Assessment of Functional Mitral Regurgitation Severity by Proximal Isovelocity Surface Area via 3D Transthoracic Echocardiography

Background: Accurate quantitative evaluation of MR severity remains challenging because limited scan plane orientation of 2D echocardiography does not provide direct measurement of the regurgitant lesion. Three-dimensional echocardiography, which has become a clinically established technique, has been shown to provide useful information for flow quantification and so has the potential to address the major drawbacks of 2D-based approaches. Objectives: To assess the reliability of PISA measurement using real-time 3D color trans-thoracic echocardiographic imaging in clinical practice and to compare its derived EROA, regurgitant volume (Rvol) and regurgitant fraction with that obtained by 2D trans thoracic PISA. Patients and Methods: This cross-sectional study, included 30 patients with at least moderate functional MR came for evaluation on clinical basis indications at Al-Hussein and Bab El-Shaareya University Hospitals during the period from November 2020 to July 2021. Two- and three-dimensional echocardiography was done to asses MR and calculate vena contract width, 2D PISA and derived EORA and regurgitant volume. Also, calculation of 3D EROA using PISA method by 3D probe. Results: There was a significant positive correlation between 2D EPISA and 3D EROA using PISA method and EROA, p value was 0.0001. With higher values for 3D EROA using PISA method when compared with 2D PISA in different degrees of MR as summarized in “the mean value of EROA by 2D PISA in moderate MR was 0.25 ±0.042 cm2, while it was 0.32±0.059 cm2 by 3D EROA using PISA method. While the mean value of EROA by 2D PISA in severe MR was 0.58 ±0.14 cm2, and it was 0.47 ±0.049 cm2 by 3D EROA”. Also showed significant difference in different direction of MR jets especially in eccentric jet as shown by the mean value of EROA by 2D PISA in central MR was 0.41±0.19 cm2, while it was 0.41±0.87 cm2 by 3D method. While the mean value of EROA by 2D PISA in eccentric MR was 0.53 ±0.21 cm2, and it was 0.44 ±0.096 cm2 by 3D EROA using PISA method. Conclusion: The use of 3D EROA using PISA method and simple calculation of a mean systolic regurgitation orifice area proved to be superior to 2D measures (VC, 2D-PISA) for distinguishing moderate from severe MR, evaluation, classification and grading of MR in a routine clinical cardiology setting. 3D EROA reduces assumptions and seemingly improves diagnostic value as compared with 2D-PISA

A multi-component spectrophotometric method for simultaneous determination of total bilirubin, oxyhemoglobin, and methemalbumin in human sera

A new multi-component spectrophotometric method was developed experimentally and theoreticallyto determine the accurate serum concentrations of the total bilirubin (TB), oxyhemoglobin (HbO2), andmethemalbumin (Mha) in healthy human adults and neonates with hemolytic jaundice. With respect to theexperimental technique, the method of preparation of serum solution has been developed, like the use ofdistilled water as a solvent and centrifugation of serum solutions to clear the sample turbidity. The resultsof TB were compared to the diazo-assay. Theoretically, the formulas used for the calculation of the majorcomponents (TB, HbO2, and Mha) in human sera have been derived based on the theory of multi-componentspectrophotometric analysis and the mathematical Gaussian elimination method for matrix calculation. Themethod of multi-component spectrophotometry, suggested in this study for determination of TB, showed% error (3.1%–4.9%), indicating the high accuracy of the method. The small coefficients of variation(CV = 3.65%–5.1%) indicate the high precision of the method. The results showed higher values of serum TB(p < 0.00005), HbO2 (p < 0.001), and Mha concentrations (p < 0.00005) in neonates, when compared to adults.The method is highly sensitive and accurate. It is inexpensive, precise, reproducible, and has the advantages ofsimplicity, speed, and can be computerized.

