Twenty-three foot deformities in 22 patients had been treated without any real surgical incision. 'the bloodless technique', after the application of the Ilizarov external fixator. The ages of the patients ranged from 2 years and 6 months to 49 years. After an average follow-up of 18.3 months (range 8-40 months). all patients had a plantigrade foot. There was no need for soft tissue release or osteotomy. Pin tract infection Occurred mostly in the metatarsal wire. However it did not affect final results. The bloodless technique is an effective A,ay of treating foot deformities in children and adults. (C) 2002 Lippincott Williams Wilkins.

This study evaluates the most widely used sonographic measurements for judging an infant's hip morphology. The alpha and beta angles of Graf, the bony coverage percentage of Morin and a new combined angle were analysed. This latter angle records the direction of the whole acetabulum (cartilagenous and bony) as one unit. One-hundred sonograms were examined independently by two observers to calculate the interobserver and intraobserver limits of agreement. The new combined angle proved to be the most reproducible measurement. Graf's alpha angle was the second most reliable measurement followed by the bone coverage percentage. The relationship between the combined angle and a angle was statistically significant with a correlation coefficient of 0.70 (P

Whereas Toxoplasma gondii infection in the immunocompetent adult usually causes no serious clinical symptoms, congenital infection can lead to abortion or severe disease in the newborn infant. Early diagnosis should be made as soon as possible particularly in pregnant women and newborn babies since early treatment can minimize fetal sequelae. This work evaluates IgM-ELISA and PCR in diagnosis of recent T. gondii infection. The results revealed that PCR detected very recently infected cases (23 out of 70 suspected cases) than IgM-ELISA (only 18 cases). The combination of both tests may help to improve the sensitivity of diagnosis (45% in suspected group) more than either PCR (32.8%) or IgM-ELISA alone (25.7%).

ELISA IgG, IgM antibodies and PCR for toxoplasmosis were performed on 55 women with complicated gestation and their babies. Besides, ELISA IgG and IgM were applied on 27 uncomplicated gestation (mothers & babies) and 152 randomly selected individuals. Seropositivity to specific IgG antibodies was 36.4%, 59.2% and 57.9% and for IgM was 27.3%, 7.4% and 10.5% in complicated gestation. uncomplicated gestation and random population respectively. PCR was positive in 20%, 50% and 60% of mothers with abortion, premature deliveries and deliveries of babies with congenital anomalies respectively. 55.5% and 40% were found seropositive for IgG from normal full term babies and abnormal babies. 13% of abnormal babies were IgM positive and 46.6% were PCR positive from the same group.

A total of 200 cases aged 1-13 years complaining of symptoms suggestive of giardiasis in addition to thirty normal healthy children as a control group was examined clinically and laboratory using stool examination and detection of Giardia coproantigen in faeces by Dot ELISA and direct IFA. Stool examination detected 39 cases (19.5%) while Dot ELISA and direct IFA detected 49 cases (24.5%) with 100% sensitivity and 93.8% specificity. The common clinical findings were diarrhea, abdominal cramps, anorexia, underweight, pallor and manifestations of vitamin deficiency. The results were discussed.

Twenty-two ocular tumors and tumor-like lesions in cattle, sheep and goat are described. Ocular dermoids (5 calves), ocular squamous cell carcinoma (13 cows, one sheep and one goat), mixed tumours of squamous cell carcinoma (one goat) and corneal papilloma (one cow) were documented. Ocular dermoids were observed unilaterally and bilaterally. The recorded sites of ocular dermoids were the ventrolateral limbus, nictitans, medial canthus, axial cornea, eyelids and conjunctiva. Superficial keratectomy with conjunctival flap was applied successfully for the treatment of ocular dermoids. Ocular squamous cell carcinoma were also observed unilaterally and bilaterally. Animals with ocular squamous cell carcinoma were treated through either blepharectomy or exenteration of the globe (transpalpebral approach). Clinical symptoms, diagnosis, surgical treatment and outcome of these cases were reported and discussed.

This work evaluated circulating anti-SWAP IgG1 and IgG4 in patients with active S. mansoni infection before and after PZQ and its correlation to clinical, laboratory and sonographic data. The main complaints was abdominal discomfort, pain, tensmus and bleeding per rectum, which progressive decreased after PZQ. The anti-SWAP IgGI and IgG4 were significantly higher in patients than controls. A progressive significant decrease in the level of circulating anti-SWAP IgG1 after treatment, a decrease of IgG4 three months after treatment and a decrease in the egg count after therapy. But, no significant difference in IgG1 or IgG4 was noticed between male and female patients before and after treatment. No significant difference in IgGI or IgG4 in patients having GIT manifestation and organomegalic patients and/or asymptomatic patient. No significant difference in lgG1 or IgG4 between patients with grade (o), graele (I) and grade (II) periportal fibrosis. The sensitivity of ELISA IgGI was 73.3% and specificity was 80% while ELISA IgG4 was 80%. Enlarged liver and/or spleen, periportal fibrosis, and dilated P.V detected by ultrasonography were more among patients than controls. There was no significant difference in hematological parameters and liver function tests between patients and control groups. So, ELISA is sensitive and specific for IgG1 and IgG4. Anti-SWAP IgG1 and IgG4 is useful means in diagnosis and cure, as well as significant reduction of anti-SWAP IgG1 and IgG4 after treatment. Anti-SWAP IgG1 and IgG4 are parameter for evaluating cure. Follow up of anti-schistosomal IgG1 and IgG4 is useful for assessment of treatment

Individuals from the suburb of Benha City and some adjacent villages were presented with various degrees of skin allergy. In addition, chiildren who spend the night (sleep) on the floor suffered generalized lymphadenopathy, with or without fever. The patients were successfully treated with carbolic acid (1:25). Besides, oral anti-histamine (H1) and systemic antibiotics were indicated in the complicated cases. In the concrete houses of the patients, a huge number of the large ants (mainly Catagliphus bicolar) were found moving here and there, particularly in animal house included indoors. Spreading or burning dried leaves of camphor tree proved to an effective repellent for the ants. Discussion focused on the medical importance of ants.

Twelve different representative areas in Sharkia Governorate were surveyed for head lice, Pediculus humanus capitis. The pre-valence was investigated among 120 houses containing 2,448 individual, with different age, sex and socioeconomic status. Examination was done by naked eye aided with hand-lens. A total of 137 individuals were infested. Infestation rates were higher in the rural areas with low socioeconomic levels, concrete houses with over-crowded family members. Children had significantly higher infestation rates than adults. Males had lower infestation rates than females. However, the hair length and permanent hair washing were the factors accounted for both age and sex difference in prevalence of pediculosis. Head lice infestations were found all over the year, but increased in summer and spring. One hundred infested patients (90 females and 10 males) with different aged and hair length were treated with tour mixed cream from plants Lawsonia alba L. (Henna). Trigonella faemum-gracanum (Fenugreek), Hibiscus cannabinus (Hibiscus) and Artemisia cina (Wormseed). The head lice completely disappeared within a week among those patients treated by henna mixed with aqueous extract of sheah (100%) or mixed with helba (75%) or with karkada (50%).

This study was conducted on 30 asthmatic patients and 10 healthy controls. They were subjected to complete history talking, thorough clinical examination, and assessment of their ventilatory functions before and after bronchodilator. Two specimens were obtained from each patients, bronchoalveolar lavage and serum samples. Chlamydia pneumoniae antigens and antibodies (IgG and IgM) were detected using microimmunoflourescence technique. Samples giving positive results for C. pneumoniae antigen were examined for apoptosis. A significant correlation between asthma and C. pnumoniae was found especially in moderate and severe, long standing, steroid dependent asthma. In addition there was a significant difference between cases and controls regarding specific IgG and IgM. An association of C. pneumoniae with forced expiratory volume 1 (FEVI) was found. In addition C. pneumoniae was found to induce inhibition of programmed cell death. On conclusion, C. pneumoniae infection is associated with severe long standing asthma, and may be an important factor in acute exacerbation of asthma.

CMV is the most common cause of congenital and perinatal infection, most infections are asymptomatic at birth but later on develop handicaps, mainly neurological disturbances. The aim of the present work is to study the prevalence of CMV infection in NICU, to detect possible nosocomial transmission of CMV infection and determine possible risk factors for neonatal CMV infection. This study was carried on 175 neonates in NICU and 19 employees in the same unit. All members of the study were investigated for serum CMV-IgG and IgM by ELISA and CMV - DNA by PCR. The overall prevalence of CMV was 12.57%, 10 (5.71%) had congenital infection, while 12 cases (6.86%) had perinatal infection. In neonates with congenital CMV infection, the prevalence of breast milk feeding, congenital anomalies and blood transfusion were 80%, 30% and 60%, respectively. In neonates with perinatal CMV infection the prevalence of breast milk feeding, congenital anomalies and blood transfusion were 75%, 16.67% and 50%, respectively. On the other hand from the 19 employees, 2 (10.53%) were CMV-DNA positive by PCR, none of them was CMV-lgM positive and all of them were CMV-IgG positive. The risk factors related to CMV infection among neonates in NICU were, low birth weight, congenital anomalies and breast milk feeding, while CMV infection among employee was related to blood transfusion and employment period. In our results there was no statistical correlation between neonates in NICU and employee in the same unit. CMV infections are of more prevalence in premature and low birth weight neonates in NICU. No evidence of nosocomial CMV transmission to employee in NICU.

Pelvic adhesions occur following the vast majority of surgical procedures. Surgical technique is the most important consideration to reducing adhesions. Anti-adhesion adjuvants can further improve adhesion reduction achieved by good surgical technique.

Although peroxisome proliferators are considered non-genotoxic agents, most of them, nevertheless, were found to promote and/or induce, hepatocellular carcinoma (HCC) in rodents. The aim of the present study is, first, to investigate whether the peroxisome proliferator perfluorooctanoic acid (PFOA) possesses inherent liver cancer promoting activity, and second, to study the possible mechanisms involved. To acheive these aims two protocols have been applied, a biphasic protocol (initiation by diethyl-nitrozamine (DEN) 200 mg/kg i.p. followed by treatment with 0.005% or 0.02% perflourooctanoic acid (PFOA) for 14 and 25 weeks) and a triphasic initiation, selection-promotion (IS) protocol (initiation by giving 200 mg/kg DEN i.p. followed by a selection procedure for 2 weeks consisting of giving 0.03% 2-acetylaminofluorene (2-AAF) in diet). In the middle of this treatment a single oral dose of carbon tetrachloride (2.0 ml/kg) was given, followed by giving diet containing 0.015% of PFOA for 25 weeks. After applying both protocols, our results showed slight increase in the catalase activity while acyl CoA oxidase activity was markedly increased. Both experiments indicated that PFOA has a liver cancer promoting activity. Other groups of rats were given either basal diet or diet containing 0.02% PFOA. Five or nine weeks later they were sacrificed and the levels of 8-hydroxydeoxyguanosine in the isolated DNA were estimated. The data showed a slight nonetheless insignificant increase in 8-hydroxydeoxyguanosine. From the present data, it is concluded that PFOA is a true liver cancer promoter that may not require extensive initial DNA damage for its promoting activity.

ELISA-hydatid cyst fluid antigen (HCF-Ag-ELISA) and conventional echinococcosis IHAT were assessed for cystic hydatid disease (CHD), confirmed by HCF-Ag immunoblotting assay. The sensitivity of the tests was 94.4% and 83.3% for HCF-Ag-ELISA and IHA respectively. HCF-Ag-ELISA showed some cross-reaction in tumor cases (5.5%), but no cross-reaction was observed in Rheumatoid arthritis patients. IHA showed 100% specificity. To confirm this data SDS-PAGE immunoblotting using HCF-Ag was applied. Echinococcus specific reactions were reported with 44Kda, 34Kda, 29Kda and 8Kda HCF-Ag resolved bands. Cross-reaction was found with 27Kda, 21Kda, 16Kda and 13Kda bands in tumor patients. Moreover, cross-reaction was found with 200Kda, 175Kda, 62Kda, 52Kda and 40Kda in serological anti-Schistosoma antibodies positive cases. So, using specific HCF-Ag components, immunoblotting provided 100% sensitivity and specificity in CHD.

Between December 1993 and 1999 we treated 34 open tibial diaphyseal fractures. Thirty patients were available for evaluation with a mean follow-up after fracture union of 40.5 (24-80) months. Patient average age was 33.1 (15-71) years. Two fractures were grade I, 16 grade II, six grade IIIA, five grade IIIB and one grade IIIC. The wound was debrided and the bone fixed with Ilizarov device. Soft-tissue healing was achieved through Z-plasty, delayed primary closure, split-thickness skin grafting, pedicle flaps and skin traction, and all fractures united with an average 5.6 (3-15.4) months. In 28 patients the results were excellent and good, in one fair and in one poor. Despite numerous complications the use of Ilizarov external fixator provides initial and definitive fracture stability.

Generally speaking, there are at least few endemic zoonotic cutaneous leishmaniasis (ZCL) in the Sinai and the Suez Canal Governorates. A spotlight survey for new cases of human ZCL among out-patients with skin complaints revealed sixteen out of 100 (16%) individuals examined. But, none ZCL infection was found among 50 normal individuals. The typing of three human isolates proved to be Leishmania major Zymodeme London 70. Trapping and examination of the rodent reservoirs and sand-fly vector(s) were carried out as well, but will be published later on.

In this work the effect of sinusoidal 50 Hz, 0.2 mT magnetic fields on the red blood cells (RBCs) and heart functions of Albino rats were investigated. Twenty-four male Albino rats were equally divided into four groups, A, B, C, and D. Animals from groups B were continuously exposed to the magnetic field for 15 days; and groups C and D, for 30 days. Group A was used as control. Animals from group D were kept after exposure to the magnetic field for a period of 45 days for delayed effect studies. The osmotic fragility and shape of RBCs' membrane and hemoglobin (Hb) structure tests were carried out for all groups. The dielectric relaxation of Hb molecules was measured in the frequency range of 0.1-10 MHz and the dielectric increment (Deltaepsilon), relaxation time (tau), molecular radius (r), and Cole-Cole parameter (alpha) were calculated for all groups. The ECG was measured for all animals before and after exposure to the magnetic field. The results indicated that exposure of the animals to 50 Hz, 0.2 mT magnetic fields resulted in the decrease of RBCs membrane elasticity and permeability and changes in the molecular structure of Hb. The ECG of the exposed animals was considerably altered. The data also indicated that there was no sign of repair in the newly generated RBCs structure and the ECG after removing the animals from the magnetic field, which indicates that the blood generating system was severely injured. The injuries in the heart of the animals were attributed to the loss of some physiological functions of the RBCs as a result of exposures of the rats to the magnetic field. (C) 2003 Wiley-Liss, Inc.

Relatively little is known about the biochemical mechanisms controlling proliferation and neoplastic transformation of Hepatocellular carcinoma (HCC). The aim of study was to determine the level of the oncoproteins Bcl-2, transforming growth factor-beta1 (TGF-beta1) and alpha fetoprotein (AFP) in serum of patients with chronic hepatitis C (CHC), and liver cirrhosis (LC) as compared to HCC as a biomarkers of malignant transformation and early detection of suspected patients. A total of forty-three patients were included, 30 of them were males and 13 females, their ages ranged from 29-66 years (49.37 +/- 8.35). Increased levels of Bcl-2 were found in liver cirrhosis and HCC groups as compared to CHC and control groups (P < 0.001). The level of Bcl-2 was higher in CHC than control but the difference was insignificant (P > 0.05). Serum TGF-beta1 was significantly increased in CHC and liver cirrhosis groups as compared to HCC and control groups (p < 0.001). However, there was no significant difference between TGF-beta1 in HCC and control group (P > 0.05). The AFP level was significantly increased in HCC than CHC and liver cirrhosis. No significant difference was detected in AFP between CHC and LC patients (P > 0.05) or between CHC and healthy control (P > 0.05). A positive correlation was found between Bcl-2, and AFP in LC and HCC groups. It is concluded that the increased level of Bcl-2 in HCC may be involved in hepatocacingenesis. TGF-beta1 may be the primary marker to start the process of carcinogenesis, however, low level of TGF-beta1 may be needed to the progress of malignancy.

There are several modalities for the treatment of the overactive bladder (OAB), but the results may not be satisfactory. A recent study has demonstrated that the OAB has a dysrhythmic electric activity that seems to result from a disordered vesical pacemaker. We hypothesized that vesical pacing may correct the irregularities of the vesical electric waves and consequently normalize the vesical contractility. In this communication, we primarily defined the adequate pacing parameters required for correction of the vesical dysrhythmia. 36 patients with OAB were divided into a study group (22; 13 women; mean age 40.2 years) and a control group (14; 8 women; mean age 41.8 years). Ten healthy volunteers (6 women; mean age 39.8 years) were included in the study. Three 28-gauge cardiac pacing electrodes were hooked to the vesical mucosa: one (pacing) to the vault, and two (recording) to the lateral wall. Electric activity at rest and during stimulation of the pacing electrode was recorded in the study group and the healthy volunteers. In the control group, recording was done without pacing. Reproducible regular triphasic SWs were recorded from the 2 electrodes of the healthy volunteers with a similar pattern from the 2 electrodes of each individual subject. The optimal pacing parameters we determined were: an amplitude of 5 mA, a pulse width of 200 ms and a frequency of 20% higher than the frequency of the basal vesical waves. Vesical pacing effected a significant increase of waves' variables. The OAB patients exhibited a "dysrhythmic" wave pattern which was normalized during vesical pacing using the aforementioned pacing parameters. The optimal parameters required for vesical pacing of the dysrhythmic waves of the OAB were determined and succeeded in normalization of the vesical electric activity. Vesical pacing is suggested to be used as a therapeutic tool for the treatment of the OAB.

The idea that stressful life events can contribute to the initiation and development of substance use disorders gained some acceptance particularly in the clinical community. Research studies of life events and their relationship to addiction disorders are reviewed. Adverse life events will be divided into predisposing or vulnerable life events, precipitating or triggers, and mediator factors. Findings from studies are summarised and their relevance to the methodology discussed.

Background: We investigated the hypothesis that the esophageal crus (EC, part of the crus surrounding the esophagus) is an "individual muscle" and does not share in the contractile activity of the costal diaphragm (CD). Material/Methods: The electric activities of the EC and the costal diaphragm (CD) were recorded in 21 subjects (12 men, 9 women, aged 41.6 +/- 10.4 years) scheduled for laparotomy. One needle electrode was introduced into the EC, one into each vertebral crus (VC), and one in the CD. Recording was performed before and after diaphragmatic paralysis by curarization. while the diaphragm was paralyzed, the responses of the EC and the 2 VCs to CD stimulation were registered. Results: The CD had significantly higher resting motor unit action potentials (MUAPs) than the EC and the 2 VCs (p

Background: We evaluated the diagnostic efficacy of urinary angiogenin (ANG) and cytokeratin 20 (CK-20) mRNA in comparison with voided urine cytology in the detection of bladder cancer patients. Objectives and methods: A total of 97 Egyptian patients provided a single voided urine sample for ANG, CK-20 and cytology before cystoscopy. Of the 97 cases, 63 were histologically diagnosed as bladder cancer; 33 with transitional cell carcinoma (TCC) and 30 with squamous cell carcinoma (SCC), whereas the remaining 34 had benign urological disorders. A group of 46 healthy volunteers were also included in this study. Voided urine was centrifuged and the supernatant was used for estimation of ANG by EIA and confirmed by Western blotting (WB). The urine sediment was used for cytology and RNA extraction. CK-20 RNA was detected by RT-PCR. Results: The best cutoff value for ANG was calculated by a ROC curve as 322.7 ng/mg protein. The median urinary ANG level in bladder carcinoma, benign urological disorders and healthy volunteer groups was: 802.7, 425 and 33 pg/mig protein, respectively. The positivity rate for urinary CK-20 mRNA of the control, benign and malignant groups was 0%, 2.9% and 82.3%, respectively (P = 0.000); while the rates for ANG were 11.6%, 54.8% and 75.4%, respectively (P = 0.000). There was no significant difference in positivity rates of CK-20 and ANG with respect to sex, smoking, schistosomiasis, urine cytology, tumor grade, tumor stage, hematuria or pus cells. The overall sensitivity and specificity were 71.4% and 90% for voided urine cytology, 75.4% and 70.3% for ANG, and 82.3% and 98.8% for CK-20. Combined sensitivity of voided urine cytology with ANG and CK-20 together (98.2%) was higher than either the combined sensitivity of voided urine cytology with ANG (96.5%) or with CK-20 (91.6%) or than that of the biomarker alone. We demonstrated significant positive correlation between CK-20 positivity with age (P = 0.043) and nodal involvement (P = 0.037); however, there was no significant correlation between CK-20 and ANG with the other clinicopathological parameters. Conclusions: Our data indicate that CK-20 and ANG in voided urine had higher sensitivities compared to voided urine cytology. However, when specificity was considered, CK-20 alone had superior sensitivity and specificity compared to ANG and voided urine cytology. (C) 2004 The Canadian Society of Clinical Chemists. All rights reserved.

AIM: To correlate hypervascular power Doppler ultrasonography with the histological evaluation of microvasculature in the prostate using trans-rectal ultrasound (TRUS)-guided needle biopsy. MATERIALS AND METHODS: Ninety-six patients with a lower urinary tract symptoms (LUTS) and prostate specific antigen (PSA) value more than 4 ng/ml were evaluated using power Doppler ultrasonography before biopsy. The vascularity of the peripheral zone was graded on a scale of PZ0 to PZ2. Core needle biopsies were immunostained with CD31 (DAKO) and counting was performed manually on separate high power fields (HPF; x 400) in areas containing the highest number of vessels. RESULTS: There was a significant correlation between the grading system used for power Doppler and the microvessel density (MVD; PZO 28.61 +/- 8.97, PZ1 36.00 +/- .12.11 Et PZ2 64.008 +/- 15.86; p < 0.001). There was also a significant difference in MVD between benign, malignant and tissue cores with atypia and prostatic intra-epithelial neoptasia (PIN; p < 0.001 and p < 0.018, respectively). There was a significant correlation between malignant tissue having a higher Gleason score and increased MVD (p < 0.001). Furthermore, cancer biopsies having a high flow PZ2 are nearly twice as likely (63.2%) to have a Gleason score of 7 or more when compared those having a Gleason score of less than 7 (36.8%). CONCLUSION: The grading system of assessing the power Doppler flow signals appears to be of value as an indicator of MVD. It also correlates with a higher Gleason score and this may reflect the clinical outcome in prostate cancer. It deserves further study and evaluation as a prognostic indicator. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Management of the tubal factor could have the most difficult and debatable role in infertility management. The methods used ranged from gaseous insufflation, hydrotubation, laparotomy, and traditional microsurgery to the more recent tactile or hysteroscopic catheterization, and laparoscopic surgery. Results of the in-vitro-fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) were compared to the surgical procedures' results and the debate continues: shall we proceed directly to assisted reproductive techniques or should surgery be tried first in tubal obstructions?

This was a prospective double blind comparative study on 40 patients. It compared the effects of the leukotriene receptor antagonist montelukast and beclomethasone nasal spray on the post-operative course of patients with sinonasal polyps. All patients underwent endoscopic sphenoethmoidectomy and were randomized post-operatively into two groups. Group I: 20 patients ( 9 females and 11 males) age 17 to 67 (32.4 +/- 9.5 years), receiving 10 mg montelukast orally daily and Group II: 20 patients ( 6 females and 14 males) age 17 years to 57 years (33.5 +/- 11.9 years), receiving 400 ug beclomethasone local sprays daily. All patients were followed up for 1 year and a symptom score was recorded throughout this period. There was a significant reduction in symptom scores in both groups throughout the study period. In the montelukast group improvement was more marked in itching, post-nasal discharge and headache. The control of sneezing and rhinorrhea was comparable in both groups with a marginal advantage of montelukast. Steroids had a more marked effect on smell disturbances and obstruction. There was no difference in the recurrence rate or in the need for rescue medications between both groups. Both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment. Copyright (C) 2005 S. Karger AG, Basel.

Objective: To evaluate the effect of N-acetyl-cysteine (NAC), a mucolytic drug with insulin sensitizing properties, as an adjuvant therapy in subjects with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC). Design: Placebo-controlled, double-blind randomized trial. Setting: University-based hospital and private infertility practice., Patient(s): One hundred fifty women diagnosed with CC-resistant PCOS, aged 18-39 years undergoing therapy for infertility were included. Intervention(s): The patients were assigned randomly to receive either NAC 1.2 g/d (group I) or placebo (group II) with CC 100 mg/d for 5 days starting at day 3 of the cycle. Main Outcome Measure(s): Ovulation rate and pregnancy rate (PR). Result(s): Combination of CC and NAC significantly increased both ovulation rate and PR in women with CC-resistant PCOS (49.3% vs. 1.3% and 21.3% vs. 0%, respectively). No cases of ovarian hyperstimulation syndrome (OHSS) were reported in the NAC group; two cases of miscarriage (12.5%) were reported. Conclusion(s): The NAC as an adjuvant to CC was more effective than placebo for CC resistaht patients with PCOS. It is safe and well tolerated. (Fertil Steril((R)) 2005;83:367-70. (C) 2005 by American Society for Revroductive, medicine.)

Background and objectives: The incidence of overexpression of HER2/neu in bladder cancer is one of the highest among all human malignancies tested; such overexpression is thought to play a role in the aberrant proliferation of cancer cells. This study was conducted to evaluate the quantitative assessment of HER2/neu expression by enzyme immunoassay (ETA) and its prognostic significance in differentiating between high and low proliferating tumors. Patients and methods: Tissue samples were collected from 35 patients with benign bladder lesions, 28 with bilharzial bladder cancer, and 25 with nonbilharzial bladder cancer. Twenty normal samples were obtained from normal safety margin areas in nonbilbarzial bladder cancer patients. Out of the malignant samples, 22 were found to be squamous cell carcinoma and 31 were transitional cell carcinoma. All samples were examined for HER2/neu expression by EIA and Western blot (WB). Flow cytometric (FCM) analysis was also performed in all the samples provided. Results: HER2/neu was found to be significantly overexpressed in the malignant group compared to the benign and normal groups (P < 0.001) and no significant difference was found between the bilharzial and nonbilharzial cancer groups or between the transitional and squamous cell carcinoma groups. HER2/neu was significantly correlated to ploidy (P = 0.001), synthetic phase fraction, SPF (P = 0.012), and DNA index (P = 0.002). No significant correlation was found between HER2/neu and stage or grade while it was significantly associated with lymph node status of the tumour (P = 0.02). Conclusion: HER2/neu can be measured reliably by the EIA method as confirmed by WB. The quantitative assessment of HER2/neu expression in malignant tumors aided by other proliferation markers such as SPF, DI, and ploidy could be useful in selecting patients for more aggressive treatment or for predicting outcome. (C) 2004 The Canadian Society of Clinical Chemists. All rights reserved.

In the present study, we examined whether the powerful antioxidant probucol (a clinically used lipid-lowering drug) would attenuate the oxidative stress and energy starvation in experimental model of heart failure (HF) using isoproterenol. Rats were injected subcutaneously with isoproterenol (2.4 mg kg(-1)) daily for 1 week, and then treated with probucol (61 mg/kg) daily for 2 weeks. Oxidative stress was assessed by measuring myocardial lipid peroxides level and antioxidant enzymes activities, glutathione peroxidase (GPx) and superoxide dismutase. In addition, cardiac metabolic damage was estimated by measuring myocardial ATP, ADP and AMP levels as well as ATP/ADP ratio. It was found that isoproterenol induced a significant increase in heart rate by approximately 30% as compared with the pre-value. These changes were significantly attenuated by post-treatment of rats with probucol. Also, isoproterenol induced several pathological changes including lymphocyte infiltration, myofibrillar hemorrhage and degeneration, and these changes were attenuated by probucol. In addition, animals treated with isoproterenol showed a significant increase in myocardial lipid peroxides level up to 163% and a significant decrease in myocardial GPx activity by 35% as compared with the control group. Probucol not only counteracted significantly the pronounced oxidative stress effect of isoproterenol but also it induced a significant increase in myocardial GPx as compared with the control group. The major new finding of the present study is that treatment with probucol induced a significant increase in myocardial ATP level (the source of energy) and ATP/ADP ratio. Moreover, there is a significant correlation between ATP/ADP ratio and myocardial probucol level. In conclusion, the cardioprotective effect of probucol in treatment of HF is a result of not only its antioxidant properties and an enhancement of endogenous antioxidant reserve (mainly GPx) but also an enhancement of myocardial energy state. (C) 2004 Elsevier Ltd.

The Taylor spatial frame uses the slow correction principles of the Ilizarov system but adds a six-axis deformity analysis incorporated within a computer program. To evaluate its use in our community, we used it in lengthening and deformity correction of the lower limbs to treat 22 cases from 1999 to 2001. There were 14 females and eight males (average age 16.5 years). Our target was lengthening in eight cases, correction of deformities in eight and both in six. The results were excellent in 18 cases, good in two, and fair in two. Despite the cost, patient profile and a steep learning curve, our results were encouraging but less favorable than with the Ilizarov external fixator.

Over a 2-year period, the prevalence and clinical characteristics of Cryptosporidium-associated diarrhea in the Nile River Delta of Egypt was studied. A stool sample was obtained from children with diarrhea attending one of two study hospitals and of the 1275 children evaluated, 214 (17%) were found to be infected with Cryptosporidium. Younger age was a risk factor for developing Cryptosporidium-associated diarrhea. Children < 12 months of age were 2.4 times more likely to be infected with Cryptosporidium (p< 0.01) and children 12 to 23 months were 1.9 (p< 0.05) times more likely to be infected with the organism as compared to older children. Breastfeeding had a trend towards protection against Cryptosporidium-associated diarrhea (p = 0.07). Clinical findings associated with Cryptosporidium diarrhea included vomiting, persistent diarrhea and the need for hospitalization. Our data suggest that Cryptosporidium is common in Egyptian children and may be associated with severe diarrhea.

Treatment of tibial hemimelia, traditionally, is by amputation. This is not acceptable in our community. Hence we treated our cases without amputation. We treated two cases of type la and four cases of type 11 tibial hemimelia. The age at operation ranged from 3.5 to 13 years For type la cases, we applied the Ilizarov external fixator to the femur, fibula and foot to centralize the fibula between the femoral condyles and talus using gradual distraction. The second step was the Brown procedure. Then the fixator was reapplied to correct the deformities. For type 11, synostosis of the tibia and fibula was performed followed by differential lengthening. Then we overlengthened the femur. After follow-up for 2-5.5 years, all patients showed improved function and were satisfied. The tibial lengthening ranged from 6 to 8.5cm, and femoral lengthening ranged from 5 to 7cm. J Pediatr Orthop B 14:250-255 (c) 2005 Lippincott Williams & Wilkins.

