Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions

INTRODUCTION@#Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease.@*OBJECTIVE@#Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access.@*METHODS@#Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool.@*RESULTS@#Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51-3.19, p < 0.05, I@*CONCLUSION@#Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

Seropositivity of Toxoplasmosis in Pregnant Women by ELISA at Minia University Hospital, Egypt

Toxoplasmosis is considered as an important risk factor for bad obstetric history (BOH) and one of the major causes of congenitally acquired infections. The present study aimed to estimate the seropositivity of T. gondii infection and associated risk factors among the attendees of high risk pregnancy and low risk antenatal care clinic of Minia Maternity and Pediatric University Hospital, Minia, Egypt. The study was carried out from April 2013 to April 2014 through 2 phases, the first phase was case-control study, and the second phase was follow-up with intervention. A total of 120 high risk pregnant and 120 normal pregnant females were submitted to clinical examinations, serological screening for anti-Toxoplasma IgM and IgG antibodies by ELISA, and an interview questionnaire. Seropositive cases were subjected to spiramycin course treatment. The results showed that the seroprevalence of toxoplasmosis in high-risk pregnancy group was 50.8%, which was significantly different from that of normal pregnancy group (P<0.05). Analysis of seropositive women in relation to BOH showed that abortion was the commonest form of the pregnancy wastage (56.5%). The high prevalence of T. gondii seropositive cases was observed in the age group of 21-30 years. Post-delivery adverse outcome was observed in 80.3% of high-risk pregnancy group compared to 20% of normal pregnancy group. There was a statistically significant relationship between seropositivity and living in rural area, low socioeconomic level, and undercooked meat consumption (P<0.05). Serological screening for anti-Toxoplasma antibodies should be routine tests especially among high-risk pregnant women.

Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby

Impact of donor and recipient sex on outcomes of HLA-identical sibling allogeneic hematopoietic stem cell transplantation

Hematopoietic cell transplantation [HCT] is well established as therapy for hematologic malignancies as well as many non-malignant disorders. Donor selection is an important way to decrease the risks after HSCS and is therefore a key component of the clinical practice of transplantation. There are many criteria proved or hypothesized to affect outcomes after SCT and one of these, sex is the most controversial. Some investigators have found an increased risk of acute or chronic graft-versus-host disease [GVHD] associated with donor sex. Transplantation of stem cells from a female donor to a male recipient is a special circumstance in which donor T cells specific for minor H antigens, encoded by genes on the recipient Y-chromosome that are polymorphic to their X-chromosome homologues, may make a contribution to GVHD and GVL activity. Investigate the effect of donor and recipient sex mismatch on outcomes of HLA-identical sibling allogeneic stem cell transplantation. This study was carried on 82 patients selected from patients who had underwent a myelo-ablative preparative regimen for a hematologic malignancy and received HSC transplant from an HLA-identical sibling being divided into 2 groups: 1st one with a female donor to a male recipient and 2nd one include otherwise. Both groups will be subjected to HLA tissue typing, CBC, Bone marrow aspirate evaluation, PT and PTT, blood culture when needed, SGPT, SGOT, ALP, blood urea, s.creatinine, urine analysis, pulmonary function tests, chest x-ray, echocardiography ECG, CMV-, EBV-, VZV-, Toxoplasma- antibodies [IgG, IgM], HBs-Ag, HBs-Ab, and HCV-Ab. After variables controlling for patient and donor, there was an increased risk of acute GVHD in patients who received grafts from female donor being 18% for patients receiving grafts from female compared with 8% for recipients of male grafts. Donor sex was also an important influence on risk of developing chronic GVHD with cumulative incidences of chronic GVHD 9.7% for patients receiving transplants from male donors grafts compared to 24.3% for recipients of female donor grafts. We found that male recipients of grafts from female donors had a significantly higher probability for acute and chronic GVHD than male recipients with male donors or female recipients with female donors and despite the beneficial GVL effect observed in male recipients with female donors, these patients had significantly reduced survival compared with all patient/donor sex combinations, suggesting that other variables, particularly GVHD, contribute to transplantation-related mortality