Assessment of Thrombin Generations in Patients with Chronic Liver Diseases

Background/objectives: The area of hypercoagulability in cirrhosis and its potential contribution to certain clinical aspects have received a lot of attention. The clinical manifestations of the hemostatic disorders of cirrhosis have been traditionally related to bleeding due to multiple procoagulant factor defects, excessive fibrinolysis, and thrombocytopenia. Aim: Assess the function of blood coagulation in patients with chronic liver diseases and improve the knowledge of the pathophysiology of haemostasis. Patients and methods: This is a prospective case-control study which was conducted at outpatient clinic of internal medicine dept., Minia University Hospital, Minia Governorate, during the period from March 2017 to August 2018. Results: Protein C and S concentrations decreased significantly in Group (II A, II B, and IIC) compared to control and also, Group (II C) decreased significantly than Group (II A, II B). Regarding Thrombin fragments (F 1+2), Child score A patients had significantly higher concentration compared to the other three groups. However, as regards, Thrombin-antithrombin (TAT), Child score C group had a significantly higher level compared to other groups. Conclusion: Thrombin fragments and thrombin antithrombin complex are considered as the main specific markers for thrombin generations which were elevated strongly depending upon the pathogenesis and the severity of the liver diseases.

The risk of secondary cancer in pediatric medulloblastoma patients due to three-dimensional conformal radiotherapy and intensity-modulated radiotherapy

BACKGROUND: Craniospinal irradiation (CSI) is the standard radiation therapy treatment for medulloblastoma. The aim of this study was to estimate and compare the lifetime risk of radiation-induced secondary cancer in pediatric medulloblastoma patients using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: 3D-CRT and IMRT plans were performed for 10 CSI pediatric patients. The average absorbed doses for organs at risk (OARs) was calculated from dose-volume histograms on the treatment planning system. The average lifetime risk of radiation-induced secondary cancer was then calculated. RESULTS: Lifetime risk of secondary cancer for CSI pediatric patients treated using IMRT decreases in some OARs compared with those treated using 3D-CRT. This is attributable to the decrease in the average absorbed dose in some OARs when using IMRT technique. CONCLUSION: Follow-up of medulloblastoma pediatric patients should be performed after ending the treatment course in order to diagnose early secondary tumors. IMRT technique is substantially better than 3D-CRT in terms of lifetime risk of radiation-induced secondary cancer, probably due to reduced dose to OARs especially to the thyroid, which is the most sensitive organ to radiation.

Ameliorative effect of vitamin B12 on seminiferous epithelium of cimetidine-treated rats: a histopathological, immunohistochemical and ultrastructural study / 대한해부학회지

Cimetidine is an H2 receptor antagonist that has an antiandrogenic effect. It intervenes with the conversion of testosterone into estrogen in the Sertoli cells with accompanying testicular structural changes. In the present study, the microscopic and the ultrastructural changes induced by cimetidine and the effect of vitamin B12 as a protective agent on rat testes were studied. Immunoexpression of estrogen receptor β (ERβ) in testes was evaluated. Twenty-four adult male rats were divided into four groups: control, cimetidine-treated, vitamin B12 treated, and combined cimetidine and vitamin B12 treated. The experimental rats were administered with cimetidine and/or vitamin B12 for 52 days. Group II rats showed marked atrophy of the seminiferous tubules with a significant increase in tubular diameter and decrease in the tubular luminal and epithelial areas. Ultrastructure of this group showed irregular Sertoli cells with basal cytoplasmic vacuolation and significantly thickened basement membrane. ERβ immunoexpression was similar to controls. Group III rats showed near normal seminiferous tubular structures with minimal cellular alterations and the immunoreactivity of the testicular sections was very close to normal. However, group IV rats showed markedly immunopositive detached cells, spermatids, and primary spermatocytes. Cimetidine interferes with the control of spermatogenesis as evidenced by microscopic and ultrastructural studies and affection of ERβ receptors and vitamin B12 has a protective action against this harmful effect.

Reprocessing practices for gastrointestinal endoscopes: a multicentre study in Egyptian university hospitals

The aim of this study was to assess the practices of health care workers during gasterointestinal endoscope reprocessing, evaluate their knowledge about reprocessing, and verify their compliance with laboratory and microbiological tests in endoscopy units at Zagazig University and Fayoum University hospitals. All nursing staff on duty from 10 endoscopy units, with 16 flexible endoscopes, were included. Knowledge and practice were assessed by a questionnaire and a checklist. The mean knowledge score was 7.5 [SD 1.9], which was poor. Compliance was 90% for disinfection and 74% for endoscope processing after disinfection. Before reuse after cleaning, no organisms were detected in 5 endoscopes, while 8 colony forming units were found in 2. Pseudomonas aeruginosa was the most common organism isolated. Strict implementation of the reprocessing guidelines are needed, especially the pre-cleaning stage and leak testing. Repeating high level disinfection after storage and before use must be followed