Bilateral uterine artery ligation was performed for 32 patients in order to control intractable postpartum hemorrhage in 25 of them (currative ligation) and as prophylaxis against postpartum hemorrhage in seven (elective ligation). Mass ligation was used for 29 patients and isolation ligation for three. Among the 25 patients for whom curative ligation was performed, successful hemostasis was achieved in 20 patients (80%) and the technique failed in five (20%). This failure was due to a clotting defect in three and placenta previa accreta in two patients. Twenty-four patients (96%) survived and one died as a result of a clotting defect. Among five patients followed up, normal menstruation occurred with pregnancy in three of them.

This technique has been developed for the separation of protein by two-dimensional polyacrylamide gel electrophoresis. Due to its resolution and sensitivity, this technique is a powerful tool for the analysis and detection of proteins from complex biological sources. Proteins were separated according to isoelectric point by isoelectric focusing in the first dimension, and according to molecular weight by sodium dodecyl sulfate electrophoresis in the second dimension. Since these two parameters are unrelated, it is possible to obtain an almost uniform distribution of protein spots across a two-dimensional gel. This technique has resolved about 20 different acidic components from cercarial Ag. So this technique provides a method for estimation of the number of proteins made by any biological system.

The prevalence of schistosomiasis serologically based on detection of anti-soluble egg antigen (SEA)--IgM and/or IgG by ELISA technique was 68% of 380 cases, and 52.7% of 148 cases by stool examination. The serological technique seems to be more sensitive and able to detect early infection as well as detection of ectopic infection.

Liver biopsy examination of 106 patients showed 47 with pure bilharzial liver, 16 with chronic persistent hepatitis, 19 with chronic persistent hepatitis associated with bilharzial liver, 14 with chronic active hepatitis and 10 with chronic active bilharzial liver. There was significant correlation between intensity of infection and bilharzial affection of the liver.

53.7% of the already parasitologically proved schistosomiasis cases showed circulating schistosomal antigen (C.S.A.) in their sera with significantly higher levels than the controls, with no correlation between the level of C.S.A. and the foecal egg count. Significant higher levels of schistosomal complement C3 were found in schistosomiasis patients as compared to the control group, with no significant difference in the mean level of C3 between patients with positive and negative C.S.A.

Among school children in a rural area the serological diagnosis (ELISA) was more accurate than the parasitological tests. The mean total leucocytic and eosinophilic counts, and the blastogenic response to S. mansoni egg antigen were significantly higher in early than in chronic schistosomal cases. Blastogenic response to mitogens and S. mansoni adults preparation was insignificantly different.

This study aimed at clarifying the relationship between iron status and atherogenic lipid profile in normal and chronic rheumatic heart as well as congenital heart defect children. The study included 31 children, 16 cases with chronic rheumatic heart disease (10 males and 6 females) and 6 with congenital heart disease. Nine children with normal hearts were taken as the control. Serum iron and total iron binding capacity were higher in both chronic rheumatic and congenital heart disease children than in the controls; but the increase was only significant in the second case. Serum low-density lipoprotein cholesterol (LDL-ch) and high-density lipoprotein-cholesterol (HDL-ch) were not significantly changed in either disease. In relation to sex, no significant changes were noticed in iron status of chronic rheumatic heart children. Serum LDL-ch and LDL-ch to HDL-ch ratio were significantly higher in females than in males. A correlation study was also done between lipid profile and iron status.

The modified double antibody sandwich ELISA was applied to detect E. histolytica antigens in the stool samples of 20 patients have amoebiasis (symptomatic or asymptomatic), 10 with intestinal parasites other than E. histolytica and 10 healthy individuals. The method was found to be sensitive (90%) and specific (85%). It is concluded that ELISA could be applied for a large scale epidemiological study and immunodiagnosis of amoebiasis.

Humoral and cellular immune response in schistosomiasis was studied pre and post praziquantel therapy. After treatment the mean anti SEA IgM and IgG and anti SWAP IgM levels in all cases showed significant reduction. In patients with high eosinophilic count anti SEA IgE and IgA were statistically decreased. Other specific antibodies showed negligible changes Cellular immune response was not affected.

The Cunningham and Sezenberg Technique (using mice sensitized lymphoid cells to SRBCs) was tested together with Trump's gel technique (using non sensitized mice lymphoid cell mixed with SRBCs and incubated in Marbrook culture chamber for sensitization). The study showed that the number of PFCs by the Cunningham slid was greater than that observed by the gel technique of Trump at the same lymphocyte concentration. Also it was observed that the Trump's method using the Marbrook tissue culture chamber was a time consuming technique than that obtained by the Cunningham technique.

Colposcopic examination was done in 189 successive parturients within 6-48 h of delivery for evidence of type, site, and extent of cervical trauma and its relation to various obstetric factors. There was trauma in 66% of cases, as erosion in 79%, as laceration in 56%, as bruising in 30%, and as yellow areas in 17%. In about two-thirds of cases, the diameter of cervical erosion, or the length of laceration did not exceed 5 mm and 81% of lacerations were of first degree. Cervical injury was significantly more frequent in primiparae, in the anterior cervical lip, in occipito-posterior positions, and with premature repture of membranes. In 117 parturients with cervical injury another colposcopic examinaiton was done 6-8 weeks postpartum. In 8% there was residual cervical damage.

Contrary to an old belief, bile duct carcinoma is not a rare disorder in Egypt. Among 730 patients referred for an ERCP examination, twenty-nine consecutive patients were diagnosed as having bile duct carcinoma. The cause of this type of carcinoma remains unknown. In the present study, only seven of the 29 (24.1%) with bile duct carcinoma patients had associated gallstones. In order to investigate the possible association between typhoid carrier state and bile duct carcinoma, stool cultures were performed for Salmonella typhi and Salmonella paratyphi A and B. Nine out of 23 patients (39.1%) with bile duct carcinoma, 17 out of 50 (34%) with calcular obstructive jaundice, and 1 out of 50 (2%) healthy individuals proved to be salmonella carriers. Statistical analysis of the results confirmed the presence of a significant association between chronic fecal typhoid carrier state and bile duct carcinoma, while that between calcular obstructive jaundice and bile duct carcinoma was not significant. In conclusion, there might be an association between chronic fecal typhoid carrier state and bile duct carcinoma.

The short-term (3 months) and long-term (15 months) effect of DMPA contraception on various coagulation parameters (predictive of thrombosis) and on serum lipids (predictive of atherosclerosis) were prospectively studied in 30 Egyptian women, compared to their pretreatment levels. There were no significant changes in all the coagulation parameters studied after 3 months, and there was only a significant reduction in antithrombin III (AT III) level after 15 months (p < 0.01). Concerning serum lipids, after 3 months, there were no significant changes in total lipids (TL), total cholesterol (TC) and triglycerides (Tg), while there was a significant decrease in high density lipoprotein cholesterol (HDL-C) (p < 0.001), and a significant increase in low density lipoprotein cholesterol (LDL-C) (p < 0.01). After 15 months there was a significant increase in TL, TC and LDL-C (p < 0.001) and a significant decrease in HDL-C (p < 0.001). Lipoprotein electrophoresis showed no significant change in pre-beta-lipoprotein percent, a significant decrease in alpha-lipoprotein percent and a significant increase in beta-lipoprotein percent after 3 and 15 months (p < 0.001). Beta-lipoprotein band increased in 50% of DMPA users after 3 months and in 90% after 15 months and the type of hyperlipoproteinaemia was IIa. All callculated atherogenic indices showed significant changes (p < 0.001) after 3 and 15 months of DMPA use. There was no significant correlation between AT III changes and changes in serum lipids. The study suggests no risk of thrombosis after 3 and 15 months of DMPA use. However, the risk of atherosclerosis appears to be possible as there were significant changes in serum lipids.

Two groups, each composed of 20 women, who used depo-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) injectable contraceptives were investigated for changes in 75-g OGTT and in the fasting and two-hour post oral glucose load (2-hours) levels of serum insulin, growth hormone, glucagon, cortisol and blood pyruvate. Samples were taken before and 3, 6 and 12 months after use of injectables. DMPA and NET-EN caused significant changes in mean blood glucose and pyruvate and in mean serum insulin, growth hormone and glucagon, but not in mean fasting cortisol. Changes with NET-EN started after 3 months, became maximal after 6 months and reverted to normal after 12 months of use, due to more frequent administration during the first 6 months of use (every 60 +/- 5 days) and to more spacing of the injections (every 84 +/- 5 days) after that. Changes with DMPA started after 3 months, and increased with the duration of use to become maximal after 12 months. Maximal changes were similar with DMPA and NET-EN and consisted of: a significant increase in fasting blood glucose and pyruvate and serum insulin; a significant increase in 2-hour blood glucose and pyruvate, serum insulin, growth hormone and glucagon. Although significant changes in blood glucose levels occurred with both DMPA and NET-EN, yet they did not reach the lower cut-off levels for impaired glucose tolerance in any user. With the same spacing of injections, i.e. every 84 +/- 5 days for NET-EN and every 90 +/- 5 days for DMPA, the effects on various parameters studied were less with NET-EN.

This study was conducted on 193 children aged 6-12 years. They were 93 children (65 boys and 28 girls) living in two residential institutions in Cairo and 100 non-instituted children (65 boys and 35 girls) who are their matched school peers. Anthropometric measurements, complete physical examination and laboratory investigations including haemoglobin concentration, complete urine and stool analysis were performed to all children. Results showed that 25.81% of instituted children have body weights below the 10th percentile and 60.22% have heights below the 10th percentile compared to 14% and 37% of non-instituted children respectively. The differences were statistically significant. The prevalence of vitamin deficiency manifestations, and skin diseases was significantly higher in the instituted group. The mean haemoglobin concentration was lower in the instituted children, with a significant difference in all males and in females aged 9-12 years. Intestinal parasitic infections were more prevalent in the instituted children. It was found that among instituted children weight and height were most affected by cause of institution and number of children cared for by a substitute mother while hemoglobin concentration was most affected by age at institution and the level of education of the substitute mother.

This technique has been developed for the estimation of the infectivity of herpes simplex virus type I passage III on a tissue culture of Vero and HBK21. The plaque assay method was performed and the number of plaques on the two culture media was counted per each dilution from (10(-5) to 10(-8)). It was found that the number and the size of plaques in 10(-5) dilution are the best in the two types of tissue cultures. The number indicates the number of virus particle (per each dilution point), which can be used for infection of experimental animals to demonstrate its infectivity character.

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique. In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.

Hepatitis E virus (HEV) is thought to be a cause of enterically transmitted non-A, non-B (ET-NANB) hepatitis. Waterborne epidemics have been recorded in many developing countries, mainly affecting young-to-middle-aged adults; sporadic infection and overt illness in children are rare. However, a convenient and sensitive diagnostic test for HEV infection is not yet available. We now report the use of a solid-phase enzyme-linked immunoassay (ELISA) that detects IgM and IgG antibody to HEV. In a prospective study of endemic acute hepatitis during 1986 in rural Benha, Egypt, 15 (42%) of 36 children with NANB hepatitis (from whom convalescent-phase sera were available every 3 months to 9 or 12 months) were positive for anti-HEV-IgG by ELISA. Of 20 sera from healthy Benha children (controls), 5 (25%) were also positive for anti-HEV-IgG. When evaluated for anti-HEV-IgM, 6 of the 15 IgG-positive children, but none of the controls, were IgM positive and were thus regarded as having confirmed acute HEV infections. These 6 cases together with 2 presumptive cases (IgM negative, IgG seroconversion from positive to negative) presented sporadically over 9 months. This ELISA is a convenient method for the diagnosis of HEV infection; we have shown that the disease is present in Egypt, that it can occur endemically as sporadic cases, and that children do have overt infection.

The leukaemogenic effect of irradiation associated with toxoplasmosis was studied. Rats were infected with Toxoplasma gondii RH strain 3 weeks prior to irradiation. The leukaemic effect of irradiation was aggravated by toxoplasmosis as leukaemia appeared in 10% of 300 cGy irradiated rats and in 30% of 500 cGy irradiated ones, six months after irradiation.

Two hundred patients (100 males and 100 females) having either marginal periodontitis or gingivitis were examined for detection of E. gingivalis and T. tenax. E. gingivalis was more prevalent among patients with periodontitis particularly females, while T. tenax was not discovered entirely in both patients and control groups.

Serum and endometrial sodium (Na) and potassium (K) levels and serum estradiol, progesterone, teststerone and cortisol were measured in the mid-follicular and mid-luteal phases of the menstrual cycle in 20 Lippes loop and 20 CuT-200 IUCD users and 20 matched controls. Na and K were measured by atomic absorption spectrophotometry, while serum steroids were measured by RIA. Regarding steroids, the only significant difference between the three groups was a significantly lower mean mid-luteal serum estradiol in CuT-200 IUCD users compared to Lippes loop users (p< 0.05). Regarding sodium in the control group, there was significantly lower mean mid-luteal serum and endometrial Na (p< 0.01) that was not found in both groups of IUCD users. In the mid-follicular phase, there was significantly higher mean serum Na in both Lippes loop and CuT-200 groups compared to controls (p< 0.05). Mean endometrial Na showed no significant difference between the three groups in both phases of the menstrual cycle. Regarding potassium in the control group, there was significantly lower mean levels in the mid-luteal-phase of the cycle (p< 0.01) that was not seen with both groups of IUCD users. Serum K showed no significant difference in the three groups in both phases of the menstrual cycle. Endometrial K showed a significantly higher mean level in both Lippes loop and CuT-200 IUCD users compared to controls in the mid-luteal (p< 0.01), but not in the mid-follicular phases of the cycle.

During a 70-month period, CO2 hysteroscopy was carried out on 52 pregnant women wearing IUDs with retracted tails. Ultrasonography was done prior to hysteroscopy to determine the size of the gestational sac and the site of the device. Successful removal of the device occurred in 46 cases. The technique, the findings of the study, and the limitations of the procedure are described.

Cutaneous leishmaniasis (CL) is a skin disease encountered in the East Mediterranean Region including Egypt. In this paper, it was intended to throw some light on the clinical picture of six parasitologically proven human CL. Also, the results of treating three cases of them with Pontostam or Cryosurgery. The whole results were discussed.

One hundred cases were suffering from chronic tonsillitis, aged between 4-12 years, of both sexes (60 males and 40 females), from outpatient clinic of E.N.T. unit at Benha Faculty of Medicine. They were examined serologically by indirect haemagglutination--antibody technique (IHAT) for toxoplasmosis. After tonsillectomy, histopathological and electronmicroscopical studies were done. Ten percent of cases were positive serologically, among males (11.71%) and females (7.5%). The positivity rate was high among age group 10-12 years than others. Two cases showed histopathological and ultrastructural changes indicating toxoplasmosis.

Background & Aims: The aim of this study was to evaluate the efficacy of nitazoxanide for the treatment of diarrhea and enteritis associated with Blastocystis hominis as the sole identified pathogen in children and adults from the Nile delta of Egypt. Methods: Two prospective, randomized, double-blind, placebo-controlled studies were conducted. Nitazoxanide 500 mg (as a 500-mg tablet) was administered twice daily for 3 days in patients aged 12 years or older, 200 ring (as 10 mL of an oral suspension) was administered twice daily for 3 days in patients aged 4-11 years, and:100 mg (as 5 mL of an oral suspension) was administered twice daily for 3 days in patients aged 1-3 years. Results: Four days after the completion of therapy, 36 (86%) of the 42 patients who received nitazoxanide showed resolution of symptoms compared with 16 (38%) of 42 patients who received placebo (P

Background: The immortalizing enzyme, telomerase, has been linked to carcinogenesis and is being targeted as a novel molecular marker. This study investigated the pattern of human telomerase reverse transcriptase (hTERT) mRNA by real-time polymerase chain reaction (PCR) in tumor core, edge, and safety margin of laryngeal tumors and related lymph nodes, as well as their relation to the proliferative index (PI) and their impact on prognosis. Material and methods: This prospective study included 35 patients with laryngeal carcinoma who were surgically treated by total or partial laryngectomy. Collected tissues from tumor core, edge, resection margin, and lymph nodes were examined by flow cytometry and real-time PCR quantification of hTERT mRNA. Results: The PI showed a statistically significant difference between the contrasted parts (P = 0.04). The highest median for PI was found in the tumor edge samples (31.3), followed by the tumor core (27.5), the resection margin (21.4), and finally the lymph nodes (10.3). There was no significant difference with regard to the ploidy patterns or the synthetic phase fraction (SPF) among the different tissue parts. Real-time PCR hTERT mRNA patterns showed that the highest median for hTERT mRNA level (copies/mu g RNA) was in the tumor core (70.5), followed by the tumor edge (36.5), the resection margin (17.3), and finally the lymph nodes (4A). There was a statistically significant difference with regard to the hTERT mRNA patterns among the different tissue parts (P = 0.04). Tumor differentiation, tumor edge ploidy, and tumor edge hTERT levels were significantly different between survivors and non-survivors, while tumor core S-phase fraction and tumor core PI significantly altered the disease-free survival rate. Conclusion: hTERT mRNA may potentially be used for molecular reevaluation of the safety margin for conservational laryngeal surgery, and as a prognostic factor for overall survival especially if determined in samples taken from the growing edge of tumors. (c) 2005 The Canadian Society of Clinical Chemists. All rights reserved.

This study evaluates our early experience with unilateral humeral lengthening in children and adolescents. From 1995 till 2001, 16 cases with unilateral humeral shortening ranging from 5.5 to 15 cm were referred to our center. The cause was Erb's palsy in eight cases, epiphyseal injury in five cases and infection in three cases. The average age at operation was 13 years (range 8.5-17 years). Hybrid fixation using wires and half pins were applied to all cases to minimize the risk of operative neurovascular complications. Osteotomy was performed in the middle third of the humerus through a posterior approach. After a latent period of 5-7 days lengthening started at a rate of 0.33 mm every 8 h. At an average follow up of 3 years and 2 months (range 1 year and 4 months to 5 years and 6 months) there were 10 excellent and six good results. The average healing index was 28 days/cm. Complications included pin tract infection in all cases; radial nerve palsy in one patient whose humerus overlengthened by 2 cm but improved completely after compression; fracture of the regenerate in two cases.

This study included one hundred cases of gallstone disease diagnosed by ultrasonography and a similar group of matched controls chosen from Benha University and General Hospitals. Both cases and controls were subjected to a specially designed questionnaire, clinical examination, anthropometric measurements, ultrasonography and laboratory investigations to find out some risk factors that may contribute to the development of gallstone disease. Females constituted the majority of cases (87%) while males were a minority (13%). In both sexes, the highest percentages of cases were among patients aged fifty years or more (53.8% and 33.3% for males and females respectively). Bad dietary habits including increased consumption of animal fats and frequent use of snacks between meals, obesity as indicated by body mass index and body fat percent, positive family history of gallstones and liver cirrhosis were found to be significant risk factors in the predisposition to gallstones in the present study. On the other hand, factors suggesting hormonal role in the pathogenesis of gallstones such as age of menarche, duration of menstrual life, age at first pregnancy, multiparity and duration of contraceptive pills use did not show any significant difference between female cases and controls.

Accurate information about acquired immunodeficiency Syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study is intended to asses AIDS knowledge in paramedical personnel working in Benha Hospitals and to measure the effect of health education programme done on knowledge about AIDS in general, modes of HIV transmission and their degree of misperception about transmission through causal contact. A well designed health education programme using personal communication & visual media techniques was conducted to 238 paramedical personnel working in Benha hospitals, during the year 1992. The results of this study pointed out that the means of the scores of general AIDS knowledge and transmission knowledge were greatly and significantly improved by the end of the programme (P < 0.01).

This study was carried out to get a picture of risk factors associated with the occurrence of cancer breast. Three hundred and seventy two females (180 breast cancer patients and 192 controls) were selected from Ain Shams and Benha University Hospitals to be the subjects of this study. The results showed that the important risk factors affecting the development of cancer breast were: parity, age at first birth, age of menarche, age of the patient, family history, number of pregnancies and age of natural menopause. Mostly these factors are interrelated to each other.

Protein kinase C (PKC), a phospholipid- and Ca 2+-dependent protein kinase, plays crucial roles in transmitting biochemical signals from the surface and transducing them to the interior of cells. PKC participates in a wide spectrum of neuronal processes including neuronal development, modulation of ion channel activity and signal transduction system, neurotransmitter synthesis and release, and synaptic plasticity. The PKC family consists of originally described alpha-betaI-, betaII-, and gammaPKC (Group A enzymes) and the recently identified but less characterized delta, epsilon, zeta, and eta (L) PKC (Group B enzymes) . Protein kinase C possesses a regulatory domain with one or more zinc finger-like structures and a basic pseudo substrate prototype. Various growth factors, neurotransmitters, and hormones elicit the breakdown of inositol 1,4,5 triphosphate to produce diacylglycerol and inositol 1,4,5 triphosphate, which in turn results in mobilization of calcium from intracellular stores. Group A enzymes are activated by calcium, phospholipid, and diacylglycerol, whereas the Group B enzymes are calcium independent. Zinc enhances the activity of protein kinase C and activation of protein kinase C leads to induction of metallothionein mRNA. Some members of the PKC family exhibit unique patterns of tissue expression and intracellular localization. Different kinases have distinct functions in the processing and modulation of a variety of physiological and pathological responses to external signals. For example, protein kinase C is able to phosphorylate Alzheimer amyloid precursor protein, and betaII PKC is reduced in the striatum of patients with Huntington's disease. Moreover, PKC modulates NMDA current, and has been linked to induction of long term potentiation, to memory formation, and cognition.

A study was conducted to determine the etiology of acute hepatitis among 261 children (age range 1-11 years) living in Cairo, Egypt. A blood sample was obtained from each subject when initially evaluated and a questionnaire was used to collect demographic and risk factor data. Sera were tested by enzyme immunoassay for acute hepatitis A (anti-hepatitis A virus IgM), hepatitis B (anti-hepatitis B core antigen IgM and hepatitis B surface antigen [HBsAg]), hepatitis C (total anti-HCV), delta hepatitis (total anti-delta), and cytomegalovirus infection (anti-CMV IgM). In addition, hepatitis E virus (HEV) infection was diagnosed using a new Western blot technique to test patients with non-A, non-B hepatitis for anti-HEV IgM. Among 261 children, acute hepatitis A was diagnosed in 85 (32.6%) patients, acute hepatitis B in 19 (7.3%), delta hepatitis in 3 (1.1%), mixed hepatitis A and B infection in 2 (0.8%), CMV infection in 1 (0.4%), hepatitis E in 58 (22.2%), and non-A, non-B hepatitis of unknown type in 51 (19.5%). Forty-two (16.1%) subjects had HBsAg without other markers of acute infection. Risk factor analysis indicated that patients living in homes not connected to a municipal source of water were at increased risk of hepatitis E infection. These data provide additional evidence that hepatitis E virus is a common cause of acute sporadic hepatitis in children living in Egypt.

A study was conducted to determine the etiology of acute hepatitis among 261 children (age range 1-11 years) living in Cairo, Egypt. A blood sample was obtained from each subject when initially evaluated and a questionnaire was used to collect demographic and risk factor data. Sera were tested by enzyme immunoassay for acute hepatitis A (anti-hepatitis A virus IgM), hepatitis B (anti-hepatitis B core antigen IgM and hepatitis B surface antigen [HBsAg]), hepatitis C (total anti-HCV), delta hepatitis (total anti-delta), and cytomegalovirus infection (anti-CMV IgM). In addition, hepatitis E virus (HEV) infection was diagnosed using a new Western blot technique to test patients with non-A, non-B hepatitis for anti-HEV IgM. Among 261 children, acute hepatitis A was diagnosed in 85 (32.6%) patients, acute hepatitis B in 19 (7.3%), delta hepatitis in 3 (1.1%), mixed hepatitis A and B infection in 2 (0.8%), CMV infection in 1 (0.4%), hepatitis E in 58 (22.2%), and non-A, non-B hepatitis of unknown type in 51 (19.5%). Forty-two (16.1%) subjects had HBsAg without other markers of acute infection. Risk factor analysis indicated that patients living in homes not connected to a municipal source of water were at increased risk of hepatitis E infection. These data provide additional evidence that hepatitis E virus is a common cause of acute sporadic hepatitis in children living in Egypt.

In the last decade, human scabies caused by Sarcoptes scabiei and other non human strains is one of the most common contagious parasitic disease. Over a period of one year (June 1991--May 1992), a total of 200 scabietic patients were diagnosed in the outpatients' clinic of Dermatology and Venereology, Benha University Hospitals. They were 120 females and 80 males (sex ratio = 1.5:1). Their ages ranged between three months up to 70 years old. Most of the patients were parasitologically positive (160 or 80%). The most common signs and symptoms were itching, skin burrows, scratch markings, papules and pustules. Regional lymphadenitis was sometimes present as well as fever in patients with secondary bacterial infection. The most affected sites were the abdomen (100%), followed by the buttocks (81.3%), the thigh (50%), legs (50%) and the arms and web spaces (62.5%). The male external genitalia was infested in 60% and the female breast was infested in 72.7%. The sex and site distribution of the infestations were attributed to the risk factor of exposure to infestation. The patients were successfully treated with 5% sulfur precipitate and 2-5% permethrin. The whole results were discussed on the light of the previous work.

Serum and endometrial copper (Cu), zinc (Zn), iron (Fe) and serum cobalt (Co) were measured in the mid-follicular and mid-luteal phases of the menstrual cycles in 30 Lippes loops users, 30 CuT-200 IUCD users and 24 matched controls by atomic absorption spectrophotometry. In the control group, there was no statistically significant difference in mean mid-luteal, compared to mid-follicular, levels of serum Cu, Zn, Fe and Co and endometrial Zn. Mid-luteal endometrium contained significantly higher mean Cu, and lower mean Fe levels. In Lippes loop users, compared to controls, the only statistically significant differences were lower mean mid-follicular serum Zn, lower mean endometrial Zn and Fe, and higher mean mid-luteal endometrial Fe. In CuT-200 users, compared to controls, there was significantly higher mean mid-follicular serum Zn and lower mean mid-luteal serum Co, higher mean mid-follicular endometrial Cu and lower mean mid-follicular endometrial Fe levels. Compared to Lippes loop, CuT-200 users had significntly higher mean mid-follicular serum Co and endometrial Cu and Zn, and lower mean mid-follicular endometrial Fe.

OBJECTIVE: To study the histopathological effects of silicone rubber on the human fallopian tube. METHODS: A prospective longtudinal study at Benha University Hospital and Boulak Eldakrour General Hospital, Egypt. Nine patients who were on the waiting list for hysterectomy and requested postponing of their operation for personal reasons. RESULTS: Our results suggest that silicone rubber induces histopathological changes in the form of ciliary loss and intracellular changes. CONCLUSIONS. These effects tend to increase with the increase of the duration of tubal plugging and are best seen by electron microscopy.

The relative concentrations of IgM and IgG antibodies (Ab) to Schistosoma mansoni soluble egg antigen (SEA) were evaluated in paired samples of venous blood sera and buffer eluates of capillary blood drops dried on filter papers, The samples were obtained from school children at early and chronic stages of schistosomiasis diagnosed on the basis of history, clinical symptomatology and parasitological criteria. Enzyme linked immunosorbent assay (ELISA), simultaneously performed, revealed paired samples to display comparable Ab levels in all cases. Samples from children with early schistosomiasis had specific IgM:IgG ratios greater than 1 [optical densities (O.D.) in sera and blood eluates of 0.77 +/- 0.32 and 0.68 +/- 0.30, respectively for IgM and 0.52 +/- 0.25 and 0.50 +/- 0.25 for IgG] This ratio, however, was less than 1 in samples from chronically infected children (O.D. of 0.20 +/- 0.11 and 0.20 +/- 0.11 for IgM and 0.69 +/- 0.33 and 0.73 +/- 0.32 for IgG) The specific advantages of this simplified technique are the use of anti SEA Abs in fingerstick blood eluates, rather than sera of venous blood to serologically diagnose schistosomiasis and to differentiate early from chronic infections particularly when used for mass screening, such as epidemiologic surveys.

330 sheep from two different flocks were examined for respiratory manifestations including serous to mucopurulent nasal discharge dyspnoea, cough and light depression. 55 animals were sick (16.6%) and 13 died (3.9%). Samples were taken from healthy, diseases and dead cases as well. Pasteurella haemolytica A2 was identified from 18 isolates, and serotyped by rapid plate agglutination (RPA). Drug susceptibility was tested and treatment applied in line with the results.

No doubt, toxoplasmosis is a prevalent infection in all the Arab countries. However, the incidence differs from one country to another and even within the same country. Congenital toxoplasmosis is the most important form of the infection. In the present study, some 78 premature infants with different clinical pictures were examined for Toxoplasma IgG (by IHAT and ELISA) and Toxoplasma IgM (by ELISA). The results showed Toxoplasma IgG ranging between 32.1% (IHAT) and 46.2% (ELISA) while IgM (ELISA) was 23.1%. The highest positivity rate was among those suffering jaundice and the lowest was among those suffering fever of unknown origin. Protection of women particularly pregnant ones, from Toxoplasma infection is a must. Other Abstract: Laboratory personnel at Taif Children's Hospital in Saudi Arabia used indirect hemagglutination tests (IHAT) to analyze blood samples from 78 Saudi Arabian premature infants suffering from neonatal jaundice (21 infants), lymphadenopathy (18), fever (20), chorioretinitis (15), hepatomegaly (3), or pneumonia (1). Laboratory personnel in Egypt used ELISA assays to examine the second set of blood samples. The researchers wanted to measure antibodies to Toxoplasma gondii in the infants exhibiting symptoms of congenital toxoplasmosis. 32.1% of the infants tested positive for Toxoplasma antibodies based on the IHAT. The most common symptoms among these positive congenital toxoplasmosis cases were jaundice (57.1%) and lymphadenopathy (38.9%). The ELISA test for IgG found Toxoplasma antibodies in 46.2% of the premature infants. The ELISA test for IgM found Toxoplasma antibodies in 23.1%. The leading symptoms for IgG included jaundice (66.7%), chorioretinitis (53.3%), and lymphadenopathy (50%). The leading symptoms for IgM were jaundice (42.9%) and lymphadenopathy (22.2%). None of the premature infants with hepatomegaly or pneumonia tested positive for Toxoplasma antibodies. Pregnant women can avoid toxoplasmosis by cooking the meat they eat, and not eating it raw or frozen; not touching cats; and washing hands after handling raw meat, cats, or contaminated soil. Women should be routinely tested for Toxoplasma antibodies before pregnancy.

