Perception and practice of social distancing among Egyptians in COVID-19 pandemic

Introduction: Social distancing is principally intended to reduce infectious disease transmission by decreasing interactions among people in a broader community. Keeping social distancing is an essential public health measure to resist the COVID-19 pandemic.Methodology: a cross sectional study was conducted among 1,036 Egyptians using an online questionnaire between 5 and 10 May 2020.Results: There was significant association between the practice of social distancing and some sociodemographic factors as sex, age, education, working status, and place of residence at p value < 0.001 and with community of residence at pvalue 0.021.Conclusions: Egyptians had good perception for social distancing to prevent transmission of COVID 19, but they were not strictly practicing it

Evaluation of antibacterial activity of silver nanoparticles against multidrug-resistant gram negative bacilli clinical isolates from Zagazig University Hospitals

Background: The growing incidence of multidrug resistant (MDR) bacterial infections has become a public health crisis. This work aims to evaluate the in-vitro activity of silver nanoparticles (AgNPs), alone and in combination with the antimicrobials amikacin and ceftazidime, against MDR Gram-negative bacilli (GNB) isolated from clinical cases in Zagazig University Hospitals. Methods: In a cross sectional study, MDR GNB were isolated from different clinical specimens and were tested to determine the minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC) and bactericidal activity of AgNPs using broth microdilution method. The effect of combining subMIC levels of AgNPs (MIC/2 and MIC/4) with amikacin and ceftazidime, was also determined by broth microdilution. Results: A total of 63 MDR GNB was obtained during the study period (22 E. coli, 17 Klebsiella, 15 Pseudomonas aeruginosa and 9 Acinetobacter isolates). AgNPs demonstrated a bactericidal effect on all tested isolates with an MBC/MIC ratio of less than 4. When combined with amikacin, a synergistic effect was demonstrated on all tested E.coli and Klebsiella isolates at AgNPs MIC/2 and on 45.4%, 40% and 77.8% of E.coli, P.aeruginosa and Acinetobacter isolates, respectively at MIC/4. In combination with ceftazidime, AgNPs exhibited a synergistic effect on 100% of E. coli and 88.2% Klebsiella at both MIC/2 and MIC/4 and on 40% of P. aeruginosa isolates at AgNPs MIC/4. Conclusions: AgNPs exert a bactericidal activity on MDR GNB as well as a synergistic effect when combined with amikacin and ceftazidime suggesting them as a new weapon in the war against MDR GNB

Silver nanoparticles: A potential antibacterial and antibiofilm agent against biofilm forming multidrug resistant bacteria

Background: Multi-drug resistant (MDR) bacteria are seriously endangering the antibiotics. Different alternative strategies are needed to reinforce antibiotics, of, these; nanostructured materials may play a fruitful role. This study aimed to investigate the antibacterial and antibiofilm activity of silver nanoparticles (AgNPs) against MDR bacteria. Methods: In a cross-sectional study, a total of 33 methicillin resistant Staphylococcus aureus (MRSA) and 52 MDR Pseudomonas aeruginosa (P. aeruginosa) isolates were recovered from intensive care units' (ICUs) admitted patients over a period of 9 months, from December 2017 to August 2018. The antibacterial activity of AgNPs on the clinical isolates of MRSA and MDR P. aeruginosa was assessed by minimum inhibitory concentrations (MICs) using broth microdilution method. The minimum bactericidal concentrations (MBCs) were determined as the lowest concentrations required to kill 99.9% of the initial inoculum. Tissue culture plate method was used to evaluate the antibiofilm activity. Results: The MIC and MBC values ranged from 1 to 16 µg/ml and 2 to 64 µg/ml, respectively. Silver nanoparticles exerted a significant antibiofilm activity against MRSA and MDR P.aeruginosa at all tested concentrations, recording a maximum inhibition value of (82%) and (91%), respectively. Conclusions: AgNPs exhibited a considerable antibacterial and antibiofilm, effect; it could represent a promising weapon in the fight against biofilm forming MDR organisms

