Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Loss of RAR-α and RXR-α and enhanced caspase-3-dependent apoptosis in N-acetyl-p-aminophenol-induced liver injury in mice is tissue factor dependent

Tissue factor (TF) activates the coagulation system and has an important role in the pathogenesis of various diseases. Our previous study stated that retinoid receptors (RAR-α and RXR-α) are released as a lipid droplet in monocrotaline/ lipopolysaccharide-induced idiosyncratic liver toxicity in mice. Herein, the interdependence between the release of retinoid receptors RAR-α and RXR-α and TF in Nacetyl-p-aminophenol (APAP)-induced mice liver toxicity, is investigated. Serum alanine transaminase (ALT) level, platelet and white blood cells (WBCs) counts, protein expression of fibrin, TF, cyclin D1 and cleaved caspase-3 in liver tissues are analyzed. In addition, histopathological evaluation and survival study are also performed. The results indicate that using of TF-antisense (TF-AS) deoxyoligonucleotide (ODN) injection (6 mg/kg), to block TF protein synthesis, significantly restores the elevated level of ALT and WBCs and corrects thrombocytopenia in mice injected with APAP. TF-AS prevents the peri-central overexpression of liver TF, fibrin, cyclin D1 and cleaved caspase-3. The release of RXR-α and RAR-α droplets, in APAP treated sections, is inhibited upon treatment with TF-AS. In conclusion, the above findings designate that the released RXR-α and RAR-α in APAP liver toxicity is TF dependent. Additionally, the enhancement of cyclin D1 to caspase-3-dependent apoptosis can be prevented by blocking of TF protein synthesis.

Loss of RAR-α and RXR-α and enhanced caspase-3-dependent apoptosis in N-acetyl-p-aminophenol-induced liver injury in mice is tissue factor dependent

Tissue factor (TF) activates the coagulation system and has an important role in the pathogenesis of various diseases. Our previous study stated that retinoid receptors (RAR-α and RXR-α) are released as a lipid droplet in monocrotaline/ lipopolysaccharide-induced idiosyncratic liver toxicity in mice. Herein, the interdependence between the release of retinoid receptors RAR-α and RXR-α and TF in Nacetyl-p-aminophenol (APAP)-induced mice liver toxicity, is investigated. Serum alanine transaminase (ALT) level, platelet and white blood cells (WBCs) counts, protein expression of fibrin, TF, cyclin D1 and cleaved caspase-3 in liver tissues are analyzed. In addition, histopathological evaluation and survival study are also performed. The results indicate that using of TF-antisense (TF-AS) deoxyoligonucleotide (ODN) injection (6 mg/kg), to block TF protein synthesis, significantly restores the elevated level of ALT and WBCs and corrects thrombocytopenia in mice injected with APAP. TF-AS prevents the peri-central overexpression of liver TF, fibrin, cyclin D1 and cleaved caspase-3. The release of RXR-α and RAR-α droplets, in APAP treated sections, is inhibited upon treatment with TF-AS. In conclusion, the above findings designate that the released RXR-α and RAR-α in APAP liver toxicity is TF dependent. Additionally, the enhancement of cyclin D1 to caspase-3-dependent apoptosis can be prevented by blocking of TF protein synthesis.

Factors affecting readmission for asthma exacerbation in children attending Alexandria university children-hospital