Changes in sex hormonal levels were studied in Schistosoma mansoni infected and praziquantel treated mice (400 x 2 mg/Kg), drug control and in normal control groups. It was observed that schistosomiasis lead to increase in the level of testosterone, progesterone and 17B-esteradiol, 60 and 70 days postinfection in male and female mice, respectively. In praziquantel treated group the level of testosterone was lowered 10, 20 & 30 days post treatment, progesterone and 17 beta-estradiol fell 30 days post treatment after primary rise. The mechanism of recorded changes will be discussed in details.

Background. Tumor necrosis factor-alpha (TNF-alpha) has been implicated as a mediator of the systemic manifestations associated with acute pancreatitis. The purpose of this study was to show that TNF-alpha expression in pancreatitis is a primary response and is not the result of endotoxemia. Methods. Severe acute pancreatitis was induced in germ-free rats, which have no source of endogenous endotoxin, by ductal infusion of artificial bile. Control animals underwent sham operation and ductal infusion of saline solution. TNF-alpha levels were measured by the WEHI bioassay. Endotoxin was measured by the Limulus assay. Results. TNF-alpha levels remained low in the sham groups (mean, 24.6 +/- 8.0 pg/ml) but were significantly elevated in normal rats with pancreatitis (181 +/- 26.8 pg/ml; p < 0.001 versus sham group) and in germ-free rats with pancreatitis (213 +/- 90 pg/ml; p < 0.002 versus sham group). No endotoxin was detected in any of the experimental rats. Conclusions. Our results indicate that TNF-alpha levels are elevated in acute pancreatitis despite the absence of endotoxin, indicating a primary role of TNF-alpha in this disease.

Twenty-four recurrent anterior traumatic unidirectional shoulder dislocations were stabilized arthroscopically with a muscular capsculolabral suturing technique. A Bankart lesion was diagnosed and repaired in all cases. Postoperative follow-up averaged 26 months (range 24-36 months). All results were rated excellent. All patients achieved full, painless range of motion, and no instances of postoperative instability occurred. There was one complication with stitch sinus. The details of the operative technique are described.

Proximal tibial osteotomy is commonly performed for osteoarthrosis of the knee with deformity. Dome-shaped osteotomy is said to be the most stable of all types of the osteotomies, and is not in need for internal fixation. Two groups of patients with medial gonarthrosis were subjected to dome-shaped osteotomy of the upper tibia and followed up in a randomized fashion. One group (17 patients) was immobilized using a cast brace with 2 hinges at the knee joint, and another group (14 knees) was immobilized by a high above-knee plaster cast. Initially after osteotomy healing, the range of motion of the cast brace group was much better (90-100 degrees) than the plaster group (10-20 degrees). Complete knee flexion was gained in the cast brace group within 3-4 weeks, while it was reached within 5-6 weeks in the plaster cast group. After 1 year there was no difference between groups regarding the knee motion and alignment. On the other hand, delayed bone healing (more than 6 weeks) at the osteotomy site was reached in the cast brace group a rate of 64.7%, while it was 7.1% in the plaster cast group. The high rate of delayed union in the cast brace group could be explained by the screw-action movement of the knee that was allowed in the cast brace during flexion extension movement.

This is a modified technique for endoscopic carpal tunnel release using the ordinary arthroscope, the menisectomy knife, and the fistula probe. It has been used successfully on 60 hands in 41 patients with no known complications. The followup period ranged from 10 to 24 months with an average 16.8 months. Based on our results, however, there has been rapid recovery with decreased scarring and postoperative pain and no loss of grip or pinch strength, which is sometimes seen with the conventional method of carpal ligament release. This modified technique offers the same benefits of endoscopic carpal tunnel release without the need for specific endoscope and hook knife that are not always readily available and are costly.

Disc herniation is a common pathological entity. The relationship between disc prolapse magnitude and severity of symptoms is not known. Controversy exists as to the exact cause of lower back pain and the anatomical structures being irritated, Seventy-seven patients with definite and resistant lumbar disc herniation underwent discectomy under local anesthesia. Type of disc was correlated with severity of symptoms, Assessment of painful structures within the spinal canal was performed. Fifty-one patients had bulging disc and disc protrusion. Most patients (86.3% of those with bulging discs and 82.8% of those with protruded disc) experienced moderate or severe pain, All patients with inflamed nerve roots had severe radicular pain on stimulation. All patients required infiltration of posterior elements to allow pain-free-retraction of paraspinal muscles to perform laminectomy. Greater magnitude of disc disruption does not correlate with more severe symptoms. Inflamed structures within the spinal canal are exceptionally sensitive to stimulation, Posterior spinal elements are a cause of significant back pain.

Since 1989, shoulder arthroscopy was performed on 36 shoulders in 30 athletic patients having different kinds of shoulder afflictions. Their mean age was 24.6 years (range 16-38 years). Swimmers represented the highest number of shoulder affections in this series, affecting 13 of 30 patients (43.35%). It is proved that shoulder arthroscopy is easy, safe, and is associated with a low incidence of complications. It can be considered an excellent invasive technique for visualizing shoulder affections, It also helps in detecting the minute details of the affection. A case of initial diagnosis of rotator cuff tear was diagnosed at arthroscopy as being a complete tear of the rotator cuff with tendinitis of the biceps tendon and rheumatoid arthritis, It also helps in the initiation of a new classification of shoulder affection.

This study was done to evaluate the effect of the use of tourniquet and the type of anesthetic technique on the incidence of deep venous thrombosis (DVT) in orthopedic surgery. It was done on 214 patients of both sexes. Their ages ranged between 16 and 98 years. They were divided into 2 groups (A and B) according to the use of tourniquet. Group A included 117 patients for hip and femoral surgery where the tourniquet was not used, However, group B was composed of 97 patients for tibial operations where the use of tourniquet was essential. In a randomized fashion, 116 patients in the present study received epidural anesthesia (EA), while 98 patients were anesthetised generally. Bilateral ascending venography was performed 9-11 days following surgery for suspicious cases. The venogram was scrutinized by a radiologist who was unaware of the technique used, The number of patients who developed DVT in the present work was 79 cases (36.9%). The majority of them were situated in group A with an incidence of 53%. In group B, DVT was recorded only in 17.5% of patients. Furthermore, the incidence of DVT was higher in generally anesthetized patients (51%) in comparison with patients who received epidural block (25%). Statistical analysis of the results revealed significant reduction of DVT incidence in patients who received epidural anesthesia together with application of tourniquet.

For proper joint surgery, joints must be assessed accurately before and after the procedure to evaluate its effect and joint function. There are many joint assessment charts for body joints including shoulder, elbow, wrist, hip, knee, ankle and spine, etc. For the knee joint, there are multiple knee assessment charts, but all of the previously available charts missed the patello-femoral joint; also, there is no separate and specific chart for patello-femoral (PF) joint assessment. As the PF joint represents an important part of the knee joint, knee assessment must include that joint state. A chart that is specific for the PF joint assessment was constructed to suit PF joint evaluation either alone or as a part of any knee assessment chart. It is composed of four main parameters: pain, stability, function, and mobility. Each parameter is subdivided into 6 grades: Grade I is the worst while Grade VI is the best. Each grade has its specific characteristics of differentiation to be evaluated by degrees. These degrees are translated into results of excellent, good, fair, and poor, and each result has its own degree from 1 to 24. At the same time, the result can be considered satisfactory (excellent and good), and unsatisfactory (fair and poor).

A retrospective study of 17 patients with cauda equina tumors is presented. Considerable delay in making the correct diagnosis was frequent. Many patients had been diagnosed as having prolapsed intervertebral discs. Computed tomography (CT) scan and plain radiographs of the lumbar spine revealed no abnormality in 13 patients (76.5%) and disc prolapse in 3 patients (17.6%), so false or negative results were found in 94.1%. Only 1 case (5.9%) was diagnosed accurately as cauda equina tumor. Myelography was accurate in diagnosing cauda equina tumor in 11 of 13 patients (84%).

Five children with a history of old Monteggia fracture presented with posttraumatic dislocation of the head of the radius are presented. The surgical treatment was osteotomy of the ulna with overcorrection of the angular deformity and fixation by plate and screws. Satisfactory results were obtained in all 5 cases.

One hundred patients with severe and resistant manifestations of lumbar disc prolapse formed the clinical material of this study. Their ages ranged between 26 and 58 years with an average of 38.7 years, and the range of the follow-up period was 8 months to 5.5 years with the mean average of 3 years and 8 months. All the patients were subjected to different measures of conservative treatment of lumbar disc disease including bed rest, smoking prohibition, nonsteroidal anti-inflammatory drug (NSAID) and muscle relaxant administration, epidural steroidal injections, and physiotherapy. All of them had resisted such conservative management, and had become candidates for surgical interference. Candidates of this study were divided into two equal groups (50 patients in each) in a randomized double-blind fashion. Patients of the first group received intravenous injections of 1 mg colchicine in a 2 ml volume twice weekly for 3 consecutive weeks, while those of the placebo group were injected with the same volume and number of sterile saline solution. They were evaluated by a blinded assistant. Neither the patient nor the evaluating assistant had been informed about the contents of the injections in order to comply with the requirements of the randomized double-blind study. About 87% showed excellent improvement without the need for surgical interference, The only complication was due to extravasation of colchicine that caused colchicine burn and phlebelgia.

The absence of established statistical studies concerning external fixation in adult forearm fractures prompted this prospective clinical study of 12 patients with 12 fractured bones treated by external elastic fixation, using a half-frame configuration. The radial nerve is the main anatomical obstacle to be considered in either closed or open fixation. Whenever possible, closed methods of reduction are used. External fixation seems capable of restoring and maintaining the precise anatomical configuration of forearm bones.

Ten cases of spontaneous rupture of quadriceps tendon were presented, and the English literature of 7 isolated case reports was reviewed. The age incidence ranged between 17 and 82 years. There were causes of rupture other than those reported in the literature (e.g., advanced rheumatoid arthritis and its complications; osteoporosis, manipulation under anesthesia for ankylosed disused weak knee joint, and blunt trauma at the tendinous junction of the quadriceps tendon in a normal healthy person. The cardinal features were diffuse swelling around the knee, a visible or palpable suprapatellar defect, and inability to lift the straight leg despite a functioning quadriceps and normal activity in all other muscle groups in the leg. In all patients operative repair was undertaken, followed by 6 weeks immobilization in plaster and subsequent physiotherapy. Although late repair was associated with successful rehabilitation of the patient and a return to useful function, the results of early repair were much better and the time of physiotherapy was shortened.

Male albino rats were fed a high lipid diet for 5 consecutive weeks. We studied the development of paw inflammation after an injection with Freund's complete adjuvant. Increasing the lipid content of the diet significantly increased the rate of paw inflammation. Also the effect on this process of oral administration of a xanthine oxidase inhibitor (allopurinol, 50 mg/kg) for 15 consecutive days was studied. Results indicated that inflammation was significantly inhibited by allopurinol.

Transmission electron microscopy (TEM) was used to clarify the effect of topically applied 20% azelaic acid (AA) on acne vulgaris lesions, Twenty male acne patients were included in this study. A punch biopsy was taken from each patient before treatment and from five of the treated patients, After 2 months of treatment with 20% AA, the pattern of follicular keratinization was markedly altered, In particular, there was a reduced thickness of the horny layer, a mild decrease in tonofilaments and a marked reduction in the number and size of keratohyaline granules, Enlargement of perinuclear rough endoplasmic reticulum (RER) and swollen nitochondria were frequently observed, A reduction in the dermal inflammatory infiltrates was frequently identified, Very few bacteria were detected in the lumen, These findings confirm the antikeratinizing effects of 20% AA on acne vulgaris lesions.

Background/Aims/Methods: Immunological responses to hepatitis C virus infection have not been fully studied. In an attempt to clarify some immunopathogenetic aspects of B cell activation during acute and chronic hepatitis C virus infection and to identify markers of chronicity or of recovery, the humoral response in hepatitis C virus-infected patients was studied. Results: In children with acute jaundice, with negative markers of acute hepatitis A, B and E, six of 87 (6,9%) had detectable anti-HCV IgM, and only one (1.1%) had detectable anti-HCV IgG. In adults with acute jaundice, with negative markers of acute hepatitis A, B and E, ten of 23 (43.5%) had detectable anti-HCV IgM associated in eight patients with detectable anti-HCV IgG. In chronic hepatitis C virus-infected adult patients, all anti-HCV IgG seropositive, four of 14 (28%) patients had detectable HCV-IgM in serum. In vitro specific antibody production was inducible in a minority of patients. In acute and chronic hepatitis C virus-infection, IgM-HCV serology did not correlate with viremia as detected by polymerase chain reaction. Conclusions: Therefore, the polymerase chain reaction remains at the moment the only direct marker to demonstrate hepatitis C virus viral replication in patients with acute and chronic hepatitis while anti-HCV IgM analysis alone has only a limited diagnostic value in hepatitis C virus-infection.

Letrozole induction of ovulation in clomiphene citrate-resistant women with polycystic ovary syndrome is associated with an ovulation rate of 54.6% and pregnancy rate of 25%. There was no significant difference between letrozole responders and nonresponders in age, period of infertility, body mass index, waist circumference, LH, FSH, or LH/FSH ratio.

Twenty-seven athletes of incomplete (partial) or complete (total) tear of the rotator cuff were treated with anterior acromioplasty and repair of the tear. The apparatus of continous passive motion was applied to each involved shoulder immediately after surgery. The age average of these patients was 22.3 years (range 16-33 years). All the patients were seen and followed up during the period from January 1985 to May 1992 with an average of 46.74 months. There were 4 females and 23 males. Whom were involved at their dominant side. Arthroscopically, there were 12 complete tears (44.4%) and 15 incomplete tears (55.6%). Postoperatively, 25 patients (92.2%) stated that they were satisfied with the result of this procedure and with the amount of pain reduction when compared with their preoperative condition. Objectively, the functional results were good in 19 shoulders (70.4%), fair in 8 (29.6%), and poor in none. None of the patients changed the sports activity or restricted use of their operated shoulders after surgery. As regards pain rating, 21 (77.8%) had no pain; 5 patients (18.5%) had pain with sports only (grade 1); 1 patient only (3.7%) had pain with daily living activity (grade 2), and none complained of pain at rest. Concerning the degree of participation in sports and competition, 15 (55.6%) patients had good results with no or mild pain and returned to their former level of performance; 9 (33.35%) patients had fair results in that they had pain with sports activity only and their performance was less than that before injury; and 3 (11.15%) patients either had no reduction in pain at rest or with the daily living activity and it was considered as a poor result. In our experience, a repair of the rotator cuff combined with an acromioplasy together with immediate performing of continous passive motion activity, in a young athletic population provides a satisfactory relief of pain. A considerable percentage of patients had regained their former degree of performance and none of them had changed or stopped their sports.

Tumor necrosis factor-alpha (TNF alpha) has been implicated as one of the numerous Likely mediators of the systemic complications of acute pancreatitis. Recent suggestions that calcium (Ca2+) acts as a signal not only for TNF alpha release but also for TNF alpha action at distant sites led us to hypothesize that the calcium channel blocker diltiazem could inhibit TNF alpha release in acute pancreatitis, ameliorating the severity of the disease and improving overall survival. A rat model of acute pancreatitis induced by retrograde ductal infusion of bile was used for two experiments (n = 120). Experiment 1 was designed to determine the effects of calcium channel blockade using diltiazem on the severity of pancreatitis as measured by changes in biochemistry, pathology, and serum TNF alpha levels. In experiment 2, effects of calcium channel blockade on animal survival were measured over 72 h. Calcium channel blockade was associated with a significant reduction in serum TNF alpha levels as well as amelioration of pancreatitis by biochemical and pathological criteria. Overall survival from bile-induced pancreatitis was dramatically improved in rats pretreated with diltiazem (80%) compared to untreated animals (40%). Our data suggest that calcium channel blockade is associated with TNF alpha inhibition and improved outcome in a rat model of acute pancreatitis.

A total of 72 bilharzial mansonian school children aged 6-12 years were studied before and six months after praziquantel (PZQ) treatment. After treatment, 21 cases showed reinfection while 51 were resistant. Using ELISA specific antibody assays titre levels of IgM, IgG, IgA & IgE for soluble egg antigen (SEA) and soluble worm antigen (SWAP), were higher among resistant cases than among reinfected ones before and after treatment. The levels of specific IgA & IgE among resistant cases were significantly higher than among reinfected cases after treatment. This may indicate the integrity of immune system and prominant humoral immune response.

Background. There is an increasing incidence of basal cell carcinoma (BCC) and skin cancer in general among various countries, where the sun is implicated as an important causative factor. Methods. Results of clinical and histopathologic examination and the incidence rate of sees were recorded over a period of 5 years at Hamad Medical Corporation, Doha, Qatar. Results. Basal cell carcinoma is the commonest skin cancer in Qatar. The average annual incidence per 100,000 residents of working manpower, standardized to the 1986 census, is 9.9 for both sexes and at all ages. Expatriates formed the highest proportion and of these. Europeans were predominant. The tumor was more frequent in men, on sun-exposed areas, was mostly of the nodular and infiltrative type, and occurred in the 3rd, 4th, and 5th decades. As a whole, persons with relatively heavily pigmented skin constituted 66.7% of the patients. Conclusions. Intense sunlight exposure during outdoor work and leisure activities in Qatar puts residents at increased risk for nonmelanoma skin cancer, even in persons with relatively pigmented skin.

In an open, randomized, clinical pilot trial, four groups with 20 hepatitis C patients each were treated with either 'liver support' therapy, with established medications (one group with ribavirin, one group with alpha-interferon), or with a novel oral test drug, Phlogenzym(R), a combination of hydrolytic enzymes with the flavonoid rutosid. The liver transaminases, AST; ALT; and S-gamma-GT markedly improved over the period of three months in the three drug groups, but only marginally in the liver support group. The best results were found with Phiogenzym(R), which was even superior to ribavirin and alpha-interferon. The tolerance of the oral enzymes was excellent. Further clinical trials with longer observation times, greater numbers of patients, double-blind and partly placebo-controlled, are under way.

The cardiac pulse is the predominant feature of the pulse oximeter (plethysmographic) waveform. Less obvious is the effect of ventilation on the waveform. There have been efforts to measure the effect of ventilation on the waveform to determine respiratory rate, tidal volume, and blood volume. We measured the relative strength of the effect of ventilation on the reflective plethysmographic waveform at three different sites: the finger, ear, and forehead. The plethysmographic waveforms from 18 patients undergoing positive pressure ventilation during surgery and 10 patients spontaneously breathing during renal dialysis were collected. The respiratory signal was isolated from the waveform. using spectral analysis. It was found that the respiratory signal in the pulse oximeter waveform was more than 10 times stronger in the region of the head when compared with the finger. This was true with both controlled positive pressure ventilation and spontaneous breathing. A significant correlation was demonstrated between the estimated blood loss from surgical procedures and the impact of ventilation on ear plethysmographic data (r(s) = 0.624, P = 0.006).

Hippocampal integrity is essential for cognitive functions. On the other hand, induction of metallothionein (MT) by ZnSO(4) and its role in neuroprotection has been documented. The present study aimed to explore the effect of MT induction on carmustine (BCNU)-induced hippocampal cognitive dysfunction in rats. A total of 60 male Wistar albino rats were randomly divided into four groups (15/group): The control group injected with single doses of normal saline (i.c.v) followed 24 h later by BCNU solvent (i.v). The second group administered ZnSO(4) (0.1 mu mol/10 mu l normal saline, i.c.v, once) then BCNU solvent (i.v) after 24 h. Third group received BCNU (20 mg/kg, i.v, once) 24 h after injection with normal saline (i.c.v). Fourth group received a single dose of ZnSO(4) (0.1 mu mol/10 mu l normal saline, i.c.v) then BCNU (20 mg/kg, i.v, once) after 24 h. The obtained data revealed that BCNU administration resulted in deterioration of learning and short-term memory (STM), as measured by using radial arm water maze, accompanied with decreased hippocampal glutathione reductase (GR) activity and reduced glutathione (GSH) content. Also, BCNU administration increased serum tumor necrosis factor-alpha (TNF alpha), hippocampal MT and malondialdehyde (MDA) contents as well as caspase-3 activity in addition to histological alterations. ZnSO(4) pretreatment counteracted BCNU-induced inhibition of GR and depletion of GSH and resulted in significant reduction in the levels of MDA and TNF alpha as well as the activity of caspase-3. The histological features were improved in hippocampus of rats treated with ZnSO(4) + BCNU compared to only BCNU-treated animals. In conclusion, MT induction halts BCNU-induced hippocampal toxicity as it prevented GR inhibition and GSH depletion and counteracted the increased levels of TNF alpha, MDA and caspase-3 activity with subsequent preservation of cognition.

The present study was carried out to evaluate the effect of exogenously administered metallothionein (MT) against carmustine (BCNU)-induced lung toxicity in rats. A total of 60 rats were randomly divided into four groups (15/group): control group in which the animals received 0.5 ml physiologic saline containing 10% ethanol (IP) weekly, MT-administered group in which rats received MT (30 mu mol/kg, IP) weekly, BCNU-administered group in which rats received BCNU (5 mg/kg, IP) weekly and MT + BCNU group in which rats received weekly doses of BCNU (5 mg/kg, IP) followed 24 h later by MT (30 mu mol/kg, IP). At the end of the experiment (after 6 weeks), lung histological changes, collagen staining, the activity of glutathione reductase (GR) and contents of reduced glutathione (GSH) and hydroxyproline (Hpr) in the lung as well as serum level of tumor necrosis factor-alpha (TNF-alpha) were evaluated. The obtained data revealed that BCNU induced pathological changes and markedly increased lung collagen and level of Hpr but decreased GSH content and GR activity and increased serum TNF-alpha compared to both control and MT-administered rats. Administration of MT + BCNU markedly improved histological features and decreased staining of collagen along with increased GR activity, GSH content but decreased level of Hpr in lung tissue as well as decreased serum level of TNF-alpha compared with BCNU-treated rats. Based on our results, it is possible to postulate that exogenous MT can act against BCNU-induced lung toxicity by a mechanism related, at least in part, to its ability to decrease oxidative stress and fibrosis.

Accelerated apoptosis is a significant factor in the pathophysiology of male infertility disorders associated with abnormal spermatogenesis. This study aimed to investigate apoptosis in varicocele-bearing testes. Sixty four men with varicocele (18 fertile and 46 infertile) were studied compared with eight men with obstructive azoospermic as controls. Apoptosis was assessed in testicular biopsy specimens using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) method as well as electron microscopy. The results demonstrated that the occurrence of apoptotic changes comprised all types of germ cells but not affecting Sertoli cells. Mean tubular apoptotic indices of fertile or infertile men with varicocele were significantly higher than controls (mean +/- SD 4.55 +/- 1.03%, 6.29 +/- 1.82% versus 2.71 +/- 0.45%, P < 0.05). Mean Leydig cells apoptotic indices of infertile men with varicocele were significantly higher than those of fertile men without varicocele as well as controls (1.18 +/- 0.38%, 0.68 +/- 0.15%, 0.31 +/- 0.21%, P < 0.05). Apoptotic indices were nonsignificantly correlated with Johnsen score, testicular volume or varicocele grade. It is concluded that testicular apoptosis is increased in varicocele-associated men either fertile or infertile who may be implicated in associated spermatogenic dysfunction.

Objective: To assess the effects of the number of motile spermatozoa inseminated and percentage of morphologically normal spermatozoa on the success of IUI. Design: A prospective observational study. Setting: University teaching hospital and private practice setting. Patient(s): The study comprised 393 couples who underwent 714 IUI cycles. Intervention(s): All IUI cycles were preceded by ovarian superovulation with clomiphene citrate 50 mg tablets orally twice daily for 5 days starting on the second day of menses and one hMG ampule 75 IU IM daily for 5 days starting day 5 of the cycle. Cycles were monitored by transvaginal ultrasound. The IUI was performed with a catheter 36 +/- 4 hours after hCG injection. Main Outcome Measure(s): Clinical pregnancy. Result(s): A total of 79 clinical pregnancies were obtained, for a pregnancy rate per cycle of 11.06%. The pregnancy rate per cycle was 5.55% when the number of motile spermatozoa was 5 x 10(6). For patients 5 x 10(6), the pregnancy rate per cycle was 28.2%, which is significantly higher than that of other age groups. Above the age of 35 years, no pregnancies were reported with number of motile spermatozoa 5 x 10(6). When the normal sperm morphology was >30% and number of motile spermatozoa inseminated >5 x 10(6), the pregnancy rate was 20.77%. Conclusion(s): Intrauterine insemination used for treating male factor infertility has little chance of success when the woman is older than 35 years, the number of motile spermatozoa inseminated is

Objective: To determine whether GnRHa administration before and during combination chemotherapy for breast cancer could preserve posttreatment ovarian function in young women or not. Design: Prospective randomized controlled study. Setting: Department of Obstetrics and Gynecology, Mansura University Hospital, Mansura, Egypt. Patient(s): Eighty patients with unilateral adenocarcinoma of the breast and with no metastasis who had undergone modified radical mastectomy or breast-conserving surgery plus full axillary lymph node dissection were included in the study. Patients were assigned randomly to receive combined GnRHa and chemotherapy or chemotherapy alone. One woman in each group dropped out. Main Outcome Measure(s): Return of spontaneous menstruation and ovulation. Hormonal changes (FSH, LH, E(2), P) during and after the course of treatment. Result(s): In the study group, 89.6% resumed menses and 69.2% resumed spontaneous ovulation within 3-8 months of termination of the GnRHa/chemotherapy cotreatment; 11.4% experienced hypergonadotrophic amenorrhoea and ovarian failure 8 months after treatment. In the control group (chemotherapy without GnRHa), 33.3% resumed menses and 25.6% resumed normal ovarian activity. The median FSH and LH concentrations, 6 months after completion of the GnRHa/chemotherapy cotreatment group, were significantly less than the control group. During the GnRHa/chemotherapy cotreatment the concentrations of FSH, LH, and P decreased to almost prepubertal levels. However, within 1-3 months after the last GnRHa injection, an increase in LH and FSH concentrations was detected, followed several weeks later in by an increase in P concentrations to within normal levels. Conclusion(s): GnRHa administration before and during combination chemotherapy for breast cancer may preserve posttreatment ovarian function in women

Cerebrospinal fluid (CSF) is produced by the choroid plexus of the lateral third and fourth ventricles at a rate of 0.35 mL/min. The CSF flows into the subarachnoid space and is absorbed by the arachnoid villi in the sagittal sinus. Normal CSF pressure is 5 to 15 cm H(2)O. Neurologic symptoms may occur when CSF pressure reaches more than 15 to 20 cm H(2)O.(1) Three concomitant factors are needed for CSF leakage: an osseous defect, a meningeal disruption, and a pressure gradient.(2)

The efficacy of leeches, as biological agents, in control of snail intermediate hosts of schistosomiasis (Bulinus truncatus, Biomphalaria alexandrina) and fascioliasis (Lymnaea natalensis) as well as their effect on the non-target snails Physa acuta, Melanioides tuberculata and Cleopatra bulimoides was evaluated. Two glossiphoniid snail leeches, Helobdella nilae and Alboglossiphonia conjugata were used. They destroyed egg masses and young snails more rapidly than adult ones. H. nilae showed a stronger destructive effect than A. conjugata. In a descending order, it preferred L. natalensis followed by B. truncatus, B. alexandrina, Ph. acuta, M. tuberculata and lastly C. bulimoides. But, A. conjugata preferred L. natalensis followed by B. truncatus, Ph. acuta, M. tuberculata, B. alexandrina and lastly C. bulimoides. The detailed diagnostic morphology and biology of the two leeches were given.

This study evaluated the molluscicidal effect of Commiphora mnolmol oil extract (Myrrh), on control of six fresh water snails (Lymnaea natalensis, Bulinus truncatus, Biomphalaria alexandrina, Physa acuta, Melania tuberculata and Cleopatra bulimoides). Also, the extract effect on the egg masses of L. natalensis, B. truncatus, B. alexandrina and Ph. acuta was evaluated. Snails and egg masses were exposed at 16-20 degrees C to various concentrations (conc.). LD50 after 24 hours expo-sure were 264/132, 283/195, 230/252, 200/224, 241/246 & 241/246 ppm for young/adult of L. natalensis, B. truncatus, B. alexandrina, Ph. acuta, M. tuberculata and C. bulimnoides respectively. LDtoo after 24 hours exposure were 400/400 for L. natalensis, B. truncatus, B. alexandrina, M. tuberculata and C. bulimoides, and 300/300 for Ph. acuta. Also, complete mortality (100%) was achieved for the egg masses of L. natalensis, B. truncatus, B. alexandrina and Ph. acuta at concentrations of 300, 200, 300 & 400 ppm respectively. Lower concentrations gave the same results after longer exposure. LD100 of C. molmol oil extract (Myrrh) had a rapid lethal effect on the six snail species and their egg masses in high conc. of 300 & 400 ppm. Commiphora molmol is a promising plant to be included with the candidate plant molluscicides. The oil extract of this plant showed a remarkable molluscicidal activity against used snail species.

Congenital Toxoplasma gondii infection may lead to abortion, stillbirth, neonatal death as well as severe congenital toxoplasmosis in the newborn infants. No doubt, early and proper diagnosis of infection pregnant women or her baby pave the way to effective treatment and minimize complications. In this study; the PCR and ELISA-IgM were used to diagnose active toxoplasmosis. The results revealed that PCR detected very recently infection (23/70 subjects) than ELISA-IgM (18/70 ones). However, the use of both ELISA-IgM and PCR together improved the diagnostic sensitivity and specificity.