Anti-Helicobacter pylori activity of Egyptian medicinal plants and bacteriophages

Background: Helicobacter pylori (H. pylori) is the most common cause of gastric infections worldwide. Due to antibiotic resistance and adverse effects, phytotherapy and phage therapy have been a research focus as an alternative therapy for H. pylori infection. Objectives: To assess the medicinal plant extracts and bacteriophages as a treatment of H. pylori infection. Methodology: Thirty five gastric biopsies were cultured for H. pylori isolation. Screening of medicinal plants extract efficiency was done by Disc diffusion method. Minimum inhibitory concentrations of extracts were assessed. In vivo effect of Punica granatum peel extract was tested by bacterial density and histopathology in rats. Sewage water samples were screened for H. pylori specific bacteriophages. Single plaque isolation technique was used for phage purification. Results: Ten out of 35 (28.57%) patients had positive gastric biopsy for H. pylori by culture. Four out of 10 (40%) isolates were resistant to all antibiotics. Inhibitory effect of Rosemarinus officinalis, Syzygium aromaticum, Rhus coriaria and Ammi visagna on H. pylori was detected. Punica granatum extract was the most efficient in vitro. In vivo, Punica granatum peel extract caused significant reduction of bacterial density (Pty (P<0.05) and enhanced ulcer healing. Sewage water filtrates contained 3 types ofH. pylorispecific bacteriophages. During phagepurification,phage infectivity waslost.Conclusions:Punicagranatumpeel extract revealed better in vivo activity againstH. pylorithanv standard regimen antimicrobials. Other effective plants can be beneficial inH. Pylori infection management .Loss of bacteriophage infectivity may be an obstacle to phage therapy of H. pylori

The incidence of Mycoplasma pneumoniae in community acquired pneumonia among children: one centre study

Background: Mycoplasma pneumoniae (M. pneumoniae) is an important cause of pediatric community acquired pneumonia (CAP). Aim: The aim of this study was to determine the incidence of M. pneumoniae in pediatric community acquired pneumonia and to determine the most frequent clinical findings of M. pneumoniae CAP. Methods: A total of 83 pediatric CAP patients were subjected to history taking, clinical examination, chest X-ray, CBC, CRP and serum antimycoplasma pneumonia IgM and IgA by ELISA. Results: Twenty-nine (34.9%) out of 83 patients were positive for M. pneumoniae Ig M while 2 (3.4%) patients were positive for M. pneumoniae Ig A. There were more infection (54%) in age group (5-9 years; p value = <0.001). M. pneumoniae pneumonia infected patients were presented with cough (29/29; 100%), fever (29/29; 100%), malaise (18/29; 43.8%), headache (16/29; 33.8%), wheeze (21/29; 52.5%), chest discomfort (13/29; 44.8%), sore throat (13/29; 46.4%), rhinitis (8/29; 27.5%) and pharyngitis (6/29; 24%). The most frequent X ray findings in M. pneumoniae pneumonia was air space pneumonia (71%); segmental more than lobar form (p-value = < 0.0001). Conclusion: The findings of this study highlight the clinical significance of M pneumoniae in pediatric community acquired pneumonia

The relation between class i integrons and multidrug-resistance in extended-spectrum beta lactamase producing escherichia coli isolates

