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.

Glycemic control in patients with diabetes across primary and tertiary government health sectors in the Emirate of Dubai, United Arab Emirates: a five-year pattern

Objectives: In the UAE, the comparative prevalence of diabetes is reported as 18.98%, but there are very few studies evaluating glycemic control. Attaining the optimum glycemic control has been a global challenge over the years. However, there is a trend of global improvement with the availability of newer options of antidiabetic medications, increasing numbers of physicians, and patient awareness. Our primary aim was to assess the level of glycemic control across Dubai Health Authority points of care over the past five years. Additionally, we aimed to compare the differences in glycemic control between primary and tertiary centers, between nationalities, and type I and II diabetes

Methods: We conducted a retrospective analysis of the electronic medical records of all patients who attended primary and tertiary care centers within the Dubai Health Authority between 2012 and 2016. All patients with any type of diabetes were included in this assessment

Results: A total of 26 447 patients were included in the study; of these, 73.8% [n = 19 508] were UAE nationals while the other nationalities accounted for 26.2% [n = 6939] of patients. The overall mean glycated hemoglobin [HbA1c] levels from 2012 to 2016 was 7.76%. Patients attending primary care clinics had a mean HbA1c of 7.64% compared to 7.68% for the tertiary care cohort. Out of the total population, 37.7% achieved HbA1c < 7%. Over 40% of the patients attending primary care centers achieved HbA1c < 7% compared to 34.9% of those who attended tertiary care centers

Conclusions: Optimum glycemic target was achieved by less than 40% of patients. Glycemic control is still below the desired levels. However, there has been a trend of improvement in the last few years and we are achieving the international average targets. Further collaborative actions from clinical, educational, and strategic sectors are needed to improve our goals further

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.

Hepatoprotective and antidiabetic effects of apple cider vinegar [A prophetic medicine remedy] on the liver of male rats

Background: Diabetes mellitus is associated with biochemical and pathological alterations in the liver. The aim of this study was to investigate the effects of apple cider vinegar [ACV] on serum biochemical markers and histopathological changes in the liver of diabetic rats for 30 days. Effects were evaluated using streptozotocin [STZ]-induced diabetic rats as an experimental model

Materials and Methods: Diabetes mellitus was induced by a single dose of STZ [65 mg/kg] given intraperitoneally. Thirty wistar rats were divided into three groups: control group, STZ-treated group and STZ plus ACV treated group [2 ml/kg BW]. Animals were sacrificed 30 days post treatment

Results: Biochemical results indicated that, ACV caused a significant decrease in glucose, TC, LDL-c and a significant increase in HDL-c. Histopathological examination of the liver sections of diabetic rats showed fatty changes in the cytoplasm of the hepatocytes in the form of accumulation of lipid droplets, lymphocytic infiltration. Electron microscopic studies revealed aggregations of polymorphic mitochondria with apparent loss of their cristae and condensed matrices. Besides, the rough endoplasmic reticulum was proliferating and fragmented into smaller stacks. The cytoplasm of the hepatocytes exhibited vacuolations and displayed a large number of lipid droplets of different sizes. On the other hand, the liver sections of diabetic rats treated with ACV showed minimal toxic effects due to streptozotocin. These ultrastructural results revealed that treatment of diabetic rats with ACV led to apparent recovery of the injured hepatocytes. In prophetic medicine, Prophet Muhammad peace is upon him strongly recommended eating vinegar in the Prophetic Hadeeth: "vinegar is the best edible"

Conclusion: This study showed that ACV, in early stages of diabetes induction- can decrease the destructive progress of diabetes and cause hepatoprotection against the metabolic damages resulting from streptozotocin- induced diabetes mellitus

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%).