Background: The admission rate for bronchial asthma has increased dramatically all over the world. This increase in admission influences the children’s quality of life in addition to health care cost. Objective of the study was to identify the risk factors for readmission because of acute asthmatic attacks.Methods: Case control study applied on asthmatic children admitted because of acute asthma attacks attending emergency room, paediatric intensive care unit and inpatient wards of Alexandria university children's hospital, Alexandria, Egypt in the period from September 2016 to July 2017. The study group was subdivided into 2 groups; group (A) readmitted within one year from first admission and group (B) firstly admitted.Results: The mean age in group (A) and (B) was 9.09±3.98 and 8.65±4.01 respectively. Males were more than females in both groups, and no sex differentiation effects on readmission. The duration of the disease in readmitted group ranged from 1-8 years, it was a risk factor for acute asthma readmission. Viral infection, exercise and dust were risk factors for acute asthma exacerbation readmission. Disease severity was found to have a higher percentage of hospitalization; cases with severe and moderate bronchial asthma compared to mild cases. Readmitted patients had more sleep disturbance and lack of school attendance. Readmitted patients were less adherent to treatment.Conclusions: Duration of the disease, viral infections, common cold, dust and exercise are risk factors for acute asthma readmission. Severity of the disease and adherence to medications affect acute asthma readmission.

Does oregano protect against testicular toxicity produced by ethylene glycol in adult male albino rat? / ¿El orégano protege contra la toxicidad testicular producida por etilenglicol en ratas macho albinas adultas?

SUMMARY: Origanum vulgare Linn has traditionally been used as a diuretic and antispasmodic. Therefore, we investigated the active extract of Origanum vulgare for possible andrological effect and preventive effects against testicular damage using ethylene glycol rat model of testicular damage, to rationalize its medicinal use. Male Wistar rats received lithogenic treatment comprising of 0.75 % ethylene glycol injection twice with one day interval, then in drinking water, active extract of Origanum vulgare treatment (20 mg/kg) was given for 3 weeks to prevent toxic damage including loss of body weight gain and appetite, Following oral administration of EGME, a rapid decrease in testis weight associated with testicular cell damage was observed. Origanum vulgare treatment (20 mg/kg) prevented as well as reversed toxic changes including loss of body weight gain.

RESUMEN: Origanum vulgare Linn se ha usado tradicionalmente como diurético y antiespasmódico. Por lo tanto, investigamos el extracto activo de Origanum vulgare por su posible efecto andrológico y efectos preventivos contra el daño testicular utilizando el modelo de rata de etilenglicol de daño testicular. El objetivo del estudio fue racionalizar su uso medicinal. Su utilizaron ratas Wistar macho que recibieron un tratamiento litogénico de una inyección de etilenglicol al 0,75 %, dos veces con un intervalo de un día, y luego se administró en agua potable. Se administró el extracto activo del tratamiento con Origanum vulgare (20 mg / kg) durante 3 semanas con el objetivo de prevenir el daño tóxico, la pérdida de peso corporal y el apetito. Tras la administración oral de EGME, se observó una rápida disminución del peso de los testículos asociada al daño de las células testiculares. El tratamiento con Origanum vulgare (20 mg / kg) logró prevenir y revertir las alteraciones tóxicas, incluyendo la pérdida de peso corporal.

Ligation of the intersphincteric fistula tract procedure and its modifications / Procedimento de ligadura de trato de fístula interesfincteriana e suas modificações