Background: The emergence and development of multidrug resistant (MDR) strains is due to inappropriate use of antibiotics and horizontal gene transfer between bacteria. The MDR strains of E. coli are highly associated with the presence of integrons; also, extended-spectrum beta lactamase producing isolates are usually resistant to various antibiotics. This study aimed to determine the incidence of class 1 integrons and its association with drug resistance in ESBL producing E. coli isolated from patients who were suffering from UTI.Methods: this study was conducted on 232 hospitalized patients with UTI, from which 160 E. coli strains were isolated. Antibiotic susceptibility testing and screening for ESBL production were performed by Kirby-Bauer disk diffusion method on Mueller- Hinton agar. Confirmation for ESBL production was performed by combined disc diffusion test. All MDR ESBL producing E. coli isolates were examined by conventional PCR for the presence of intI1 gene and related gene cassettes.Results: One hundred sixty E. coli strains (69 %) were isolated from 232 hospitalized patients. The highest percentage of resistance was to azetronam (92%) followed by ceftazidime and cefotaxime (90%) then ciprofloxacin (79 %). seventy two E. coli isolates (45%) were found to be ESBL producers and out of them, 61 isolates (84.7 %) were MDR. Out of the 61 MDR ESBL-producing isolates, class I integron was identified in 56 isolates (91.8%).Conclusion: our findings indicate high prevalence of class 1 integrons and gene cassettes suggests possible risk for the dissemination of resistance genes and the spread of MDR bacteria

Comparison of different techniques and stains for direct diagnosis of Trichinella spiralis

Background: The aim of Trichinella inspection is to reliably detect larvae in meat at levels which are capable of causing human trichinellosis. Trichinoscopy is a rapid, cost effective but is less sensitive in detection of low muscle larvae (ML)numbers. Artificial digestion is more convenient, and flexible, but may destroy immature larvae. Baermann technique may enhance the efficiency of diagnosis. Giemsa and Leishman stains provide identical contrasting coloration as Hematoxylin and Eosin (H-E) with the both advantages of that they can be used for staining non-histological sectionsand rapid preparation.The primary aim of the study was to compare the efficiency of digestion and Baermann techniques for detection of ML in muscles. Secondary aim was detection of ML by Geimsa and Leishman stain and their comparison with routinely used stain H-E. Methods: Muscles from 36 mice orally infected with Trichinella spiralis encysted larvae were examined. Larvae from 1 g samples of different muscles were recovered by digestion and Baermann techniques after different dose of infection. Muscle samples were prepared for staining with Giemsa, Leishman and H-E. Results: Number of larvae recovered by Baermann was higher recovered by digestion method (P ˃0.5). Leishman stain was the best stain for rapid detection of ML after 30 min followed in validity by Geimsa then H-E. Conclusion: Baermann concentration technique showed higher sensitivity than digestion method. Leishman stain is superior to Giemsa stain as it takes less time. Both stains are considered good alternative to H-E for rapid and easy diagnosis of trichinellosis in post-mortem animals

Efficacy of olibanum and propolis medicinal extracts versus metronidazole in Giardia lamblia experimentally infected mice

Giardiasis is a common intestinal infection, recently included by the World Health Organization in the 'Neglected Diseases Initiative'. Despite the efficacy of nitroimidazoles; the main antigiardial chemotherapeutics, adverse effects and resistance enforced developing non-chemical alternatives. The present study aimed to assess the therapeutic efficacy of ethanol extract of olibanum (OL), propolis (PR), and their combination versus metronidazole (MTZ) against G. lamblia infection. Sixty Swiss male albino mice were randomly divided into 6 groups; 10 mice each,: Group I: normal control (non-treated; non-infected). Group II: infected with G. lamblia cysts, non-treated. On the 6th day postinfection (dPI), the remaining 4 infected groups were treated orally with: Group III: (OL). Group IV: (PR). Group V: combination of (OL+PR). Group VI: (MTZ). These mice were subjected to direct parasitological diagnosis of Giardia trophozoite in intestinal exudate, immunochromatographic test for antigen detection and histopathological studies. After 7 days therapy, complete clearance of Giardia trophozoites were in the combination of (OL+PR) and MTZ groups therapy. Lower percentages of reduction (91%) & (83%) were recorded in PR and OL-treated groups, respectively. Histopathological examination showed marked healing of intestinal mucosa using non-chemical combination and different degrees of dysplasia using MTZ, while partial healing was observed using olibanum and propolis separately. Olibanum, propolis and their combination were proved to enhance the clearance of Giardia trophozoites; with progressive improvement of the histopathological changes of jejunal mucosa, making good non-chemical alternative antigiardial therapeutics sidestepping the obstacles of metronidazole like dysplasia and teratogenicity