Safety and outcome of treatment of metastatic melanoma using 3-bromopyruvate: a concise literature review and case study / 癌症

3-Bromopyruvate (3BP) is a new, promising anticancer alkylating agent with several notable functions. In addition to inhibiting key glycolysis enzymes including hexokinase II and lactate dehydrogenase (LDH), 3BP also selectively inhibits mitochondrial oxidative phosphorylation, angiogenesis, and energy production in cancer cells. Moreover, 3BP induces hydrogen peroxide generation in cancer cells (oxidative stress effect) and competes with the LDH substrates pyruvate and lactate. There is only one published human clinical study showing that 3BP was effective in treating fibrolamellar hepatocellular carcinoma. LDH is a good measure for tumor evaluation and predicts the outcome of treatment better than the presence of a residual tumor mass. According to the Warburg effect, LDH is responsible for lactate synthesis, which facilitates cancer cell survival, progression, aggressiveness, metastasis, and angiogenesis. Lactate produced through LDH activity fuels aerobic cell populations inside tumors via metabolic symbiosis. In melanoma, the most deadly skin cancer, 3BP induced necrotic cell death in sensitive cells, whereas high glutathione (GSH) content made other melanoma cells resistant to 3BP. Concurrent use of a GSH depletor with 3BP killed resistant melanoma cells. Survival of melanoma patients was inversely associated with high serum LDH levels, which was reported to be highly predictive of melanoma treatment in randomized clinical trials. Here, we report a 28-year-old man presented with stage IV metastatic melanoma affecting the back, left pleura, and lung. The disease caused total destruction of the left lung and a high serum LDH level (4,283 U/L). After ethics committee approval and written patient consent, the patient received 3BP intravenous infusions (1-2.2 mg/kg), but the anticancer effect was minimal as indicated by a high serum LDH level. This may have been due to high tumor GSH content. On combining oral paracetamol, which depletes tumor GSH, with 3BP treatment, serum LDH level dropped maximally. Although a slow intravenous infusion of 3BP appeared to have minimal cytotoxicity, its anticancer efficacy via this delivery method was low. This was possibly due to high tumor GSH content, which was increased after concurrent use of the GSH depletor paracetamol. If the anticancer effectiveness of 3BP is less than expected, the combination with paracetamol may be needed to sensitize cancer cells to 3BP-induced effects.

Cerebral sinus thrombosis secondary to epidural anaesthesia

Cerebral venous sinus thrombosis [CVST] is an uncommon, and yet potentially fatal, condition; we present a rare case of CVST as a complication of epidural anaesthesia used for caesarean section, we review different aspects of CVST in terms of epidemiology, aetiology, investigations, and treatment, as well as most acceptable theory explaining the pathogenesis in our case report

Letter: Treatment of Acute Tuberculous Spondylitis by the Spinal Shortening Osteotomy: A Technical Notes and Case Illustrations

No abstract available.

Acupressure as a safe and easy method in post Management chemotherapy of nausea and Vomiting among leukemic children

One of the major problems facing the clinician dealing with cancer patient is the post chemotherapy nausea and vomiting. This study aimed to assess the effect of acupressure as a method to manage nausea and vomiting post chemotherapy in leukemic children. The study was conducted in pediatric hematology oncology unit at Tanta university hospital from May to August 2010. A convenient sample of 60 children with acute lymphoblast leukemia [ALL] was included in the study .Their ages ranged between 6-18 years. All of them were under chemotherapy. They were divided into two equal groups, group 1 [received acupressure at p 6 acupoint plus routine hospital care, group 11 as a control group [received routine hospital care only]. Visual analog scale [VAS] and Rhodes index scale [INVR] were used to assess intensity, duration and frequency of nausea and vomiting post chemotherapy. Results revealed significant reduction in the amount of vomiting and the intensity of nausea over time among acupressure group, compared to the usual-care group. Concerning child distress from nausea and vomiting, significant improvement was detected regarding the duration, seventy and distress from nausea and vomiting after one hour as well as after 2-3 hours in comparison with immediately after one hour .But no significant between after one hour and 2-3 hours . In conclusion, Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for children undergoing chemotherapy to reduce the amount and intensity of nausea and vomiting. Thus should be applied to children undergoing chemotherapy

