External Auditory Canal: Computed Tomography Analysis and Classification

Abstract Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CTscans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ±0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ±1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ±0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Retardo na transferência do pronto-socorro para a unidade de terapia intensiva: impacto nos desfechos do paciente. Um estudo retrospectivo / Delayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study

RESUMO Objetivo: Estudar o impacto do retardo na admissão à unidade de terapia intensiva em mais do que 4 horas nos desfechos de pacientes críticos. Métodos: Este foi um estudo observacional retrospectivo, no qual pacientes adultos admitidos diretamente do pronto-socorro para a unidade de terapia intensiva foram divididos em dois grupos: Tempo Adequado, se admitidos dentro de 4 horas, e Admissão Retardada, nos casos em que a admissão demorou mais do que 4 horas para ocorrer. Compararam-se, entre os grupos, o tempo de permanência na unidade de terapia intensiva e a taxa de mortalidade na unidade de terapia intensiva e no hospital. Foi realizado pareamento por escore de propensão para correção de desequilíbrios. Utilizou-se uma análise de regressão logística para explorar retardo da admissão como fator independente de risco para mortalidade na unidade de terapia intensiva. Resultados: Durante o período do estudo, 1.887 pacientes foram admitidos diretamente do pronto-socorro para a unidade de terapia intensiva, sendo que 42% dessas admissões foram retardadas. Os pacientes com retardo tiveram permanências na unidade de terapia intensiva significantemente mais longas e maior mortalidade na unidade de terapia intensiva e no hospital. Esses resultados persistiram após pareamento dos grupos por escore de propensão. O retardo da admissão foi fator independente de risco para mortalidade na unidade de terapia intensiva (RC = 2,6; IC95% 1,9 - 3,5; p < 0,001). A associação de retardo e mortalidade na unidade de terapia intensiva surgiu após período de retardo de 2 horas e foi mais alta após período de retardo de 4 horas. Conclusão: O retardo da admissão do pronto-socorro para a unidade de terapia intensiva é fator de risco independente para mortalidade na unidade de terapia intensiva, sendo a associação mais forte após retardo de 4 horas.

Abstract Objective: To study the impact of delayed admission by more than 4 hours on the outcomes of critically ill patients. Methods: This was a retrospective observational study in which adult patients admitted directly from the emergency department to the intensive care unit were divided into two groups: Timely Admission if they were admitted within 4 hours and Delayed Admission if admission was delayed for more than 4 hours. Intensive care unit length of stay and hospital/intensive care unit mortality were compared between the groups. Propensity score matching was performed to correct for imbalances. Logistic regression analysis was used to explore delayed admission as an independent risk factor for intensive care unit mortality. Results: During the study period, 1,887 patients were admitted directly from the emergency department to the intensive care unit, with 42% being delayed admissions. Delayed patients had significantly longer intensive care unit lengths of stay and higher intensive care unit and hospital mortality. These results were persistent after propensity score matching of the groups. Delayed admission was an independent risk factor for intensive care unit mortality (OR = 2.6; 95%CI 1.9 - 3.5; p < 0.001). The association of delay and intensive care unit mortality emerged after a delay of 2 hours and was highest after a delay of 4 hours. Conclusion: Delayed admission to the intensive care unit from the emergency department is an independent risk factor for intensive care unit mortality, with the strongest association being after a delay of 4 hours.

Modified Early Warning Score como preditor de readmissão à unidade de terapia intensiva dentro de 48 horas: um estudo observacional retrospectivo / Modified Early Warning Score as a predictor of intensive care unit readmission within 48 hours: a retrospective observational study