Influence de la vitamine D3 livrée localement sur la conservation des crêtes alvéolaires après extraction, des dents (évaluation clinique radiographique et histologique)

BUT DE L'ÉTUDE: Le but de cette étude d'essais cliniques contrôlés randomisés était d'évaluer et de comparer la conservation des dimensions de la crête alvéolaire après une extraction dentaire atraumatique à l'aide d'une membrane de collagène et d'une xénogreffe mélangée avec du gel vit D3 actif par rapport à une membrane de collagène et à une xénogreffe uniquement. MATÉRIEL ET MÉTHODES: Dix patients ont été sélectionnés. Tous les patients ont dû extraire deux prémolaires non restaurables (ou dents antérieures) situées dans des quadrants symétriques d'arcs maxillaires ou mandibulaires et ont demandé une restauration d'implant. Deux chirurgies ont été réalisées pour chaque patient; le premier était destiné à l'extraction de la préservation de la crête alvéolaire, tandis que le second était destiné à la biopsie osseuse centrale et à la pose d'implants de façon routinière. Chez le même patient, une prise d'extraction (site de test) a été traitée avec une membrane de collagène et une xénogreffe mélangée avec de la vit active D3 tandis que la deuxième prise d'extraction (site de contrôle) a été traitée avec une membrane de collagène et une xénogreffe uniquement. Des évaluations cliniques, radiographiques et histologiques / histomorphométriques ont été réalisées. RÉSULTATS: Cliniquement et par radiographie tout au long de la période d'étude, il n'y avait pas de différence statistiquement significative entre les variations moyennes en% de la largeur des crêtes BL et de la hauteur des crêtes dans les deux groupes. L'analyse histomorphométrique a montré une différence statistiquement significative entre la fraction de surface moyenne de la nouvelle formation osseuse dans les deux groupes. CONCLUSION: L'application locale de vitamine d3 avec la xénogreffe dans la préservation de la crête alvéolaire accélère la formation de nouveaux os et favorise la maturation osseuse lors de la comparaison avec la xénogreffe uniquement

Non-operative management of blunt abdominal solid organ trauma in adult patients

Introduction: Despite agreement in the literature that"stable"blunt trauma patients may be managed con-servatively, in Egypt many such patients receive operative management. This paper presents the results of apragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP)management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to TantaUniversity Emergency Hospital (TUH) in Egypt.Methods:A prospective observational study enrolled adult blunt abdominal trauma patients with solid organinjury at TUH over a 3-year period (June 2014­June 2017). Inclusion criteria were age≥18 yr, mean arterialpressure > 65 mm Hg, heart rate < 110 bpm, hematocrit≥7 mg/dl, and abdominal organ injury diagnosed byultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-tients were assigned to non-operative or operative management based on clinician preference. Outcomes ofinterest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics andχ2wereused to compare outcomes. Results:During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominaltrauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10­NOP vs. 28 ± 11­OP,p= 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP]vs.1155.17 ± 380.4 ml [OP] (p< 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs.6.45 ± 1.97 days [OP] (p= 0.012)). There was no difference in mortality between groups (p= 0.091). Conclusion:Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma wassafe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longerlength of stay for non-operative patients might reflect treating physician caution in their management

A challenging case of hereditary type 1 tyrosinaemia associated with persistent diarrhoea: Case report and literature review