Cone mesh repair in paraumbilical hernia in comparison with Mayo's repair

This study was designed to assess and evaluate the recent method of tension free prosthetic mesh plug hernioplasty and comparing it with the old method of tension repair "Mayo's repair' in cases of paraumbilical hernias. The present study included 60 patients presented with clinical diagnosis of midline aponeunotic hernia, during the period from April 2007 to April 2009, selected from Al-Azhar University Hospital at Damietta. All included cases were submitted to full history taking and thorough clinical examination. Routine laboratory investigations were carried out. There was a statistically significant decrease in operative time hospitalization time and number of drains I in group 2 [Mesh repair] in comparison to group 1 [Mayo's repair] [47.33 +/- 6.26, 1.33 +/- 0.54 and 6.7% vs 76.20 +/- 9.60, 2.76 +/- 0.50 and 83.3% respectively]. Early complications were in the form of seroma in 6.7%, hematoma in 1.7%, superficial wound infection in 6.7%, persistent wound pan in 3.3% and respiratory complications in 1.7%, while late complications were in the form of chronic wound pain in 5%, recurrence in 6.7% and patient unsatisfaction in 11.7% . There were statistically signficant decreases in late complications in group 2 [Mesh repair] in comparison to group 1 [Mayo's repair], while this difference was statistically non-signficant as regard early complications. Mesh plug hernioplasty has a good outcome compared to Mayo's repair. So, the mesh plug hernioplasty seems to be the logic major improvement in the management of these cases that formerly has a high recurrence rate and thus it is recommended to replace the Mayo's repair, in cases of mid-aponeunotic hernias specially that of a small defect of few centimeters

effectiveness of home care program conducted by diabetic team of sohar hospital for diabetic children

Insulin dependent diabetes mellitus [IDDM] is the most common endocrine-metabolic disease, affecting approximately I in 500 children and adolescents. It is considered one of the major health problems in Oman, due to high incidence of obesity and family history. Diabetic Team plays a significant role to help those children and their families to adapt with the disease process and reduce their hospitalization. The aim of this study was to evaluate the effectiveness of home care program conducted by diabetic team on the adaptation of diabetic children with the disease process. The study was conducted at diabetic out patient clinic of New Sohar Hospital, North Batinah Region, Sultanate of Oman and follow up was done at their houses. A purposive sample of 21 children with IDDM and their families were included in this study. They represented all the attendants in the diabetic clinic, during the period of the study. Their age ranged between 8-12 years. All of them undergo insulin therapy. Interview questionnaire sheet and observation check list were used to collect data as pre and post intervention phase. Data were collected in different 4 phases [initial assessment, development, implementation and evaluation phases]. The results showed significant improvement in maternal management in post test, as well as diabetic children adaptation with the disease process. In Conclusion, Diabetic Team plays a prominent role in creating a positive learning atmosphere to encourage and motivate diabetic children and their families to carry out self care practices in order to promote their health, prevent complications and achieve rehabilitation

Effect of open reduction and internal fixation [ORIF] on salivary immunoglobulin a [SIgA] in parasymphyseal fractures of mandible

Oral and maxillofacial trauma studied has been directed extensively towards improvement of surgical approaches, appliances, and techniques, yet the study of surgical trauma with regards patient's immunocompetence has not received the same attention. The present investigation was directed to clarify the effect of open reduction and internal fixation [ORIF] and surgical insult in cases of parasymphyseal mandibular fractures on salivary immunoglobulin A [SIgA]. It was hoped to rationalize the trauma associated with surgery, especially in cases of already traumatized patients. This was an attempt to give the oral mucosal immune system the due attention in planning of different surgical techniques. Fourteen adult Egyptian patients with parasymphyseal mandibular fractures were the subjects of this study. All patients have been treated under general anaesthesia [G.A.]. Patients were divided randomly into two equal groups; Group I: parasymphyseal fractures were managed by non-surgical lingual splint. Group II: parasymphyseal fractures were managed by surgical open reduction and internal fixation [ORIF]. Unstimulated whole saliva samples were collected from the patients preoperatively [on the day of admission], postoperatively [before discharge], 24 hours postoperatively, then at one week, three weeks, six weeks, and eight weeks postoperatively. The quantitative determination of the concentration of salivary immunoglobulin A [SIgA] was done by enzyme linked immunosorbent assay [ELISA]. The data was tabulated and statistically analyzed. Group II patients returned to normal level of SIgA by the seventh day of postoperatively. The results revealed that though it seems that the surgical procedures of the ORIF are more insulting to the oral mucosal immune system than the application of the interdental wires of the splint, but the results of the study showed that the lingual splint to be more traumatizing and insulting to the oral mucosa