Isolation of lactobacilli and bifidobacteria species from human breast milk

Bacterial colonization of the infant gut is a gradual process that exerts a strong influence on the health status of the host. The source of bacterial diversity in breast fed babies remains unclear. For many decades, breast milk has been regarded as a sterile body fluid which exerts its influence on the infant's microbiota environment via presenting only some growth factors and optimal conditions for helping the growth of bacteria. However, in recent years, breast milk has been hypothesized to be a source of commensal bacteria for the infant gut. This study aimed at searching for bacteria in breast milk to assess the role of breast milk as their probable source. Samples of breast milk were obtained from 50 lactating women and were tested for the presence of different bacteria, using specific media and specific biochemical reactions. Culture of the 50 breast milk specimens showed growth of different species of lactobacilli in 100% of the specimens and bifidobacteria in the milk of 14 mothers [28%]. Breast milk can be a source of lactobacilli and bifidobacteria for the infants

Isolation of enterococci and streptococci species from human breast milk

Bacterial colonization of the infant gut is a gradual process that exerts a strong influence on the health status of the host. The source of bacterial diversity in breast fed babies remains unclear. For many decades, breast milk has been regarded as a sterile body fluid which exerts its influence on the infant's microbiota environment via presenting only some growth factors and optimal conditions for helping the growth of bacteria. However, in recent years, breast milk has been hypothesized to be a source of commensal bacteria for the infant gut. This study aimed at searching for bacteria in breast milk to assess the role of breast milk as their probable source. Samples of breast milk were obtained from 50 lactating women and were tested for the presence of different bacteria, using specific media and specific biochemical reactions. Culture of the 50 breast milk specimens showed growth of different species of enterococci and streptococci in 60% and 84% of the specimens; respectively. Breast milk can be a source of enterococci and streptococci for the infants

Intravenous patients controlled analgesia versus maxillary nerve block in unilateral maxillary surgery

The aim of the present study was to compare perioperative pain relief with intravenous patient controlled analgesia using morphine and maxillary nerve block in patients undergoing unilateral maxillary surgery. Sixty patients, ages between 17 and 70 years, ASA I and II, undergoing unilateral maxillary surgery [cystectomy, odontogenic tumour excision and orodental fistula repair], were recruited in the study and divided into two equal groups. In Group-A patients were administered general anesthesia plus maxillary nerve block with bupivacaine, and in Group-B patients were anesthetized with general anesthesia and morphine followed by PCA. Blood pressure, heart rate and Spo[2] were measured intraoperatively every 15 min. VAS was used postoperatively every 4 hours during first 24 hours. Satisfaction of the patient, conscious level, and complications, e.g. nausea, vomiting, itching and urine retention, were recorded in both groups. Results are presented as mean +/- standard deviation [SD]. Statistical analysis was performed with SPSS software version 16. The unpaired students t-test was used to compare the results of both groups. Complications are presented as percentage. P value <0.05 is considered significant. The hemodynamic parameters were increased in group B in comparison to group A. No significant changes in oxygen saturation during intraoperative period were observed between both groups or within groups. Regarding pain score [VAS], there were no statistically significant difference between both groups at [0] hour but difference was statistically significant between both groups after 4, 8, 12, 16, 20 and 24 hours, VAS score being more in Group B in comparison to Group A. Only 10% and 3.3% of patients inGroup A suffered from nausea and drowsiness respectively. In group B, 30%10%, 10%, 20 %and 10% of patients suffered from nausea, vomiting, Pruritus, drowsiness and urine retention respectively. This part needs to be described in a better way. Perioperative pain relief in cases of unilateral maxillary medium sized maxillary pathology removal achieved by maxillary nerve block is better than intravenous patient controlled analgesia due to hemodynamic stability, better pain control and lower side effects

effect of local injection of mesenchymal stem cells and IL-10 with platelet lysate on fracture healing in a rat model

Objective: This study investigates the effect of mesenchymal stem cells [MSC], an immuneprivileged cell source for tissue repair, Interluken [IL-10], an immune inhibitory factor, and platelet lysate [PL] on the fracture healing process

Methods: Forty adult male Sprague-Dawley rats were anesthetized, and left tibia mid shaft fractures were created. The rats were randomly assigned to 5 groups and received injections with saline [ A]; MSC and PL [B]; IL-10 and PL [C]; PL [D]; and MSC, PL, and IL-10 [E]. Lateral radiographs of four randomly selected rats in each group were taken at different days post-fracture. Four rats from each group were sacrificed at day twenty one post-fracture, with left tibiae harvested for histological analysis