Percutaneous ablation [radiofrequency and ethanol injection] versus hepatic resection in treatment of HCC in Egypt

Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed

Effect transfusional of iron overload on hepatic fibrosis in Egyptian beta-thalassemia major patients

Multitransfused beta-thalassemia patients constitute a population with high prevalence of Hepatitis C virus [HCV] infection, because of transmission of HCV from infected blood donors. Increased hepatic iron is assumed to potentiate progression towards liver fibrosis in chronic HCV infection. The aim of the present work is to evaluate the potentiating effect of marked hepatic iron overload and chronic HCV infection on hepatic fibrosis in Thalassemia patients. Sixty eight patients, previously diagnosed to have homozygous beta-thalassemia and followed up at the Hematology Clinic of the New Children's Hospital of Cairo University [44 hepatitis C positive and 24 hepatitis C negative patients], were selected to participate in this study after signing a written informed consent. Their age ranged between 6 and 27 years with a mean age of 9.7 +/- 2.1 years and compared to a group of 42 non thalassemic chronic HCV patients whose age ranged between 7 and 27 years with a mean age of 10.9 +/- 1.5 years [control group]. Liver Biopsies were done for all patients for estimation of stage of hepatic fibrosis and liver iron content [LIC]. The results were then correlated to liver function tests and serum ferritin. The stage of fibrosis and LIC were significantly higher in beta-thalassemia patients than the non thalassemia HCV patients [p = 0.005, p<0.0001 respectively]. There was no significant difference between the two groups of thalassemia as regards staging of fibrosis. The degree of hepatic fibrosis was significantly correlated to the LIC in hepatitis negative thalassemic group while it was significantly correlated to serum ferritin in thalasemic patients with positive HCV. Hepatic iron overload has a potentiating effect on hepatic fibrogenesis in beta-thalassemia major. The proper use of chelating agents is of great importance in delaying progression of liver disease in these patients

Feeding camel milk and Nigella sativa oil [NS] and their effect on the immunity of children with viral hepatitis

Camel milk is known for its antimicrobial properties, and used for treatment of diabetes and liver diseases in folk medicine. So, this study aimed to find out the health benefits of camel milk alone or mixed with Nigella sativa [NS] oil on outcome of viral hepatitis among children. 35 [14 girl and 21 boy] children infected with viral hepatitis with mean age 8.1 +/- 3.6 years were selected from outpatients of Minufiya University and Monshaat Sultan hospitals, Minufiya Governorate, Egypt. The selected children were divided into 4 groups; control group [CG] [n=5] they didn't receive any dietary intervention; milk group [MG] [n=10] they receive 100ml/day of camel milk; oil group [OG] [n=10] they receive 2ml/day of NS oil; and milk oil group [MOG] [n=10] they receive 100 ml of camel milk in addition to 2 ml of NS oil daily. The children were free living and receive their standard medical treatment and normal diet without any modification. The dietary intervention continued for 35 consecutive days. Blood samples were collected from subjects at baseline and after dietary intervention period for determination of ALT, AST, IgG, IgM, alkaline phosphatase, bilirubin, hemoglobin, and HCT. The results showed that feeding camel milk alone decreased IgM by 34.5% and increased IgG by 84.3%, while mixing it with NS oil resulted in decrement of IgM by 47.1% and increment of IgG by 91.7%, and surprisingly NS oil decreased IgM by 64.8% and increased IgG by 72.7%. Whereas, the concentration of elevated liver enzymes decreased significantly by the dietary intervention, especially among group fed camel milk alone or combined with NS oil. In conclusion, feeding camel milk alone or mixed with NS oil had a favorable affect on health status of children with viral hepatitis

Aortic elasticity in young pregnant women

Background: cardiovascular changes that occur during pregnancy include not only increase heart rate, blood volume, changes in left ventricular dimensions and functions but also changes of aortic elastic properties

Objectives: our aim was to study the aortic elasticity of young pregnant women by comparing them with those of age-matched healthy females