Hereditary tyrosinaemia type 1 (HT1) is a rare inherited genetic disorder attributed to deficiency of the enzyme fumarylacetoacetate hydrolase (FAH). HT1 may present with diarrhoea in its acute form. We report on a 2.5-year-old Egyptian girl diagnosed with HT1. At the age of 1 year and 9 months, the patient started to have persistent diarrhoea with marked abdominal distension, anorexia and irritability, and with no fever or vomiting. At the onset of diarrhoea, liver synthetic functions deteriorated and ascites progressed, requiring frequent paracentesis. These manifestations did not improve after starting specific treatment for HT1 (2-(2-nitro-4-trifluoromethylbenzoyl)- 1,3-cyclohexanedione) (NTBC). Coeliac disease was diagnosed; this disorder was not previously reported as having an association with HT1

Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased.Objective. To investigate four treatment methods, based on each patient's clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP.Methods. CSEP cases (N=30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage (n=12), embryo reduction with local methotrexate injection (n=12), laparoscopic excision (n=3) and excision through laparotomy (n=3). Serum levels of beta-human chorionic gonadotrophin (ß-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values.Results. There was a significant positive correlation between gestational age in weeks and the CSEP management strategy employed. ß-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later.No cases required a hysterectomy, and no maternal complications were reported in this study.Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of ß-hCG levels and ultrasonographic examinations, is recommended after CSEP management

Knowledge and attitude of physicians towards 2019 novel Coronavirus (COVID-19) pandemic: A cross sectional survey from Egypt

Background: Coronavirus disease 2019 (COVID-19) is a serious emerging public health issue and it has been identified as a major risk to human health in 2020. Egypt has more than 100 million population, of whom in poor economic conditions and with low education levels could be vulnerable to COVID-19 infection. Physicians are at the frontiers in battles against the emergence, spread, and control of COVID-19 pandemic. Research data are needed to develop evidence-based strategies to prepare health care systems to deal with the current epidemic. Aim: The aim of this study is to assess the level of knowledge and attitudes to COVID-19 pandemic among a group of Egyptian physicians. Methods: From March 15th to March 25th, 2020, we conducted a cross-sectional online survey using non-probability accessibility sampling technique. The structured questionnaire was distributed online through E-mails and social networks to identify the knowledge and attitude among a group of Egyptian physicians regarding COVID-19 pandemic. Result: The study included 256 physicians. Of the participants, 48% were males 49.6% were females. The mean of total score was (19.6±2.3) out of 23 gained mainly from the social media (50.7%). About 67% of the participants heard of Coronaviruses before this pandemic, 78.5% identified other Coronaviruses. All the participants correctly identified the incubation period and 81.6% correctly identified the typical clinical symptoms. Most of the participants (97.6%) could estimate the fatality of COVID-19. Approximately 95% of the respondents knew no vaccination and 88% correctly answered that no current specific treatment for COVID-19 available. Almost all 98% of the participants knew the recommended general infection control precautions. Most of the participants showed positive attitude, about (97%) agreed that health care workers must avail themselves of all information about the COVID-19. Conclusion: The finding of this survey indicating that, faced with the COVID-19 pandemic, this studied group of Egyptian physicians showed positive attitude and satisfactory knowledge about emerging COVID-19 infection. Recommendations: Although the Egyptian Ministry of Health (MOH) has taken several major steps to prepare the health care system to be ready dealing with COVID-19 pandemic, it is important to develop educational programs to ensure continuous updated knowledge of the physicians

Efficacy of sofosbuvir plus daclatasvir in treatment of chronic HCV infection in Egyptian patients: a prospective cohort study