Results: At 7 days post-fracture, the highest level of callus formation and bone healing was observed in group E [treated with MSC, PL, and IL-10] followed by groups B [treated with MSC and PL]. The same results were obtained at days 14, 21 and 28 post-fracture. At 21days post-fracture, histological analysis revealed that the callus of fractured tibiae in group A consisted mostly of chondrocytes, while in groups C and D, extensive remodeling with a limited amount of chondrocytes present at the fracture. Combination of MSC, PL, and IL-10was associated with the greatest fracture healing performance. After 3 weeks of treatment in group E and B, trabecular bone formation and cortex remodeling were observed

Conclusions: The use of MSC in combination with IL-10 and PL is a promising alternative treatment to promote fracture healing

Demographic pattern and clinical features of patients with carpal tunnel syndrome presenting to orthopedic outpatient clinics in a military hospital in Kuwait

Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. Our aim was to provide data about the demographic pattern and clinical features of this syndrome among patients in Kuwait, and compare it to data from other countries. Retrospective review of patients' medical records. Jaber Al-Ahmad Armed Forces hospital, Kuwait. A retrospective review of the medical records of 175 Kuwaiti patients diagnosed with CTS at Jaber Al-Ahmad Armed Forces hospital in Kuwait between January 2006 and December 2010 was done. The diagnosis was based on history, physical examination and electrodiagnostic studies. Results are presented using frequencies and percentages. Demographic and clinical features of patients with CTS. Out of the 175 cases, 132 [75.4%] were females, with a male to female ratio of 1:3.1. The mean age was 43.68 years [range 25-70 years], peaking between 46 to 50 years [40; 22.9%]. All the patients complained of nocturnal symptoms, while 173 [98.35] had daytime symptoms. Physical examination revealed abnormal sensation, positive Phalen's test, positive Tinel sign, thenar muscle wasting and decreased power of thenar muscles in 150 [85.7%], 161 [92.0%], 129 [73.7%], 17 [9.7%] and 91 [52.0%] patients respectively. involvement was bilateral in 141 [80.6%] patients. The most common cause / risk factor of CTS in this sample was obesity [66; 37.7%]. The demographic pattern and clinical features of this sample of CTS patients in Kuwait are similar to what was found elsewhere

Significance of plasma osteopontin in diagnosis of hepatitis C virus-related hepatocellular carcinoma

Alfa fetoprotein [AFP] is widely used as a surveillance test for hepatocellular carcinoma [HCC] among patients with liver cirrhosis [LC]. However, the clinical use of AFP has been shown to present some important limitations in sensitivity and specificity. Osteopontin [OPN] is a secreted matrix glycoprotein that is emerging as a significant protein in the biology of HCC. The aim of this study was to assess the diagnostic value of plasma OPN compared with that of AFP in the diagnosis of HCC among hepatitis C virus [HCV]-related LC. Plasma levels of OPN and AFP were measured in 69 Egyptian patients with HCV-related LC [35 with HCC and 34 without HCC] and 20 healthy controls. Both median AFP and OPN levels were significantly higher in the HCC group compared to LC and healthy control groups [p < 0.001 in each] and in LC compared to the control group [p < 0.001]. In the HCC group, both OPN and AFP levels were significantly higher in patients with Child-Pugh class C and B compared to class A [p < 0.05 in each]. There was no correlation between OPN and AFP levels. The OPN level was significantly higher in patients with multiple focal lesions than in those with single lesions [p < 0.05] and in patients with portal vein invasion compared to patients without portal vein invasion [p < 0.05]. Receiver operator characteristic [ROC] curves showed that the area under the curve [AUC] for OPN and AFP was 0.824 and 0.730, respectively. OPN is a promising tumour marker which could be used as a screening test for the diagnosis of HCC in patients with LC and, hence, improves the prognosis and survival rate of these patients. The association of OPN with the multiplicity of focal lesions and portal vein invasion suggests an additional prognostic value

Phenotypic and genotypic detection of some antimicrobial resistance mechanisms among multidrug-resistant acinetobacter baumannii isolated from immunocompromised patients in Egypt