Patients and methods: the study population consisted of 25 pregnant women and 23 healthy women served as controls. Both groups were subjected to Doppler echocardiographic examination and measurement of serum estradiol [E2] levels. The blood samples were obtained from the control group in the first week after menstrual bleeding. Left ventricular dimensions, functions, systolic and diastolic aortic diameters [AOS and AOD, 3 cm proximal to the aortic valves] were measured. Aortic elastic properties [strain, dispensability, diameter changes and stiffness index were then calculated

Result: all women in the study group were in the second trimester of their first pregnancy there were no significant differences between both groups as regards age and body mass index. The height and weight were 157 +/- 4 vs 160 +/- 3 cm and 70 +/- 8 vs 65 +/- 4 kg in the study vs control groups, [p=0.08, and p<0.009] respectively. There · were no significant differences between pregnant and non-pregnant women as regards. systolic, diastolic, mean blood pressure, pulse pressure, LVEDD, LVESD, FS%, and C-~EF% while the heart rate was higher in pregnant women than in controls, however, it :did not reach a statistically significant level. LVEDV, LVPWTH, LV mass, LV mass index, were significantly higher in pregnant than control group. The AOD was 27 +/- 3 vs 26 +/- 4 mm and AOS 30 +/- 4 vs 29 +/- 4 mm Pulse pressure was 42 +/- 3 vs 44 +/- 4 mmHg in the study vs control groups, respectively [P> 0.05]. The serum E2 level was significantly higher in pregnant women [21600 +/- 3050 pg/ml] than non-pregnant ones [219 +/- 51 pg/ml] [p<0.0001]. Aortic elastic properties in pregnant women were also increased significantly [P<0.0001]. The E2 serum level was significantly conflated for both groups with the aortic elastic properties. Correlation coefficients between E2 and aortic strain, aortic distention, aortic diameter change, and aortic stiffness index were 0.65, 0.86, 0.88, and 0.62 in the pregnant and 0.77, 0.75, 0.92, and 0.77 in the non-pregnant group, respectively

Conclusion: the aortic elastic properties increased while aortic stiffness decreased in young pregnant women

Replacement of missing maxillary anterior teeth: role of dental implants

Purpose: To evaluate the dental implants as a treatment option for replacement of missing maxillary anterior teeth

Patients and Method: Eleven patients seeking replacement of their missing maxillary anterior teeth were selected for this study. Screw-vent dental implants were used for such porpose. Surgery was performed under local anaesthesia at 2 stages with a six months latency period. Patients were recalled at 6 months and one year following crown cementation for clinical and radiographic evaluation

Results: Included patients were 7 males and 3 females with an average age range of 27.6 years. Trauma was the main reason for single tooth loss [80%]. Except for one implant, which failed to os-seoiniegrate, all the implants were successfully integrated and no failures have been reported both clinically and radiographically

Conclusion: From the results of the present paper, it could be concluded that, dental implants are good treatment option for replacement of missing maxillary anterior teeth

Cryosurgical treatment of oral hemangiomas

Purpose: To report the outcome of treatment of eleven cases of hemangioma of the oral cavity using cryosurgery, and to discuss the different modalities used for treating oral hemangiomas

Patients and Method: Eleven patients with hemangiomas of different sites of the oral cavity were treated using cryosurgery. The freezing session was performed using two consecutive freeze-thaw cycles. In each cycle, freezing was continued for 2 minutes and thawing proceeds spontaneously for 5 minutes. If any residual lesion remained, another course of cryosurgical treatment was performed after one week, and so on until complete resolution of the lesion

Results: Of the 11 included patients, there were 8 females and 3 males with an age range of 19.6 years. Healing was uneventful in all patients. Except for two cases, no recurrence of the lesions was recorded up to 18 months following treatment

Conclusion: Based on the results of the present paper, it could be concluded that, cryosurgery has been both effective and predictable method for the treatment of oral hemangiomas. Its conservative, vital tissue-sparing, non-hemorrhagic, non-infecive and painless nature gives it, in our opinion, clear prefrence over the other treatment modalities

Role of polylactic polyglycolic co-polymer [Fisiograft] in bone regeneration: an experimental study

Purpose: An animal study was earned out to evaluate the effect of locally implanted polylactic polyglycolic acid [Fisiograft] on bone repair in induced bone defects