ABSTRACT Purpose: Treatment of anal fistulae is regarded as a challenge due to the diverse nature of this disease and its countless complications. Ligation of the intersphincteric fistula tract procedure and its modifications have been popularized among many surgeons worldwide due to their simplicity and promising outcomes. The main purpose of this article was to conduct a comprehensives review of the published literature on ligation of the intersphincteric fistula tract procedure and its modifications. Method: PubMed, the Cochrane database and Ovid were searched from January 2007 to June 2017. Fully published peer-reviewed studies which applied ligation of the intersphincteric fistula tract procedure and its modifications for the treatment of anal fistulae of cryptogenic origin with follow-up of median 12 months were eligible. Uncompleted studies, case reports, reviews, abstracts, letters, short communication, comments, and studies which did not fulfill inclusion criteria were excluded. The primary outcome was to measure primary healing, overall healing, failure, and recurrence of ligation of the intersphincteric fistula tract procedure and its modifications. Results: Twenty-two studies were identified with only ten studies meeting criteria of inclusion. Original ligation of the intersphincteric fistula tract was performed in five studies with a population of 199 patients while the remaining five studies showed four different modifications of the ligation of the intersphincteric fistula tract with a total number of 147 patients. Both original LIFT and its modifications have promising as well as potentially similar outcomes; primary healing in the original ligation of the intersphincteric fistula tract (73.95%) (95% CI 60.3-85.6) performed less than the modifications (82.3%) (95% CI 64.8-94.7). Overall healing in the original ligation of the intersphincteric fistula tract (78.9%) (95% CI 58.5-93.7) performed relatively less than in the modifications (93.6%) (95% CI 81.4-99.6). Failure in the original ligation of the intersphincteric fistula tract (17.9%) (95% CI 4.9-36.5) performed almost the same as the modifications (17.7%) (95% CI 5.3-35.2). Recurrence in the original ligation of the intersphincteric fistula tract was 9.7% (95% CI 1.7-23.2). However, there was no recurrence in the modifications. Conclusion: Ligation of the intersphincteric fistula tract and its modifications are effective and simple procedures in treating simple anal fistulae, especially high transsphincteric ones. However, more trials should be performed to evaluate its effectiveness regarding complex fistulae.

RESUMO Objetivo: O tratamento de fístulas anais é considerado um desafio devido à natureza diversa dessa doença e suas incontáveis complicações. O procedimento de ligadura do trato da fístula interesfincteriana e suas modificações foi popularizado entre cirurgiões em todo o mundo devido a sua simplicidade e desfechos promissores. O principal objetivo deste artigo foi conduzir uma revisão abrangente da literatura publicada sobre o procedimento de ligadura do trato da fístula interesfincteriana e suas modificações. Método: as bases de dados PubMed, Cochrane e Ovid foram pesquisadas de janeiro de 2007 a junho de 2017. Estudos publicados com revisão por pares que aplicaram o procedimento de ligadura do trato da fístula interesfincteriana e suas modificações para o tratamento de fístulas anais de origem criptogênica com acompanhamento de mediana de 12 meses foram elegíveis. Estudos incompletos, relatos de casos, revisões, resumos, cartas, comunicação breve, comentários e estudos que não preenchiam os critérios de inclusão foram excluídos. O desfecho primário foi medir a cicatrização primária, a cicatrização geral, falhas e recorrência do procedimento de ligadura do trato da fístula interesfincteriana e suas modificações. Resultados: Vinte e dois estudos foram identificados com apenas dez estudos atendendo aos critérios de inclusão. A ligadura original do trato da fístula interesfincteriana foi realizada em cinco estudos com uma população de 199 pacientes, enquanto os cinco estudos restantes apresentaram quatro modificações diferentes da ligadura do trato da fístula interesfincteriana com um total de 147 pacientes. Tanto o LIFT original quanto suas modificações têm resultados promissores e desfechos potencialmente semelhantes; cicatrização primária na ligadura original do trato da fístula interesfincteriana de 73,95% (IC 95% 60,3-85,6) menos realizada que as modificações de 82,3% (IC 95% 64,8-94,7). Cicatrização geral na ligadura original do trato da fístula interesfincteriana de 78,9% (IC 95% 58,5-93,7) realizada relativamente menos do que as modificações (93,6%, IC 95% 81,4-99,6). A falha na ligadura original do trato da fístula interesfincteriana (17,9%; IC 95% 4,9-36,5) realizada quase tanto quanto as modificações (17,7%; IC 95% 5,3-35,2). Recidiva na ligadura original do trato da fístula interesfincteriana em 9,7% (IC 95% 1,7-23,2). No entanto, não houve recorrência nas modificações. Conclusão: A ligadura do trato da fístula interesfincteriana e suas modificações são procedimentos eficazes e simples no tratamento de fístulas anais simples, especialmente as transesfincterianas altas. No entanto, mais estudos devem ser realizados para avaliar sua eficácia em relação às fístulas complexas.