Acinetobacter spp. are Gram-negative bacteria that have become one of the most difficult pathogens to treat. The species A. baumannii, largely unknown 30 years ago, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients. It is now a predominant pathogen in many hospitals as it has acquired resistance genes to virtually all antibiotics capable of treating Gram-negative bacteria, including the fluoroquinolones and the cephalosporins. The aims of this study were to [i] evaluate the antimicrobial susceptibility of Acinetobacter baumannii isolated from immunocompromised host [ii] phenotypic assessmentof the prevalent mechanism of resistance among multi drug resistant Acinetobacter spp. [iii] evaluate the prevalence of metallo beta-lactamases [MBLs] phenotypically and genotypically among multidrug resistant A. baumannii. Seventy-two nonreplicated A. baumannii isolates were recovered from 631 clinical specimens referred for bacteriological cultures from immunecompromised patients of all age groups and both sexes admitted in El-Demerdash Hospital and National Cancer Institute [NCI] Cairo-Egypt. Isolates were identified conventionally using standard biochemical tests and also using Microscan [Dade Behring, West Sacramento, USA]. Both manual [following the CLSI protocol] and automated methods [using Microscan system] were used to detect antimicrobial susceptibility pattern of Acinetobacter isolates. Different potential resistance mechanisms were investigated in 45 carbapenem resistant A. baumannii phenotypically. Genotypic detection of MBLs was carried out using PCR. Acinetobacter baumannii represents the predominant Acinetobacter isolates [83.3%]. The mean age group of patient with Acinetobacter infection was more than 55 years old [36.1%]. A. baumannii exhibited high resistance rate to the majority of commercially available drugs including imipenem [66.6%], meropenem [73.3%] andcefazolin and cephalothin [100%]. Isolates show moderate susceptibility to tetracycline [40% of the isolates were susceptible] and gentamicin [33.3%]. MDR A. baumannii represent 75% of the Acinetobacter isolates [45/72].Using phenotypic tests; none of the carbapenem-resistant A. baumannii were carbapenemase producers and44.4%wereAmpC beta-lactamase positive. MBLs were detected in 55.6% using phenotypic tests and in 44.4% of isolates using PCR. Moreover Efflux pump was detected in 77.8% of isolates. Multidrug resistant A. baumanniiis a problematic organism in immunosuppressed patients since it became resistant to the majority of commercially available antimicrobials with different resistance mechanisms. Metallo-beta-lactamase production is an important mechanism of carbapenem resistance and AmpC - beta-lactamase could be a contributory factor for meropenem resistance among MDRAB isolates. This underlies the importance of their accurate identification and reporting to prevent the emergence of absolute resistance to the useful drugs against Acinetobacter spp. in Egypt

Retrospective study of teat surgical affections in dairy farms of Armed Forces and their treatment

A survey study was done during the period between September 2010 and December 2012 on 2580 Friesian cows and heifers distributed in four armed forces farms.This work revealed that, teat wounds represent the higher acquired teat affections [28.16%] while teat papilloma represents the lowest affection [1.65%]. The supernumerary teat represents the higher congenital teat abnormalities [36.8%] while the lower was incompetent teat [1.5%].The present study revealed that the prevalence of acquired teat affections were in November, December, January, and February, whenever the weather is cold and rainy and stables are muddy and the accidental injuries during milking, feeding or even laying were predominant and predictable

Hepatitis C, hepatitis B and HIV infection among Egyptian prisoners: seroprevalence, risk factors and related chronic liver diseases

Prisons in Egypt do not currently screen for blood-borne viruses, and there are no statistics concerning the prevalence of hepatitis C virus, hepatitis B virus or human immunodeficiency virus among prisoners. This study was performed to detect the prevalence of antibodies against hepatitis C, hepatitis B core and human immunodeficiency virus among Egyptian prisoners. The study was conducted in an Egyptian prison. The prisoners voluntarily completed a risk factor questionnaire and provided blood specimens for testing for antibodies against hepatitis C virus, hepatitis B virus core antigen and human immunodeficiency virus. Positive results were confirmed by the detecting HCV RNA via polymerase chain reaction. Multivariate regression analysis was performed to determine the factors that were independently associated with positive HCV serology. Five hundred resident prisoners were screened. The prevalence of hepatitis C virus antibodies was 15.8% [79/500], and viremia was confirmed by PCR in 77.2% [61/79] of the antibody-positive prisoners. The prevalence of antibodies to hepatitis B core antigen was 9.8% [49/500], and 1.2% [6/500] of prisoners were dually infected with HBV and HCV. Antibodies to human immunodeficiency virus were not detected in any of the prisoners. The best predictor for hepatitis C and hepatitis B infection was a history of intravenous drug use [P < 0.011 for HBV and P < 0.001 for HCV], a period of >10 years spent in prison [P < 0.052 for HBV and P < 0.021 for HCV] and shared toiletries [P < 0.059 for HBV and P < 0.002 for HCV]. Hepatitis C and hepatitis B virus infections constitute an important public health problem in prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV testing, counseling and medical management of infected prisoners