Standards of nursing care for patients with upper gastro intestinal bleeding

In a climate of rapid changes in the structure of health services and the development of mew categories of nursing personnel, it is imperative to define and set standards for the practice of nursing. Such standards demonstrate to the public that nurses are concerned with the quality of nursing care and with self-regulation to assuse a desirable level of care. The aim of the study was to establish standards of nursing care for upper gastro-intestinal bleeding patients at the hematemsis unit of Emergency hospital- Mansoura University. Subjects of study consisted of two groups experts in the fields FGI surgery and all nursing staff present in the setting. Two tools were used in the study regarding essential standards of nursing care of UGIB patients. The results reuealed lacke of nurses efficiency in assessment and performing nursing care needed for those patients and recommended establishing nursing care standards for UGIB patients

uterine relaxant effect of curcumin in rats ; An in vitro study

Addition of curcumin in concentrations of 1.4 x 10-5 M, 2.8 x 10-5 M and 5.6 x 10-5 M to the organ bath, resulted in significant inhibitions in the normal uterine contractions of non-pregnant rats in the diestrus stage. The recorded decline in the frequency of uterine contractions were 32%, 47% and 67%, while the inhibitions were 50%, 67% and 76% for the amplitude respectively. The reductions in area under the curve [AUC] of contractions were 67%, 71% and 86% for the added concentrations. Pretreatment with curcumin revealed inhibitory effects on the uterine response to oxytocin [10-11M] amounting to 77%, 78% and 72% in AUC with respect to that obtained post-addition of oxytocin alone. These results indicate that the tocolytic potential of curcumin may involve oxytocin receptor-dependent pathway

Role of husbands during pregnancy and puerperium: the expected versus the actual

Pregnancy and child bearing are crucial developmental phases in family life: they are often characterized by ambivalence and conflicting emotions as expectant parents face significant role and lifestyle changes. Everybody responds differently to the diagnosis of pregnancy. Quite often expectant fathers get bent out of shape over what they should be doing during the period of pregnancy, and puerperium. The current study was designed to explore women's expectations of their husbands' role during pregnancy and puerperium, further to compare their expectations with what was actually provided. The study was conducted at El-Shatby hospital in post partum wards, the subjects were hundred post partum women during the first 24 hours alter delivery. The data were collected using a semi-structured interview schedule which was developed by the researchers. Results revealed that almost all studied women expected their husband support during pregnancy and puerperum, and almost all women stated they need understanding and approval from their husband. An active, positive role of the husband: increases the women sense of well being. From this study it's recommended to increase husband involvement in the care and support of their spouse, to prepare the husband to accept paternal responsibilities, and strengthen the marital relationship of the couples

Value of coronary pressure measurement in percutaneous coronary intervention for chronic total occlusion

The relevance of procedural parameters such as stent length and the angiographic result had been shown to be a major determinant of [TVF] target vessel failure after successful PCI in CTOs. However, limited data is known about the influence of collateral and coronary hemodynamics on TVF. FFRmyo reflects both antegrade and collateral contribution to the maximum myocardial perfusion, so it is one of the most important flow indexes from a clinical point of view. The aim of this work is to assess clinical outcome after successful PCI in CTO, and to assess the importance of collateral function and coronary hermodynamics on the risk of adverse cardiac events [ACE] after recanalization of a CTO. The present study included 50 patients with successful percutaneous coronary intervention [PCI] for CTO lesion. All patients were subjected to full history taking; coronary pressure was recorded distal to occlusion before PCI [P[occ1]] by pressure wire and aortic pressure [P[AO]], was also recorded. Baseline collateral function before PCI and recruitable after PCI were determined. Collateral pressure index [CPI] was calculated by using central venous pressure [CVP], CPI = [P[occ1] - CVP]/ [P[AO] -CVP]. Fractional flow reserve FFR was measured at the end of PCI as FFR= P[D]/P[AO] after intracoronary injection of 20 to 40 micro g of adenosine. Follow up for all patients for 6 months were done for any adverse cardiac events. On follow up ten patients reported adverse cardiac events. There was no significant difference between patients with ACE and those without according to clinical characters. Length of stented segment was significantly higher in patients with ACE compared to those without. Pressure parameters of collateral function measured before and after PCI showed no significant difference in patients with ACE in comparison to those without. However, in patients with ACE, it was found that FFR was significantly lower [P<0.05] compared to those without [0.82 +/- 0. 07 versus [0.89 +/- 0. 08]. The presence of well-developed collaterals after PCI does not influence the risk of adverse cardiac events after recanalization of CTOs and should not prevent us from attempting a recanalization. Length of stented segment and low FFR were the most powerful predictors of ACE after successful PCI in CTO