RESUMO Objetivo: Avaliar a hipótese de que o Modified Early Warning Score (MEWS) por ocasião da alta da unidade de terapia intensiva associa-se com readmissão, e identificar o nível desse escore que prediz com maior confiabilidade a readmissão à unidade de terapia intensiva dentro de 48 horas após a alta. Métodos: Este foi um estudo observacional retrospectivo a respeito do MEWS de pacientes que receberam alta da unidade de terapia intensiva. Comparamos dados demográficos, escores de severidade, características da doença crítica e MEWS de pacientes readmitidos e não readmitidos. Identificamos os fatores associados com a readmissão em um modelo de regressão logística. Construímos uma curva Característica de Operação do Receptor para o MEWS na predição da probabilidade de readmissão. Por fim, apresentamos o critério ideal com maior sensibilidade e especificidade. Resultados: A taxa de readmissões foi de 2,6%, e o MEWS foi preditor significante de readmissão, juntamente do tempo de permanência na unidade de terapia intensiva acima de 10 dias e traqueostomia. A curva Característica de Operação do Receptor relativa ao MEWS para predizer a probabilidade de readmissão teve área sob a curva de 0,82, e MEWS acima de 6 teve sensibilidade de 0,78 (IC95% 0,66 - 0,9) e especificidade de 0,9 (IC95% 0,87 - 0,93). Conclusão: O MEWS associa-se com readmissão à unidade de terapia intensiva, e o escore acima de 6 teve excelente precisão como preditor prognóstico.

ABSTRACT Objective: To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge. Methods: This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity. Results: The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93). Conclusion: The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.

Genotypic Identification of Cystoisospora in Immunocompromised Patients Using T(m)-Variation Analysis

Cystoisospora is responsible for morbidity in immunocompromised patients. PCR is sensitive for diagnosing Cystoisospora; however, it needs reevaluation for differential molecular diagnosis of cystoisosporiasis. We aimed at evaluating melting curve analysis (MCA) after real-time PCR (qPCR) in diagnosis and genotyping of Cystoisospora as an alternative to conventional PCR. We included 293 diarrheic stool samples of patients attending the Department of Clinical Oncology and Nuclear Medicine of Cairo University Hospitals, Egypt. Samples were subjected to microscopy, nested PCR (nPCR), and qPCR targeting the internal transcribed spacer 2 region (ITS2) of the ribosomal RNA (r RNA) gene followed by melting temperatures (T(m)s) analysis and comparing the results to PCR-RFLP banding patterns. Using microscopy and ITS2-nPCR, 3.1% and 5.8% of cases were Cystoisospora positive, respectively, while 10.9% were positive using qPCR. Genotyping of Cystoisospora by qPCR-MCA revealed 2 genotypes. These genotypes matched with 2 distinct melting peaks with specified T(m)s at 85.8°C and 88.6°C, which indicated genetic variation among Cystoisospora isolates in Egypt. Genotype II proved to be more prevalent (65.6%). HIV-related Kaposi sarcoma and leukemic patients harbored both genotypes with a tendency to genotype II. Genotype I was more prevalent in lymphomas and mammary gland tumors while colorectal and hepatocellular tumors harbored genotype II suggesting that this genotype might be responsible for the development of cystoisosporiasis in immunocompromised patients. Direct reliable identification and differentiation of Cystoisospora species could be established using qPCR-T(m)s analysis which is useful for rapid detection and screening of Cystoisospora genotypes principally in high risk groups.

Preparation and characterization of two new forced degradation products of letrozole and development of a stability-indicating RP-LC method for its determination

Two new hydrolytic products of letrozole were identified and proved to be true degradation products obtained by alkaline and acidic degradation of the drug. The acid and amide forms of the nitrile groups of letrozole were prepared and identified by IR and mass spectroscopic techniques. Subsequently, a simple, precise and selective stability-indicating RPLC method was developed and validated for the determination of letrozole in the presence of its degradation products. Letrozole was subjected to alkali and acid hydrolysis, oxidation, thermal degradation and photo-degradation. The degradation products were well isolated from letrozole. The chromatographic method was achieved usinggradient elution of the drug and its degradation products on a reversed phase Zorbax Eclipse C18 column [100mm x 4.6mm, 3.5microm] using a mobile phase consisting of 0.01M KH[2]PO[4] and methanol at a flow rate of 1mL min[?1]. Quantitation was achieved with UV detection at 230nm. Linearity, accuracy and precision were found to be acceptable over the concentration range of 0.01-80microgmL[-1]. The proposed method was successfully applied to the determination of letrozole in bulk, plasma and in its pharmaceutical preparation