Timing of renal replacement therapy and its impact on the outcome of acute kidney injury patients

Background: Previous studies using Acute Kidney Injury Network [AKIN]/RIFLE criteria to classify early initiation of renal replacement therapy [RRT] have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits

Aim: To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients

Methods: We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury [AKI] stage 3 were considered early starters. AKIN criteria were evaluated by both urine output [UO] and serum creatinine [sCr] and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables

Results: A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group [51.5 vs. 77.9%, P = 0.001]. After achieving balance between the groups using a propensity score, there was a significant 30.5 [95% confidence interval [CI] 14.4 to 45.2%, P = 0.002] relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit [ICU] length of stay

Conclusions: For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI

Assessment of pulmonary artery pressure in chronic obstructive pulmonary disease patients without resting hypoxemia

Background: Chronic obstructive pulmonary disease [COPD] is a disease state characterized by progressive airflow limitation and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Pulmonary hypertension primarily occurs in COPD patients with severe hypoxemia and fortunately it is typically mild. Hypoxemia increases pulmonary artery pressure [PAP] through hypoxic pulmonary vasoconstriction and vascular remodeling, but there is a correlation between lung function parameters and PAP, suggesting that factors other than airway obstruction and/or loss of alveolar surface may play a role in its etiology

Objective: The aim of the work was to Identify other factors other than resting hypoxemia contributing to pulmonary hypertension in COPD patients

Patients and Methods: This study was a prospective study including 80 cases referred to Ain Shams University Hospitals presented with COPD defined using the standard criteria for chronic bronchitis. All patients underwent spirometry with pre and post bronchodilator treatment and trans-thoracic echocardiography

Results: The results showed that there was significant correlation between right ventricular systolic pressure [RVSP] values and each of the following; age, duration of smoking and degree of airway obstruction which were all contributing to pulmonary hypertension in COPD patients. Among 80 patients, 18 had elevated RVSP value. The mean age of those 18 patients was 58.8 +/- 7.78 years while in those with normal RVSP 54.15 +/- 10.56 years. Those 18 patients had mean FEV1 percentage of predicted 44.5 +/- 12.1% while in those with normal RVSP value 48.72 +/- 1.62%. Among those 18 patients 16 had history of smoking for >20 years representing 88.9%. Multivariate analysis showed that among all the studied parameters in our study, degree of obstruction determined by measured FEV1 percentage of predicted is an independent predictor for pulmonary hypertension in stable COPD patients

Conclusion: It could be concluded that pulmonary hypertension occurs frequently in stable COPD outpatients without resting hypoxemia and that age, duration of smoking and low pre-bronchodilator FEV1 are all risk factors for pulmonary hypertension. And that degree of airway obstruction is an independent predictor for pulmonary hypertension in stable COPD patients

diagnostic accuracy of ultrasound guided fine needle aspiration biopsy for dominant nodules in multinodular goiter

Background: FNAC is useful tool to evaluate dominant thyroid nodule in patients with multi nodular goiter however, because the diagnostic performance of US-based FNAC criteria varies according to the individual international society guidelines, clinicians should be aware of the strengths and weaknesses of US-based FNAC criteria in the management of dominsnt nodules in patients with multinodular goiter. FNAC is an office procedure, done with or without local anesthesia with 23 to 27 gauge needle, to obtain cells samples for cytological examination. It is a safe, accurate and cost-effective way for evaluating dominant thyroid nodules

Objective: the aim of this study was to discuss the accuracy of Ultrasound guided FNAC technique in diagnosis of pathological types of dominant nodule in multinodular goiter

Patients and Methods: this was a prospective study to evaluate the accuracy of FNAC in diagnosis of pathological type of dominant nodule in 20 patients with multinodular goiters who referred to the endocrine surgery unit at El-Demerdash Hospital, Ain Shams University from March 2017 to December 2017