Triphasic spiral CT imaging of hepato-cellular carcinoma in the cirrhotic liver

Hepatocellular carcinoma [HCC] is responsible for a large proportion of cancer deaths worldwide and derives its blood supply predominantly from the hepatic artery. The imaging modalities used in diagnosis of HCC include ultrasound [US], multiphase spiral CT [MsCT], magnetic resonance imaging [MRI], angiography, positron emission tomography [PET], and imaging-guided biopsy. The aim of this study was to clarify the role of triphasic spiral CT in evaluation of patients with hepatocellular carcinoma developed on top of cirrhosis. This study included 30 male patients with evident cirrhosis and suspected clinically and/ or by real time ultrasonography [US] to have hepatocellular carcinoma [HCC]. All of them were subjected to the followings: 1]-Full history taking and clinical examination.2]-Laboratory investigations including: hepatic function tests and serum alfa-feto-protein level. 3]-Real time ultrasonography of the liver [US]. 4]-Triphasic spiral CT of the liver [TsCT]. 5]-Finally, the results were confirmed by CT-guided biopsy in 15 cases, US-guided biopsy in 10 cases, and follow up in the remaining 5 cases. The mean age of the studied patients was 57 years. Their commonest clinical presentation was right upper quadrant abdominal pain. All of them showed elevated liver function tests and the alfa-feto-protein level was elevated in 73.3% of these cases. All of the detected lesions were solid and/or predominantly solid on real time US study and 20/30[66.7%] lesions showed non-homogenous echo texture pattern. Their outlines were ill-defined in 20/30[66.7%] lesions and halo sign was noted in 15/30[50%] lesions. The lesions commonly affected the medial segment of left hepatic lobe in 12/30[40%] cases. On triphasic spiral CT [TsCT], the mean size of the examined lesions was 7.1cm. 15/30[50%] lesions showed faint, non-homogenous enhancement, 10/30[33.3%] lesions showed intense, and homogenous enhancement and 5/30[16.7%] showed peripheral enhancement on the arterial phase. 66.7% and 83.3% of the studied lesions appeared isodense compared with the adjacent cirrhotic hepatic parenchymal tissue on both portal venous and delayed phases. Associated findings included splenomegaly in 66.7% of the cases, ascites was noted in 20% of the patients and portal vein thrombosis was seen in 13.3% of the cases. Real time US is the preliminary imaging modality for evaluation of patients with suspected HCC on top of cirrhosis, as it gives a good idea about the morphological characteristics of these lesions. In addition, US-guided needle biopsy is frequently required for their diagnosis. Triphasic spiral CT is valuable for further characterization of these lesions, determination of their vascular supply and guides their percutaneous biopsy

Psychiatric nurses' attitudes toward aggressive psychotic patients

Aggression by mentally ill patients has been recognized as a significant and increasing problem in psychiatric settings. Inpatient aggressive behaviour represents a serious threat to the safety of staff, and it provokes strong emotional reactions among staff members Nurses' attitudes towards patient aggression may influence their behavior toward patients. This study aims to explore psychiatric nurses' attitudes toward aggressive psychotic patients. The study was conducted at EL-Mamoura Hospital for Psychiatric Medicine in Alexandria. Subjects of the study comprised all staff nurses working at the psychotic inpatients wards. The data of the study were collected using the Attitude toward aggression scale [ATAS], which comprise five subscales namely, offensive. Destructive, intrusive, communicative, and protective, and aggressive incident, The results of this study revealed that there is a negative attitude toward patients aggression. A negative correlation between the age of nurses, their years of experience and offensive, communicative and intrusive attitude, i.e. the younger the age and fewer years of experience associated, with more negative attitude toward aggression, but no statistical significant difference was found. But in contrast, the protective attitude had a positive correlation with age and years of experience, i.e. viewing the aggression may exhibit to defend about personal and emotional space