Relation of ALT and AST levels to the histopathological changes in liver biopsies of patients with chronic hepatitis C genotype 4

Worldwide, Egypt has a high prevalence of adult hepatitis C virus [HCV] infection. Serum alanine aminotransferase [ALT] activity is most commonly measured to assess hepatic disease. The revision of the definition of the normal limits for the ALT level is advisable. The aim of this work was to compare the histopathological changes in the liver tissue biopsies of HCV-infected patients, clinically presenting with ALT levels below normal, based on the conventional, previously used upper limit of normal [ULN] of ALT [40 U/L for men and 30 U/L for women] with the proposed new ULN [30 U/L for men, and 19 U/L for women]. This is a retrospective cross-sectional study. A total of 668 cases of chronic hepatitis C genotype 4 were included. Patients were classified according to grades of histological activity and fibrosis stages [by the Metavir scoring system]. They were also classified into normal and high groups according to the old and new cutoffs of both aspartate transaminase [AST] and ALT levels.The results of our study showed that the serum AST level in our study showed a better correlation with the histopathological changes in liver biopsy rather than ALT, especially when using the old cutoff of the ULN for AST. The serum ALT level in our study [both the old and the new cutoffs] did not show a significant correlation with the histopathological status in the liver biopsies of our patients. This study concluded that the old cutoff of the ULN AST is a better predictor of fibrosis

Cultural awareness between the privacy of the constants and global variables

The study aims to highlight the cultural awareness of teanagers between the privacy of the constants and global variables. It is the findings of the researcher in the study for a doctorate titled "The problems of new media and ways of facing them on a sample of teenagers", you must educate teenagers in various fields, such as awareness of identity, awareness of religion, awareness of the Arabic language of the Koran, awareness of oriental traditions and habits, awareness of expatriate culture and egyptianizing it, awareness of the English language of the age and predict the future, awareness of variables needed to enter the age, awareness of technological Innovations, warning parents, teachers and children of the downsides of technological innovations and make them aware of the technological skills so that they can join the labor market, succeed, marry and live happy. Income is very important [that who does not learn and master the technology skills is considered now backward, illiterate and never learnt, and difficult for him to catch the modern era and entering the labor market]. The researcher considers that the conscious family that guide their children and educate them about constants and prepare them for the modern era. The Upbringing institutions [family, school, media, club and mosque, etc.] must be involved in enlightenment, education and supporting teenagers

Fibroscan of chronic HCV patients coinfected with schistosomiasis

Both hepatitis C virus [HCV] and schistosomiasis are highly endemic in Egypt and coinfection is frequently encountered. Such coinfection is responsible for leading to a more severe liver disease. Hence, the aim of the study was to assess the fibroscan in chronic HCV patients coinfected with Schistosoma. This study included 231 chronic HCV patients. Routine pre-treatment work-up was done including anti-schistosomal antibodies. Liver stiffness measurements using fibroscan and reference needle-liver biopsy were done. Patients were categorised into two groups: HCV patients with positive schistosomal serology and HCV patients with negative schistosomal serology. Anti-schistosomal antibody was positive in 29% of the studied population. Positive schistosomal serology status was significantly associated with the disagreement between the results of liver biopsy [Metavir] and the fibroscan results [p value = 0.02], which was more obvious in F2 and F3 fibrosis stages. The sensitivity of fibroscan for the detection of the F2 stage decreased from 64% among negative schistosomal serology patients to 30.8% among positive schistosomal serology patients, and for the F3 stage it decreased from 43.8% to 21.4%, respectively. Multivariate logistic regression showed that fibrosis stages [FO-F1 and F4] were the most independent factors that were associated with the agreement between fibroscan and liver biopsy [odds ratio [OR] 3.4, 7.12 and p value <0.001, <0.001, respectively]. Although the sensitivity of fibroscan for the detection of fibrosis stages [F2 and F3] was impaired in patients with positive schistosomal serology, fibrosis stages [FO-F1 and F4] were the most independent factors associated with the agreement between fibroscan and liver biopsy

Evaluation of the diagnostic value of serum and tissue apoptotoic cytokeratin- 18 in patients with chronic hepatitis C