Volatile oils, lipid constitutes and the antimicrobial activity of Daucus syrticus growing in Libya

Apiaceae is a large plant family; it comprises about 60 annual and biannual species mostly distributed in Europe, Africa, West Asia, and Australia. The Daucus genus is one of the most common genera of this family in which Daucus syrticus [DS] is a common member, growing mainly in the Sirt region [Libya]. It is locally known as wild carrot. This study aims to investigate volatile oils, lipid constitutes, and the antimicrobial activity of DS extracts. The herb of DS was collected from Wadi Telal, Sirt region [Libya], during January and April 2011. About 250 g of different parts from fresh plant material [aerial parts, roots, and seeds] of DS were subjected to hydrodistillation. Extraction of lipid constituents was carried out as follows: About 1500 g of dried powdered plant material of DS were extracted with petroleum ether in a soxhlet. The antimicrobial activity was determined using the disk diffusion method, and the inhibition zone [IZ] was measured for each extract under study against Escherichia coli, Bacillus subtilis, Aspergillus niger, and Candida albicans. Results of Gas chromatography/Mass spectrometry GC/MS analyses of the volatile oils of the aerial parts [January and April collections] proved that they contain a mixture of 47 and 33 compounds, respectively, whereas the roots [April and July] were found to contain a mixture of 32 and 20 compounds, respectively. In addition, the seeds [July] were found to contain 18 compounds, with beta-asarone [26.23%] as the main compound. Investigation of the lipid fraction of the herb revealed the presence of a mixture of fatty alcohols; the major contents of the unsaponifiable fraction were identified as a series of n-alkanes C[8]-C[28] [84.85%], four steroidal compounds, triterpene, and a mixture of fatty acid methyl esters consisting of eight different acids. The antimicrobial evaluation of DS extracts exhibited different IZ values against the tested microorganisms. The main constituents of the different volatile oils of the aerial parts, the roots, and the seeds were identified. The fraction of total fatty acid had the highest activity against E. coli [IZ = 2.7, minimum inhibitory concentration = 250 mg/ml]

Ventriculosubgaleal shunt in the management of obstructive hydrocephalus caused by cerebellar infarction

Cerebellar infarction is relatively uncommon. Small infarctions only cause cerebellar manifestations e.g. ataxia and nystagmus and are treated medically. Large cerebellar infarctions, however, can be life threatening. It cause brain stem compression and can obstruct the cerebrospinal fluid pathway causing obstructive hydrocephalus. It has to be treated promptly and may require besides the medical treatment surgical intervention as well. This is mainly in the form of posterior fossa decompression. In this study, we studied the beneficial effect of inserting a temporary ventriculoperitoneal shunt to relieve the supratentorial hydrocephalus in addition to posterior fossa decompression on the morbidity and mortality of patients in comparison to posterior fossa decompression alone. The aim of this study was to evaluate the role of ventriculosubgaleal shunt in cerebellar infarction causing supratentorial ventricular dilatation. This was a retrospective study that included ten patients having extensive cerebellar infarction causing spratentorial hydrocephalus. They were divided into two groups, group [1] was submitted to posterior fossa decompression alone and group [2] was submitted to posterior fossa decompression in addition to temporary ventriculosubgaleal shunt insertion. Group [2] which had posterior fossa decompression in addition to temporary. ventriculosubgaleal shunt hadmuch better results than group [1] which had only posterior fossa decompression. Group [2] had a lower morbidity and mortality and a shorter hospital stay than group [1]. Temporary insertion of ventriculosubgaleal shunt is recommended in patients having extensive cerebellar infarction causing supratentorial hydrocephalus in addition to posterior fossa decompression. It results in a lower morbidity and mortality and a shorter hospital stay

Effect of leave extract of Ocimum basilicum on deltamethrin induced nephrotoxicity and oxidative stress in albino rats.