Cryptosporidiosis has a worldwide geographical and zoological distribution. Cryptosporidium baileyi oocysts were isolated from the bursa of Fabricius (BF) of 4 weeks-old of 100 broilers. Twenty five broiler chicks of 2 day old free from cryptosporidial infection were inoculated intratracheally at a dose of 1 x 10(6) chicks. Five chicks were sacrificed at 4th, 8th, 12th, 16th, and 20th day postinoculation. Selected tissues from bursa of Fabricius, cloaca, colon, caeci and tracheas were taken and examined directly by scraping technique for endogenous stages. The distribution of C. baileyi in different tissues in the case of intratracheal inoculation; trachea 23 (92 %) chicks infected, bursa of Fabricius 21 (84%) chicks, Cloaca 5 (16 %) chicks, Colon 1 (4%) chick and the caeci showing no infection. Daily examination of the intratracheal droppings inoculation was done at the 5th day and lasted for 18-20 days, the patent period.

Encysted metacercariae (EMC) from seven trematod-zoonotic parasites were exposed to different temperature mechanisms. Boiling of the infected fishes was sufficient to kill the EMC, frying of fishes for five minutes was quite sufficient to inhibit the viability of EMC, but frying for 10 minutes killed all EMC. Grilling of infected Tilapia zillii was sufficient to kill EMC after 10 minutes; however five minutes were sufficient only to kill EMC in Clarias gariepinus. Regarding chilling at 5 degrees C, T. zillii EMC showed variation in response. Complete loss of viability of Prohemistomatidae EMC was achieved after 14 days, for Haplorchidae after 11 days, for Diplostomatidae after 12 days, while Clinostomatidae EMC required 15 days. For Cl. gariepinus, Bagrus bajad and Chrysichthys auratus achieved results were similar to those for T. zillii but with fewer days of withstanding chilling. The EMC infecting Tilapia lost their viability by freezing at -5 degrees C & -10 degrees k for Prohemistomatidae after 48 & 40 hours, for Diplostomatidae after 24 & 16 hours and for Clinostomatidae cysts after 48 &32 hours respectively. In infected Clarias gariepinus, Bagrus bajad and Chrysichthys auratus the EMC lost their viability by fireezing at -5 degrees C & -10 degrees C for periods shorter than those of Tilapia sp.

To evaluate changes in female sexual function after a transobturator vaginal tape (TOT) procedure for treating genuine stress urinary incontinence (SUI), and its correlation with patient's expectation. PATIENTS AND METHODS The study included women treated with a suburethral TOT for genuine SUI, neurologically intact, heterosexual and married, aged > 18 years, with no previous history of malignancy, pelvic radiotherapy and no other associated surgical or psychological diseases. Patients were interviewed before surgery and with the aid of a questionnaire including female sexual function, the Beck depression indices and their expectation of sexual function after surgery. RESULTS Sixty-two premenopausal sexually active women were included (mean age 40.5 years). The cure rate from SUI was 92%, 89%, 87% and 84% at 6, 12, 18 and 24 months, respectively. All patients attended the visit before and the first visit after surgery, while 71%, 42% and 24% were assessed at the 12-, 18 and 24-month visits, respectively. The mean follow-up was 12 months. Fifty-two women resumed their sexual activity early within the 8 weeks after surgery and the frequency of coitus in more than two-thirds of patients was at least once per month. The number of women who expected either looseness or tightness of the vagina was more than that estimated from patient perceptions. There was a difference between the patient's sensation of vaginal length abnormalities during coitus (two women) and patient expectation (18 women). CONCLUSION Although the TOT is effective for treating SUI, counselling the patient and her partner is important in correcting false ideas and expectations about future sexual activity. Indeed, sexual dysfunction is reported after vaginal surgery, with a physiological and psychological background. Further assessment should be used to characterize sexual dysfunction after vaginal surgery for SUI to find new solutions.

In this paper, we study the stability of the zero solution of a system of ordinary differential equations subject to impulse action. Using the method of Lyapunov functions, we obtain tests for asymptotic stability or instability of the system. Illustrative examples are given.

The purpose of this study is to evaluate the immunohistochemical detection of telomerase enzyme and estrogen receptor (ER) and progesterone receptor (PGR) in gestational trophoblastic neoplasia (GTN) and its clinical significance. Formalin-fixed paraffin blocks for 30 patients (24 with molar pregnancy, 3 with choriocarcinoma, and 3 with placental site trophoblastic tumor) as cases and six products of conception samples from patients with incomplete abortion as controls were included in the study. Immunohistochemical detection of the telomerase catalytic protein and ER and PGR was carried out using streptavidin-biotin-peroxidase method. All control tissues were negative for telomerase and ER expression, while five of six were PGR positive. Significant positive telomerase expression was detected in all gestational trophoblastic tumors (three of six partial moles, 12 of 18 complete moles, three of three choriocarcinomas, and two of three placental site trophoblastic tumors). Nine of 24 molar pregnancies were followed by GTN. Molar pregnancies followed by GTN were associated with higher serum beta-hCG (human chorionic gonadotrophic hormone), larger uterine size for gestational age, negative ER expression, negative PGR expression, and positive telomerase expression. All patients with molar pregnancy with negative telomerase expression (9 of 24) showed spontaneous regression after evacuation. Positive telomerase expression and its immunohistochemical detection are associated with the development of GTN. Negative telomerase expression is highly predictive of postmolar spontaneous regression. Patients with molar pregnancies with negative telomerase expression can be saved the long-term follow-up. ER and PGR expression do not show a significantly different pattern in molar tissues, while negative expression is associated with developing GTN. Cautions on the use of postmolar hormonal contraception may be unjustified.

Objective: To compare clomiphene citrate with N-acetyl cysteine vs. clomiphene citrate alone for augmenting ovulation in management of unexplained infertility. Design: Prospective randomized double-blind controlled trial. Setting: Department of obstetrics and gynecology in a university medical faculty in Egypt. Patient(s): Four hundred four patients as a study group (clomiphene citrate plus N-acetyl cysteine group) and 400 patients as a control group (clomiphene citrate-alone group). All women had unexplained infertility. Intervention(s): Patients in the study group were treated with clomiphene citrate (50-mg tablets) twice per day and with N-acetyl cysteine (1,200 mg/d orally) for 5 days starting on day 2 of the cycle. Patients in the control group were treated with clomiphene citrated with sugar powder. Main Outcome Measure(s): The primary outcomes were number and size of growing follicles, serum E-2, serum P, and endometrial thickness. The secondary outcome was the occurrence of pregnancy. Result(s): There were no statistically significant differences between the two groups in the number of follicles sized > 18 mm, mean E-2 levels, serum P, or endometrial thickness. Pregnancy rate was comparable in both groups (22.2% vs. 27%). Miscarriage rate was comparable in both groups (6.7% in the study group vs. 7.4% in the control group). Conclusion(s): N-Acetyl cysteine is ineffective in inducing or augmenting ovulation in patients with unexplained infertility and cannot be recommended as an adjuvant to clomiphene citrate in such patients.

AIM: To study the effects of ferulic acid on gastrointestinal motility both in vitro and in vivo. METHODS: Ferulic acid induced concentration-dependent stimulation of the basal tone of isolated guinea pig ileum (2-20 mu mol/L) and isolated rat fundus (0.05-0.4 mmol/L). RESULTS: Ferulic acid significantly accelerated the gastrointestinal transit and gastric emptying in rats in a dose-dependent manner (50-200 mg/kg, po). Cisplatin (2.5-20 mg/kg, ip) induced a dose-dependent delay in gastric emptying in rats. Pretreatment with ferulic acid dose-dependently, significantly reversed the cisplatin-induced delay in gastric emptying. CONCLUSION: The endogenous prostaglandins (PGs) are involved in mediating the stimulant effects of ferulic acid. This effect of dietary ferulic acid may help improve other accompanying gastrointestinal symptoms such as abdominal discomfort and also may protect against emesis induced by cytotoxic drugs. (c) 2006 The WJG Press. All rights reserved.

Objective: To explore whether a single-step diagnosis and treatment of premalignant cervical lesions by the loop electrosurgical excision Procedure (LEEP) is appropriate in women at high risk in low-resource countries. Method: Sixty women suspected of having a high-grade lesion on both visual inspection with acetic acid (VIA) and colposcopic examination were randomly allotted to one of 2 groups. In group 1, LEEP was performed immediately and a tissue specimen was sent for histopathologic evaluation; in group 2, a punch biopsy was performed, followed by a histopathologic evaluation; then, LEEP was performed if needed. Results: Among the patients who underwent LEEP, 4 (16%) in group 1 and 3 (15.8%) in group 2 were overtreated. No patients dropped out of the study in group I but 5 (20.8%) did in group 2. Conclusion: The single-step diagnosis and LEEP treatment of premalignant cervical lesions is appropriate in low-resource countries. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

The authors present the case of a 63-year-old woman with a 5-year history of intractable paroxysmal 'atypical' otofacial pain. The patient's pain attacks were not typical for either trigeminal or vagoglossopharyngeal neuralgia. Surgical exploration via a suboccipital retromastoid craniotomy showed vascular compression of the nervus intermedius by the anterior inferior cerebellar artery and the patient's pain was successfully managed with microvascular decompression. Copyright (C) 2010 S. Karger AG, Basel

Aim: The aim of this work was to investigate the impact of life events on the profile of opioid dependent patients. Method: Recruitment was achieved through outpatient drug treatment clinic in Birmingham, UK, and data were collected through semistructured interviews. One-hundred and twenty subjects with opioid dependence syndrome were interviewed, and 100 controls of nondrug-using family members and friends. Result: The mean age of the opioid group was 33.3 years, SD = 8.8. The majority individuals of the sample were White British (80.8%), unemployed (69.2%), and male (75%). The mean severity of dependence as measured by two scales indicated severe level of dependence according to the authors of each scale. The mean number of traumatic events for the opioid dependence group was 4.8, SD = 3.57 vs. 3.55; SD = 3.65 in control group with significant difference (t = 2.56, df = 218, p =.01). Significant predictors of severe opioid dependency were age of second exposure to events, change of residence, breakup with boy/girlfriend, and conflict with father. Conclusion: The data presented indicate that a significant group of opioid dependent patients experience adverse life events in both childhood and adulthood. It is by attending to and addressing these issues that health care workers can alleviate ongoing distress and promote confidence.

We studied the ability of pre- and postcaptopril renal scintigraphy to predict renovascular disease (RVD) in children. Retrospective review of medical notes and radiology reports of all hypertensive children who had had both pre- and postcaptopril renal scintigraphy with [(99m)Tc] dimercaptosuccinic acid (DMSA) and/or [(99m)Tc] mercaptoacetyltriglycine (MAG3) and digital subtraction angiography (DSA). 81 children aged 1-18 (median 10) years were studied with 62% (51) having a diagnosis of RVD. Main renal artery disease, intrarenal disease, and both main and intrarenal artery disease were present in 25, 14, and 12 patients respectively. The isotope study accurately diagnosed RVD, confirmed by DSA, in 47% (24 of 51) children, with eight false positive studies. The sensitivity, specificity, and positive and negative predictive values of the isotope study to predict RVD were 48%, 73%, 76%, and 51%, respectively. Pre- and postcaptopril renal scintigraphy was unable to predict RVD in children.

Growth reference charts are among the most sensitive and valuable tools for assessing the health and development of children. A questionnaire survey was answered by 16 of the 21 ministries of health in the Eastern Mediterranean Region countries (EMR) about their use of growth charts for children under 5 years. Most of the countries (13/16) used the NCHS/WHO charts and weight-for-age was the most commonly used. Charts for height-for-age and head circumference-for-age were less commonly used. Problems in the use of charts were identified. The introduction of the new WHO Child Growth Standards, based on exclusively breastfed babies, is a unique opportunity to support growth monitoring and optimal feeding practices in EMR.

Purpose We investigated the relationship among esophageal warming, pain perception, and the site of radiofrequency (RF) delivery in the left atrium (LA) during the course of catheter ablation of atrial fibrillation. Such a procedure in awake patients is often linked to the development of visceral pain and esophageal warming. As a consequence, potentially dangerous complications have been described. Methods Twenty patients undergoing RF ablation in the LA were studied. An esophageal probe (EP) capable of measuring endoesophageal temperature (ET) was positioned before starting the procedure. The relative position of the EP and the tip of the ablator were evaluated through fluoroscopy imaging before starting each RF delivery, during which the highest value of the temperature was collected. After RF withdrawal, the patients were asked to define the intensity of the experienced pain by using a score index ranging from 0 (no pain) to 4 (pain requiring immediate RF interruption). Results The mean ET value during ablation was 39.59 +/- 4.71 degrees C. The EP proximity to the ablator's tip showed a high correlation with the development of the highest ET values (Spearman's rank correlation coefficient r=0.49, confidence interval (CI) 0.55-0.41). Moreover, the highest values of pain intensity were reported when the RF was delivered to the atrial zones close to the EP projection (r=0.50, CI 0.55-0.42) and when the highest ET levels were reached (r=0.38, CI 0.30-0.45). Conclusions Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short-and long-erm jeopardizing of the esophageal wall.

The aim of the present work was to study the effect of tobacco smoking on disease progression in rheumatoid arthritis patients and its relation to anti-cyclical citrullinated peptide (anti-CCP) antibodies. The study included 54 patients; 20 non-smokers, 9 ex-smokers, 14 mild to moderate smokers and 11 heavy smokers. Fifteen normal volunteers were also studied as controls. Disease stage was clinically and radiologically determined, rheumatoid factor (RF) and anti-CCP antibodies were measured in serum. Higher percentage of severe disease (stage III) was seen in heavy smoker patients than mild to moderate smokers (54.6% versus 35.7%) and in moderate smokers than ex-smokers (35.7% versus 33.6%). Lowest percentage of severe disease was seen in non-smokers (15%). RF and anti-CCP were significantly higher in smoker than non-smoker and in heavy than mild to moderate smoker patients (p

Objective: To evaluate urinary albumin excretion (UAE) in normotensive and nondiabetic women with polycystic ovary syndrome (PCOS) in relation to their clinical, endocrine, and metabolic profiles. Design: Observational study. Setting: University fertility center. Patient(s): Sixty-three women with PCOS were evaluated. Intervention(s): Clinical assessments and urine and blood testing. Main Outcome Measure(s): Urinary albumin excretion, systolic and diastolic blood pressure, serum levels of LH, FSH, PRL, T, 17-hydroxyprogesterone, glucose, insulin, lipids, C-reactive protein, and 24-hour urinary free cortisol. Result(s): In univariate and multivariate correlation analysis, UAE correlated with diastolic blood pressure, insulin area under the curve during glucose tolerance test, PRL, and 17-hydroxyprogesterone. Overt microalbuminuria was detected in a significant proportion of subjects. Conclusion(s): Urinary albumin excretion in women with PCOS correlates well with other cardiovascular risk factors. Because the relationship between UAE and adverse cardiovascular events is continuous, evaluation of UAE in the presence of PCOS may provide clinically relevant information and may aid in selecting appropriate patients for more aggressive treatment of likely aggravating factors, such as hyperinsulinemia or borderline hypertension. (Fertil Steril (R) 2010; 93: 2285-90. (C) 2010 by American Society for Reproductive Medicine.)

Respiratory distress syndrome (RDS) secondary to surfactant deficiency is a common cause of morbidity and mortality in premature infants. An increasing evidence suggests that vascular endothelial growth factor (VEGF) may contribute to surfactant secretion and pulmonary maturation. This study determines cord blood VEGF levels in preterm infants and investigates its association with the development and severity of RDS. 50 preterm neonates and 10 healthy full term neonates were included in this study. All preterm neonates were subjected to full history taking, complete clinical examination, chest X-ray and laboratory investigations including arterial blood gases, CBC and C-reactive protein. Cord blood samples were obtained for determination of VEGF levels using ELISA. Cord blood VEGF level was significantly lower in preterm infants with RDS (7.76 +/- 2.28 in mild cases and 3.64 +/- 1.22 in severe cases) as compared to preterm infants without RDS (16.61 +/- 4.58) and controls (16.48 +/- 3.23) (p < 0.001). Infants with severe RDS especially those with small gestational age (GA), low birth weight (BW) and low APGAR score at 1 and 5 minutes had significantly lower cord blood VEGF level than those with mild RDS (p < 0.001). There was no significant effect on the level of VEGF regarding maternal use of antenatal steroids, premature rupture of membrane (PROM) and sex of newborn infants (P > 0.05). The sensitivity and specificity of cord blood VEGF test was 80% and 62% respectively with positive predictive value (PPV) of 80% and negative predictive value 56% at cutoff point of 10.02 ng/mL. It's concluded that cord blood VEGF elevation is associated with the absence of RDS, and that its level negatively correlates with the severity of the disease and duration on ventilation.

Aim To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants in Benha, Egypt. Methods A total of 1224 pregnant women who were treated at Benha University Hospital, Egypt, were included in the study. They completed a questionnaire about risk factors for HCV acquisition and suspected risk factors for mother-to-infant transmission and were tested for HCV antibody using a third-generation ELISA test. Women positive for HCV antibody were tested for HCV RNA by polymerase chain reaction. Peripheral blood of infants of positive HCV-RNA women was tested for HCV antibody and HCV-RNA at 1 and after 6 months of age. Results Out of 1224 pregnant women, 105 (8.6%; 95% confidence interval, 7.05-10.17) were positive for HCV antibody. Only 83 (6.8%; 5.39-7.21) were positive for HCV-RNA. HCV infection was associated with older age (1.16; 1.1-1.2, P = 0.001), blood transfusion (2.69; 1.2-6.0, P = 0.016), and HCV infection of the husband (5.47; 1.4-21, P = 0.014) or other household members (2.29; 1.2-4.6, P = 0.019). Out of 53 infants tested at first month, 43 (81%; 71-92%) were positive for HCV antibody, but only 7 (13%; 4.1-22%) were positive for HCV-RNA. After 6 months, only 2 (3.8%; 0-8.95%) remained positive for HCV RNA. Conclusions The prevalence of HCV in pregnant women in Egypt is lower than previously reported and the potential risk factors associated with HCV infection suggest intra-familial transmission. The frequency of vertical transmission of HCV in Egypt is not substantially different from other countries and does not play a role in the high prevalence of HCV in Egypt.

Novel strategies for early detection of breast cancer, the most common and second most lethal cancer in women, are urgently needed. Silencing tumor suppressor genes via DNA methylation has established hypermethylation as one of the most frequent molecular alterations that may initiate and drive many types of human neoplasia including breast cancer. Detecting such epigenetic changes in DNA derived not only from tumor tissue, but also from bodily fluids, may be a promising target for the molecular analysis of cancer. In this study we examined serum, a readily accessible bodily fluid known to contain neoplastie DNA, from individuals with breast carcinoma. Using sensitive methylation-specific polymerase chain reaction, we searched for aberrant promoter hypermethylation of two normally nonmethylated genes: RAS association domain family member 1A (RASSF1A) and death-associated protein kinase 1 (DAPK1) in 26 patients with breast cancer, 16 patients with benign breast diseases, and 12 age-matched healthy controls. Hypermethylation of at least one gene was detected in 25/26 (96%) cancer patients, in 7/16 (43%) cases with benign breast diseases, and only 1/12 (8%) control subjects. Furthermore, methylation of both genes was found to be associated with ductal type of breast carcinoma. RASSF1A was hypermethylated in 18/26 cases (69%) and DAPK1 in 23/26 (88%). However, DAPK I promoter methylation was more pronounced, as 12/23 DAPK1 methylated cases (52%) were strongly methylated (>75%) compared to the weaker methylation of RASSF1A (none of the cases with methylation at the level of > 75%). These findings, if confirmed in studies of extended cohorts, may lead to useful clinical application in early diagnosis of breast cancer and better management of the neoplastic disease. (C) 2010 Elsevier Inc. All rights reserved.

PURPOSE: To evaluate the outcomes of implantation of an accommodating intraocular lens (IOL) in pseudophakic presbyopic eyes. SETTING: Ophthalmology Department, Benha Medical School, Benha, Egypt. METHODS: In this prospective controlled trial, near and distance visual acuities, the manifest refraction spherical equivalent, and patient satisfaction were evaluated in presbyopic eyes that had phacoemulsification cataract removal and implantation of a Crystalens AT-45 IOL accommodating IOL. The difference between preoperative and postoperative mean values was compared using the Student t and paired-sample t tests. Comparison between postoperative follow-up visits was by analysis of variance. RESULTS: The study comprised 25 eyes (23 patients; 13 men). The mean IOL power was 21.80 diopters (D) +/- 1.45 (SD) (range 19.00 to 24.00 D). At 6 months, 23 eyes (92%) had an uncorrected distance visual acuity (UDVA) of 6/12 or better; all eyes had a corrected distance visual acuity (CDVA) of 6/12 or better (P = .000). The difference in CDVA and UDVA between 1 month and 6 months postoperatively was not statistically significant. The mean distance-corrected near visual acuity (DCNVA) was J5 at 1 month and 6 months; from 1 month on, the DCNVA was J3 or better in more than 60% of eyes. There was a statistically significant difference in DCNVA between preoperatively and 6 months postoperatively (P = .021). CONCLUSIONS: Initial experience indicates that the accommodating IOL provides functional near and distance visual acuity for daily tasks. Surgeon experience and refinement of IOL calculations are required to improve outcomes.

This study was designed to compare the intra-operative and post-operative analgesic requirements and side effects of using fentanyl infusion versus remifentanil infusion during short-duration surgical procedures in children. The study comprised of 40 children randomly allocated into two equal groups: fentanyl (F-group) or remifentanil (R-group). Both were administered a continuous intravenous (i.v.) infusion. Anaesthetic recovery was assessed using the Brussels sedation scale every 5 min from the time of entry till discharge from recovery room. Post-operative analgesia was assessed throughout the first three post-operative (PO) hours using observational pain-discomfort scale (OPS) and adverse events were recorded. Haemodynamic variables showed a non-significant difference between both the groups. Patients who received remifentanil showed significantly shorter time to spontaneous respiration, eye opening, extubation and verbalization compared to those who received fentanyl. Discharge time was significantly shorter in R-group, and 18 patients fulfilled criteria for recovery-room discharge at ≤25 min with a significant difference in favour of remifentanil. Fentanyl provided significantly better PO analgesia than remifentanil and children in F-group showed a significantly lower mean cumulative OPS record than those in R-group; however, the number of patients requiring rescue analgesia did not show a significant difference between both the groups. Two cases in F-group and one in R-group had bradycardia, one case in R-group had mild hypotension and PO vomiting had occurred in three patients in the F-group and two patients in the R-group. In conclusion, remifentanil is appropriate for opioid-based anaesthesia for paediatric patients as it provides haemodynamic stability and rapid recovery with minimal post-operative side effects.

The objective of this study was to test the use of letrozole in combination with follicle-stimulating hormone (FSH) vs clomiphene citrate (CC) with FSH for ovarian hyperstimulation prior to intrauterine insemination (IUI). A prospective randomised trial in which 280 women with unexplained infertility were randomised to 100 mg of CC (141 patients, 219 cycles) or 5 mg of letrozole daily (139 patients, 215 cycles) for 5 days starting on day 3 of menses both combined with gonadotropins for ovarian stimulation prior to IUI. The primary outcome measures were the number of growing and mature follicles, the concentrations of serum E2 (pg/ml) and progesterone (ng/ml), and the endometrial thickness (mm). The secondary outcome measure was the occurrence of pregnancy and miscarriage. The total number of follicles was significantly greater in the CC group (4.1 +/- 0.46 vs 2.6 +/- 0.43). There was no significant difference in endometrial thickness between the two groups. Pregnancy occurred in 33 out of 139 patients (215 cycles) in the letrozole group (23.7% and 15.3%, respectively) and 37 out of 141 patients (219 cycles) (26.2% and 16.8%, respectively) in the CC group; the differences were not statistically significant. The allied use of either CC or letrozole, during ovarian stimulation to reduce the dose of gonadotropins prior to IUI is justified. This approach will reduce the cost of stimulation protocols without effect on the treatment outcome and letrozole has no advantage over CC in this respect.

Telomerase is a ribonucleoprotein enzyme capable of extending chromosome ends with telomeric DNA sequences. It protects the germline and stem cells from senescence by preventing telomere attrition. Cutaneous aging includes intrinsic aging, and photo-aging. Telomere-associated cellular senescence contributes to certain age-related cutaneous disorders, including increased cancer incidence. Premature skin aging in xeroderma pigmentosa (XP) is expected to show increased telomere attrition. We aimed to study human telomerase reverse transcriptase (hTERT) expression in normal, aged and photo-aged skin and to investigate its possible role in the pathogenesis of aging and photo-aging. Methods hTERT expression using immunohistochemistry was studied in 75 subjects comprising four groups: group I, 10 subjects with aged skin; group II, 20 subjects with photo-aging; group III, Five patients with XP; and group IV, 40 subjects comprising the control groups. Results We found positive hTERT in normal skin and in the basal and sometimes in supra-basal layers. We reported positive hTERT expression in dermal fibroblasts, histiocytes, and skin appendages (other than hair follicles) in some cases from all the studied groups. Photo-aged and prematurely photo-aged skin showed greater hTERT expression than young and aged skin. Conclusion Telomeres rather than telomerase are involved in cellular senescence. Yet, telomerase is intimately related to photo-aging in which lifetime cumulative sun exposure is an important factor. However, genetic damage in XP is the decisive factor and not merely ultraviolet exposure.

Aim: One of the main problems concerning repeated spontaneous miscarriage (RSM) is the etiological diagnosis. The relation of thrombophilia to RSM is a matter of debate. In this case-control study, we determined the percentages of three thrombophilic mutations (factor V leiden, prothrombin, and methylenetetrahydrofolate reductase) amongst 20 cases with RSM and 20 control normal parous women. Results: There were high statistically significant increases in the number of cases with factor V, prothrombin, and methylenetetrahydrofolate reductase gene mutations compared with normal control and the percentage of multiple gene mutations was higher than single gene mutation. Conclusion: The prevalence of thrombophilic mutations is higher in cases of RSM than control.

Introduction: This was a prospective, randomized clinical trial to compare the safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation versus standard transurethral resection of the prostate (TURP) for the surgical treatment of patients with bladder outlet obstruction due to benign prosta tic hyperplasia (BPH). The patients had prostates that were greater than 30 g and less than 100 g and were followed for 1 year. Patients and methods: From April 2008 to December 2009, 80 consecutive patients with lower urinary tract obstruction (LUTS) due to BPH were randomized to either surgical treatment with HoLEP (group 1, n = 40) or standard TURP (group 2, n = 40). Preoperative assessments included American Urological Association (AUA) symptom score, serum prostate-specific antigen (PSA), post-voiding residual (PVR) urine volume, transrectal ultrasound (TRUS), and urodynamic studies. Perioperative parameters included total operating time, resected tissue weight, hemoglobin loss, presence or absence of blood transfusion, time of catheter removal, and duration of hospital stay. Postoperative evaluations were conducted at 1, 6, and 12 months. Results: Patients in the HoLEP group had shorter catheterization times and hospital stays than patients in the TURP group. There was no significant difference in operating times between the two groups. Mean hemoglobin loss was lower in the HoLEP group (1.8 1.3 g/dL versus 2.9 +/- 1.5 g/dL). There was a significantly greater improvement from baseline AUA symptom scores and PVR urine volumes in the HoLEP group versus the TURP group, at all postoperative assessments. Postoperatively, 25% of patients in group 1 (HoLEP) and 20% of patients in group 2 (TURP) had irritative voiding symptoms. Urethral stricture occurred in three cases (one case in the HoLEP group and two cases in the TURP group). Conclusion: HoLEP proved to be a safe and highly effective technique for surgical treatment of bladder outlet obstruction due to BPH.

AIM: To examine p27 (Kip 1) and MUC1 expression in specimens of papillary transitional cell carcinoma (PTCC) of the urinary bladder and to correlate their expression with the tumor grades,stages and outcome. PATIENTS AND METHODS: Paraffin sections from previously diagnosed PTCC bladder were graded, staged and the patients were followed up for 5 years. Ten non-neoplastic urological lesions diagnosed as polypoid cystitis were taken as control. Three sections of 4 um thickness were obtained from every case. One was hematoxylin and eosin (H and E) stained for diagnosis, reviewing and confirmation. The other two sections were immunohistochemically stained for both p27and MUC1. The data of immunohistochemical results were correlated with the following conventional prognostic variables: tumor grade, stage, distant metastasis and 5 year survival. RESULTS: The results showed a highly significant and an insignificant relationship between p27 expression and tumor grade and stage (P0.05), respectively. Correlating p27 expression with distant metastasis and overall survival showed a significant relationship with distant metastasis (P

Objective The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction (FSD) in Lower Egypt. Design A cross-sectional clinic-/hospital-based survey. Setting Five district medical centres in Dakahlia Governorate: Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura City. Population One thousand married women aged between 16 and 49 years. Methods Data were collected by personal interview in a questionnaire format in addition to physical examination (when allowed). Main outcome measures FSD and associated risk factors. Results The response rate was 93.6%. 68.9% of women had one or more sexual problems; however, 23% of the women with sexual problems were not distressed by these issues. 31.5% of women suffered from dyspareunia. 49.6% of the women had decreased sexual desire, 36% had difficult arousal and 16.9% had anorgasmia (primary and secondary). Marital disharmony, 'hate' and unfavourable socio-economic circumstances were the most common aggravating factors (28.1%) for sexual dysfunction among the participants, followed by pregnancy-related events (15.7%). Most women (84.5%) received no help for their sexual problems. 90.3% of the women were circumcised. Only 7.1% (46 of 645) of women with sexual problems had received treatment, with no real improvement reported in 58.7% (27 of the 46 women). Conclusion FSD is a highly prevalent problem within the scope of this study. Low reporting rates and very low treatment rates were identified in the sample from Lower Egypt.

Background. Arthritis is a common condition that co-exists in the elderly population. This condition leads to frequent administration of comorbid analgesics especially non steroidal anti-inflammatory drugs (NSAIDs). Aim. To study cardiorenal toxicity of celecoxib versus ibuprofen in arthritic patients. Subjects and Methods. Seven hundred ninety-wo arthritic patients were enrolled in the study for 6 months. Three hundred ninety-six patients administered celecoxib 400mg twice a day; 396 patients administered ibuprofen 300mg three times a day. Effects measured included investigator-reported hypertension, edema, or congestive heart failure, increases in serum creatinine or reduction in serum creatinine clearance, and changes in serum electrolytes. Results. Celecoxib was associated with significant (P < .05) lower incidence of hypertension and edema in comparison with ibuprofen. Systolic hypertension occurred significantly less (P < .05) with celecoxib compared with ibuprofen. Serum creatinine was significantly increased (P < .05) in patients treated with ibuprofen in comparison with celecoxib. Creatinine clearance was significantly lower (P < .05) in cases treated with ibuprofen in comparison to celecoxib. Nonsignificant changes in serum body electrolytes occurred. Conclusion. The most important finding of this study was the lowering incidence of cardiorenal toxicity of celecoxib in comparison with ibuprofen.