Hepatitis C virus [HCV] is considered the most common aetiology of chronic liver disease [CLD] in Egypt. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma. A role for apoptosis in liver damage caused by HCV chronic infection has been suggested. Cytokeratin 18 [CK-18] is the major intermediate filament protein in the liver and is a known caspase substrate in hepatocyte apoptosis. Therefore, we analysed the serum and tissue levels of CK-18 in patients with chronic HCV infection to evaluate its role in hepatocyte apoptosis. We also correlated CK-18 expression with the severity of hepatic pathology. This study examined 80 Egyptian patients with liver disease. There were 69 patients with chronic hepatitis C and 11 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. The levels of CK-18 fragment were quantified in paired serum and liver biopsy samples. The serum and tissue CK-18 levels were reduced in chronic HCV patients compared to early cirrhosis patients. This result indicates that serum levels of CK-18 and the hepatic expression of CK-18 might play an important role in disease progression. The serum and tissue levels of CK-18 were significantly increased and directly correlated with inflammation severity, stage of fibrosis, and ALT levels in the chronic HCV group and the cirrhotic liver group. There was no significant difference in viral load between patient cohorts. The serum level and the hepatic expression of CK-18 are related to disease activity and are directly correlated with METAVIR scoring. This result suggests that serum CK-18 levels may be useful for monitoring disease activity in chronic HCV and liver cirrhosis patients

Study of medical malpractice claims in sharqyia governorate [2007-2010]

The present study aimed to throw light on medical malpractice claims in Sharqyia governorate as a step for a primary evaluation all over the Egyptian goveraorates. 114 cases of malpractice claims were collected from Sharqyia Medicolegal Department, Ministry of Justice during the period from the beginning of 2007 till the end of 2010. The data obtained were analyzed in relation to plaintiff aspects, defendant aspects, locations of medical services, the final outcomes as well as the rate of autopsy performance. The results revealed that, there was a statistically significant increase in the total number of claims during the years of study. 20.2% of claims cases were positive and one defendant was involved in 96.5% of cases. The highest incidence of claims was in general surgery followed by orthopedics with a statistically

Assessment of different hand measurements for sex prediction among some Egyptians

The need for determination of sex from human skeletal remains is of great importance for genetic, anthropological, odontologic and forensic purposes. The present study aimed to detect the possibility of sex prediction using different measurements of hands belonging to random, living Egyptian population sample. Three hundred individuals [150 males and 150 females] with age ranges from 19 to 25 years were included in the study. The hand length, breadth and palm length of each subject were measured in both sides using a sliding caliper. The statistical analysis of the data obtained showed that, mean values of hand dimensions are significantly larger in males than females. These mean values were also larger in right hand than the left. The hand length was the measurement with the greatest sex difference in both hands. The distance between sex means was higher in left hand than the right regarding all variables. In both hands, the hand length was the most sensitive variable with 94% accuracy in right hand and 94.32% in left hand. Palm length is found to be the most specific variable with 89% accuracy in both hands. Combination of two measurements showed that, the hand length with the palm length give the highest rate of accuracy [86.22% for the right hand and 88.37% for the left]. The same combination between hand length and palm length gives the highest sensitivity in both hands [99.3% for right hand and 100% for left hand]. These results can help in correct sex prediction from the hand when a dismembered hand is brought to forensic examination

Is cellular phone a source of infection? a hospital based study among dentists in Ajman and Sharjah, UAE