Deltamethrin is a pyrethroid insecticide used extensively in pest control. On the other hand it showed different toxicity in mammalian animals. Basil or sweet basil (Ocimum basilicum) is a plant which showed many pharmacological effects. The present work studied the potential protective effect of Ocimum basilicum extract on deltamethrin-induced nephrotoxicity in albino rats. Treating animals with deltamethrin induced several histopathological alterations in the kidney. The renal tubules lost their characteristic appearance and their lining epithelial cells were degenerated. The glomeruli were atrophied and the renal blood vessels were dilated and congested. The intertubular spaces were infiltrated by inflammatory leucocytic cells. Marked elevation in serum creatinine and urea was recorded. Moreover, deltamethrin increased significantly the concentration of malondialdehyde (MDA) and decrease the activities of superoxide dismutase (SOD) and catalase (CAT) in renal tissue. Treating animals with deltamethrin and aqueous extract of basil led to an improvement in histological and biochemical alterations induced by deltamethrin. The biochemical results showed that creatinine and urea appeared within normal level. Reduction in the level of MDA (lipid peroxidation marker) and increase in the activities of SOD and CAT was recorded. It was concluded from this study that basil aqueous extract has a beneficial impact on deltamethrininduced nephrotoxicity in albino rats by its antioxidant effect.

When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

PURPOSE: To assess safety and efficacy of supine percutaneous nephrolithotomy in patients for whom prone position or general anesthesia is contraindicated or not preferable due to associated comorbidities, overweight or ipsilateral upper ureteric calculi. MATERIALS AND METHODS: Fifty two patients (37 males and 15 females, mean age 33 ± 10.2 years) were included in this study. Supine position was selected due to anesthetic considerations (preexisting compromised cardiopulmonary status, morbid obesity (body mass index > 40 kg/m²) and/or other associated medical comorbidities), impossible prone position due to bone deformities or associated ipsilateral upper ureteric stone. Regional anesthesia was used in 24 patients while 28 patients underwent general anesthesia. After standard cystoscopy and retrograde ureteropyelography in the dorsal lithotomy position, the position was modified using 3 liters of saline bag below the ipsilateral upper flank. Percutaneous access to the pelvicalyceal system was performed through the posterior axillary line under fluoroscopic guidance. RESULTS: Successful renal puncture was achieved in all cases. Single access via the lower calyx was the most commonly used access (36 cases). Stone-free rate was 92.3%. Postoperative complications classified according to Clavien Dindo classification included bleeding requiring transfusion (3.8%), urinary leakage requiring ureteric stenting (5.8%), prolonged fever (7.7%), deep venous thrombosis (1.9%) [grade III in all] and urinary leakage requiring ureteric stenting (5.8%) [grade IIIa]. CONCLUSIONS: The modified supine position for percutaneous nephrolithotomy is a safe and effective option that offers several advantages with an excellent outcome. It can be performed safely for morbidly obese patients and those with cardiopulmonary compromise.

Surgical management of porencephalic cyst in patients with medically-intractable epilepsy

To detect the ability of surgical management of porencephalic cyst to control intractable epilepsy. Five patients diagnosed with porencephalic cyst causing epilepsy that could not be controlled with adequate dosing of three anti-epileptic drugs were included in the study. The study included four males and one female. The age of the patients ranged from 9 to 23 with a mean of 16.4 years. All patients were submitted to complete general and neurological examination, laboratory and radiological investigations as well as Electroencephalography [EEG]. The radiological investigations included tomography [CT] and magnetic resonance imaging [MRI] of the brain. Craniotomy was done for all cases with uncapping of the cyst; removing all the gliotic tissues with or without fenestration of the cyst to the lateral ventricles. Cases were followed-up for six months postoperatively. Most cases were under 20 years old. Etiology of the porencephalic cyst included trauma, congenital, vascular insult as well as infection. The cysts were located in the frontal, parietal and the temporal lobes. All patients benefited from the surgery, four cases [80%] discontinued or reduced the dose of anti-epileptic drugs and one had epilepsy controlled with three anti-epileptic drugs. Surgical management of intractable epilepsy in porencephalic cyst patients is a valuable method for controlling epilepsy and should be resorted to in all indicated patients