To evaluate uterine artery Doppler flow resistance and plasma adrenomedullin levels in women with unexplained recurrent pregnancy loss (RPL) compared to controls. Material & Methods: Eighty-three women, who attend the department of Obstetrics and Gynecology, Benha University, Egypt, participated in this study (RPL group: n = 40, and control group: n = 43). Uterine artery Doppler and plasma adrenomedullin (AM) (pg/mL) levels were measured for all women in the mid-luteal phase of a non-pregnant cycle. Results: Both uterine artery pulsatility index (PI) and AM levels were significantly higher in RPL group compared to controls (2.71 +/- 0.259 vs 2.06 +/- 0.194 for PI and 287.5 +/- 80.4 pg/mL vs 156.1 +/- 39.8 pg/mL for AM, P < 0.01). Uterine artery PI had a significant positive correlation with plasma AM levels both in the RPL group (r = 0.645, P < 0.001) and in the control group (r = 0.384, P = 0.011). Number of previous miscarriages in RPL group was significantly correlated with both uterine artery PI (r = 0.838, P = 0.015) and plasma AM levels (r = 0.509, P = 0.001). Conclusions: Uterine artery PI may be useful in identifying women with unexplained RPL who have impaired uterine circulation. Plasma AM may serve as a biochemical marker for RPL caused by impaired uterine perfusion.

Injudicious reaming of the tibial shaft can lead to extreme local hyperthermia, which in turn can result in the rare but catastrophic complication of segmental bone and soft tissue necrosis (osteocutaneous thermal necrosis). This is a retrospective study showing osteocutaneous thermal necrosis occurring after tibial intramedullary reaming salvaged by Ilizarov reconstruction in seven patients from the collective experience of four limb reconstruction centres. All patients were males, with an average age of 51.8 years (range, 30-70 years), who had undergone intramedullary reaming during the treatment of closed tibial fractures. In all patients, circumferential bone and variable contiguous soft tissue necrosis developed a few days after reaming. Bone and soft tissue reconstruction was subsequently performed using a circular external fixator (Ilizarov apparatus or Taylor spatial frame) a mean of four months after injury in six patients; in one case, reconstruction was undertaken four years after the original injury. Two complications (secondary tissue breakdown at a bone transport site; premature consolidation) necessitated cessation of bone transport at one of two bone transport levels in two patients. All patients eventually healed with a good functional result after an average of 11.5 months in the fixator (range, 10-13 months).

PURPOSE: To assess the safety and efficacy of laser-assisted in situ keratomileusis (LASIK) in facilitating strabismus management in noncompliant children with fully accommodative esotropia. SETTING: Ebsar Eye Center, Benha University (Benha, Egypt). METHODS: The study comprised 20 eyes of ten consecutive patients with accommodative esotropia. All patients were noncompliant with glasses and had refractive stability. They received brief general anesthesia and had bilateral LASIK using Wavelight Algretto Wave Eye-Q Excimer Laser (Alcon, Inc, Hunenberg, Switzerland) to fully correct their hyperopic refractive errors aiming to achieve orthophoria. Preoperative and postoperative best corrected visual acuity, cycloplegic refraction, angle of squint, and any LASIK complications were recorded. Follow-up period was 9 months. RESULTS: The age of patients ranged 5.1-9.2 years and the hyperopic error range was +3.5 D to +6.75 D, with anisometropia 2 D or less. No patient had decreased best corrected visual acuity or loss of fusion ability. The postoperative refractive error ranged from -0.75 D to +1.5 D at the end of the study period. All patients achieved orthophoria. No significant intraoperative or postoperative complications were recorded. CONCLUSION: LASIK appears to be effective and relatively safe to treat accommodative esotropic children by reducing their hyperopic refractive error, however, patient selection is critical. Larger studies with longer follow-up are necessary to determine its long-term effects.

BACKGROUND: The aim of this work was to study the ultrasonographic (USG) features of knee joints in relation to clinical and laboratory measures in patients with juvenile rheumatoid arthritis (JRA), and also to evaluate the accuracy of ultrasound in the diagnosis of local joint activity. METHODS: This study included 20 with JRA and 20 matched and apparently healthy controls. All patients were subjected to full history taking, careful clinical examination and laboratory investigation. The knee joints of all patients and control were examined with plain radiography and ultrasonography on the same day of clinical examination using ultrasound to detect synovial thickness and effusion at the knee. RESULTS: Mean USG knee synovial thickness was significantly greater in JRA patients versus controls (4.2 ± 2.4 mm versus 1.7 ± 0.3 mm, P < 0.001). Although knee effusion was not detected in any of the controls, it was demonstrated in 90% of JRA patients, with a mean effusion volume of 3.8 ± 3.1 mL. There was a statistically significant difference (P < 0.001) between clinically active and inactive knees with regard to knee synovial thickness. Mean knee effusion volume was significantly (P < 0.05) higher in the clinically active than in the clinically inactive knees. Patients with high disease activity had a significantly (P < 0.05) higher knee synovial thickness and knee effusion volume than patients with low and moderate disease activity. Significantly (P < 0.05) positive correlations were found between knee synovial thickness and articular index (AI) scores, disease activity score, clinical knee scores, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Significant positive correlations (P < 0.05) were found between knee effusion volume and AI scores, visual analog scores, disease activity scores, clinical knee scores, ESR, and CRP levels. Significant negative correlations (P < 0.05) were found between knee effusion volumes and hemoglobin levels. CONCLUSION: UGS-detected parameters represent a reliable index of JRA disease activity with a higher sensitivity for knee synovial thickness and higher specificity for knee effusion.

It is well known that erythropoietin (EPO) ameliorates the renal injury induced by ischemia or toxins such as cisplatin and radiocontrast media. Also, epidermal growth factor (EGF) exerts a prophylactic nephroprotective effect against the deleterious consequences of the ischemia/reperfusion (I/R) injury. Nevertheless, the combined effect of both drugs remains to be further investigated. This study examined the protective effects of EPO and EGF alone and in combination against renal I/R injury and showed that EPO alone was more powerful than EGF alone and the combination of both drugs was more protective than each agent alone. OBJECTIVE To investigate effects of combination of erythropoietin (EPO) and epidermal growth factor (EGF) on renal ischaemia and on reactive oxygen species in a rat model. MATERIALS AND METHODS In all, 90 male Sprague-Dawley rats were allocated into five groups of 18, designated: Sham; treated with right nephrectomy only; Control, subjected to left renal ischaemia for 45 min with no treatment; EPO-treated, as the control but with EPO pretreatment; EGF-treated, as the control but with EGF pretreatment; EPO + EGF-treated, as the control but with EPO and EGF pretreatment. Renal function, histopathology and malondialdehyde (MDA), superoxide dismutase (SOD) and reduced glutathione (GSH) levels in kidneys were assessed at 1, 2 and 7 days after ischaemia. RESULTS All rats except the controls had a significant improvement in serum creatinine, creatinine clearance and fractional excretion of Na+; all three were significantly better in EPO + EGF group than in all other groups Histopathological examination showed marked structural damage in control rats. The tubular damage was least in the EPO + EGF group. The control group had a significant increase in MDA level and a significant decrease in SOD and GSH, while the EPO + EGF group had a marked significant reduction in MDA and increase in GSH and SOD. CONCLUSION The protection against ischaemia/reperfusion injury might be maximal when EPO and EGF are administered concomitantly, and their protective effect might be partly due to their antioxidant effects.

Background/Aims: We evaluated whether surrogate serum biomarkers for liver injury are comparable to liver biopsy in Egyptian patients with hepatitis C virus (HCV) infection. Subjects: Two hundred and twenty Egyptian patients, 91% infected with genotype-4 HCV, undergoing liver biopsy during evaluation for interferon/ribavirin therapy. Methods: Liver biopsy scored by the Ishak method was compared to biochemical tests, platelet count and two fibrosis biomarkers: hyaluronic acid (HA) and YKL-40. Univariate and logistic regression analyses determined independent predictors of fibrotic, inflammatory, and fatty changes. Biomarkers were evaluated for ability to differentiate between severe fibrosis/cirrhosis and no/mild fibrosis. Results: Although increasing age, HA, YKL-40, AST, reduced platelet count, and AST and HA/platelet count ratios were associated with fibrosis by univariate analysis, the other variables were not significant after controlling for HA (p = 0.0001) and age (p = 0.004). Although age and some biomarkers were associated with inflammation, none remained significant after controlling for fibrosis. YKL-40 (p = 0.04) and aspartate aminotransferase (p = 0.05) remained associated with steatosis after controlling for fibrosis. Conclusions: In Egyptians with chronic HCV, young patients with low levels of HA are at very low risk of fibrosis. This can limit the number of liver biopsies to those whose clinical findings conflict with the biomarker results. (c) 2007 European Association for the Study of the Liver. Published by Elsevier B.V.

Background: Orthotopic liver transplantation (OLT) is regarded as the only choice for treatment of patients with end stage liver disease (ESLD) and liver failure. Outcome for those patients is much better after liver transplantation resulting in reasonably good quality of life, provided complications are detected and treated promptly. Evaluation of needle liver graft biopsies and extensive clinicopathological correlation play an important role in the determination of liver allograft dysfunction after transplantation. Objective: To evaluate possible post-transplant outcome of patients underwent OLT. Methods: We analyzed 80 patients with liver cirrhosis who underwent deceased donor liver transplantation (DDLT) over a 10-year period in a cohort and observational study. The study was performed from June 2000 to June 2010 and included 75 men and 5 women. Results: Among all patients; origin of cirrhosis was post-viral in 76 patients, brimary biliary cirrhosis (PBC) in 2 cases, autoimmune hepatitis (AIH) in one case and cryptogenic cirrhosis in another case. The cases of post-viral cirrhosis were all of viral C etiology with 20 cases associated with hepatocellular carcinoma and 2 associated with hepatitis B viral infection. The patients are followed up for at least 18 months after enrolling in the study. They all had routine tests at the start of the study used as baseline for each patient. These tests are repeated according to the requirements of the individual patient. All patients had Tacrolimus (FK 506) as an immunosuppressive agent. Patients with hepatitis B viral infection had hepatitis B immunoglobulin, along with Lamivudine for relapse prophylaxis. Out of 80 patients, postoperative liver biopsy was performed, at least once, for 73 patients. The results of the biopsies revealed that recurrent HCV was detected in 46 (63.01%) cases, acute rejection in 14 (19.18%) cases, chronic rejection in 4 (5.48%) cases, cirrhosis in 2 (2.74%) cases, fibrosing cholestatic hepatitis in 2 (2.74%) cases, chronic active hepatitis with cholangitis and bile duct obstruction in 2 (2.74%) cases, recurrent primary biliary cirrhosis in 2 (2.74%) cases and one case (1.37%) with acquired schistosoma japonicum. A total of 24 (30%) patients died during follow up. Conclusion: The results of liver graft biopsies revealed that recurrent HCV is the prominent cause of organ dysfunction. Meanwhile; organ rejection was less frequently encountered. The complications of liver transplantation can be controlled and managed if diagnosed promptly and treated early. [Zeinab Kamar, Medhat El-Sahhar, Hala Agena, Nehal A. Radwan and Charles Nelson. Liver Transplantation: An Experience in Post-Operative Follow Up Of 80 Patients. Life Science Journal 2011;8(4):1088-1096]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 135

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common human malignancies and its impact on mortality is significant and well documented. Biomarkers have been developed for early HCC detection, with serum a-fetoprotein (S.AFP) being the most widely used clinically, but with relatively low diagnostic sensitivity. Therefore new biomarkers are needed for early HCC detection to improve overall-survival rates. METHODS: Blood RASSF1A promoter methylation was evaluated using methylation specific PCR in patients with chronic liver diseases together with its potential use as a biomarker for detecting HCC in comparison to or in association with S.AFP. RESULTS: Blood RASSF1A promoter methylation was detected in 70% of HCC patients on top of hepatitis C virus-associated liver cirrhosis, 28.5% of hepatitis C virus-associated liver patients and 16.6% of bilharzial liver fibrosis patients. However none of the healthy control subjects showed blood RASSF1A promoter methylation. The sensitivity, specificity, PPV and NPP of blood RASSF1A promoter methylation for HCC diagnosis were 70%, 83.3%, 73.7% and 80.6% respectively. On the other hand the sensitivity, specificity, PPV and NPP of S.AFP with a cut off value of 33.6 for HCC diagnosis were 85%, 80%, 88.9% and 90.7% respectively. Moreover it was found that the combined use of RASSF1A promoter methylation status and S.AFP is better than S.AFP use alone in HCC prediction. CONCLUSION: RASSF1A promoter methylation plays an important role in the process of human hepatocarcinogenesis and is related to hepatic inflammation due to bilharziasis and viral hepatitis. Moreover it can be considered as an important biomarker for the diagnosis of HCC when combined with S.AFP. [Naglaa Ibrahim Azab, Heba Mohamed Abd El Kariem, Tawheed Mowafi, Hanan F. Fouad, Awad M. El Abd. Blood Ras-Association Domain Family 1 A Gene Methylation Status In some Liver Diseases. Life Science Journal. 2011; 8(2): 531-539(ISSN: 1097-8135). http://www.lifesciencesite.com.

Liver biopsy is currently the gold standard for assessing liver fibrosis and non reliable non invasive approach is available, therefore a suitable serologic Biomarker is needed. Several biochemical markers have shown promise for the detection of advanced fibrosis and cirrhosis. The aim of the present work is to study the diagnostic value of serum hyaluronic acid (SHA) and matrix metalloproteinase-2 (MMP-2) as indicators for the stage of hepatic fibrosis, and to correlate the liver pathology and liver function tests with serum fibrosis markers. Eighty treatment naive patients with chronic hepatitis C [CHC] with or without HBV and forty healthy subjects are used as a control group. The patients were divided according to Metavir classification of liver biopsy into 3 groups. Group 1 with normal biopsy (17 patients), group 2 was 35 patients with mild fibrotic changes (stage 1-2) and group 3 of 28 patients with severe fibrosis (stage 3-4). SHA level was significantly higher in patients with severe fibrosis than patients with mild or no hepatic fibrosis. (378.7 +/- 147.5, 226.2 +/- 123.7 and 85.3 +/- 52.2 pg/ml). (P

Triclocarban (TCC; 3,4,4'-trichlorocarbanilide) is an antimicrobial agent used widely in various personal hygiene products including soaps. Recently, TCC has been shown to enhance testosterone-induced effects in vitro and to enlarge accessory sex organs in castrated male rats. This study was designed to evaluate the effects of TCC on intact age-matched male rats and on human prostate LNCaP and C4-2B cells. Seven-week-old male Sprague-Dawley rats received either a normal diet or a diet supplemented with TCC (0.25% in diet) for 10 days. Triclocarban induced hyperplasia of accessory sex organs in the absence of significant qualitative histological changes. Serum luteinizing hormone (LH) and testosterone were not significantly altered by TCC treatment. In prostate cancer-derived LNCaP and C4-2B cells, TCC potentiated androgen actions via androgen receptor-dependent actions. In conclusion, TCC significantly affects intact male reproductive organs and potentiates androgen effects in prostate cancer cells.

The sural nerve is the most commonly nerve used in nerve transplantation, and so the aim of this study was to determine the variations of the sural nerve in the back of the leg, its relations to the calcaneal tendon and lateral malleolus, and determine the patterns of its distribution on the dorsum of the foot. Twenty-four Egyptian legs and feet were dissected. The results showed that the sural communicating nerve connected with the sural nerve in 87.5%. The predominant site of union between these two nerves was in the lower one-third of the leg and ankle region (62%). There was only one right leg that the sural nerve passed through the gastrocnemius. The small saphenous vein passed along the medial side of the sural nerve in 100%. The sural nerve crossed the lateral border of the calcaneal tendon in 50%. The distance between the sural nerve and insertion of calcaneal tendon was 16 + 7 mm in 91.7%. There were four types of pattern of innervation of the toes by the sural nerve. The predominant pattern was type I (45.8%), where the lateral side of the little toe was supplied by the sural nerve alone. The second pattern was type IV (29.2%), where the lateral 2 1/2 toes were supplied by the sural nerve alone. These findings are important for sural nerve biopsy and grafts, surgical repair of the calcaneal tendon, and regional anesthesia of the foot. Clin. Anat. 24:237-245, 2011. (C) 2010 Wiley-Liss, Inc.

Objective: To assess and compare the results of trifocal (two-level bone lengthening with compression at the nonunion site) and bifocal (one-level bone lengthening with compression at the nonunion site) bone transport using the Taylor Spatial Frame (TSF; Smith and Nephew, Inc, Memphis, TN) for postinfectious segmental tibial bone defects. Design: Retrospective study of 12 patients with atrophic tibial nonunions. These patients were treated with resection of the nonunion followed by bone transport using the TSF for the segmental tibial bone defects. All patients were treated by the same surgeon (F.S.). Setting: Level I trauma center. Patients/Participants: Twelve consecutive patients treated for postinfectious segmental tibial bone defects between November 2004 and September 2007. Intervention: All patients were treated using the TSF for a trifocal or bifocal technique of bone transport along with associated soft tissue reconstructive surgeries. All patients were additionally treated with 45 days of culture-specific antibiotics. Outcome Measurement: All patients were evaluated by the guidelines of the Association for the Study of the Method of Ilizarov. Results and Conclusion: All patients achieved complete union and eradication of infection. The results were evaluated according to Association for the Study of the Method of Ilizarov criteria: 83% were excellent and 17% were good in terms of bony outcomes; functional results were excellent in 50%, good in 42%, and fair in 8%. Combined Ilizarov/TSF trifocal and bifocal techniques for the treatment of segmental tibial bone defects achieve union without malalignment of the mechanical axis.

Aim. The aim of this study was to evaluate seminal plasma (SP) malonaldehyde (MDA), superoxide desmutase (SOD) and CoQ10 levels in infertile men with and without varicocele as a trial to evaluate the predictability of their preoperative estimation for postoperative (PO) improvement of seminal parameters. Methods. Seventy infertile men; with (N.=35) and without (N.=35) and 20 fertile men with (N.=10) and without (N.=10) clinically and ultrasonographically diagnosed varicocele. Infertile men with varicocele were assigned to undergo bilateral varicocelectomy using subinguinal approach. All infertile patients had preoperative hormonal profile. Semen samples were obtained from all men for standard semen analysis and SP estimation of CoQ10 using high-performance liquid chromatography (HPLC), SP MDA using a thiobarbituric acid reactive substances (TBARS) assay and SP SOD activity by chemiluminescence. Another semen sample was obtained PO for standard semen analysis. Results. Baseline data showed a significant decrease of sperm concentration and percentage of sperms with rapid progressive motility with significantly higher percentage of sperms with abnormal morphology and significantly lower SP CoQ10 and SOD levels with significantly higher SP MDA levels in infertile men compared to fertile men with significant difference among infertile men in favor of those free of varicocele. In all infertile men, there was negative significant correlation between SP MDA and CoQ10 levels and a positive significant correlation between SP SOD and CoQ10 levels with higher significance in those had varicocele. In infertile men free of varicocele, there was a negative correlation between sperm count and SP MDA with a positive significant correlation with SP SOD levels, while in infertile men with varicocele, the correlation was significant between SP SOD and the three seminal parameters and between the percentage of abnormal sperm forms and SP MDA and CoQ10. PO sperm count showed a negative significant correlation with preoperative SP MDA levels, while the correlation was positive significant with SP CoQ10 and SP SOD levels. Regression analysis identified high preoperative SP SOD level as significant predictor of improvement of sperm count after varicocelectomy. ROC curve analysis defined preoperative SOD level at >= 88 U/mL as a specific predictor for PO improvement of sperm count, while identified preoperative SP MDA level at >= 0.53 nmol/mL and SP CoQ10 at cut-off point of 0.12 mu g/mL could identify infertile men with varicocele most probably will not get benefit of varicocelectomy. Conclusion. Combined varicocele and disturbed oxidant/antioxidant system could be the underlying mechanism for varicocele associated male infertility and highly disturbed oxidant/antioxidant system could influence the outcome of varicocelectomy as a therapeutic modality. Preoperative estimation of SP levels of MDA and SOD could aid to predict the outcome of varicocelectomy.

Differentiation between E. histolytica and non pathogenic species as Entamoeba dispar, which are morphologically identical species, is essential for rapid treatment decision, precaution of the invasive disease and public health. This study evaluated the real time PCR for detection of intestinal amoebiasis in comparison with microscopic examination. Stool samples were obtained from symptomatic 40 patients from outpatient clinic of Benha University Hospitals and Benha Educational Hospital. Twenty suffered from dysentery and 20 cases were not suffering dysentery. In addition 10 stool samples of other parasitic infection as Giardia lamblia and Cryptospordium parvum were examined by direct smear, iodine stained smear, formol ether concentration technique and real time PCR for detection of E. histolytica DNA. Formol ether concentration technique showed that 20 (40%) samples were positive for E. histolytica but real time PCR showed 26 (52%) positivity. All samples positive by microscopy were also positive by PCR and additional 6 PCR positive cases. There was no cross reaction with other parasites as G. lamblia and C. parvum.

Objectives: To determine the level of serum procalcitonin, blood leukocyte count (TLC) and C-reactive protein (CRP) in children with bacterial and non bacterial meningitis and document their efficacy in differential diagnosis. Also described are procalcitonin levels variation during treatment. Methods: From March 2005 to February 2008, we evaluated 38 clinically suspected meningitis patients in the paediatric departments, Al-Jedaany Hospital, Jeddah, KSA, for Serum procalcitonin, CRP, TLC and Lumbar punctures and CSF analysis. Patients were classified into bacterial meningitis group 1 (18) and non bacterial meningitis group 11(20). Results: Serum PCT levels were significantly higher in bacterial meningitis (BM) {mean 4.8 +/- 3.85 ng/ml (2.9-11.6)} compared with non bacterial meningitis (NBM) {mean 0.38 +/- 0.25ng/ml(0.31-0.61)} {P < 0.001}. Mean of all CSF parameters, TLC {15,000 +/- 2,900 cell/ml(BM) & 9,500 +/- 1,105 cell/ml(NBM)}and CRP {20 +/- 6.8 mg/l(BM) & 12.5 +/- 12.0 mg/l(NBM)}showed a zone of overlapping between the two groups. There is a positive correlation between serum PCT, TLC and CRP in bacterial and non bacterial meningitis cases but this relation becomes highly significant with bacterial meningitis positive group. Day 3 and day 6 treatment serum PCT was less than on admission levels (P < 0.001). Conclusion: PCT can be used in the early diagnosis of bacterial meningitis and may be a useful adjunct in differentiating bacterial and non bacterial meningitis than CRP or TLC and diminishing the value of lumbar puncture performed 48-72 hours after admission to assess treatment efficacy.

Purpose: To evaluate the effects of intervals between preoperative intravitreal injection of bevacizumab (IVB) and surgery on the components of removed diabetic fibrovascular proliferative membranes. Design: Interventional, consecutive, prospective, comparative case series. Participants: A total of 52 eyes of 49 patients with active diabetic fibrovascular proliferation with complications necessitating vitrectomy. Methods: Participant eyes that had IVB were divided into 8 groups in which vitreoretinal surgery was performed at days 1, 3, 5, 7, 10, 15, 20, and 30 postinjection. A group of eyes with the same diagnosis and surgical intervention without IVB injection was used for comparison. In all eyes, proliferative membrane specimens obtained during vitrectomy were sent for histopathologic examination using hematoxylin-eosin stain, immunohistochemistry (CD34 and smooth muscle actin), and Masson's trichrome stain. Main Outcome Measures: Comparative analysis of different components of the fibrovascular proliferation (CD34, smooth muscle actin, and collagen) among the study groups. Results: Pan-endothelial marker CD34 expression levels starting from day 5 postinjection were significantly less than in the control group (P < 0.001), with minimum expression (1+) in all specimens removed at or after day 30 postinjection. Positive staining for smooth muscle actin was barely detected in the control eyes at day 1, and consistently intense at day 15 and beyond (P < 0.001). The expression level of trichrome staining was significantly high at day 10, compared with control eyes (P < 0.001), and continued to increase at subsequent surgical time points. Conclusions: A profibrotic switch was observed in diabetic fibrovascular proliferation after IVB, and our results suggest that at approximately 10 days post-IVB the vascular component of proliferation is markedly reduced, whereas the contractile components (smooth muscle actin and collagen) are not yet abundant.

Objective: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. Methods: Randomly selected (264) newly married women were the subjects of this work. Results: Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P < 0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's unsatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P < 0.001). Conclusion: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth. (c) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd

Objective: To evaluate the effect of laparoscopic ovarian drilling (LOD) on plasma levels of anti-Mullerian hormone (AMH) and ovarian stromal blood flow changes, by using three-dimensional power Doppler ultrasonography, in polycystic ovary syndrome (PCOS). Design: Prospective controlled study. Setting: Taiba hospital, Kuwait. Patient(s): Twenty-three anovulatory clomiphene citrate (CC)-resistant women with PCOS and 20 fertile women as a control group. Intervention(s): Laparoscopic ovarian drilling. Mean Outcome Measure(s): Serum levels of AMH, ovarian three-dimensional power Doppler indices (vascularization index, flow index, and vascularization flow index) and occurrence of ovulation or pregnancy. Result(s): Plasma AMH and power Doppler indices of ovarian stromal blood flow were significantly higher in the PCOS group than in the control group. Plasma AMH and ovarian stromal blood flow Doppler indices were significantly reduced in the PCOS group after LOD. Women who ovulated after LOD had a significantly lower preoperative AMH compared with the nonresponders. There was a significant positive correlation between AMH and power Doppler flow indices before and after LOD in PCOS group. Conclusion(s): Measuring AMH and ovarian stromal three-dimensional power Doppler blood flow for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of LOD. (Fertil Steril (R) 2011; 95: 2342-6. (C) 2011 by American Society for Reproductive Medicine.)

The authors have investigated the expression of the microcephalin (MCPH1) protein to evaluate its prognostic importance in breast cancer. Microcephalin is a damage response protein involved in the regulation of BRCA1 and BRCA2. BRCA1 mutations are often associated with basal-like breast cancer, which are also often negative for oestrogen receptor (ER), progesterone receptor (PR) and HER2. MCPH1 immunohistochemistry was performed on 319 breast cancers prepared as tissue microarray and correlated with pathology, survival, ER, PR, HER2, EGFR, CK5/6, CK14 and BRCA1 expression. After performing continuous data analysis, mean microcephalin expression decreased with increasing grade (P < 0.006). Mean microcephalin expression was lower in ER/PR negative (P < 0.001) and triple negative cancers (P < 0.004). Conversely, an association with HER2-positive cancers was also identified (P < 0.034). Reduced microcephalin also correlated with reduced nuclear BRCA1 staining (P < 0.001). No association was identified with basal markers. After dichotomising the data into low and high microcephalin expression, reduced expression was identified in 29% (93/319) of breast cancers. An association with low expression was identified in invasive ductal carcinomas with breast cancer-specific survival (BCSS) (P = 0.052). Multivariate analysis of ductal carcinomas showed that microcephalin, together with lymph node involvement and tumour size were independent predictors of BCSS (P = 0.037). Microcephalin expression is reduced in 29% of breast cancers, particularly in higher grade tumours and BRCA1-negative cases. Microcephalin is an independent predictor of BCSS in invasive ductal breast cancer patients and may prove to be a useful biomarker for the identification of aggressive breast cancers.

Aim. This study aimed to evaluate the diagnostic yield of estimation of serum cartilage oligomeric matrix protein (COMP) as a screening tool for osteoarthritis (OA) among patients with knee joint pain. Methods. The study included 140 female patients with knee pain and 20 volunteers to donate blood as a control group for laboratory findings. All patients underwent full history taking, clinical examination for evaluation of pain severity using a visual analogue scale (VAS) and extent of patient mobility using mobility score (MS) and had knee anteroposterior radiographs that were scored using the Kellgren-Lawrence scoring (K-L score) system. Patients were classified according to K-L scores into: group A: pain plus no radiographic findings (K-L score=1), group B: pain plus doubtful or minimal radiographic findings (K-L score=1) and group C: pain plus radiographically determined OA (K-L score >= 2). Venous blood samples were obtained from all patients and controls for erythrocyte sedimentation rate (ESR) determination and ELISA estimation of serum COMP and high-sensitivity C-reactive protein (hsCRP) levels. Results. Group C patients had significantly higher pain scores and lower MS compared to groups A and B. Mean patients' serum COMP levels was significantly higher compared to control levels and in group C compared both to controls and to groups B and A levels with significantly higher levels in group B compared to controls and group A. However, serum COMP levels were non-significantly higher levels in group A compared to control levels. There was a positive significant correlation between serum COMP levels and body mass index (BMI), pain VAS score and radiological grade and a negative significant correlation with MS. ROC curve analysis revealed that elevated serum COMP is a sensitive predictor and high BMI is a specific predictor for the presence of OA. Serum COMP at 1097.5 ng/ml was the best cutoff point with high sensitivity (87.7%), positive predictive value (PPV, 92.6%) and accuracy (84.3%) for differentiation between patient with and without OA radiological manifestations and serum COMP at 1290 ng/ml showed 100% specificity and PPV and accuracy rate of 65.7% for diagnosis of the presence of radiological findings of OA. Conclusion. Estimation of serum COMP level could be considered as screening modality for patients with knee pain and using cutoff point of 1097.5 ng/mL helps to define patients free of OA and cutoff of 1290 ng/ml could define patients with OA.

Articulated Distraction Gamal Ahmed Hosny Articular hip distraction can be applied either by using a monolateral articulated distractor or a circular fixator. The fixator should be aligned such that its axis is aligned with the transverse axis of the hip joint. Following distraction, the range of motion is maintained with regular physiotherapy. It is a useful salvage procedure in older children with hip stiffness, when other methods of containment are not applicable.