This study was carried out to know the different micro-organisms harboring the cell phones of health care persons working in the dental centre of our hospital and to determine what are the potential pathogenic organisms transmitted via mobile phones. An interviewer-administered questionnaire was used for data collection. Samples were collected by rotating the swabs over all the surfaces of cell phones including the mouthpiece, earpiece, keypad, sides and the back, and from Bluetooth, hands free, and external cover of the mobile, one without any sterilization and second sample after decontaminating the cell phone using isopropyl alcohol in the beginning of the day. The swabs were inoculated and streaked onto five per cent sheep blood agar, Mac-Conkey agar and chocolate agar. Sheep blood agar and Mac-Conkey agar plates were incubated aerobically at 37°C for 24 hours. Isolated organisms were processed according to colony morphology and gram stain. Bacteria were identified according to standard protocol [Mackie and McCartney]. Tests for identification of gram positive cocci included catalase, Oxidative/ Fermentative test, anaerobic mannitol fermentation and coagulase production. Tests for identification of gram negative bacilli included catalase, oxidase and other relevant biochemical tests [API 20E]. In the samples taken without prior decontamination, 40% of the samples did not show any growth owing to the sterilization carried out by them at the end of the day. Staphylococcus species dominated the growth in the remaining specimens. Gram positive bacilli, Pantoe species and Enterobacter Cloacae were also found. In the samples taken with prior decontamination at the beginning of the day, 36% of the samples did not show any growth again owing to the sterilization carried out by them at the end of the day. Staphylococcus species dominated the growth in the remaining specimens. Gram positive bacilli, Micrococci and Citrobacter Freundii were also found. Nearly 40% of our samples did not show any pathogenic organisms, due to the cell phones being kept away on a table or inside the bags rather than close to the patient chair and because most of the professionals used some kind of decontamination procedure at the end of the day or at least once in a week. A wider study with increased sample size should be carried out to create awareness among Dentists and other Health care professionals

Sleeping pattern of depressed elders living in elderly homes

Sleep disorders are common and significant complaints of depressed older people. A large proportion of depressed older people are at risk for sleep disturbances, which may be caused by many factors. It was thus the intent of this study to assess the sleeping pattern of depressed elders living in elderly homes. Results of the present study revealed that, the majority of the studied depressed elders had sleeping difficulties and more than half of them took more than 60 minutes in bed to fall asleep. Almost all the subjects woke up more than 3 times during the night, and the most frequently reported causes were frequency of micturation, anxiety, and pain. Three-quarters of the studied elders didn't feel comfortable when waking up in the morning, and this affected their ability to perform their daily living activities. It is thus recommended to encourage elderly clients to establish a routine sleep schedule, to stick to rituals that help to relax before bed time and to suggest consultation with appropriate specialist depending on the underlying causes of the sleep disorder

Surgery or chemotherapy in locally advanced operable breast cancer; which comes first?

Background: Unfortunately, locally advanced cancer breast [LABC] represents more than 50% 0f the newly diagnosed breast cancer patients. There are 2 approaches for treating these patients. The first is modified radical mastectomy [MRM] 0r radical mastectomy [RM] followed by adjuvant systemic therapy and radiotherapy. While the second is preoperative chemotherapyfollowed by surgery and radiotherapy

Aim: The aim of this prospective randomized study was to evaluate two different lines in the management of operable LABC

Methods: This study had been conducted on 40 patients with operable LABC presented to surgical or medical oncology units, Alexandria University Hospital. These patients were equally divided at random by closed enve10pes method into two groups: Group 1. who received 6 cycles of neoadjuvant chemotherapy followed by surgery and postoperative Adjuvant radiotherapy. Group II. who had been treated by surgery with early postoperative chemotherapy where first cycle chemotherapy started immediate] y after tissue diagnosis independent of the time of surgery. In both groups completion of the adjuvant chemotherapy, radiotherapy and hormonal therapy had been applied

Results: After completion of neoadjuvant chemotherapy for group 1, two patients [5%] showed complete clinical response [CRc], while 10 patients [50%] had partial clinical response [PRC]. This gave a total clinical response rate of 55%. At pathologic examination of the mastectomy specimen; none of studied patients had CR, while 13 patients [65%] had smaller diameter tumors [PR]. No statistical significant difference was found in the postoperative wound complications in both groups. Postoperative pathological examination of mastectomy specimens in both groups showed that there were significant decrease in tumor size, nodal number and size in group I after Iry chemotherapy with significant increase in lymphocytic infiltration. 65 %of patients in group I survived with no evidence of loco-regional or distant recurrence compared to 70% in group II with no significant difference. Systemic recurrence alone or in combination with loco-regional was found in 18% and 20% of cases in each of the two groups respectively. 75% of patients in group I survived compared to 80% in group II with no significant statistical difference