Results: in our study the FNAC results indicated malignancy in 1 patients [5%], benign in 13 patients [65%] and intermediate in 6 patients [35%]. The final histopathological diagnosis was malignancy in 3 of the patients [15%]; one case had follicular thyroid carcinoma while two of the patients had malignant papillary thyroid tumor. Among the rest, 17 patients [85%] had benign lesion or tumor. Out of the 13 cases identified to be benign lesion by thyroid FNAC 7.7% of the group subjects were found to be malignant follicular carcinoma by biopsy [N=1]

Conclusion: the main problem among the clinical features is false negatives, as it implies the presence of undetected carcinomas. Although FNAC is useful test, our decision making should not be depend on the basis of its results and sometimes clinical and U/S criteria are preferred to cytological data

Effect of pravastatin on the incidence of preeclampsia

Background: Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema

Aim of the Work: is to study the effect of pravastatin given for primigravidae from 13th week to 16th week of gestation on the incidence of preeclampsia compared to a control group in Egyptian women

Subjects and methods: This prospective case control study included 400 pregnant women presenting for routine antenatal care at 13th to 16th weeks' gestation at EL Sayed Galal Obstetric outpatient clinic, Al-Azhar University

Results: In our study, 16 cases developed preeclampsia in the control group [11 cases were severe and the remaining 5 were mild] with a percentage of 8% instead of 6 cases in the study group [4 cases were severe and 2 were mild] with a percentage of 3%

Conclusion: Pravastatin can be used as an effective agent in the prevention of preeclampsia in newborns within neonatal period including fetal weight, gestational age at time of delivery and NICU admission. However, extended follow up is needed till the age of 5 years to assess cognitive functions and school performance among children born for women who received pravastatin for prevention of preeclampsia

Study of serum levels and skin expression of S100B protein in psoriasis

Abstract Background: S100B protein was reported to be elevated in psoriatic patients' serum, with no previous evaluation of its skin expression, in contrast to the extensively studied S100 protein. Objective: To evaluate the serum level and skin expression of S100B in psoriasis to assess its possible involvement in its pathogenesis. Methods: Serum level of S100B protein was estimated in 40 psoriatic patients of different clinical varieties and 10 healthy controls. S100B protein expression was assessed immunohistochemically in lesional and non-lesional skin of patients and in normal skin of controls. Relation to disease severity was also evaluated. Results: Serum level of S100B protein was significantly higher in psoriatic patients (0.15±0.03 µg/l) than in controls (0.03±0.007 µg/l) (P-value <0.001) with no significant correlation with PASI score. On comparing grades of S100B protein skin expression in lesional and non-lesional skin biopsies, a statistically significant difference was found (P=0.046) with higher percentage of strong S100B skin expression (60%) in non-lesional than in lesional (42%) skin. All the control biopsies showed negative expression. Study limitations: Relatively small sample size with a limited range of low PASI scores. Conclusion: This study points to a potential link between psoriasis and S100B protein with higher serum and skin expression in patients than in controls.

A bench-top micro-CT capable of simulating head motions

Computational three-dimensional (3D) models of a dental structure generated from 3D dental computed tomography (CT) images are now widely used in digital dentistry. To generate precise 3D models, high-resolution imaging of the dental structure with a dental CT is required. However, a small head motion of the patient during the dental CT scan could degrade the spatial resolution of CT images to the extent that digital dentistry is no longer possible. A bench-top micro-CT has been built to evaluate the head motion effects on the dental CT images. A micro-CT has been built on an optic table with a micro-focus x-ray source and a flat-panel detector. A rotation stage, placed in between the x-ray source and the detector, is mounted on two-directional goniometers that can rotate the rotation stage in two orthogonal directions while the rotation stage is performing the CT scan. The goniometers can make object motions of an arbitrary waveform to simulate head tilting or head nodding. CT images of a phantom have been taken with and without introducing the motions, and the motion effects on the CT images have been evaluated. Object motions parallel to the detector plane have greater effects on the CT images than those against the detector plane. With the bench-top micro-CT, the motion effects have been visually seen at a tiny rotational motion as small as 0.3°. The bench-top micro-CT can be used to evaluate head motion effects on the dental CT images. The projection data, taken with the motion effects, would be used to develop motion artifact correction methods for a high-resolution dental-CT.