Background and study aim: Chronic hepatitis C virus infection is a massive health challenge in Egypt. New DAAs in the past few years have proven to be extremely effective in treatment of HCV infection. The aim of this study was to evaluate the efficacy of a sofosbuvir-based treatment protocol composed of sofosbuvir and daclatasvir with or without the addition of ribavirin in Egyptian patients infected with HCV genotype 4 in Sharkia governorate. Patients and Methods: One hundred patients were included in the study. Patients were divided into three groups, group I: 48 treatment-naïve non-cirrhotic patients who were assigned to receive dual therapy (Daclatasvir+Sofosbuvir) for a duration of 12 weeks, group II: 32 treatment-naïve cirrhotic patients who were assigned to receive triple therapy (Daclatasvir + Sofosbuvir + Ribavirin) for a duration of 12 weeks, and group III: A control group composed of 20 chronic HCV patients, not receiving antiviral therapy. Patients were followed up thoroughly by clinical and laboratory evaluation monthly throughout treatment and for 3 months after the end of treatment (EOT). In addition, the virological response for each patient was recorded. Results: No statistically significant difference was found between both groups that received treatment regarding virological response, since 100% of patients achieved SVR12 rates in both groups. Conclusion: The combination of Daclatasvir plus Sofosbuvir with or without the addition of ribavirin for a duration of 12 weeks has proven to possess high efficacy in the treatment of cirrhotic and non-cirrhotic naïve Egyptian patients with chronic infection with HCV genotype4 in Sharkia governorate

Relationship between Elevated Liver enzymes and Metabolic syndrome among Egyptian adults

Background and study aim: Liver enzymes are important markers for hepatocyte damage. Metabolic syndrome (MS) is a combination of metabolic abnormalities including high blood glucose, obesity, hypertension and dyslipidemia. The incidence of MS is believed to be increasing in Egypt. The purpose of this study is to examine the relationship between elevated liver enzymes and MS among Egyptian adults. Patients and Methods: A total 138 apparently healthy subjects were randomly included (99 females and 39 males). Demographic, clinical (blood pressure, body mass index and waist circumference) and biochemical (measurements of alanine aminotransferase (ALT), aspartate amino-transferase (AST), alkaline phosphatase (ALP), lipid profile, blood glucose and viral markers) were collected from every subject. Metabolic syndrome was defined according to a well-known criteria and subjects in the final analysis were divided into group I; metabolic syndrome and group II; non-metabolic syndrome subjects. Results: In this study, 92 persons fulfilled three of the five criteria of metabolic syndrome (group I) with prevalence of 66.7% while group II (non-metabolic syndrome) represented 33.3%. Patients with MS were older and less physically active in comparison with group II. There were an association between elevations in liver enzymes (ALT, AST, ALP) and MS. ALT, AST and ALP were elevated in 42.4%, 17.2% and 20.7% of patients with MS respectively. ALT and AST showed positive correlation with elevated blood glucose and triglycerides levels while AST/ALT ratio showed negative correlation with diastolic blood pressure, triglycerides level and waist circumference. The more items of MS the patient have the higher the level of liver enzymes. Conclusion: Among Egyptian adults elevated levels of liver enzymes were associated with MS and a correlation was noticed with its components

Early prediction of acute kidney injury in patients with acute on chronic liver failure by measuring kidney injury Molecule-1 level in Urine at Zagazig University Hospitals

Background and study aim: Some of patients with decompensated cirrhosis will exhibit newly developed acute liver failure. This condition is called acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is common with ACLF. Kidney injury Molecule-1 (KIM-1) is an ideal biomarker of AKI. The aim of this study was to evaluate role of KIM-1 in prediction of AKI in ACLF patients. Patients and Methods: Eighty four patients were included in this study. They were selected from hospitalized patients with acute decompensated cirrhosis. They were allocated into two groups; group I: patients with no acute-on-chronic liver failure (ACLF), group II: patients with ACLF. Results: KIM-1 was significantly higher in the ACLF (group II). KLM-1 median was 2.4 in group I vs 7.35 in group II with p value <0.001. We found that at cut off value of ≥0.5 KLM-1 can predict the presence of AKI with sensitivity of 85.7%, specificity 88.1%, positive predictive value 87.8%, negative predictive value 86%, accuracy 86.9% and AUC= 0.867 p <0.001. Conclusion: KLM-1 rises significantly in patients with ACLF. KLM-1 can be reliable in prediction of the presence of acute kidney injury in decompensated cirrhosis

Diagnostic value of serum heat shock protein 70 in hepatocellular carcinoma patients