A total of 200 cases aged 10-30 years complaining of symptoms suggestive of giardiasis in addition to thirty cross matched normal individuals as a control group was examined clinically and laboratory using stool examination and detection of Giardia coproantigen in faeces by the Dot-ELISA. Stool examination detected 39 cases (19.5%) while Dot-ELISA detected 49 cases (24.5%) with 100% sensitivity and 93.8% specificity. The common clinical findings were diarrhea, abdominal cramps, anorexia, underweight, pallor and manifestations of vitamin deficiency.

Objective: To compare the effect of N-acetyl cysteine and metformin on hormonal profile (insulin and T) and ovulation rate in women with clomiphene citrate-resistant polycystic ovary syndrome. Design: Prospective randomized controlled study. Setting: Department of obstetrics and gynecology in a university hospital in Egypt. Patient(s): Sixty-one infertile women with clomiphene citrate-resistant polycystic ovary syndrome were assigned randomly to receive either metformin (1,500 mg/d) or N-acetyl cysteine (1.8 g/d) for 6 weeks. Intervention(S): Hormonal profile was determined before and after the course of treatment. Folliculometry was performed to assess ovulation. Main Outcome Measure(s): Ovulation rate and insulin and T changes. Result(s): In the metformin group, there was a significant decrease in the fasting glucose, fasting insulin, and total T. In the N-acetyl cysteine group, there was no significant difference in the fasting glucose or fasting insulin and there was a significant decrease in total T. There was no significant difference in the fasting glucose-fasting insulin ratio in both groups. In the metformin group, the rate of ovulation was 51.6% (16/31), vs. 6.7% (2/30) in the N-acetyl cysteine group, which was statistically significant. Conclusion(s): Metformin alone is an effective drug in inducing ovulation in clomiphene citrate-resistant polycystic ovary syndrome, whereas N-acetyl cysteine alone is not. Further large studies are required to confirm our results.

Objectives Renal ischaemia-reperfusion (I/R) is a well-characterised model of acute renal failure that causes both local and remote organ injury. The aim of this work was to investigate the effect of thymoquinone, the main constituent of the volatile oil extracted from Nigella sativa seeds, on renal and hepatic changes after renal ischaemia-reperfusion. Methods Male Sprague-Dawley rats were divided into sham I/R vehicle-treated groups, and I/R thymoquinone-treated groups. Thymoquinone (10 mg/kg, p.o.) was administered for ten consecutive days to the I/R thymoquinone group before injury. I/R and I/R thymoquinone groups were subjected to 30-min ischaemia followed by 4-h reperfusion. Key findings I/R resulted in a significant increase in malondialdehyde (MDA) level and decreases in glutathione-S-transferase (GST) and superoxide dismutase (SOD) activity in liver and kidney tissues. Thymoquinone treatment caused the reversal of I/R-induced changes in MDA as well as GST and SOD activity. Moreover, I/R caused a significant rise in creatinine and alanine aminotransferase serum levels. CYP3A1 mRNA expression was induced significantly by I/R in both liver and kidney tissues compared with sham group. Thymoquinone reduced significantly this increase. I/R caused induction of mRNA expression of spermidine/spermine N-1-acetyl-transferase (SSAT), a catabolic enzyme that participates in polyamine metabolism, in liver and kidney tissues. Thymoquinone reduced SSAT mRNA expression significantly in liver and markedly in kidney. Conclusions These findings suggested that thymoquinone protected against renal I/R-induced damage through an antioxidant mechanism as well as the decrease of CYP3A1 and SSAT gene expression.

Gradual limb lengthening with external fixators using distraction osteogenesis principles is the gold standard for treatment of limb-length discrepancy. However, long treatment time is a major disadvantage of the current lengthening procedures. Efforts to decrease the treatment include biological and biomechanical factors. Injection of platelet-rich plasma (PRP) is a biological method to enhance bone healing during distraction osteogenesis. We hypothesised that PRP can enhance bone healing during limb lengthening. We report our experience with the use of PRP during distraction osteogenesis. This retrospective study included 19 patients divided into the standard group of 10 patients who did not receive PRP and the PRP group of nine patients who received PRP at the end of the distraction phase. The study variables included external fixator time, external fixation index, and complications during treatment. The PRP group had statistically significantly shorter treatment time (p = 0.0412). Injection of PRP into regenerate bone might be an effective method to shorten treatment time during limb lengthening and lead to better functional outcomes and improved patient satisfaction. Level of evidence: Level IV, therapeutic study. (C) 2011 Elsevier Ltd. All rights reserved.

This study is an extension of an earlier, randomized; placebo-controlled that showed the efficacy of nitazoxanide (NTZ) 500 mg tablets twice daily for 6 months in treating HCV genotype 4. Access was available to 13/32 patients of the original study with chronic HCV during more than 3 years after the study was finished. One patient (with portal hypertension and oesophageal varices "O.V") was among 3 with SVR out of 9 of the NTZ treated patients suggesting that NTZ could successfully be used even in patients with O.V. SVR remain so up to the end of the follow-up period compared to none of the other 4 patients who received placebo. A fourth patient of NTZ group achieved virological response at the end of follow-up although she firstly showed RVR and then viral breakthrough. Most of the remaining patients of the NTZ group who did not achieve SVR showed variable partial response. No serious adverse events were reported in both groups during treatment and thereafter.

Introduction: The aim of the study was to demonstrate interleukin-18 (IL-18) expression in keratinocytes from psoriatic lesions in comparison to keratinocytes from uninvolved skin and to study the change of expression after therapeutic interventions. Material and methods: This study included 16 patients of different clinical subtypes of psoriasis. Interleukin-18 gene expression analysis was performed using real time quantitative PCR. Three biopsies were obtained from each patient. Two were taken from the lesional psoriatic skin and from uninvolved skin before starting treatment. A third lesional skin biopsy was taken at the end of 2 months of treatment. The treatment was in the form of topical steroids or oral systemic methotrexate. Results: Of all 16 studied patients, significantly increased IL-18 expression was noted in keratinocytes from psoriatic lesions before and after treatment when compared to keratinocytes from uninvolved skin (p = 0.001 and p = 0.002 respectively). The IL-18 expression in the skin lesions after treatment was significantly lower than lesional skin before treatment (p = 0.023). In psoriatic skin lesions of all studied patients IL-18 expression was significantly correlated with disease duration (r = 0.40 and p = 0.01) and clinical severity of psoriasis (r = 0.72 and p = 0.001). Conclusions: Increased IL-18 expression in keratinocytes from psoriatic lesions of our patients and its correlation with disease duration and severity supported the concept of psoriasis as a T cell mediated autoimmune disease. This could establish therapeutic and preventive approaches for psoriasis that ultimately lead to improved outcomes for patients.

Objectives: To evaluate the predictability of estimation of serum mannan-binding lectin (MBL) for the presence of infectious complications in type 2 diabetes mellitus (T2DM) and its relation to the extent of diabetes control. Methods: A comparative cross-sectional study was conducted at the Departments of Clinical Pathology and Internal Medicine, Faculty of Medicine, Benha University, Benha, Egypt from October 2009 to December 2010. Sixty adult patients with T2DM were divided into 2 groups: Group B and Group C and Group A as the control group. All subjects evaluation of insulin sensitivity (Homeostasis Model Assessment of Insulin Resistance [HOMA-IR]), and blood samples for estimation of fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c) and serum insulin, urea, creatinine, C-reactive protein (CRP), and MBL. Results: All patients had significantly increased FBG, serum insulin, HOMA-IR index, serum CRP and MBL levels compared with the control group, with significantly higher levels in Group C. Levels of HbA1c, serum urea, and creatinine were significantly higher in patients than controls. There was a positive significant correlation between serum MBL and FBG, HOMAIR index, serum urea, creatinine, and CRP levels. The receiver operating characteristics curve analysis in infectious cases revealed high FBG, HOMA-index and serum levels of HbA1c, CRP, and MBL, while regression analysis defined elevated serum MBL levels as a significant independent predictor for the presence of infection. Conclusion: Elevated serum MBL in T2DM patients indicated a possible poor diabetic control and bad progression of the disease with possibility of the presence, or development of diabetic nephropathy especially in combination with elevated serum CRP.

BACKGROUND: Hip distraction in Legg-Calve-Perthes disease unloads the joint, which negates the harmful effect of the stresses on the articular surface, which may promote the sound healing of the areas of necrosis. METHODS: Nonarticulated arthrodiastasis without soft tissue release using an Ilizarov external fixator was applied to 29 patients with Legg-Calve-Perthes disease (older than 8 y at onset and lateral pillar type C or B). RESULTS: Follow-up period ranged from 2.5 to 11 years with an average of 7.5 years. Twenty-seven cases (93%) had improvement of the range of motion postoperatively. Preoperatively, all patients had constant pain, whereas at last follow-up 26 (86%) patients had no pain and 3 had an improvement. Stulberg classification was applied to 21 cases who reached skeletal maturity at last follow-up: 9 cases were type II, 7 cases were type III, 4 cases were type IV, and 1 case was type V. CONCLUSIONS: Nonarticulated hip distraction without soft tissue release seems to be a valid treatment option in cases with Legg-Calve-Perthes disease where poor results are expected from conventional treatment.

Liver diseases and its complications is common health problem worldwide. The emergence of metabolic disorders as a cause after exclusion of viral hepatitis nowadays is important. This is retrospective study on 200 patient's age range from 6months to 18 years old (50 females and 150 males). The patients divided into 2 groups according to age < 5 years & >5 years and all investigations done was collected and statistically processed. Abdominal enlargement was observed in 166/200 of all patients, 48/166 (67.6%) in patients 5 years old with statistical significant, jaundice was present in 34/200 of patients, 23/34 (32.4%) in patients 5 years old, with statistical significant difference, CBC was normal in 58/200 of all age groups. 10/58 (14.1%) in patients

Amoebiasis is a significant cause of morbidity worldwide and is the third leading cause of death from parasitic diseases. This study evaluated nitazoxanide, a thiazolide anti-infective, in the treatment of intestinal and hepatic amoebiasis. Prospective, randomised, double-blind, placebo-controlled studies were conducted in outpatients with intestinal amoebiasis from the Nile Delta of Egypt. Nitazoxanide was administered twice daily for 3 days at doses of 500 mg (age >= 12 years), 200 mg (age 4-11 years) or 100 mg (age 1-3 years). Seventeen adults hospitalised with hepatic amoebiasis were treated with 500 mg nitazoxanide twice daily for 10 days. Four days after completion of therapy, 32 (94%) of 34 nitazoxanide-treated patients with intestinal amoebiasis resolved symptoms compared with 15 (50%) of 30 patients who received placebo (P< 0.001). Thirty-two (94%) of 34 nitazoxanide-treated patients were free of Entamoeba histolytica in two post-treatment stool specimens compared with only 13 (43%) of 30 patients receiving placebo (P< 0.0001). All patients with hepatic amoebiasis responded to nitazoxanide therapy. Nitazoxanide is effective in treating invasive intestinal amoebiasis and in eliminating E. histolytica colonisation of the intestinal tract. Further studies are warranted in patients with hepatic amoebiasis. (C) 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that occurs in genetically prone individuals. Autoimmunity could not be simply explained by Th1/Th2 cell paradigm. T helper 17(Th17) cells producing the cytokine interleukin-17 (IL-17) may explain the promotion and progression of autoimmune phenomena. This study aimed to investigate the role of Th17cells, IL-17 and interleukin-23 (IL-23) in the pathogenesis of SLE and their correlation with disease activity. The frequencies of circulating Th17 cells in 15 patients with active SLE, 15 patients with inactive disease and 15 healthy control subjects were measured using Flowcytometry after stimulation with phorbol myristate acetate (PMA) and ionomycin for 4 hours. Serum levels of IL-17 and IL-23 were measured using the enzyme linked immunosorbent assay (ELISA). Significantly higher mean frequencies of circulating Th17 cells were found in active SLE patients (1.54 +/- 0.38%, P < 0.001) and inactive SLE patients (1.23 +/- 0.25%, P = 0.009) compared to the control group (0.88 +/- 0.41%). The frequencies of circulating Th17 cells positively correlated with the SLEDAI score (r = 0.812, P < 0.001). The serum levels of IL-17 and IL-23 were significantly higher in active SLE (P < 0.001) and inactive SLE patients (P < 0.001) than the control group while, serum levels of both cytokines correlated positively with SLEDAI score (r = 0.661, P < 0.01 and r = 0.701, P < 0.01 respectively). There was significant positive correlation between the frequency of circulating Th17 cells and plasma levels of IL-17 and IL-23 (r = 0.789, P < 0.001) and (r = 0.792, P < 0.001) respectively. Results of this study provides evidence of a role of Th17 cells in the pathogenesis of SLE, and offer scientific rationale for the utility of Th17 cells, IL-17 and IL-23 as biological markers for SLE disease activity. This would raise the possibility of anti-IL-17 and anti-IL-23 as innovative therapeutic options in controlling disease activity of SLE.

The aim of this study was to investigate the association of interleukin-18 (IL-18) promoter single nucleotide polymorphisms (SNPs) at - 607 and - 137 regions with risk for rheumatoid arthritis (RA) and their association with activity and severity of the disease. The study included 80 RA patients and 80 age and sex matched healthy subjects. Forty RA patients and 40 control subjects were randomly chosen to measure their serum IL-18 levels. IL-18 SNPs at - 607 and - 137 regions were analyzed using polymerase chain reaction-sequence specific polymorphism (PCR-SSP) analysis. The frequency of -137CC genotype was significantly lower in RA patients than controls (OR = 0.23, 95% CI 0.07-0.72, p = 0.012), while the -607C/A genotypes (CC, CA, AA) showed insignificant differences between patients and controls. No association was found between erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin (HB), DAS 28 and X ray grades and -607C/A and - 137G/C genotypes. Serums levels of IL-18 were not significantly different among individuals with different IL-18 -607 and -137 genotypes. It is concluded that RA is negatively associated with IL-18 -137CC SNP, and that IL-18 607-SNPs may not be a risk factors for RA in Egyptian patients with no specific genotype association with disease activity or severity. No specific genotype was associated with higher IL-18 serum levels.

BACKGROUND: Various methods have been investigated to avoid postoperative scarring of the filtering bleb in modern glaucoma surgery. Most deal with the application of antimetabolic drugs such as mitomycin C (MMC). 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester (BCECF-AM) is a locally acting intracellular photosensitizer which could control and decrease postoperative fibrosis at the trabeculectomy site. PURPOSE: To compare the effect of photodynamic therapy in combination with trabeculectomy to the effect of MMC combined with the same procedure in controlling postoperative intraocular pressure (IOP) in patients with medically uncontrolled primary open angle glaucoma (1ry OAG). METHODS: A randomized controlled clinical trial was conducted on 76 eyes of 76 patients divided into three groups undergoing trabeculectomy, trabeculectomy with BCECF-AM (group A), trabeculectomy with MMC (group B), and trabeculectomy only as a control group (group C). Patients were reviewed postoperatively for clinical evaluation and photo documentation of the blebs with a fundus camera and ultrasonic biomicroscopy (UBM). The desirable effect of the adjunctive material was evaluated according to the clinical efficacy, tolerability, and safety by comparison with the control group. SETTING: Benha University Hospital, Benha, Egypt. RESULTS: After a mean follow-up of 24 months, all procedures succeeded in lowering IOP. The cumulative probability of complete success at the 24 month follow-up was 91% for group B, compared to 82% and 81.5% for group A and group C, respectively. The percentage of complete success was highest for group B, second highest for group A, and lowest for group C over the follow-up period; however, these differences were not statistically significant (P > 0.05). Regarding the bleb morphology and UBM reflectivity, the differences were not statistically significant (P > 0.05). The mean bleb height and breadth were larger in groups A and B in comparison to group C over the study period. The mean aqueous drainage route was similar in groups A and C, but less than in group B at 3 and 12 months postoperatively. Complications were generally mild and less marked in group A and C than group B. CONCLUSION: Cellular photoablation using BCECF-AM seems to be a feasible new method to use in combination with glaucoma filtration surgery. Although MMC might be considered a more potent adjunctive to trabeculectomy in promoting IOP reduction, photodynamic therapy carries relatively less risk of adverse effects and complications. Cellular photoablation using BCECF-AM could be considered efficient, tolerable and relatively safer in managing patients with 1ry OAG. Further studies are necessary to determine the safety and the reliability of this therapy.

Cataract is considered as a significant global health problem and represents the most important cause of visual impairment world-wide. Extraction of the cataract which accounts for a significant proportion of the surgical workload among most ophthalmologists, improving quality of the vision. Aim: This study aims to propose a protocol for health needs management among patients undergoing day case cataract surgery, through identifying the health needs and assessing the care given on day of the surgery. Methods: A descriptive explorative design was utilized to conduct this study that was carried out in the Ophthalmic Outpatient Clinic and surgical waiting room of the ophthalmic unit, at Ain Shams University Hospital and Benha University Hospital. Sample: A purposive sample composed of 160 patients undergoing cataract surgery, adults and old age, from both genders and were recruited from the above mentioned settings. Tools: 1) Patients' interviewing questionnaire, to determine patients' needs regarding day case cataract surgery (pre / post tests), 2) An observation checklist, to assess care given for the studied patients on the surgical day and 3) Hamilton's Anxiety Rating Scale, to determine patients' levels of anxiety (pre / post tests). Results: There are statistically significant differences between patients' health needs pre / post surgery, added to more than half of the studied patients had severe anxiety pre - surgery, compared to post - surgery. Moreover, mean percent of unsatisfactory care was higher on day of the surgery. Conclusion: The current study concluded that, there were more significant health needs among the studied patients pre - surgery, added to the positive effect of the surgery on the reduction of these needs and relieving patients' anxiety post - surgery. Furthermore, unsatisfactory patients' care had higher mean compared to satisfactory care on day of the surgery. Recommendations: Based on findings of the present study, it can be recommended that, the proposed protocol of patients health needs management that's evidence - based should be implemented and evaluated in relation to the incidence of cataract surgery complications. [Soad M. Hegazy, Marwa M. Ragheb, Seham G. Ragheb, Nessrin O. El-Sayed, Mohamed A. Rashad. Health Needs Management among Patients Undergoing Day Case Cataract Surgery: A Proposed Protocol. Life Sci J 2012;9(2):1316-1327] (ISSN: 1097-8135). http://www.lifesciencesite.com. 196

Objective: To assess serum levels of Matrix metalloproteinases-2 (MMPs-2) and MMP-9 in Behcet's disease (BD) patients to investigate the possible association between MMP-2 and MMP-9 serum levels with clinical manifestations and disease activity. Methodology: Thirty BD patients and 30 age and sex matched healthy controls were included. Thorough clinical examination with stress on dermatological, locomotor, neurological and ophthalmologic manifestations. Assessment of disease activity was done. We compared the activity scores of patients with their serum levels of MMP2 and MMP-9. Assessment of ESR, CRP, MMP-2 and MMP-9 serum levels by ELISA were performed. Results: A statistical significant increase (P0.05) in MMP-2 levels in BD patients in comparison with the control group. Within the BD patients' group, there were elevations of MMP-2 and MMP-9 serum levels in BD patients with vascular lesions, CNS lesions and disease activity (P

Background: Obesity is highly associated with insulin resistance and the increased risk of type 2 diabetes and cardiovascular diseases. Visfatin is a cytokine that is highly expressed in visceral fat. It's expression in visceral fat is increased in obese subjects. Visfatin exerts insulin-mimetic effects and was as effective as insulin in reducing hyperglycemia in insulin-deficient diabetic mice. Objective: To study serum visfatin level in patients with type2 diabetes mellitus and to clarify its possible relationship with insulin resistance and glycemic control. Patients and Methods: Eighty cases (60 type2 diabetic patients and 20 apparently healthy subjects) were subjected for estimation of visfatin and fasting insulin by ELISA technique together with routine laboratory investigations including fasting blood glucose, cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and HbA1C. Results: Fasting blood glucose, fasting insulin level, HOMA-IR, HbA(1)C and visfatin levels were significantly higher in diabetic than control group. HBA1C, fasting serum glucose and serum visfatin were significantly higher in uncontrolled than controlled diabetic subgroups. Weight, BMI and serum visfatin were significantly higher in overweight diabetic subgroup than normal BMI diabetic subgroup. A positive significant correlation was found between serum visfatin & HbA(1)C levels in the diabetic group. Conclusion: The increased serum visfatin concentration may be a compensatory mechanism aimed at ameliorating the functional consequences of insulin deficiency. The increased visfatin concentration may also promote insulin sensitivity by its stimulatory effects on insulin receptors. [Osama S. El-Shaer; Khaled M. Belal; Hesham A. Issa and Tawfik El-Adl. Increased Serum Visfatin Levels in Patients with Type 2 Diabetic Patients. Life Sci J 2012;9(3):114-120]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 15

Background: SLE is an unpredictable multi-systemic autoimmune life-long disease whose etiology and pathogenesis are incompletely understood. The monocyte chomoattractant protein-1(MCP-1) is a chemokine thought to be responsible for monocyte and T lymphocytes recruitment in acute inflammatory conditions and may be an important mediator in chronic inflammation. Objective: Aimed to measure the serum and urinary levels of MCP-1 in patients with SLE, to find out its relation to clinical disease activity and to explore its role in LN. We also aimed to investigate correlations of these levels with histopathological changes of renal biopsies in order to evaluate their reliability as biomarkers for LN clinical status. Patients and Methods: After an ethical approval, this correlative study was conducted on thirty SLE female patients and 20 apparently healthy volunteers-age and sex matched. Serum and urinary levels of MCP-1 were determined by the ELISA technique, while a transcutaneous renal biopsy was obtained from all patients. Results: There were significant differences in the mean levels of serum MCP-1 (P

The effects of four environmental stresses of heat, drought, wounding and cell culture, on the transcriptional reactivation of seven long terminal repeat retrotransposons (LTRs) of barley (Hordeum vulgare) genome, were investigated. These LTRs included two Copia-type (Bare and Maximus); and five Gypsy-type (Erika, Jeli, Sabrina, Sukkula1 and Sukkula3) LTRs. RT-qPCR analyses revealed that Erika1 LTR was highly reactivated under heat, drought, and wounding with 28.1, 9.9 and 9.4 fold increments, respectively. Sabrina LTR was 6.2 fold reactivated under cell culture. Bare1 LTR was reactivated by drought (4.1 fold) and cell culture (3.4 fold). Transcription activity of Jeli LTR was increased by 3.4 fold under cell culture. Sukkula1, Sukkula3 and Maximus LTRs were slightly reactivated under drought, wounding and cell culture. These changes in the reactivation pattern of LTRs provide fingerprints for tracking the molecular changes occurred in barley genome upon exposure to environmental stresses, which might result in gain or loss of yield. Such sensitive LTR expression profiles underline one of the important role of LTR genetics in agriculture. [Nehal E. Yousef, Amgad Ezzat, Amani Shaman and Nagwa S. M. Aly. Virulence of Candida albicans, Trichomonas vaginalis and Chlamydia trachomatis Vaginal Pathogens in Sexually Transmitted Diseases. Life Sci J 2012;9(4):5854-5861] (ISSN:1097-8135). http://www.lifesciencesite.com. 873

Objective and importance. Trochlear nerve schwannomas without neurofibromatosis are very rare. No more than 33 cases have been pathologically verified. None of the reported cases showed postoperative improvement of trochlear palsy. The authors present a case of trochlear palsy due to a trochlear nerve schwannoma with subsequent improvement of trochlear palsy after subtotal excision of the tumour. Clinical presentation. A 65-year-old woman presented with diplopia, vertigo and left arm weakness. There was no history of neurofibromatosis. MR imaging demonstrated a tumour in the right perimesencephalic/ambient cistern. Intervention. The tumour was operated by a pterional approach, and subtotal excision was achieved preserving the tumour capsule with the trochlear nerve. The tumour was pathologically diagnosed as a schwannoma. Conclusion. At 2-year follow-up, there was no double vision and MR imaging showed a small, stable tumour remnant. To our knowledge, this is the first reported case of a trochlear schwannoma in whom postoperative improvement of trochlear function was achieved.

Objective: The aim of this work is to study the resistive index (RI) of prostatic blood flow by transrectal power Doppler sonography in benign prostatic hyperplasia (BPH) to determine its correlation with other parameters of BPH. Materials and Methods: Eighty-two male patients aged 52-86 years with lower urinary tract symptoms (LUTS) due to BPH were included in the study. Patients with prostate cancer, neurogenic bladder, or with other pathology (e. g. prostatitis, bladder stone) were excluded from the study. All patients were evaluated by full history including Internatinoal Prostate Symptoms Score (IPSS), general and local examination (DRE), neurologic examination, uroflowmetry, laboratory investigations including urine analysis, routine laboratory tests and serum prostate specific antigen (PSA). Transrectal ultrasonography was used to calculate the total prostatic volume. Transrectal Power Doppler Ultrasound (PUD) was used to identify the capsular and urethral arteries of the prostate and to measures the RI value. Results: The mean prostate volume was 75.1 +/- 44.7 g. The mean RI of the right and left capsular arteries were 0.76 +/- 0.06 and 0.76 +/- 0.07, respectively. The mean RI of the urethral arteries was 0.76 +/- 0.08. There was a high significative correlation between the increase of the RI of the right and left capsular and urethral arteries and the degree of obstruction (P value < 0.001), severity of symptoms (P value < 0.001) and also the prostatic volume (P value < 0.001). Conclusion: Resistive index of the prostatic blood flow can be applied as an easy and non-invasive tool to evaluate the lower urinary tract obstruction due to BPH.

Objective. To compare the efficacy of aromatase inhibitor vs. gonadotrophin-releasing hormone agonists in treating premenopausal women with uterine adenomyosis. Design. A prospective randomized controlled study. Setting. A university hospital and a private practice setting. Population. Thirty-two patients with uterine adenomyosis. Methods. Patients were randomly allocated to receive oral letrozole (2.5mg/day) or a subcutaneous gonadotropin-releasing hormone agonist (goserelin, 3.6mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks. Outcome measures. Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated. Results. No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0cm3 vs. 21.7, 15.1 and 11.7cm3, at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment. Conclusions. Aromatase inhibitors are as effective as gonadotropin-releasing hormone agonists in reducing adenomyoma volume and improving symptoms.

This retrospective review follows 31 tibial nonunions to compare union at the docking site using closed versus open strategies. In this cohort of patients, all but five were infected nonunions. Thirteen patients initially treated with single compression were compared with 18 patients treated by open revision of the docking site. In the single compression group, an average of 6.5 cm of bone was resected and index lengthening was 2.04. In the open revision group, a mean of 9.4 cm was resected and the index lengthening was 1.73. Consolidation at the docking site occurred in all subjects in both groups. There was no statistical difference between the two groups. Conclusive evidence of superiority of one modality of treatment over the other cannot be drawn from our data. The simple compression procedure requires less invasive surgery and is probably less demanding and more cost-effective in short transports.

INTRODUCTION: To assess the feasibility of single-incision laparoscopic surgery (SILS) in some urological surgeries. MATERIAL AND METHODS: This prospective study was conducted on 40 patients (27 males and 13 females) from January 2010 to June 2011. Six procedures were done, SILS renal cyst decortication (n = 10), SILS varicocelectomy (n = 10), SILS orchiopexy (n = 10), SILS nephrectomy (n = 3), SILS pyelolithtomy (n = 6) and SILS adrenalectomy (n = 1). RESULTS: Postoperative complications included ileus (10%) and fever (10%) in SILS renal cyst ablation. SILS varicocelectomy had postoperative sequalae as persistent varicocele (10%) and hydrocele (10%). SILS orchiopexy was also done with a success rate 100% in this series. SILS pyelolithotomy was successfully done in 5 out of 6 patients and only 1 patient was converted to conventional laparoscopy. In SILS nephrectomy 1 patient out of 3 was converted to conventional laparoscopy. CONCLUSION: SILS in urology has proven to be safe and feasible in the hands of experienced laparoscopic surgeons, using specially designed ports and instruments in selected patients.

Leptin is an adipocyte-secreted protein that participates in the regulation of energy homeostasis. Eighty men were investigated; fertile normozoospermia as a control (n = 30) and infertile oligozoospermia (n = 50). The patients underwent estimation of body weight (kg), height (cm), calculation of body mass index (BMI), semen analysis, serum leptin and testosterone hormones. Mean body weight was significantly higher in infertile oligozoospermia compared with controls. Mean height, BMI and serum testosterone levels showed nonsignificant differences between the two groups. Infertile oligozoospermia had significantly higher mean serum leptin level than controls (mean +/- SD; 6.88 +/- 8.65, 16.3 +/- 13.98 ng ml(-1), P < 0.01). Serum leptin demonstrated significant positive correlation with age, body weight, BMI and significant inverse correlation with serum testosterone. It had nonsignificant correlation with the height and sperm concentration. These results are suggestive of a link between the adipocyte derived hormone, leptin and male reproduction.

In the human ovary, expression of anti-Miillerian hormone (AMH) is detected primarily in granulosa cells of preantral and small antral follicles. The aim of this study was to compare serum ANIH measurements in obese women with polycystic ovary syndrome (PCOS) with those in obese normo-ovulatory women and to evaluate the role of AMH as a predictor of ovulation induction by clorniphene citrate compared to FSH. Sixty-eight obese women with PCOS were compared to 17 normoovulatory obese women. All women had a body mass index greater than 30 kg/m'. Women with PCOS received clomiphene citrate (150 mg/day) for 5 days starting from day 3 of cycle and were subdivided into responsive and non-responsive groups. There was a significant difference in AMH concentration between women with PCOS and the control group (P < 0.05) and also between women with PCOS who responded to clomiphene citrate and those who did not (P < 0.01). A value of 1.2 ng/ml AMH could be used to predict response to clomiphene citrate in obese women with PCOS (sensitivity 71%, specificity 65.7%). AMH production increases in women with PCOS compared to controls. AMH measurement could also be useful in the prediction of ovarian response to clorniphene citrate.