Materials and Method: Eighteen, 2-3 months old, male guinea pigs weighing between 200 and 250 grams were used in this study. After anesthesia, each animal was subjected to implantation of Fisiograft in an induced bony cavity at the right side of the submental region. A similar bony cavity was induced on the left side to serve as a control. Animals were divided into 3 groups, each of 6. They were sacrificed at 2, 6 and 12 weeks following implantation. The mandibles were dissected out, fixed, decalcified and stained using both hematoxylin and eosin and Massqn's trichrome stains

Results: There was no evidence of adverse responses in any of the animals throughout the study. At 2 and 6 weeks, histological examination revealed that gradual new bone formation took place at the experimental sides in a more rapid rate than that occurred at the control sides. At 12 weeks, the level of reossirlcation had adjusted similarly in both study and control sides

Conclusion: Fisiograft is allowing fibro-vascular tissue ingrowth, permitting bone healing in a more rapid rate, completely reabsorbed, and do not cause foreign body reactions. These advantages make it a promising choice when the jaw bone augmentation is needed

protective role of anti-oxidant beta-carotene on schistosoma mansoni infected murine mice

Schistosomiasis is the second most prevalent tropical disease in the world after malaria and is caused by the Schistosoma, genus of fluke. The pathophysiology of schistosomiasis is due to the immune response against the schistosome eggs. The clinical manifestations depend on the species of parasite, intensity of worm burden, and immunity of the person to the parasite. Many trials were done for production of vaccine against infection of shistosomiasis and many efforts were spent to prevent infection, but the rate of new cases is still high. On the other hand, we need a methed to prevent or at least decrease the inflammatory reaction caused by schistosomiasis. This study aimed to the evaluation of possible protective effect of anti-oxidant beta-carotene on S.mansoni infected mice or decrease the inflammatory reaction caused by schistosomiasis. Sixty mice were included in this study and they were divided into 4 groups, every group is 15 mice: Group [1]: [treated infected group]; Group [2]: [treated noninfected group]; Group [3]: [infected group] and Group [4]: [normal control]. The results: b-carotene reduced worm burden to about 20%. Beta-carotene significantly reduced hepatic and intestinal tissue egg load with a reduction percentage of 26% and 18% respectively. Beta-carotene normalized the serum enzyme AST that were elevated by schistosomal infection. Beta-carotene did not significantly change serum proteins both in infected and non infected animals. Beta-carotene exerted immunomodulatory effects on inflammatory reaction of hepatic schistosoma reflected as significant reduction in mean cellular infiltration diameter, more circumscription and less inflammatory cellular content, as well as more inflammatory reaction changes in schistosomal ova. We recommended further studies to judge the protective efficacy of beta-carotene through histological study of animal skin and to judge its therapeutic efficacy if administered adjuvant with antibilharzial therapy

Treatment of central giant cell granuloma of the mandible with intralesional injection of corticosteroid

This study was carried-out to report our experience with ten cases of central giant cell granuloma [CGCG] of the mandible treated with intralesional injection of corticosteroid with special reference to the possible effect of corticosteroid on CGCG microscopically and by DNA cytophotmetry. Ten patients with CGCG of the mandible were included in this study. Triamcinolone acetonide was injected into the lesions, the injection was repeated weekly for a total of six weeks. Panoramic radiographs were obtained every three months to evaluate the healing process. Complete regression of the lesions was proved in three patients with no evidence of recurrences during a follow-up period of one year. The other seven cases needed surgical excision, which revealed significant decrease in the number [P=0.001] and size [P=0.01] of multinucleated giant cells [MNGCs]. Whereas, no differences were reported between the number of blood vessels, DNA content and ploidy pattern of MNGCs before and after the intralesional corticosteroid injection. It could be concluded that, this form of treatment may be advantageous, particularly for large lesions in order to cure or reduce the size of the lesion and thus minimize the need for extensive surgical resection that could result in functional and esthetic deficits

Dental extractions in patients on oral anticoagulant

Purpose: To evaluate the local hemostatic effect of oxidized, regenerated cellulose [Surgicel; Johnson and Johnson Products, Inc, New Bruunswick. NJ] in patients on oral anticoagulant undergoing dental extraction without interruption of their treatment

Patients and Method: This study included 50 consecutive patients who were on warfarin, requiring dental extraction of their single teeth, randomly allocated into study and control groups. Other 25 patients who had never been on anticoagulant therapy were considered as a negative control group. For all patients, prothrombin time [PT] and international normalized ratio [INR] were detected on the day of extraction. Following dental extraction, in the study group, the sockets were packed with Surgicel and the gingival mucosa was sutured. In the control and the negative control groups, the gingival mucosa was only sutured. Patients were instructed to communicate any bleeding complication after extraction. Patients with no bleeding complication were seen on the eighth day for suture removal. They were examined for the presence of swelling, pain, and local infection. Data were collected and statistical difference in age and sex distributions, INR level, and post-extraction bleeding that required treatment were analyzed. Statistical significance was defined as a value of P < 0.05

Results: Local hemostasis was obtained immediately in the study group and only after 10 to 30 minutes in both the control and negative control groups. As regard bleeding complications, no cases of post-extraction bleeding that required treatment were recorded in both the negative control and study groups. Five cases of post-extraction bleeding that required treatment were encountered in the control group. This difference was statistically significant. No patient had postoperative pain, swelling or wound infection

Conclusion: Dental extractions can be performed in patients on oral anticoagulant without modification of their treatment regimen, provided that an effective local measure is used. Local haemostasis with Surgicel and sutures appears to be efficient in preventing postoperative bleeding

Transnasal endoscopic enucleation of dentigerous cysts involving the maxillary sinus

Purpose: To evaluate the efficacy of transnasal endoscopic sinus surgery [TESS] for enucleation of dentigerous cysts involving the maxillary sinus

Patients and Method: Ten patients with dentigerous cysts were treated between January 2001 and February 2004. Patients ranged in age between 14-50 years with an average age of 21.8 years. Preoperative evaluation included, clinical examination, panoramic and occipitomental radiographs, and computed tomography [CT] scan of the paranasal sinuses. The surgical technique included retrograde resection of the posteroinferior part of the uncinate process, enlargement of the natural maxillary ostium and enucleation of the cysts through the middle meatal antrostomy window

Results: TESS was sufficient for complete enucleation of the cysts and their associated teeth in 7 cases. In the other 3 cases, trials or removal of the cyst wall were failed as the cysts had partially destroyed the antral bony walls. Intinoral approach was used for enucleation of cysts in those 3 cases. Postoperative follow-up ranged from 8 to 15 months. All the patients had uneventful recovers and the presenting symptoms were completely relieved after surgery

Conclusion: Based on the results of the present paper, it could be concluded that TESS is a reliable, minimally invasive method or enucleation of dentigerous cysts involving the maxillary sinus, provided that the bony walk of the sinus are intact

Correlation between carbohydrate antigen 19-9 and alpha-fetoprotein in diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a common malignancy over the world and Egypt, specially related to viral [B, C] hepatitis and cirrhosis. In many patients, imaging radiology is not conclusive in diagnosis of HCC, so tumor markers may help to solve the problem. Alpha fetoprotein [AFP] and Carbohydrate antigen 19-9 [CA 19-9] are used in this situation. This study was done on 60 patients divided into 2 groups: group I; 30 patients with HCC and group II: 30 patients with chronic liver diseases with or without cirrhosis. The results were: demographic case distribution; HCC is still of old age group [>52 years], more in males [70%] than in females [30%], farmers [40%] more than other jobs, rural population [60%] than urban [40%], related to HCV infection [96%] and HBV infection [23%]. AFP and CA 19-9 were highly significant in serum of HCC group than group II. There was no correlation between the level of both AFP and CA19-9 and biochemical liver tests, number or size of the tumor. But there is high correlation with histopathology of the tumor. By using ROC curve, the best cut-off of AFP is 25 ng/ml with a sensitivity and specificity of 86.7%, and for CA19-9, it was 97 u/ml with a sensitivity of 53.3% and specificity of 86.7%. CA19-9 enhance AFP in diagnosis of HCC in 30% of cases. So, using CA19-9 in combination with APP can increase diagnosis of HCC in hepatic focal lesion by 30%. But, we still need other sensitive and specific non invasive technique for diagnosis of HCC

Reconstruction of anterior skull base after craniofacial resection

Anterior craniofacial resection and reconstruction surgeries were per formed upon 21 patients [13 females and 8 males] aged 12-72 years, at the period between 1996-2002 at Mansoura University Hospital, Department of ORL Head and Neck surgery. Surgeries were performed for nasal and paranasal sinus malignant tumors with cranial and/or intracranial extention. Various forms of anterior cranial base reconstruction strategies were used in our work, anteriorly pedicled galeal pericranial flap, galeal- pericranial flap+ skin graft, galeal pericranial flap + calvarial bone graft, and galeal-pericranial flap+ temporal is osteo muscular flap. Orbital exenteration was done for two patients with ethmoidal undifferentiated carcinoma and obliteration of the orbit was done using pedicled temporalis muscle flap. Subtotal maxillectomy [18 cases], and total maxillectomy [3 cases] were per- formed. We described the technique of the resection and the reconstruction with evaluation of reconstruction results. Our objective is to evaluate the clinical outcome of our technique in resection and reconstruction of anterior skull base. We concluded that Knowledge's about different methods of reconstruction after craniofacial resection enabled the skull base surgeons to extend their resections in or der to increase the safety margin. Also we found that the pericranial flap is the most ideal and reliable method for reconstruction of skull base after resection. Rigid bony reconstruction can be used in cases where the resection of anterior skull base was extended laterally to involve the orbital roof

Vascular endothelial growth factor in hepatocellular carcinoma: Its clinical, pathological and prognostic significance

Twenty-seven patients with an age range of 36-71 years were included in this study. They were subjected to thorough clinical, radiological and biochemical assessment as well as serological testing for HCV, HBV and serum alpha fetoprotein [AFP] level. Serum vascular endothelial growth factor [VEGF] levels were measured by an enzymeournallinked immunosorbent assay kit. Samples from 15 healthy adults were obtained as controls for the assessment of serum VEGF levels. An immunohistochemical staining was done to study the tumor VEGF expression in the resected specimens. A histologic grade of tumor differentiation was also performed. Prognostic information was obtained by a close follow up every 2-3 months. The study demonstrated that serum VEGF level in HCC patients appears to reflect the disease potential activity for an aggressive behavior and can be used as a predictor of tumor recurrence

Haemophilus influenzae meningitis at the Abbassia Fever Hospital 1982 to 2001

The aim of this work was to study the prevalence, clinical presentation, outcome of patients with H. influenza meningitis and to determine the efficacy and safety of new therapeutic regimens that could be used in the treatment of the disease and test the susceptibility of the isolates to different antibiotics. During the period from January 1982 to December 2001, 472 children with H. influenza meningitis were admitted to El-Abbassia Fever Hospital, Meningitis Ward in Cairo. The study indicated that H. influenzae is the main causative organism in Egypt accompanied high morality and morbidity rates. Although there has been no increase in the number of cases over the year, a steady increase in the resistance to the traditional drugs has occurred. Thus, it was recommended to use third generation cephalosporins for treatment and Hib vaccines in children

Acute viral hepatitis in Egyptian pregnant women; natural history

Seventy-three pregnant women with acute hepatitis were selected for this study. All cases were subjected to history taking, obstetric status, clinical and abdominal ultrasonography examinations. Out of these cases, 61 patients agreed to participate in this study. The commonest symptoms and signs were jaundice, urine darkness, anorexia, abdominal pain, fever, diarrhea, hepatomegaly and splenomegaly. Fulminant hepatitis was found in seven cases. Serum bilirubin and transaminases were about 3-5 fold above the normal level. Two deaths, three were still birth and five premature labor were the mean complications and the normal labor was 82.2%. A benign clinical course was given in 88.7% and the mortality rate was 3.2%. There was no specific clinical course indicated to a specific virus infection. Pregnancy did not aggravate the course of acute viral hepatitis, but the viral hepatitis could complicate the pregnancy course