended by abortion. All females were submitted to: detailed history, clinical examination (General and abdominal) and investigations in the form of ultrasound. Data were collected and statistically analyzed. Results: 15% of studied females had early miscarriage. There was a significant relation between occurrence of abortion and gestational age as abortion was more frequent with reduced gestational age. In addition, high parity (P1-2) was significantly associated with abortion. Also, current abortion associated with abortion in previous pregnancy, sub-chorionic hematoma, irregular wall of gestational sac and low fetal heart rate. The best cutoff of fetal heart rate is 100 beat/minute. The sensitivity of fetal heart rate in prediction of abortion was 67.1%, specificity was 80.0%, PPV was 95.0%, NPV was 30.0% and overall accuracy was 69%. Conclusion: The sonographic findings have a prognostic value that interacts with other clinical and maternal factors analyzed. Some parameters considered as prognostic factors and include irregular wall of gestational sac, perigestational hemorrhage and embryonic bradycardia