Background: Despite the proven effectiveness of the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative (RPM), its impact on community practices in Egypt has yet to be assessed. The aim of this investigation was to evaluate the knowledge, attitudes, and practice (KAP) of Egyptian mothers towards the Ten Steps. We interviewed 1,052 breastfeeding mothers with infants less than 24 months of age from 12 governorates representing Upper Egypt (UE) and Lower Egypt (LE). Results: Marked regional variations are noted in the KAP of the samples from UE and LE. These differences can be explained to some extent by socioeconomic factors. Hospital delivery, lower parity, and a higher level of education were characteristic of mothers in LE compared with UE. More mothers in UE did not know about the protective effects of breastfeeding to the mother. In LE, 75% delayed breastfeeding initiation until after the first hour compared with 61% in UE, with the mothers reporting that they did not experience skin-to-skin care in the first hours after birth. Nipple pain was given as a cause for supplementation in 56% of mothers in UE and 36% in LE (p

BACKGROUND: Callotasis of the hand has several advantages: it is less invasive than other techniques as bone grafting is unnecessary, gradual distraction is possible, joint mobilization can be performed during treatment, and sensation is maintained. Disadvantages include longer period of treatment and perhaps the need for complicated and bulky instrumentation. METHODS: We reported results of the lengthening of eight traumatically shortened metacarpals or phalanges (in six patients). There were two men and four women, with a mean age of 17.5 years. There were one thumb and seven fingers. There were three proximal phalanges and five metacarpals. Unilateral external fixator was applied to all cases. Osteotomy was performed at the proximal metaphysis in three cases, middle diaphysis in two cases, and the distal metaphysis in three cases. Lengthening was begun after 10 days to 14 days at a rate of 0.25mm two times or three times daily. We modified the rate of distraction according to the development of pain, sensory disturbance, and contracture of the digit during lengthening. In former cases, the rate was 0.25 mm three times daily. RESULTS: The proposed length was achieved in all digits and no bone graft was required. The mean length increase was 18.9 mm (53.5% of the original length of 35.25 mm). Age was positively correlated with the healing index and consolidation time as younger patients healed faster than older patients. Conversely, the faster the distraction rate, the slower were the healing index and consolidation time. There were few complications which did not affect the final results. We preferred metacarpal lengthening in cases with very short proximal phalangeal traumatic amputation stump (< 1 cm). CONCLUSION: Distraction lengthening is a valid option with minor complications rate. (J Trauma Acute Care Surg. 2012;72: 1676-1680. Copyright (C) 2012 by Lippincott Williams & Wilkins)

Cutaneous leishmaniasis (ZCL) is a protozoan disease well documented not only in Egypt, but in nearly all the East Mediterranean Countries. Sinai Peninsula was a sparsely populated area where sporadic cases of ZCL were reported with the reconstruction of Sinai and people coming in and out, it was indicated to study the status of ZCL in North Sinai Governorate, the reservoir host(s) and insect vector(s) in Sinai. In the present study, the six species of rodents were trapped from areas or nearby areas where human ZCL cases were detected. Rodents (50) were Mus musculus (10), Rattus r. alexandrinus (18), R. norvegicus (2), Gerbillus gerbillus (4), G. pyramidum (12) and Jaculus jaculus (4). The rodents were examined clinically for any skin lesion or even nodule, particularly in head and tail. One G. pyramidumn had natural infection with L. major as indicated by smears and culture, but typing was not done. The spot light surveys for Phlebotomus were carried out by the sticky paper traps and the CDC light traps in four main centers; Al Hassanah, Nakhil, Al Arish, and Bir Al-Abd. A total of 1320 sandflies were identified. They were P. papatasi (1150) and P. sergenti (170) in a ratio of 7:1. A total of three isolates of zymodeme London 70 undistinguished from the formerly obtained human and rodent isolates were enzymatically identified in P. papatasi.

Objective: To assess the prevalence of sexual abuse (SA) and associated factors among married women in Lower Egypt. Methods: A cross-sectional clinic- and hospitai-based survey was designed for married women aged between 16 and 49 years. The study was conducted with 936 women from the Dakahlia Governorate, which is considered representative of Lower Egypt. Data were collected by personal interview using a questionnaire. Results: The response rate was 93.6%. The most commonly reported frequency of sexual intercourse was 2 to 4 times per week. More than one-third of the women (36.2%) thought this was too frequent, and 11.5% reported being sexually abused in addition to other sexual problems. The educational level of the women; the presence of genital mutilation; parity, especially for those who had more than 5 deliveries; number of gynecologic visits; and history of gynecologic interventions were significantly or highly significantly associated with SA. The husbands' educational level and age were highly significantly correlated with their wives reporting SA, particularly when the men were illiterate or were smokers or drug users. Conclusion: The study's findings demonstrate an immediate need for the prevention of SA in Lower Egypt. (c) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome.

Aim: To assess the levels of homocysteine (Hcy) and hydroxyproline (Hyp) in aqueous humor and plasma of human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity of glaucoma. Methods: Fifty patients with POAG and 35 patients with senile cataract (control group) were enrolled in the study prospectively. Aqueous humor samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous humor and corresponding plasma samples were analyzed for Hcy and Hyp concentrations by high-performance liquid chromatography and spectrometry, respectively. Results: Hcy and Hyp levels were significantly higher in aqueous humor of POAG patients with respect to the comparative group of cataract patients (p < 0.001). No significant difference in the levels of Hcy and Hyp in plasma of POAG and cataract patients. A positive correlation was found between Hcy and Hyp in aqueous humor of POAG patients (p < 0.001). No significant correlation was found between either Hcy or Hyp levels and the severity of visual field loss. Conclusion: Increased levels of aqueous humor Hcy and Hyp may be associated with POAG. In addition, Hcy and Hyp may be useful protein levels in aqueous humor of POAG patients as a consequence of glaucomatous damage.

The aim of this study was to evaluate the presence of FoxP3+ cells in oral lichen planus (OLP) and to correlate the findings with clinical and histopathological features of these lesions. The sample consisted of 32 cases of OLP (17 reticular and 15 erosive cases) and 10 cases of inflammatory fibrous hyperplasia (IFH). Clinical examination, histopathological and histomorphometric analysis, and immunohistochemistry (anti-FoxP3 antibody) were performed. Cells were counted in juxtaepithelial and intraepithelial regions of the lesions, and the results are expressed as the mean and range. Most erosive lesions were keratinized and exhibited epithelial atrophy, whereas most reticular lesions were hyperkeratinized. Mean epithelial thickness and mean density of the inflammatory infiltrate were higher in reticular lesions than in erosive OLP. Juxtaepithelial FoxP3+ cells were slightly more frequent in erosive lesions (mean: 1.7 and range: 09.4) than in reticular lesions (mean: 1.5 and range: 08.3). There was a significant difference in the frequency of these cells between OLP (mean: 1.6 and range: 09.4) and IFH (mean: 0.5 and range: 01.4) (P < 0.05). The number of intraepithelial FoxP3+ cells was higher in reticular OLP and IFH when compared with erosive lesions. The larger number of juxtaepithelial FoxP3+ cells in OLP compared to IFH might be related to the distinct etiopathogenesis of these lesions. High disease activity or action of the oral microbiota may explain the slightly higher frequency of FoxP3+ cells in erosive lesions.

Background: Transfusion Transmitted virus (TTV) is a novel single-stranded DNA virus that was identified in patients with post-transfusion hepatitis of non-A-G type. Clinical significance of TTV infection was analyzed in Egyptian hepatocellular carcinoma (HCC) patients. The present study attempted to clarify these issues in Egypt, particularly in Qaluobia governorate, a country known for its high endemicity of liver disease and hepatotropic viruses. Methods: TTV are determined in the serum of 60 samples obtained from HCC and liver cirrhosis (LC) patients and 30 healthy individuals. TTV DNA is amplified by nested-PCR with TTV-specific mixed primers derived from the conserved open reading frame 1 (ORF1) region followed by digestion with restriction enzyme. Using the enzymes HaeIII, DraI, EcoRI and PstI, we are able to distinguish between the four TTV genotypes. Results: The positive rate of TTV detection was 46.7%, 40% and 36.7% among HCC, LC patients and healthy individuals respectively. The more prevalence genotype was detected in the positive serum samples was genotype 1 (35.7%) in HCC patients, (50%) in LC and (63.3%) in healthy individuals, Genotype 5 (21.4%), (25.5%) and (18.2%) in HCC, LC and healthy individuals respectively. Discussion: This study indicates that TTV is commonly present in adult patients with HCC and LC as well as healthy individuals. The most prevalence TTV genotype is genotype 1. It seems that the infection neither contribute to the severity of liver disease no to the causation of HCC.

Background: Early discontinuation of breastfeeding exposes babies to severe and fatal illnesses. The aim of this study was to identify the barriers to relactation among Egyptian women who had stopped breastfeeding and to test different interventions to support the mothers to relactate. Subjects and Methods: We conducted a prospective longitudinal cohort study of 200 mothers from Alexandria with babies less than 3 months of age who were not breastfeeding. They were exposed to three different types of educational models (problem solving, coaching, and cautioning) and followed up by phone calls over a period of 6 weeks. Results: Compliance with the protocol for relactation varied according to the educational model used. Only 10% succeeded in relactating. The most effective educational strategy was the problem solving (45%) and the coaching (50%). The least effective was the cautioning approach (5%). Determinants of relactation included mother's education level (100%), cup feeding with no nipples or soothers (70%), and the husband's involvement (70%). Conclusions: We conclude that the choice of appropriate educational models is key to encouraging mothers to return to breastfeeding. This study strongly supports Step Ten of the Baby Friendly Hospital Initiative.

OBJECTIVE: To compare the results of Snodgrass repair with single versus double vascularized dartos pedicle flap for neouretheral coverage. PATIENTS AND METHODS: Fifty-eight pediatric patients with mean age 41.5 ± 21 months (range 9-96 months) underwent primary hypospadias repair, 39 uncircumcised and 19 circumcised, classified into 2 groups according to coverage of the neourethra. Single layer coverage (Group I) was performed in 28 (48.3%) while double layers coverage (Group II) was done in 30 (51.7%) cases. RESULTS: After mean follow-up 8.6 ± 5.4 months (range 3-24 months), good cosmetic results with vertical slit like meatus at the tip of conical shaped glans were obtained in 53 cases (91.4%). Totally 5 cases occurred postoperative complications, of which 4 cases in Group I [2 (7.1%) with urethrocutaneous fistula, 1 (3.6%) with meatal stenosis and 1 (3.6%) with skin necrosis], 1 case in Group II [glanular dehiscence (3.3%)]. No fistula was observed in Group II. CONCLUSION: The Snodgrass tubularized incised-plate repair in conjunction with double layer coverage of the neourethra could be considered the procedure of choice for distal hypospadias with low complications rate especially urethrocutaneous fistula.

The aim of this work is to determine the effect of this type of treatment on the shape of the femoral head, the range of motion (ROM), radiological changes in the femoral head, and the prognosis of Perthes disease at skeletal maturity. From 1998 to 2007, 53 patients with Perthes disease were treated with a combination of soft tissue release and joint distraction with a hinged monolateral external fixator in 32 patients and by Ilizarov external fixator in 21 patients. Nineteen of our 53 patients attained skeletal maturity and were evaluated in our study. This study included 15 boys and four girls, mean age at surgery 9.3 years (range 7.2-13.1), and mean age at the last follow-up 17.4 years (range 14.9-21.3). The duration of symptoms varied from a period of 6 to 60 months before the operation. Radiographs taken during the fragmentation stage of the disease were classified by the lateral pillar classification of Herring; 19 of our patients attained skeletal maturity and were evaluated. Clinical assessment included the Harris hip score, hip ROM, and limb length discrepancy. Radiographic assessment included sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre-Brook), at frame removal, and at the last follow-up, the epiphyseal quotient (of Sjovall), and the Stulberg classification. The mean follow-up was 7.2 years (range 4.1-11.3). The mean Harris hip score was 87.1/100 (range 49.2-94.8). An improvement in hip (ROM) of 83.3% of the normal range was restored. There was a marked improvement in the degree of pain and limp postoperatively. The hip ROM was slightly limited in most patients, and seven patients had limb shortening of between 1 and 3 cm. The mean sharp transverse acetabular inclination of the affected side was 448 (range 35-51) compared with 378 for the unaffected side (P=0.042). The mean uncoverage percentage was 36% (range 24-45) compared with 21% for the unaffected side P=0.027). The mean epiphyseal index was 0.74 (range 0.36-0.94) before surgery, 0.78 (range 0.49-0.89) at frame removal (P=0.017), and 0.80 (range 0.54-0.91) at the last follow-up (P=0.701). The epiphyseal quotient was 0.74 (range 0.51-0.94) and the Stulberg classifications were type II in eight patients, type III in seven patients, type IV in three patients, and type V in one patient. Arthrodiastasis of the hip joint with soft tissue release may represent a good contribution toward the treatment of Legg-Calve-Perthes disease. This method of treatment has many advantages such as easy technique, minimal rate of complications, a short hospitalization period, correction of shortening because it adds to the length of the limb, and a higher rate of acceptable results than would be expected compared with other methods. It also improves the ROM, reduces superior and lateral subluxation, and provides better radiographic sphericity of the femoral head. In addition, it does not distort the anatomy of the pelvis or the proximal femur; it can be used with equal success in older children who are typically expected to have a poor prognosis. Distraction treatment is not limited by hip stiffness, degree of femoral head deformity, or subluxation, and can be used when other methods of treatment are contraindicated. J Pediatr Orthop B 21:386-393 (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Expression of uPAR (CD87) may play a relevant role in the diagnosis and pathophysiology and prognostic pattern of acute myeloid leukemia. The aims of this study were to find out the prognostic significance of pretreatment detection of CD87 and study the prevalence of CD87 expression and its value as a predictor for survival in AML patients. CD87 expression has been studied on blasts in 110 newly diagnosed AML patients. Immunophenotyping and cytogenetic analysis of these cases were performed. CD87 was positive in 80 (72.7%) cases of patients. The MFI categorized the expression of CD87 into CD87(High) and CD87(Low) expression. Blast cells show that monocytic differentiation has a significantly more CD87(High) expression than CD87(Low) expression. Cytogenetic abnormalities were found in 58.7% of patients with CD87(Low) AML and 41.25% of patients with CD87(High) AML. Cases with CD87(High) expression cells were characterized by a significantly lower survival period especially when co-expressed with CD56, CD34, and/or CD64. There is a negative prognostic influence of the expression of CD87 on the surface of AML blasts, but more tests are necessary to explain the pathophysiological mechanisms behind these findings and to learn about the mechanism that influences the CD87 expression and function.

Injuries to children arising from home accidents are an increasing community health concern. The aim of this cross-sectional study in Qalubeya governorate, Egypt was to measure the incidence and types of home injuries affecting rural children aged up to 12 years and to assess their mothers' knowledge, attitudes and practices (KAP) about first aid and its associated factors. An interview questionnaire was completed by 1450 rural mothers. The incidence of home injuries in the previous 4 weeks was 38.3% (57.5% were boys). Cut wounds, falls and fractures, burns, poisoning and foreign body aspiration were the common forms of home injuries. Mothers answered an average of 11.0 (SD 5.3) out of 29 KAP questions correctly. Younger age of mother, higher level of education, higher socioeconomic status, being in paid employment, source of knowledge about first aid and having attended a training course on first aid were significant predictors of better KAP among mothers.

Hindfoot salvage procedures by definition present circumstances requiring extraordinary measures to prevent or limit damage or destruction. Although this technique is used at some centers as the only means of correcting and fixating foot and ankle deformities, it is an expensive procedure. Other available methods may be more expeditious depending on the circumstances. However, the benefits of external fixation in certain circumstances are invaluable. Circular frame external fixators are important tool for the foot and ankle surgeon.

Aims The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye. Methods At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7 +/- 16.2 years. The LIPCOF were graded according to the method of Hoh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions. Results The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r>0.2, p

Sudden cardiac arrest (SCA) remains a tragic occurrence on the football field. The limits of preparticipation cardiovascular screening make it compulsory that prearranged emergency medical services be available at all football matches to immediately respond to any collapsed player. Management of SCA involves prompt recognition, immediate cardiopulmonary resuscitation (CPR) and early defibrillation. Any football player who collapses without contact with another player or obstacle should be regarded as being in SCA until proven otherwise. An automated external defibrillator (AED), or manual defibrillator if an AED is not available, should be immediately accessible on the field during competitions. This study presents guidelines for a practical and systematic approach to the management of SCA on the football field.

Background: Poison is a substance capable of producing damage or dysfunction in the body by its chemical activity. Aim of the work: to determine and analyse the various factors influencing the pattern of poisoning in Holy Makkah, KSA during the period from Jan 1st 2009-to Jan 1st 2011. Subjects and methods: This is a cross-sectional retrospective study. The data were derived from the routinely registered data of poisoned cases admitted to different hospitals in Makkah, KSA. Results: The total number of studied poisoned cases in the study area was 330 cases: 200 adult cases and 130 pediatric cases. Manner of poisoning was mainly suicidal among adult (51%) and all pediatric cases were accidental 100%. The major cause of intentional poisoning was therapeutic drugs (45%) especially acetaminophen among adults. Male/Female ratio were 3: 5 among the whole number of cases. Most of poisoning adult cases was observed among age group between 21-35 years (40%) and most of poisoned pediatric cases were < 4 years (70%). The majority of cases adults and pediatrics originated from the urban areas (71%) and (84.6%) respectively. Conclusion and Recommendation: The rate of acute poisoning in Makkah region is considered to be low. All of the pediatric cases and most of the adult cases are mainly accidental. When the standard management rules are followed the resulting mortality rate will be very low. To prevent poisoning, there should be continuous education of the public.

BACKGROUND: The purpose of this study was to compare the safety and efficacy of combined vitrectomy, intravitreal triamcinolone acetonide (IVTA), and bevacizumab injection with that of IVTA and bevacizumab injection and subsequent macular grid laser photocoagulation for the treatment of intractable diffuse diabetic macular edema. METHODS: This randomized controlled clinical trial was performed at Benha University Hospital, Benha, Egypt, and included 34 eyes from 34 diabetic patients diagnosed with intractable diffuse diabetic macular edema without vitreomacular traction. The patients were divided into two groups. In group 1, pars plana vitrectomy with removal of the posterior hyaloid was performed, and at the end of the procedure, IVTA 0.1 mL (40 mg/mL) and bevacizumab 1.25 mg were injected. In group 2, macular grid laser photocoagulation was performed 2 weeks after the same intravitreal injection combination as used in group 1. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness, which were measured using optical coherence tomography at 3, 6, and 12 months. RESULTS: Changes in BCVA and central foveal thickness at 3, 6, and 12 months from baseline were highly statistically significant (P < 0.01). Mean BCVA was better in group 1 at 3 months, nearly equal at 6 months, and less at 12 months. Mean central foveal thickness was more improved in group 1 than in group 2 at 3 months, and was better in group 2 at subsequent measurement points. The major adverse events were development of cataract (more common in group 1) and elevation of intraocular pressure (more common in group 2). CONCLUSION: The combined therapy described here could represent a solution for the treatment of intractable diabetic macular edema, and could have a favorable long-term outcome. Combined treatment of IVTA and bevacizumab plus grid laser resulted in a more favorable reduction in central foveal thickness and improvement in BCVA at 12 months than vitrectomy combined with the same injections. This small study favors the safer, cheaper, and more available line of treatment.

Context: Type 2 diabetes mellitus doubles the odds of suffering from depressive illness. Objectives: The present prospective randomized controlled study aimed to estimate the prevalence of anxiety and depressive disorders among a consecutive group of patients with type 2 non obese diabetes and assess its impact on glycemic control. Subjects and Methods: We selected 200 consecutive adult patients with type 2 non obese diabetes mellitus. Patients were divided into 2 groups according to HbA1c level: >7% defined group1 with poor glycemic control (n=140) and

OBJECTIVE: Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. PATIENTS AND METHODS: Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. RESULTS: All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. CONCLUSION: PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.

INTRODUCTION: An early and a quick identification of dementia is desirable to improve the overall care to the affected persons in the developing countries. The aim of this study was to evaluate the discriminative abilities of the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in differentiating the demented patients from the controls and also the differentiation between the different types of dementia. PATIENTS AND METHODS: This study was designed to evaluate the patients with varied types and severities of dementia, who were diagnosed by using the Clinical Dementia Rating (CDR) scale. All the patients completed the MMSE and the simplified CDT. RESULTS: This study included 197 patients with an age range of 43-79 years. Fifty-one patients (25.9%) were diagnosed with Alzheimer Dementia (AD), 37 patients (18.8%) with Vascular Dementia (VD), 23 patients (11.7%) with Parkinson's Disease Dementia (PDD) and 86 patients (43.6%) with other variants of dementia. The total MMSE score of the enrolled patients was significantly lower as compared to that of the control subjects, with a non-significant difference between the varied diagnoses. The total CDT scores were significantly lower in the patients as compared to those in the controls, with significantly lower scores in the PDD group as compared to those in the AD group. The patients who had AD showed non-significantly higher CDT scores as compared to the patients who had vascular and other types of dementia. CONCLUSION: A combined application of both MMSE and CDT can identify the persons with a cognitive affection and this may be a useful tool for the diagnosis of the non Alzheimer's type of dementia.

BACKGROUND: Of all the osteochondrosis, Freiberg's disease is reported to be the fourth most common, exceeded by Kohler's disease, Panner's disease, and Sever's disease. This disease usually occurs in the 2nd metatarsal head and relatively in the 3rd and 4th metatarsal heads. OBJECTIVE: The purpose of this study was to evaluate the outcome of debridement, synovectomy, dorsal closing wedge osteotomy and pin fixation for Freiberg's disease treatment. METHODS: Ten female patients, mean age 18.3 years; (ranged 14-24 years) were treated by the above mentioned technique. The main presenting symptom was pain on walking or sport; affected their daily life and activities and was not improved by non-surgical treatment. The second metatarsal head was affected in all patients. Halve of patients had a history of trauma. According to Smillie's classification, four patients were type V and six patients were type IV. Mean follow-up period was 19.2 months (range 6-36 months). RESULTS: Were assessed by the Lesser Metatarsophalangeal-Interphalangeal (LMPI)Scale by Kitaoka et al. At the final follow up, scoring was changed from (44-76) with an average 57 to (66-100) with an average 80. There was no case of infection, avascular necrosis, arthritis or pseudoarthrosis. CONCLUSION: We founded that dorsiflexion osteotomy of the metatarsal head is presented as a logical procedure that is simple, reliable, not destructive, and capable of good results regardless of the stage of the disease. Copyright 2012 Elsevier Ltd. All rights reserved.

Background: Joubert Syndrome (JS) is a rare genetic developmental disorder, first identified in 1969. In patients with JS, certain regions of the brain (mainly cerebellar vermis and brainstem) are underdeveloped or malformed. This can lead to impaired attention, visual, spatial, motor, language and social functional skills. JS is characterized by a host of features, many of which do not occur in every patient. Aim of the Study: To spotlight and increase awareness of clinical profile and neuroimaging findings of children with Joubert syndrome. Methods: This is a retrospective case series study of patients with JS who attended the Pediatric Neurology Clinic in Aladan and Alfarawanya Hospitals in Kuwait, from September 2007 to September 2012. Clinical and radiological data were obtained from the patient medical records. Results: Cerebellar vermis hypoplasia/aplasia and apnea were present in all patients, polydactly in 3 of 16, renal problems with cysts in 5 patients and 11 of 16 had abnormal electroretinograms (ERGs). Blood investigations of organic acids, amino acids and very-long-chain fatty acid, were normal in the all the nine patients. Conclusion: JS is a rare genetic brain malformation with association of retinal dystrophy and renal abnormalities. The retinal dystrophy may be progressive. The prognosis of patients depends mainly on the degree of brain malformation.

There have been conflicting results regarding a correlation between CD133 expression and disease outcome. To assess CD133 expression in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) and to evaluate its correlation with the different clinical and laboratory data as well as its relation to disease outcome, the present study included 60 newly diagnosed acute leukemic patients; 30 ALL patients with a male to female ratio of 1.5:1 and their ages ranged from 9 months to 48 years, and 30 AML patients with a male to female ratio of 1: 1 and their ages ranged from 17 to 66 years. Flow cytometric assessment of CD133 expression was performed on blast cells. In ALL, no correlations were elicited between CD133 expression and some monoclonal antibodies, but in AML group, there was a significant positive correlation between CD133 and HLA-DR, CD3, CD7 and TDT, CD13 and CD34. In ALL group, patients with negative CD133 expression achieved complete remission more than patients with positive CD133 expression. In AML group, there was no statistically significant association found between positive CD133 expression and treatment outcome. The Kaplan-Meier curve illustrated a high significant negative correlation between CD133 expression and the overall survival of the AML patients. CD133 expression is an independent prognostic factor in acute leukemia, especially ALL patients and its expression could characterize a group of acute leukemic patients with higher resistance to standard chemotherapy and relapse. CD133 expression was highly associated with poor prognosis in acute leukemic patients.

Objective: Somatic mutations of the nucleophosmin gene (NPM1), which alter the subcellular localization of the product, are the most frequent mutations in patients with acute myeloid leukemia. The aim of the study was to assess the prevalence and prognostic impact of NPM1 gene mutations in adult AML patients. Materials and Methods: Polymerase chain reaction and single-strand conformation polymorphism (PCR-SSCP) were used to screen 55 AML patients for mutations of NPM1 gene. Results: NPM1 mutations were found in 12 (21.8%) of 55 patients, significantly associated with higher total leukocytie count, marrow blast percentage (p=0.03 and p.0.02, respectively), and M5 subtype (p

Objective: To evaluate the Taylor spatial frame (TSF) for primary and definitive fixation of lower limb long-bone fractures in patients with multiple traumatic injuries.Design: Retrospective.Setting: Level I trauma center.Patients: Consecutive series of 52 patients, 57 fractures (25 femoral and 32 tibial), treated between 2005 and 2009. Forty-nine fractures (86%) were open. Injury Severity Score 16 for all patients.Intervention: Fifty-four fractures (95%) underwent definitive fixation with the TSF and 3 were treated primarily within 48 hours of injury. In 22 cases (39%), fractures were acutely reduced with the TSF, fixed to bone and the struts in sliding mode without further adjustment, and in 35 cases (61%), the total residual deformity correction program was undertaken.Main Outcome Measure: Clinical and radiological.Results: Complete union was obtained in 52 fractures (91%) without additional surgery at an average of 29 weeks. Four nonunions and 1 delayed union occurred. Results based on Association for the Study and Application of the Method of Ilizarov criteria: 74% excellent, 16% good, 4% fair, and 7% poor for bone outcomes and 35% excellent, 47% good, and 18% fair for functional outcomes. Eighty-eight percent of patients returned to preinjury work activities.Conclusions: Primary and definitive fixation with the TSF is effective. Advantages include continuity of device until union, reduced risk of infection, early mobilization, restoration of primary defect caused by bone loss, easy and accurate application, convertibility and versatility compared with a monolateral fixator, and improved union rate and range of motion for lower extremity long-bone fractures in patients with multiple traumatic injuries.

The study determined the relation between prevalence of intestinal parasites and soil-transmitted parasites among households in Shiblanga representing a rural area of Qualyobia Governorate and Benha City representing an urban area of the same Governorate. The effect of soil's type on the intensity of parasites and to provide guidance on the prevention and control of soil transmitted parasitic infections for future studies in this field. This study was conducted at Benha City and Shiblanga village representing the urban and rural areas of Qualyobia Governorate. Geoparasites were investigated in-doors, around houses, in the fields and the streets from both areas. One hundred soil samples from Benha city and one hundred soil samples from Shiblanga village were collected .each hundred soil samples was collected in the form of: 25 samples from the fields, 25 samples in-indoor yards, 25 samples the streets, 25 samples around houses. Approximately 200 g soil was collected in plastic bags at 2-10 cm depth from different parts. Stool samples from households in same areas were collected after taken oral consent. All soil samples were screened for parasites using different parasitological methods (Zinc sulphate flotation, ether sedimentation technique, modified Baerman's apparatus and modified Berlese technique). All stool samples were examined using direct smear, formalinether concentration techniques for detection of helminthes eggs, and modified acid-fast staining for detection of protozoa. The results showed that 86/200 soil samples were contaminated with different parasites, the prevalence rate of 43%. Soil samples from Shiblanga village showed higher level of parasitic contamination (56%) and Benha city showed a lower level of contamination by different parasites (30%). Soil samples obtained from Manshiet El-Nour district, Benha revealed the highest level of parasitic contamination. While, in Shiblanga, El-Mansheya district revealed the highest level of parasitic contamination. Clay soil was the most type of soil contaminated by hel-minthes.The10 houses out of 50 houses had the same parasites in the soil and in stool of their households, 8 houses in Shiblinga village and 2 houses in Benha city.

AIM: The aim of this paper was to study the incidence and predictors of hematological abnormalities during treatment of chronic hepatitis C virus (HCV) patients with interferon and ribavirin. METHODS: One thousand and eighty-one chronic HCV patients who were treated with PEGylated interferon alpha-2a 180 mug (n=536) or alpha-2b 1.5 mug/kg (n=545) plus ribavirin for 48 weeks were included. Baseline demographic, laboratory, and histopathological data and, during treatment, hematological data were collected and analyzed using univariate and multivariate analyses to identify independent predictors of hematological side effects. RESULTS: During therapy, 168 of 1,018 (15.5 %) had moderate anemia (Hb

The objective of the study was to evaluate the outcome of septoplasty without inferior turbinectomy in patients with septum deviation and nasal obstruction. After exclusion of allergic rhinitis, this study included 30 patients with deviated nasal septum and hypertrophied inferior nasal turbinate who were prepared for septoplasty without turbinectomy. After full history taking and complete otorhinological examination, all patients graded their extent of obstruction using the Nasal Obstruction Symptoms Evaluation scale and underwent CT scans to evaluate the side and shape of deviation, thickness of the medial and lateral mucosa and inferior conchal bone on both the concave and convex sides. Postoperative (PO) follow-up consisted of evaluation of surgical outcome, nasal obstruction grading and patient's satisfaction. CT imaging was repeated for evaluation of the previous items and to compare with preoperative data. All surgeries were conducted smoothly without intraoperative complications and all were managed as day surgery. The mean duration of follow-up was 20.1 +/- A 4.4 months. All patients showed progressive significant decline of nasal obstruction symptoms and only eight patients still had mild symptoms. Patients' satisfaction scores showed significant progressive increase reaching a peak at the 12th month. Preoperative CT confirmed the presence of hypertrophied mucosa on the concave septal side with significantly thicker medial and non-significantly thicker lateral mucosa on the concave side compared to the convex side. At the 12th month PO, mean medial mucosal thickness significantly decreased on the concave side with significant increase on the convex side, but the effect was significantly pronounced on the concave side. Mean lateral mucosal thickness was significantly decreased on the concave and non-significantly increased on the convex side. Conchal bone thickness showed non-significant change despite the diminution on both sides In the absence of allergic rhinitis, septoplasty without turbinectomy significantly improves nasal obstruction-related manifestations and approaches high patient satisfaction with associated reduction of hypertrophied mucosa and spares turbinectomy-related complications.

Obesity, insulin resistance, and hyperandrogenism are considered crucial parameters of polycystic ovary syndrome (PCOS) which might be related to vitamin D metabolism. The aim of this study was to investigate the associations between polymorphisms (TaqI and ApaI) in the vitamin D receptor gene (VDR) and PCOS among Egyptian women. We aimed also to elucidate the impact of these polymorphisms on vitamin D level, hormonal and metabolic parameters of PCOS. One hundred and fifty Egyptian women with PCOS and 150 unrelated controls were enrolled in this study. Polymorphisms of VDR Taq-I T/C (rs731236) and Apa-I A/C (rs7975232) gene were genotyped using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Serum 25 hydroxy vitamin D [25(OH) D] levels were measured by high-performance liquid chromatography. PCOS women had significantly lower levels of 25(OH) D compared to healthy women. Our results revealed that Taq-I CC genotype and C allele were associated with increased risk of PCOS, while the Apa-I polymorphism was not. Haplotype Taq-I C/ Apa-I C was associated with a higher PCOS risk more than controls. Moreover, there was a significant decrease of 25(OH) D levels in carriers of haplotype Taq-I C/ Apa-I C (with variant alleles) compared to the non-carriers. Results showed also that there was an obesity- VDR Taq-I genotypes interactions. These results suggested that, VDR Taq-I gene polymorphism is associated with increased risk of PCOS in Egyptian women.

The clinical and radiological results of distraction lengthening in cases with posttraumatic radial club hand were evaluated. Five patients (3 men and 2 women, with average age of 21 years) with traumatic radial shortening (3 patients had nonunited fracture of distal end radius with bone loss and 2 patients had short radius after malunited fracture of radius or growth arrest of distal radial epiphysis, the average shortening was 4.2 cm) were treated with distraction lengthening using Ilizarov fixator and hybrid fixation technique. Patients were evaluated clinically for hand function and appearance, and radiologically for union. The average follow-up was 25 months. The preplanned length was achieved in all cases with good union and no bone graft was needed, clinically there was much improvement in hand function (the range of motion of the wrist increased and the power of hand grip increased) and appearance. Pin tract infection occurred in 3 cases, broken pin in 1 case, and stiff wrist in 1 case. These complications were treated and did not affect the final results. Acquired radial club hand is difficult to treat. Treatment with distraction lengthening is a good option with excellent results and mild complications that did not affect the overall results.

alpha+beta titanium alloy with a composition of Ti-6.55Al-3.41Mo-1.77Zr (mass fraction, %) was cast into bars in a graphite mould using vacuum induction skull melting furnace (ISM). The cast bars were hot swaged at 700 degrees C and then heat treated by two different regimes which resulted in fine and coarse lamella structures, respectively. The grain size of the as-cast structure was estimated to be 660 mu m and the swaged samples obtained a very fine grain size in the range of 50 mu m. The overall best combination of hardness, tensile properties, and wear resistance of the alpha+beta titanium alloy was achieved by heat treating the samples at 1050 degrees C for getting fine lamellar structure. The maximum compression strength was reported for the heat treated samples at 800 degrees C with coarse lamella structure. The minimum wear rate was reported for the heat treated samples with fine lamellar structure and the maximum wear rate was obtained for as-cast samples due to its coarse and heterogeneity microstructure.

BACKGROUND: Pain, limping, and deformity are the most common complications following calcaneal malunion which results from non-operative treatment for calcaneal fractures. OBJECTIVE: To introduce the experience of treating calcaneal fracture malunion. METHOD: Between December 2009 and April 2011, eleven patients with calcaneal malunion were treated operatively. Age of patients ranged between 23 and 40 years with an average 28.7. All of them were followed up with a mean 13.5 (9-18 months). Eight of them were right-sided and the other three were left-sided. All of them were male. The mechanism of trauma was fall from a height in all patients. All of them were treated non-operatively since the prime trauma. According to Stephens and Sanders classification, all of cases were type II. The extended lateral calcaneal "L" approach was used in all cases. Lateral wall exostectomy and peroneal tendons are decompressed below the tip of the lateral malleolus and in situ subtalar bone block arthrodesis was done. RESULT: The mean of American Orthopedic Foot and Ankle Society and pain score systems score was improved from 33 (19-44 points) preoperatively to 69 (42-83 points) postoperatively. The reported complications were superficial wound infection in two cases (18.18%) and reflex sympathetic dystrophy in three cases (27.27%). CONCLUSION: Calcaneal lateral wall exostectomy, peroneal tenolysis and subtalar joint arthrodesis is an efficient method to treat calcaneal malunion type II after calcaneal fracture by reshaping the calcaneal contour and recovering the hind foot function. LEVEL OF EVIDENCE: IV.

OBJECTIVE: The goal of this study was to evaluate the impact of urinary leukotriene E4 (ULTE4) in asthmatic children during acute asthma exacerbation. Also, we wanted to correlate it with the total serum (TS) immunoglobulin (Ig) E level in relation to asthma severity. METHODS: This prospective study was conducted in the emergency room of the Department of Pediatrics, Benha University Hospital in Benha, Egypt, from November 2011 to May 2012. In this study, 63 children with acute asthma exacerbation (group I) and 25 healthy children as the control (group II) were included. Their ages ranged between 3-14 years. All children were subjected to a full medical history, and an emphasis was placed on the symptoms of asthma exacerbation and a complete clinical examination. TS IgE and ULTE4 were measured by an enzyme-linked immunosorbent assay after receiving the parents' consent. The LTE4 concentration was measured in urine samples obtained at the onset of admission and adjusted by urinary creatinine concentrations. RESULTS: The ULTE4 levels were significantly higher in cases compared to the controls (309.7±97.1 versus 14.5±5.7 pg/mg creatinine, respectively). It correlated positively to both the TS IgE and asthma severity in the cases. Also, the TS IgE levels increased significantly in cases (392.1±309.7 IU/mL), when compared to the controls (45.5±22.1 IU/mL). CONCLUSION: The ULTE4 and the TS IgE levels are significantly elevated during acute asthma episodes in children. The significant positive correlation between the severity of these attacks and the ULTE4 levels makes it a good noninvasive marker for monitoring acute asthma exacerbations and follow-up of the inflammatory process in asthmatic children.

Background. Diagnosis of patchy hair loss in pediatric patients is often a matter of considerable debate among dermatologists. Trichoscopy is a rapid and noninvasive tool to detect more details of patchy hair loss. Like clinical dermatology, trichoscopy works parallel to the skin surface and perpendicular to the histological plane; like the histopathology, it thus allows the viewing of structures not discovered by the naked eye. Objective. Aiming to compare the different trichoscopic features of tinea capitis and alopecia areata in pediatric patients. Patients and Methods. This study included 40 patients, 20 patients with tinea capitis and 20 patients with alopecia areata. They were exposed toclinical examination, laboratory investigations (10% KOH and fungal culture), and trichoscope examination. Results. Our obtained results reported that, in tinea capitis patients, comma shaped hairs, corkscrew hairs, and zigzag shaped hairs are the diagnostic trichoscopic features of tinea capitis. While in alopecia areata patients, the most trichoscopic specific features were yellow dots, exclamation mark, and short vellus hairs. Conclusion. Trichoscopy can be used as a noninvasive tool for rapid diagnosis of tinea capitis and alopecia areata in pediatric patients.

This study evaluated the degree of parasitic contamination of vegetables which are commercialized and consumed fresh in Benha, Egypt. It included 530 vegetables: lettuce, watercress, parsley, green onion, and leek. Vegetables were collected randomly from markets within Benha. Samples were washed in saline, and the resulting washing solution was filtered and centrifuged to concentrate the parasitic stages. Sediments and supernatants were examined by iodine and modified Ziehl-Neelsen stained smears. Intestinal parasites were detected in 157/530 (29.6%) samples. Giardia lamblia cysts were the most prevalent parasite (8.8%) followed by Entamoeba spp. cysts (6.8%), Enterobius vermicularis eggs (4.9%), various helminth larvae (3.6%), Hymenolepis nana eggs (2.8%), Hymenolepis diminuta eggs (2.1%), and Ascaris lumbricoides eggs (0.6%). The highest contaminated vegetable was lettuce (45.5%) followed by watercress (41.3%), parsley (34.3%), green onion (16.5%), and leek (10.7%). These results indicate a significant seasonal variation (P < 0.05), with highest prevalence in summer (49%) and the lowest in winter (10.8%). These findings provide evidence for the high risk of acquiring parasitic infection from the consumption of raw vegetables in Benha, Egypt. Effective measures are necessary to reduce parasitic contamination of vegetables.

PURPOSE: To provide a feasible solution to the problem of failed glaucoma surgery. The aim was to evaluate the efficacy and safety of the additional effects of a combined surgical approach. This approach augments the application of trabeculectomy with mitomycin C (MMC) by adding subconjunctival bevacizumab injection. The results were compared with those of trabeculectomy with only adjunctive MMC. METHODS: A randomized controlled prospective clinical trial included 28 eyes diagnosed with failed scarred bleb of a previous trabeculectomy. The eyes were divided into two equal groups: combined group A, "trabeculectomy with adjunctive MMC and subconjunctival bevacizumab," and control group B, "trabeculectomy with adjunctive MMC only." The main outcome results included the cumulative probability of surgical success, intraocular pressure (IOP) values, and number of IOP-lowering medications needed to achieve the target IOP. RESULTS: Group A achieved a cumulative probability of complete success of 0.769 and of qualified success of 0.231 at the end of the 24 month study period; group B achieved cumulative probabilities of 0.538 and 0.308, respectively. Group A achieved a lower mean IOP value than group B, with fewer antiglaucoma drugs at all postoperative visits, but this lower value did not reach a statistically significant level (P>0.05). There was no statistically significant difference between both groups regarding best corrected visual acuity, visual field parameters, operative and/or postoperative complications, and additional interventions. No significant adverse effects were caused by this combined approach. CONCLUSION: Bevacizumab was not found to add much to the favorable long-term outcome of conventional trabeculectomy with MMC as a solution to the problem of scarred failed bleb.

Background: Lower extremity angular deformities are common in children with skeletal dysplasia and can be treated with various surgical options. Both acute correction by osteotomy with internal fixation and gradual correction by external fixation have been used with acceptable results. Recently, the Guided Growth concept using temporary hemiepiphysiodesis for correction of angular deformities in the growing child has been proposed. This study presents the results of temporary hemiepiphysiodesis using eight-Plates and medial malleolus transphyseal screws in children with skeletal dysplasia with lower extremity angular deformities. Methods: Twenty-nine patients (50 lower extremities) with skeletal dysplasia of different types were treated for varus or valgus deformities at 2 centers. The mean age at the time of hemiepiphysiodesis was 10 +/- 2.9 years. A total of 66 eight-Plates and 12 medial malleolus screws were used. The average follow-up time between the index surgery and the latest follow-up with the eight-Plate in was 25 +/- 13.4 months. Erect long-standing anteroposterior and lateral view radiographs were obtained for deformity planning before the procedure. Angular deformities on radiograph were evaluated by mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle. Mechanical axis deviation was also expressed as a percentage to one half of the width of the tibial plateau, and the magnitude of the deformity was classified by determining the zones through which the mechanical axis of the lower extremity passed. Four zones were determined on both the medial and lateral side of the knee and the zones were labeled 1, 2, 3, and 4, corresponding to the severity of the deformity. A positive value was assigned for valgus alignment and a negative for varus alignment. Results: Patients were analyzed in valgus and varus groups. There was correction in 34 of 38 valgus legs and 7 of 12 varus legs. In the valgus group, the mean preoperative and postoperative mechanical lateral distal femoral angles were 82.1 +/- 3.7 and 91.1 +/- 4.9 degrees, respectively (P < 0.001). The mean preoperative and postoperative medial proximal tibial angles were 98.5 +/- 8 and 87.8 +/- 7.1 degrees, respectively (P < 0.001). Six patients with bilateral ankle valgus deformities (12 ankles) underwent single-screw medial malleolus hemiepiphysiodesis. The mean preoperative and postoperative lateral distal tibial angles were 73.9 +/- 8.7 and 86.1 +/- 6.8 degrees, respectively (P < 0.001). The numbers of plates in each anatomic location were not enough to make statistical conclusions in varus legs. Four patients in the valgus group and 3 patients in the varus group did not benefit from the procedure. Mechanical axes were in zone 2 or over in 94% of the legs preoperatively, whereas postoperatively, only 23% of the legs had mechanical axes in zone 2 or over in varus and valgus groups. Conclusions: Growth modulation with an eight-Plate is a relatively simple surgery and has low risk of mechanical failure or physeal damage. It can be performed in very young patients, which is an important advantage in skeletal dysplasia. Screw purchase is reliable even in the abnormal epiphysis and metaphysis. Our results show that Guided Growth using eight-Plates in skeletal dysplasia is safe and effective. Level of Evidence: Level IV.

UNLABELLED: Background Pregnancy is a special period in the life of women characterised by physical, hormonal and psychological changes that, in conjugation with social and cultural influences, could affect women's sexuality as well as couples' sexual relationships. This cross-sectional study aimed to evaluate female sexual dysfunction (FSD) among the three pregnancy trimesters. METHODS: A total of 300 healthy heterosexual pregnant Egyptian women with stable marital relationships were included. The Female Sexual Function Index (FSFI) questionnaire was used as a standard method for measuring female sexual function in each pregnancy trimester. RESULTS: There was no significant relationship between FSD and women's education, work, gravidity and parity. The incidence of FSD demonstrated significant alterations throughout pregnancy, being 68% in the first trimester, decreasing in the second trimester to 51% and increasing to 72% in the third trimester. Sexual desire decreased in the first trimester, was variable in the second trimester and decreased at the end of the third trimester (3.5±1.2, 3.7±1.2 and 3.4±1.1 respectively). Sexual satisfaction declined significantly in the first trimester compared with the second and the third trimesters (4.2±1.1, 4.8±0.8 and 4.6±1.0 respectively). Scores for the arousal, lubrication and orgasm domains were significantly decreased in the third trimester, where pain was increased in the second trimester compared with the first and third trimesters. CONCLUSION: Female sexual function is affected du

BACKGROUND: Nitric oxide plays a major role in increasing uterine blood flow during the luteal phase and early pregnancy. This study was done to compare uterine artery and sub-endometrial blood flow indices during the luteal phase between patients with unexplained recurrent abortion and fertile women and also to evaluate the effects of nitric oxide donors on blood flow indices in the abortion group. METHODS: The study included a control group of 30 primiparae who had normal vaginal delivery and no history of abortion and an abortion group of 30 nulliparous women with history of two or more unexplained recurrent abortions. Transvaginal three-dimensional pulsed color Doppler ultrasound was done on days 21-23 of the cycle to measure uterine artery resistance and pulsation indices and the subendometrial vascular, flow and vascular-flow indices. Isosorbide mononitrate 20 mg tablet was administered vaginally in the abortion group and blood flow indices were measured again after two hours. The Student t-test and the paired t-test were used for analysis of results and a p-value of ≤0.05 was considered significant. RESULTS: Patients with unexplained recurrent abortion had significantly higher uterine artery resistance and pulsation indices and lower sub-endometrial vascular, flow and vascular-flow index (p < 0.01-0.0001). Isosorbide mononitrite significantly decreased uterine artery and increased sub-endometrial blood flow indices (p < 0.001). CONCLUSION: Uterine artery and sub-endometrial blood flow decreased during the luteal phase in patients with unexplained recurrent abortion. Nitric oxide donors increased blood flow and may be of a therapeutic value.

The aim of the present study was to find out the potential impact of occupational exposure to mixtures of organic solvents on liver function tests. Serum bile acid (BA) was evaluated as a marker of early hepatic derangement and compared to routine liver function tests. The study included two comparable groups: 57 male workers exposed to organic solvents from a paints factory and 59 administrative male controls. Occupational and medical data and serum analysis for liver function parameters (BAs, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), total and direct bilirubin) were obtained. Bile acids showed significantly elevated mean levels in the exposed workers compared to the controls (50.2+/- 47.9 and 5.4+/- 2.7 mu mol/L, respectively, p < 0.01). Bile acids were elevated in almost all exposed workers (87.7%) but in none of the controls. Bile acids had significant positive correlation with duration of exposure to organic solvents and lifetime hydrocarbon exposure score (HES) (p < 0.01 and p < 0.05, respectively). All other liver function tests exhibited normal mean levels and did not show statistically significant differences between both groups. The performance of BA versus combined liver enzymes is evaluated using receiver-operating characteristic (ROC) curve and likelihood ratios. The area under the curve was significantly high (0.687 > 0.5, p=0.012) and had optimal decision level (8 mmol/L). Serum BA can be recommended as a screening test for exposure to organic solvents. It can be suggested for follow-up every 1-2 years or accordingly.

This study evaluated the performance of direct amplification of Acanthamoeba-DNA bypassing DNA extraction in the diagnosis of Acanthamoeba keratitis in clinically suspected cases in comparison to direct microscopic examination and in vitro culture. Corneal scrapings were collected from 110 patients who were clinically suspected to have Acanthamoeba keratitis, 63 contact lens wearers (CLW), and 47 non-contact lens wearers (NCLW). Taken samples were subjected to direct microscopic examination, cultivation onto the non-nutrient agar plate surface seeded with Escherichia coli, and PCR amplification. The diagnostic performance of these methods was statistically compared. The results showed that Acanthamoeba infection was detected in 21 (19.1 %) of clinically suspected cases (110); 17 (81 %) of them were CLW and the remaining 4 (19 %) positive cases were NCLW. Regarding the used diagnostic methods, it was found that direct amplification of Acanthamoeba DNA bypassing nucleic acid extraction was superior to microscopy and culture in which 21 cases (19.1 %) were positive for Acanthamoeba by PCR compared to 19 positive cases by culture (17.3 %) and one case (0.9 %) by direct smear. The difference in detection rates between culture and direct smear was highly statistically significant (P = 0.001). On the other hand, there was no significant difference in detection rates between culture and PCR (P = 0.86). On using culture as the gold standard, PCR showed three false-positive samples that were negative by culture and one false-negative sample that was positive by culture. At the same time, direct smear showed 18 false-negative samples. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PCR were 94.7, 96.7, 85.7, 98.9, and 96.4, respectively, while those of direct smear were 5.3, 100, 100, 83.5, and 83.6, respectively. In conclusion, direct amplification of Acanthamoeba-DNA bypassing DNA extraction is a reliable, specific, sensitive method in the diagnosis of Acanthamoeba keratitis in clinically suspected cases. It should set up in ophthalmological centers as an easy diagnostic tool.

Background Nitazoxanide, licensed in the US for treatment of Cryptosporidium parvum and Giardia lamblia, inhibits hepatitis C virus replication in replicon systems. Aim To evaluate the safety and efficacy of nitazoxanide monotherapy for the treatment of chronic hepatitis C. Methods This multicentre, randomized, double-blind, placebo-controlled study randomized 50 adult patients with chronic hepatitis C genotype 4 at three centres in Egypt to nitazoxanide 500 mg tablet or placebo twice daily for 24 weeks. Patients were followed up every 4 weeks during treatment and for 24 weeks after therapy. Results Seven of 23 patients (30.4%) in the nitazoxanide group achieved undetectable serum HCV RNA compared to 0 of 24 in the placebo group during therapy (P = 0.004). Each of the seven responders had baseline HCV RNA levels

The study included 11 patients; seven males and four females with mean age of 68.3 +/- 11 years. All patients had sciatic nerve entrapment: three had a penetrating injury, three suffered postoperative trauma, two had a crush injury, two had inadvertent injections and one was trapped in a machine belt. Clinical examination included: an evaluation of the extent of motor and sensory impacts according to the British Medical Research Council (BMRC) scale and the Semmes-Weinstein monofilament test; assessment of pain sensation using the visual analogue scale (VAS); electromyography; and nerve conduction velocitiey determination. The applied operative procedure for sciatic neurolysis was modulated according to the suspected site of sciatic nerve entrapment. At 6 and 12 months after surgery all patients were evaluated for recovery of motor and sensory function. All patients passed the smooth intraoperative course within a mean operative time of 77.7 +/- 21 min. The mean duration of wound drainage and postoperative hospital stay was 2.6 +/- 0.7 and 4.8 +/- 0.8 days, respectively. Pain sensation showed progressive significant improvement in nine patients but decreased at time of discharge and remained stationary till 12-m post-operative (PO). Recovery of motor function showed progressive significant improvement at 6 and 12 months after sciatic nerve neurolysis. The frequency of patients having muscle power recovery and regained sensation was significantly higher at 6-m and 12-m PO as compared to preoperative grading with a significantly higher frequency at the 6-m grading compared to preoperative grading. Two patients showed no change of their muscle strength grade, while nine patients showed improvement for a total success rate of motor strength recovery of 81.8%. At 6- m PO five patients showed no change of their sensory group, while six patients showed improvement for a total success rate of sensation recovery of 54.5%. At 12-m PO ten patients had fullly recovered protective sensation for a success rate of 90.9%. Surgical exploration and neurolysis of cases with sciatic nerve entrapment is a safe and effective therapeutic modality with significant improvement of both motor and sensory functions without risk of additional deficit secondary to neurolysis.

Objective: p53 antigen is an oncoprotective antigen and when damaged, leads to production of anti-p53 and also predisposes to various cancers, including hepatocellular carcinoma (HCC). Serum anti-p53 has been proven to have a prognostic value in patients with HCC. The objective of this study was to determine the prevalence and prognostic utility of serum anti-p53 in Egyptian patients with HCC. Methods: Forty one patients with HCC, 26 patients with liver cirrhosis and 29 healthy controls were included in this study. For all the studied groups, we studied the clinical data, abdominal ultrasound (US) findings, biochemical liver function tests, serum alpha-fetoprotein (AFP) levels detected by enzyme immunoassay (EIA) kit and anti-p53 antibody levels by a modified enzyme-linked immunosorbent assay (ELISA). The severity of liver disease was assessed by Child-Pugh and MELD scores. Tumor characteristics were detected by (US) with or without computed tomography (CT) scan. These characteristics included tumor size, number and site. Tumor staging was done using Okuda, Cancer Liver Italian Program (CLIP) and Tokyo staging systems. Also, the overall survival of patients with HCC with reference to p53 antibody level was studied. Results: The mean age of HCC patients was 57.95 +/- 8.41. There was a male predominance among HCC patients with male-to-female ratio of 3.6:1. Anti-p53 antibodies were detected in the sera of 68.3% of HCC patients, 50% of liver cirrhosis patients and 17.2% of healthy control subjects. The data showed that HCC patients had a significantly higher mean anti-p53 antibody values (p=0.0001), than both liver cirrhosis patients and healthy control groups. Our results revealed that anti-p53 has a positive significant correlation with AFP (p=0.002), severity of liver disease [Child Pugh score (p=0.02) and MELD score (p

BACKGROUND AND PURPOSE: Biotin-responsive basal ganglia disease is an autosomal recessive neurometabolic disorder presenting with subacute encephalopathy that can cause death if left untreated. The purpose of this study is to assess the neuroimaging and clinical features of the disease before and after treatment with biotin. MATERIALS AND METHODS: We retrospectively reviewed the clinical, laboratory, and neuroimaging features of 15 genetically-proved Middle Eastern cases of biotin-responsive basal ganglia disease. Brain MR imaging was done at the onset of symptoms in all cases and within 2-8 weeks after biotin and thiamine therapy in 14 patients. The MR imaging datasets were analyzed according to lesion location, extent, and distribution. RESULTS: Brain MR imaging showed bilateral lesions in the caudate nuclei with complete or partial involvement of the putamen and sparing of the globus pallidus in all cases. In 80%, discrete abnormal signals were observed in the mesencephalon, cerebral cortical-subcortical regions, and thalami. In 53%, when the disease was advanced, patchy deep white matter affection was found. The cerebellum was involved in 13.3%. The signal abnormality of the mesencephalon, cortex, and white matter disappeared after treatment whereas the caudate and putamen necrosis persisted in all patients, including those who became asymptomatic. CONCLUSIONS: Biotin-responsive basal ganglia disease is a treatable underdiagnosed disease. It should be suspected in pediatric patients with unexplained encephalopathy whose brain MR imaging shows bilateral and symmetric lesions in the caudate heads and putamen, with or without involvement of mesencephalon, thalami, and cortical-subcortical regions, as the therapeutic trial of biotin and thiamine can be lifesaving.

Objective: Adeno-tonsillar hypertrophy is the commonest cause of childhood obstructive sleep apnoea (OSA). Our aim of the study is to correlate the severity of OSA with levels of 8-isoprostane and interleukin-6 (IL-6) and with cardiac diastolic dysfunctions. Methods: Forty children with adenoidal hypertrophy and 20 control children were recruited. The OSA clinical score was evaluated and IL-6 and 8-isoprostane were measured in exhaled breath condensate. The cardiac functions were evaluated by conventional and tissue Doppler echocardiography (TDE). Results: Higher concentrations of isoprostane-8 and IL-6 were found in group with clinical score > 40 (58.595 +/- 2.86 pg/mL and 38 +/- 1.77 pg/mL, respectively) than in control group (34.9 +/- 1.5 pg/mL and 7.02 +/- 0.3 pg/mL, respectively) {p < 0.0001*}. There was positive correlation between level of isoprostane-8 and IL-6 and value of clinical score {p < 0.0001*} and also with the degree of the cardiac dysfunction in those children. Conclusion: The severity of OSA as indicated by clinical score was positively correlated with degree of elevation of 8-Isoprostane and IL-6 in breath condensate of children with OSA and also with degree of cardiac dysfunction. Echocardiography and tissue Doppler modality are advised to examine these children.

Evaluation of the impact of live unrelated kidney donor (LURD) source on the outcome of renal transplantation is not adequately studied. We aimed to compare the long-term outcome of kidney transplantation from LURDs to that from living related donors (LRDs) among a pediatric recipient population. This study comprised 235 pediatric recipients who received their kidney grafts between 1976 and 2005 at our center. These patients were further subdivided into two groups according to donor source (211 with LRDs) and (24 with LURDs). All patients' data were assessed with special emphasis on graft and patient survival as well as posttransplant medical complications. Both groups were comparable regarding graft and patient survival at 1, 5, and 10 years. Despite higher incidence of acute vascular rejection among recipients with LURD (12%) vs. LRD (2.8%) (P=0.03), there was no difference in the incidence of chronic allograft nephropathy. Moreover, the overall incidence of posttransplant complications was comparable among the two groups. In our series, kidney survival was poorer in LURDs compared with LRDs. However, the number of patients with LURD was small, and the difference in results was also small and justifies LURD in exceptional cases when LRD is not possible.

BACKGROUND: Endogenous opiates may affect various aspects of reproductive and metabolic function in patients with polycystic ovary syndrome (PCOS). This study evaluated long-term inhibition of the opioid system using naltrexone in clomiphene citrate (CC)-resistant women with PCOS. METHODS: A group of 30 infertile females with PCOS were evaluated; all subjects were obese, hyperandrogenic and hyperinsulinemic; 16 patients were amenorrhic and 14 were oligomenorrhic. All subjects received natrexone (50 mg p.o. daily) for 6 months. Patients who did not ovulate after 12 weeks of naltrexone monotherapy, also received CC (starting at 50 mg/day for 5 days and, for non-responders, increasing it up to 150 mg/day). RESULTS: Of the 30 women, 3 ovulated during naltrexone monotherapy and 19 of the remaining 27 ovulated during naltrexone + CC therapy. There were no conceptions during naltrexone monotherapy, but 9 of 27 women (33.3%) conceived during naltrexone + CC; there was one missed abortion at 9 weeks, one preterm delivery at 34 weeks and seven term live births. Naltrexone therapy was also followed by significant reductions in BMI, fasting serum insulin, luteinizing hormone (LH), LH/follicle-stimulating hormone ratio and testosterone. CONCLUSIONS: In this preliminary trial, naltrexone improved endocrine and metabolic function in women with CC-resistant PCOS. Furthermore, naltrexone restored CC sensitivity in the majority of subjects, resulting in a significant number of pregnancies.

The origin of acute lymphoblastic leukemia (ALL) may be explained by a combination of genetic susceptibility and environmental exposure. We aimed to study the frequency of CYP1A1 allelic variants in Egyptian patients with ALL, to evaluate their role in the development of ALL and to correlate these allelic variants with clinical and biological characteristics of the patients. Polymorphism of CYP1A1*2A, *2B and *4 alleles was examined in 186 Egyptian children with ALL and 200 normal individuals using polymerase chain reaction-single stranded conformation polymorphism (PCR-SSCP). A higher prevalence of the CYP1A1 *4 allele was found in patients with ALL than in the normal population (19.4% vs. 10.0%, odds ratio [OR] = 2.160, 95% confidence interval [CI] = 1.200-3.89, p = 0.01), especially in the homozygous variant (OR = 6.6, 95% CI = 2.23-19.58, p = 0.001) and in male patients (p = 0.005), particularly those aged 2-10 years (OR = 5.214, 95% CI = 1.535-17.706, p = 0.008). CYP1A1*2A showed a significant difference between age groups (p = 0.046), with a higher incidence in the 10-17-year-old group (21.1%). Multivariate analysis showed that only the CYP1A1*4 allele remained as a probable independent risk factor for ALL development (OR = 2.250, 95% CI = 1.244-4.069; p = 0.007). Our results suggest that polymorphic variants in the CYP1A1*4 gene may increase the risk of childhood ALL, particularly in male patients aged 2-10 years.

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and contribute significantly to the overall road traffic injuries. The aims of this work were to study the attitudes and practices of the motorcyclists regarding training and safety measures, and to determine some underlying factors of motorcycle crashes. This cross sectional hospital based study was conducted on all injured conscious motorcyclists who were admitted to the emergency department at Benha University Hospital, Benha City, Qalubia governorate, Egypt from December 2012 up to December 2013. The data were collected using a standard interview questionnaire which included four main sections; personal data, data about the rider's experience and training, safety issues and data about the crash the motorcyclist involved in. The questionnaire was completed by 246 motorcyclists. Of these, 67.5% did not have a motor cycle license and friends/family were the source of training for 56.9% of them. There were highly significant associations between the source of training and age, education, occupation and marital status (P