Role of the antidiabetic drugs: Glibenclamide and metformin on the contractility of isolated rat uteri

The current investigation has designed to study the role of two antidiabetics, glibenclamide and metformin on the spontaneous uterine contractions in the non-diabetic non-pregnant female rats. The rat uteri were isolated and allocated to two groups: 1] the glibenclamide group: After recording the normal spontaneous uterine contractions, the vehicle [ethanol] and glibenclamide molar concentrations [10[-7], 10[-6] and 10[-5] M] were analyzed on uterine contractions by recording on smoked paper on a rotating kymograph drum, and 2] the metformin group: After recording the normal spontaneous uterine contractions, the metformin concentrations [10[-7], 10[-6] and 10[-5] M] were analyzed on uterine contractions. Responses to the two drugs and vehicle control [ethanol] were recorded for 30 min. Glibenclamide has not significantly effected on the amplitude and frequency of spontaneous contractions of the isolated rat uteri. Metformin also has no significant effect on the amplitude and frequency of spontaneous contractions of the isolated rat uteri. In conclusion, the two oral antidiabetics glibenclamide and metformin have not changed both the amplitude and frequency of spontaneous uterine contractions in the non-pregnant non-diabetic female rats

A Morphometric Study of the Sella Turcica: Gender Effect.

Background and objective: Precise anatomical knowledge of the sella turcica is important for neurologists and surgeons operating in the region of cavernous sinus or the surrounding structures. The current study was undertaken to record normal morphometric parameters for future reference and to determine if there is any significance difference in the sella turcica morphometry regarding the gender. Methodology: A Morphometric analysis of the Sella Turcica and structures in vicinity were done in thirty six adults’ formalin fixed cadaver’s skulls (22 male and 14 female). Results: The pituitary stalk positions weremiddle inmajority ofmale cases (72.7%), the remaining 27.3% were posterior. Among female; 57.1%weremiddle and the remaining 42.9%were posterior, no anterior position was detected among both genders with no different between male and female (p = 0.494) Normal Optic chiasma position was detected in all female cases and in 63.6% of male cases with no significant differences regarding gender (p= 0.070). No significant different in diaphragma sella shape and opening regarding gender (p.value = 0.170 and 0.914 respectively) No significant difference betweenmales and females concerning linear dimensions of sella turcica (length, depth and Anteroposterior diameters). Concerning diaphragma sella opening; no significant different regarding gender in transverse diameter (p.value= 0.316) while significant different was detected in anteroposterior diameter (p.value= 0.046) For interclinoid (anterior, posterior) diameters, which represented statistically significant different regarding gender in both right and left sides (p.value = 0.004 and 0.001 respectively). Conclusion: Present studywill providing the normalmorphometric data for future reference and further studies.

Insulin Resistance in Egyptian Nonalcoholic Fatty Liver Disease patients.