Background and study aim: Hepato-cellular carcinoma (HCC) is the commonest essential hepatic threat among adult. Nowadays, the HCC determination without obsessive relationship is done by imaging methods. To elucidate the role of heat shock protein 70(HSP70) in the diagnosis of HCC. Subjects and Methods: This case control study was achieved in Internal Medicine and Clinical Pathology Departments, Zagazig University, Egypt. It involved 99 participants divided into three groups; control group, cirrhotic patients and cirrhotic patients with HCC. Participants underwent complete history taking, comprehensive clinical examination, laboratory investigations including viral markers and alpha-fetoprotein. HSP 70 level was calculated via the enzyme-linked immunosorbent assay (ELISA) technique. Radiological investigations including abdominal ultrasonography and triphasic CT scan were done. Results: There was a non-significant difference between the studied groups concerning demographic characteristics. There was a significant difference between them regarding hemoglobin, platelet count, liver and kidney function tests and coagulation profile(p<0.05). Also, there was a significant difference between them as regards HSP 70, and AFP with the maximum values in HCC group. HSP 70 at cutoff ≥120 ng/ml can diagnose HCC at sensitivity 85%, specificity 50%, and accuracy 84% (p<0.05). AFP at cutoff ≥20 ng/ml can recognize HCC with sensitivity 87.5%, specificity 75.8% and accuracy 89%. Combined HSP 70 and AFP increase the sensitivity of diagnosis at 91.5% and accuracy to 93%. Conclusion: HSP 70 as a serum biomarker can be used with AFP to increase the accuracy of HCC diagnosis

Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE

Image case: celiac disease in 14 years old girl with Type 1 Diabetes Mellitus

Celiac disease is an autoimmune disease that primarily affects the small intestine. Classic symptoms in children include gastrointestinal disorders as chronic diarrhea, malabsorption and failure to grow normally. It is associated with other autoimmune diseases, such as thyroiditis and diabetes mellitus type 1 . Mild or absent gastrointestinal symptoms may be found specially in older people.Celiac disease may be presented with rare but life threatening crisis. 14 years old underbuilt anemic (iron deficiency) girl with type 1 diabetes mellitus without gastrointestinal symptoms was endoscopicaly examined for clinical suspicion of Celiac disease. On endoscopic examination there was fissurization (cracked-mud ) of the mucosa of the duodenal bulb as well as descending duodenum. Pathological examination of the endosopic biopsies confirmed the diagnosis. Upper gastrointestinal endoscopy in celiac disease usually shows scalloped (indentations and erosions) blunted duodenal mucosa, visible mucosal vessels, micronodular appearance of the mucosa and mucosal fissures(cracked-mud). Duodenal biopsy shows villous blunting with intraepithelial lymphocytosis

Cosmetic outcome of hypofractionated whole-breast irradiation with concomitant boost in breast cancer

Background: Breast cancer is the most common cancer in women worldwide, second most common malignancy in Egypt.Methods: 60 early-stage breast cancer patients who underwent breast-conserving surgery were clusterized into 2 groups: Arm A hypofractionation with concomitant boost and Arm B conventional fractionation, each compromising 30 early stage breast cancer patients. Assessment of cosmetic outcome after breast irradiation was recorded in both groups in 4 intervals to correlate cosmesis in relation to different irradiation schedules and boost dosage and timing. The study was conducted from April 2016 till December 2018, 32 months were obtained to assure that all patients completed their irradiation schedule and 12 months follow-up period.Results: Lowest cosmetic outcome was recorded immediately after completion of breast irradiation with excellent/good in 66.7% and 73.3% of patients and fair/poor in 33.3% and 26.7% in Arm A and B, respectively. Improvement in cosmesis after 12 months of breast irradiation reaching excellent/good in 83.4% and fair/poor in 16.7% in both Arm A and B.Conclusion: An abbreviated 4-week hypofractionated schedule with a concomitant boost is as effective as conventional irradiation with comparable cosmesis and may be a reasonable alternative following breast conserving surgery