Conclusions: Primary ehemotherapy in operable LABC resulted in significant reduction in tumor and nodal stage with reduction of their size and fixation that allowed their treatment with less radical surgery and direct wound closure. Complete clinical response to neoadjuvant chemotherapy doesn't mean complete pathological response. Preoperative chemotherapy had no impact on postoperative wound complications or patient tolerance to postoperative adjuvant chemo and radiotherapy. There was no significant disease free or overall sun'ival benefit of neoadjuvant over adjuvant chemotherapy in treatment of patients with operable LABC. Also better overall survival rates [OS] were correlated with better diseasefree survival rates [DFS]

prevalence of hepatopulmonary syndrome in cirrhotic patients due to hepatitis C

Hepatopulmonary syndrome is defined as the triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. It complicates a substantial percent of cirrhotic patients and has an impact on survival. Hepatitis C virus is the most common cause of cirrhosis in Egypt. The aim of this study: was to explore the prevalence of hepatopulmonary syndrome in HCV- induced cirrhotic patients and the risk factors associated with it. Patients and Thirty HCV- induced cirrhotic patients were studied. They underwent careful history taking, through clinical examination, chest X-ray,a complete blood count, prothrombin time, serum albumin, bilirubin, hepatitis markers, abdominal ultrasound, upper gastrointestinal endoscopy, arterial blood gases and transthoracic contrast echocardiography. Results' Four patients [13.3%] were found to have HPS. Patients with Hepatopulmonary syndrome had significantly higher Child-Pugh score compared with patients without Hepatopulmonary syndrome. The prevalence of HPS was significantly higher in ChildPugh class C compared with Child-Pugh A. Hepatopulmonary syndrome was not uncommon in HCV- induced cirrhotic patients [13.3. [% The study showed a significant correlation between the severity of liver disease and Hepatopulmonary syndrome

Cardiac abnormalities associated with liver cirrhosis

The occurrence of unexpected deaths due to heart failure following liver transplantation and major surgery in cirrhocic patients and the studies that shown evidence of cardiac dysfunction in patients with cirrhosis have led to the introduction of the new clinical entity, [cirrhotic cardiomyopatby]. This study explores the cardiac abnormalities in cirrhotic patients and its correlation with aetiology and severity of cirrhosis and degree of portal hypertension. 40 cirrhocic patients with no history of cardiac disease and 20 age- and sex-matched healthy individuals were studied. They underwent: [1]Laboratory analysis: including liver function tests and hepatitis markers [2]Abdominal ultrasound [3]Upper gastrointestinal endoscopy [4] Trans-thoracic echocardiographic examination to assess left ventricular systolic and diastolic chamber dimensions, interventricular septal thickness, left ventricular posterior wall thickness and systolic and diastolic function. Cirrhotic patients had significantly increased interventricular septal thickness [P= 0.017] and Left atrial size [P= 0.03]. The ejection fraction was significantly higher in cirrhotic patients compared with the controls [P < 0.05]. The isovolumic relaxation time was significantly prolonged in cirrhotic patients [P= 0.04] and the deceleration time was significantly increased in cirrhotic patients [P< 0.05]. Cirrhotic patients with advanced liver disease [Child-Pugh class C] had a significantly smaller left ventricular diameter at the end of diastole compared with the controls [P= 0.03]. The E/A ratio was also significantly reduced in this group [P< 0.05]. The deceleration time was increased in all cirrhotic groups, and significantly so in the class C cirrhotic patients [P= 0.03]. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients. Cirrhosis is associated with changes in cardiac structure and function. There is thickening of interventricular septum and increased Left atrial size associated with diastolic dysfunction, as demonstrated by prolongation of the isovolumic relaxation time and increased the deceleration time. The ejection fraction was significantly higher in cirrhotic patients compared with the controls. The severity of liver disease is associated with more severe diastolic dysfunction. Child-Pugh class C cirrhotic patients had a significantly smaller left ventricular diameter at the end of diastole and the E/A ratio was also significantly reduced compared with the controls. The deceleration time was significantly increased in the class C cirrhotic patients compared with class A and B. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients

Evaluation of risk factors associated with recurrent cesarean section morbidity: a suggested score

This prospective study included 1000 women undergoing cesarean section [CS] under general anesthesia. They were divided into two groups. Group 1 [control group] included 500 patients, who underwent CS for the first time. Group 2 [study group] included 500 patients who had one or more previous CS. Simple scoring system was developed to record the possible risk factors related to CS morbidity. There were six significant preoperative risk factors [high parity, preterm delivery, placenta praevia, antepartum hemorrhage, medical disorders and bad general condition]. There were five highly significant risk factors related to intra-operative morbidity [high parity, placenta praevia, intra-peritoneal adhesions, low experienced surgeon and preterm gestational age] and five risk factors related to previous CS operation [previous three or more CS, previous CS at rural hospital or private clinic, previous upper segment CS, previous complicated CS and tender previous scar]. Eleven factors related to postoperative morbidity were more significant in the repeated CS group. The incidence of overall morbidities was significantly more in the repeated CS group. Total postoperative morbidity was highly significant starting from previous 4 or more CS. Risk factors related to intra-operative morbidity were used to develop a mortality scoring system. Based on a summation of logistic coefficient corresponding to individual risk factors, a scoring system was suggested, which can help in the prediction of CS morbidity. Further prospective evaluation of this scoring system would be helpful to confirm the usefulness and practicality of this system

Nutritional status of children in squatter and urban areas in Alexandria, Egypt

Normal individuals have their own growth potential, which is genetically determined. However, variations in the growth are due to interactions between these potential and environmental factors such as nutrition and/or chronic diseases. The objective of the study was to compare the nutritional status of squatter and urban children less than two years in relation to their feeding practices. Methodology: Through a cross-sectional approach, 1000 healthy children [<2 years] from a squatter and urban area in Alexandria-Egypt were submitted to weight and length measurements. Mothers were interviewed about demographic characteristics, socioeconomic data, and the current feeding practices using the 24-hours recall method. Stepwise multiple logistic regression analysis was performed with stunting, wasting, and underweight as dependent variables. There is a statistically significant difference between squatter and urban children in the prevalence of wasting [4.2% and 1.4% respectively] and underweight [11.3% and 2.4% respectively], whereas the prevalence of stunting was insignificantly higher among squatter children compared to urban children [21.7% and 16% respectively]. Nutritional status was generally better among exclusively breast-fed infants and those breast-fed for 23 months. Beside squatter residence, poor nutritional status was strongly associated with older child's age, male sex and being a child of non-working mothers. Conclusion and recommendations: Better nutritional status was encountered among urban children compared to squatter ones. Measures that enables children to live in environment that favor achievement of their growth potentials were recommended

Pulmonary function tests in rheumatoid arthritis

Thirty-two patients suffering from rheumatoid arthritis were examined for their lung functions using spirometry. Apart from the forced vital capacity [FVC], all other parameters [forced expiratory volume in the first second [FV1], FEVl/FVC ratio, forced expiratory flow at 25-75% of FVC [FEF 25-75%] and peak expiratory flow rate [PEFR]] decreased than their predicted values. The results showed marked obstruction in both large and small airways. It was concluded that obstructive lung disease progresses with the progress of the disease. It is recommended to test the pulmonary function as early as possible on diagnosing rheumatoid arthritis for the first time to establish a reference for subsequent tests during the course of the disease

inferior approach for hip arthroscopy

This work describes a new inferior approach for hip arthroscopy. Five newlyborn and five adult cadavers were tried upon. Penetration was carried out just lateral to the ischial tuberosity in the direction of the anterior superior iliac spine. So, the manipulation was easy to perform being guided by two points on the same bone, i.e. two fixed landmarks whatever the position is. All trials were successful without using guides or screens. The joint was reached at a shallow distance from the skin. The capsule was pierced in the most dependent part, and that procedure enabled the removal of loose bodies during arthroscopy. In addition, a complete visualization of the joint could be possible. By dissection the present portal proved to be very safe. In conclusion, this new approach seems to be the most easy, safe and useful portal for hip joint up till now. This will encourage the practice of hip arthroscopy and instrumentation