Background: The liver has been recognized as a major target of injury in patients with insulin resistance or the metabolic syndrome. Insulin resistance is associated with fat accumulation in the liver, a condition called nonalcoholic fatty liver disease (NAFLD). NAFLD is a clinicopathologic entity that includes a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), advanced fibrosis, and rarely, progression to cirrhosis. Recent studies emphasize the role of insulin resistance, oxidative stress and subsequent lipid peroxidation, proinflammatory cytokines, adipokines and mitochondrial dysfunction in the development and progression of NAFLD. About 20% all adults have NAFLD and 2% to 3% of adults have NASH. A strong correlation exists between overweight, in particular visceral fat accumulation, and prevalence of NASH. Aim: "This study aimed at assessing the effect of insulin resistance in a sample of Egyptian patients with non-Alcoholic fatty liver". Methods: This study was conducted on 2 groups 104 NAFLD as diagnosed by ultrasound examination and 21 healthy participants as control group. All the participants were subjected to an abdominal ultrasonography, liver enzymes, lipid profile (triglycerides, HDL, LDL cholesterol), glucose and fasting insulin. Results: The blood sugar and fasting insulin levels were significantly higher in NAFLD patients than control group (172.81±35.47 mg/ml vs 101.33±11.95 mg/ml and11.72±4.7 U/ml vs 5.93±4.68) respectively. 88.5% of NAFLD patients were obese (BMI ≥ 30) and 11.5% were over weight (BMI < 30) while 23.8% were obese and 76.2% were overweight for control group. HOMA-IR was significantly higher in NAFLD patients than in healthy controls (5.02±2.39 vs. 1.41±1.20; P<0.001). We found 81.7% of the studied patients fulfilled the metabolic syndrome criteria while 9.5% for controls. HOMA-IR ROC curve showed 94.23% sensitivity and 85.71 specificity in NAFLD group. Fasting Insulin ROC curve showed 91.35% sensitivity and 80.95% specificity in NAFLD group. Conclusion: Patients with NAFLD have higher insulin resistance and have higher lipid profile, ALT & AST levels compared with their control group. Also the Ratio of the metabolic syndrome was higher in the NAFLD patients (81.7%).

Quadriceps Tendon and Patellar Ligament; a morphometric study

Background: Anterior cruciate ligament [ACL] is commonly injured especially in sportsmen. Autografts using tissue from various sources including the quadriceps tendon and patellar ligament are popular but still controversial due to varying degree of success. The morphological characteristics of the quadriceps tendon and the patellar ligament are of prime importance for this purpose

Objectives: This cadaveric study was undertaken to evaluate the morphometric characteristics of the quadriceps tendon and patellar ligament as an autograft for ACL reconstructive surgery

Study design: Qualitative cadaveric study

Material and Methods: The morphometric observations of the quadriceps tendon and patellar ligament on 36 [18 male and 18 female] adult formalin fixed cadavers were recorded by dissection. The observations included the length, breadth and thickness of the quadriceps tendon and the patellar ligament and were recorded on both sides separately in the male and female subjects. The data were tabulated, compared and statistically analyzed

Results: There was no significant difference in measurements on the right and left sides both in the male and in the female specimens. However the length and width of the quadriceps tendon was more in the males as compared to the females. The patellar ligament was significantly longer in the male specimens as was its width. Thickness of the patellar ligament, however, was not significantly different in the two genders

Conclusion: Both the quadriceps tendon and the patellar ligament are safe and convenient sources of autograft tissue for reconstruction of the ACL

TV coverage of the 25th of January revolution and its impact on political socialization of children in late childhood stage

Problem: The main problem lies in the question of how much influence did the follow up of the 25th of January Revolution's events had on the political socialization of our children?

Objectives: This study is designed to identify the degree of influence and the change in political behavior that has happened to our children as a result of the follow up of the events of the 25th of January Revolution

Type and Methodology: The researcher used the field sample survey method on a sample of children in late childhood stage between the ages [9-12] years

Population and Sample: The study was applied to a sample of 400 boys and girls [9-12] years old-late childhood stage in urban and rural, in Giza, Sharkiya, and Qalubiya

Tools: Survey Questionnaire

Results: The study confirmed that a slight shift occurred in the character of the Egyptian childen as a result of events that they witnesses since the 25th of January Revolution and beyound. and they became familiar with a lot of information regarding these issues, The study clearly confirmed that a number of children interacted with the media directly and have become more confident to interact with media and discuss what they prodcast with the ability to oppose media openions, The study also confirmed the tendency of a significant proportion of children to the electronic media where they participated by commenting on what has been broadcasted by TV channels of political programs through the websites of such channels, The study also confirmed that all the sample followed the events of the 25th of January Revolution and that they were interested in the beginning of the revolution and most of them participated in the events at least by raising the national flag in the window of their houses and a few of them watched the events of violence and participated in violence with no regret, and that there is a small percentage of them was hit or arrested, and The study also confirmed that their participation in the students' unions elections and political events

Comparative study of endoscopic variceal ligation and endoscopic variceal sclerotherapy in children with portal hypertension

Gastroesophageal variceal bleebing is a serious complication of portal hypertension. Endoscopic variceal Sclerotherapy [EVS] has been considered the mainstay of therapy for bleeding esophageal varices but it is associated with substantial local and systemic complications. However, recent data have shown that ehdoscopic variceal ligation [EVL] is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. The aim of this work was to compare the effectiveness and safety of endoscopic variceal ligation [EVL] and endoscopic variceal Sclerotherapy [EVS] in children with portal hypertension who had proved recent bleeding from esophageal varices. This study was conducted on 30 children [17 males and 13 females] with portal hypertension who had proved recent bleeding from esophageal varices. Their ages ranged from 5 to 18 years. They were selected from those admitted to the Hepatology Unit of Pediatric Department, Tanta University Hospitals. In this study all patients were subjected to the following: full clinical history, thorough physical examination, routine abdominal ultrasonography as well as laboratory investigations. The latter included complete blood count, liver function tests, blood urea, serum creatinine and hepatitis markers. Upper gastrointestinal endoscopy was performed after resuscitation of bleeding patients for diagnosis and treatment of bleeding esophageal varices. Fifteen patients were treated with Sclerotherapy [Group I], and the other 15 patients were treated with band ligation [Group II]. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications, the number of sessions needed to eradicate varices, rebleeding and recurrences of varices. Endoscopic Sclerotherapy and ligation were equally effective for the control of active variceal bleeding and no significant differences were found between the Sclerotherapy and ligation groups in arresting active index bleeding and achieving variceal eradication. The rate of variceal eradication in the EVS group was not significantly different from the EVL group [86.7% vs. 93.3%, respectively, P = 0.55], but band ligation eradicated varices more quickly than did Sclerotherapy [59.2 +/- 17 vs. 91.3 +/- 32.6 days, respectively, P = 0.0001] and in fewer endoscopic sessions [4.7 +/- 1.1 vs. 7.3 +/- 2.6, respectively, P= 0.0001]. The overall rate of rebleeding before variceal eradication wassignificantly higher in patients undergoing EVS than those undergoing EVL [39.9% vs. 6.6%, P = 0.034] as was the rate of major complications [46.2% vs. 6.6%, P =0.035] After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy [21.4%% vs. 15.4%, P =0.927]. EVL is superior to EVS for acute and long-term management of bleeding esophageal varices because of its relative ease, faster obliteration, and lower complication and rebleeding rates. It appears that band ligation may replace sclerotherapy as the first choice for control of acute variceal bleeding and for eventual esophageal variceal eradication. Further long-term studies are needed to understand the evolution of variceal recurrence and portal hypertensive gastropathy in patients undergoing EVL

Mitomycin-C needle bleb revision in congenital glaucoma

This study was designed to evaluate the efficacy and safety of mitomycin-C [MMC] augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 +/- 3.4 years [range, 1-12 years]. Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC [0.04 mg/mL] and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous out flow. Follow-up ranged from 6 to 20 months [mean, 9.23 +/- 5.25 months]. One needling revision was performed in 22 eyes [73.3%] and eight eyes [26.7%] received two needle revisions. The mean intraocular pressure [IOP] decreased from 26.9 +/- 2.85 mmHg [range, 21-34 mmHg] before surgery to 15.63 +/- 3.15 mmHg [range, 10-24 mmHg] at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery