Evaluation of patent ductus arteriosus by using two dimensional echocardiography in infant and neonate

Background: Patent ductus arteriosus (PDA) is a part of the typical morbidity profile of the preterm infant, with a high incidence of 80­90% in extremely low birth weight infants born before 26 weeks of gestation. Whereas spontaneous closure of the ductus arteriosus (DA) is likely in term infants, it is less so in preterm ones. The aim of this study is to Evaluate Patent Ductus Arteriosus by using two dimensional echocardiography in infant and neonate. Method: The present study is a case-control study including 46 cases aged between neonate below 37 weeks of gestation to infant ˂6 months. This study was conducted in Neonatal ICU, Cardiology Unit and Pediatric Echocardiography Unit in Pediatric Department, Zagazig University. The period of the study was from January 2017 t0 December 2017. Results ECHO findings of both PDA cases and their controls were close to each other and there was no statistical significant difference between them except in size of left atrium which was significantly higher among PDA cases ranged from 0.91 cm to 1.7 cm with mean of 1.25±0.24, also ratio of LVED/ AO was higher among PDA cases than their controls and the difference was statistically highly significant. 9 cases (39%) of the studied PDA cases presented with high significant PDA, while 14 cases (61%) had low significant PDA.Concolusion: 1. Clinical assessment is somewhat helpful at detecting PDA early in the course of sick infants. Echocardiography is a safe method of detecting PDA and classifying it as HSPDA and LSPDA

Prevalence of internal hernia post laparoscopic surgery

Background: Laparoscopic approach for colorectal resections is now very popular. Internal small bowel herniation [SBH] through a mesenteric defect has been recorded especially if the mesentery is not repaired. Although it's rare, it is a severe complication. Lack of postoperative adhesions is one advantage of minimally invasive surgery but it's also responsible for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction with completely normal contrast radiographs. Laparoscopic surgery is a minimally invasive approach with good treatment outcomes and is currently the standard surgery for colorectal cancer in Saudi Arabia

Objective: the aim of our study was to evaluate the incidence and outcome of internal hernias after laparoscopic procedure in King Abdul-Aziz Hospital and Oncology Center

Patients and methods: a total of 372 patients underwent laparoscopic colon resection surgery for colon cancer during the study period from August 2015 to October 2016 in King Abdul-Aziz Hospital and oncology center. Results: our result found that internal hernia was reported 48 times

Prevalence of tuberculosis among HIV patients in Jeddah, Saudi Arabia

Background: Tuberculosis [TB] is the commonest infection that has been reported in HIV/AIDS patients in developing countries. This cross sectional study has been conducted in the chest clinic, King Abdulaziz Hospital and Oncology Center to evaluate the prevalence of TB among these patients in Saudi Arabia

Methods: across sectional survey has been conducted in the City of Jeddah, Chest Department, King Abdul-Aziz Hospital and Oncology Center of total 172 HIV positive patients

Conclusion: we have found that the majority of HIV/AIDS patients had tuberculosis and the rest of them had a high susceptibility to get it. Radiograph has also TB findings .TB can occur at any stage of CD4+T cells depletion

Membrane permeabilization of colistin toward pan-drug resistant Gram-negative isolates

Abstract Pan-drug resistant Gram-negative bacteria, being resistant to most available antibiotics, represent a huge threat to the medical community. Colistin is considered the last therapeutic option for patients in hospital settings. Thus, we were concerned in this study to demonstrate the membrane permeabilizing activity of colistin focusing on investigating its efficiency toward those pan-drug resistant isolates which represent a critical situation. We determined the killing dynamics of colistin against pan-drug resistant isolates. The permeability alteration was confirmed by different techniques as: leakage, electron microscopy and construction of an artificial membrane model; liposomes. Moreover, selectivity of colistin against microbial cells was also elucidated. Colistin was proved to be rapid bactericidal against pan-drug resistant isolates. It interacts with the outer bacterial membrane leading to deformation of its outline, pore formation, leakage of internal contents, cell lysis and finally death. Furthermore, variations in membrane composition of eukaryotic and microbial cells provide a key for colistin selectivity toward bacterial cells. Colistin selectively alters membrane permeability of pan-drug resistant isolates which leads to cell lysis. Colistin was proved to be an efficient last line treatment for pan-drug resistant infections which are hard to treat.

Airway inflammatory biomarker: could it tailor the right medications for the right asthmatic patient?

Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1] could differentiate poor symptoms perceivers from over-perceivers, 2] could predict disease activity and hence disease outcome, 3] could clarify asthma phenotype responders from non-responders, and finally 4] could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis

Factors affecting the production of lactulose by Lactobacillus acidophilus NRRL 4495 β-galactosidase and its biological activity

Aim: Production of lactulose and other oligosaccharides by Lactobacillus acidophilus NRRL 4495 β-galactosidase and their biological activity. Methodology and Results: The transgalactosylation activity of Lactobacillus acidophilus NRRL 4495 β-galactosidase was investigated under different conditions for synthesis of lactulose and oligosaccharides. The synthesis was optimized with respect to pH; time; enzyme concentration and substrates ratio (lactose: fructose). Maximum production for lactulose was found to be 25 g/L at pH 6.6 with 40: 20% (w/v) lactose to fructose, respectively and enzyme concentration 4 IU/mL after 7 h. With respect to the other oligosaccharides the maximum yield (19 .68 g/L) was obtained under the same conditions but with enzyme concentration 2 IU/mL and after 10 h. As a new pharmaceutical application the produced lactulose and oligosaccharide and their sulfated derivative were found to have fibrinolytic activity, but they failed to act as anticoagulant. Conclusion significance and impact of study: the research leads to increase the production of lactulose and other oligosaccharides with a significant yield and discovered a new pharmaceutical application for all the products.

Role of ginkgo biloba extract on jejunal mucosal changes induced by laparotomy in adult albino rat: histological, immunohistochemical and scanning electron microscopic study

The intestine is extremely sensitive to surgical stress. Surgical manipulation of the intestine generates oxygen free radicals resulting in mucosal damage. To evaluate the role of Ginkgo biloba in protection and restitution of mucosal damage of jejunum after laparotomy. Twenty four adult albino rats were divided into three groups. Group I as a control, group II subjected to laparotomy with mild intestinal handling and group III was injected I/P with as a single dose of 50 mg/kg of Ginkgo biloba solution 1 hour before laparotomy. All animals were sacrificed after 48 hs and jejunum specimens were extracted and processed for light and scanning electron microscopic study. Revealed that laparotomy induced shortening of the villi with mucosal damage and ballooning of Paneth cells. Some epithelial cells with atypical appearance were seen aggregated towards the luminal surface. Strong P53 reaction was observed in enterocytes. SEM revealed eroded luminal surface with wide gaps of epithelial loss. On the other hand, Ginkgo biloba showed a favorable protective effect with rapid healing of the damaged jejunal mucosa. Laparotomy induced jejunal mucosal damage, which was not repaired after 48 hs. Ginkgo biloba could be used as a protective agent against intestinal mucosal damage with a rapid recovery after surgical operation

Effect of sildenafil adminstration on ischemia/ reperfusion of the testis in adult albino rat light and electron microscopic study

Testicular torsion is a pathologic condition that renders the testis ischemic and surgical intervention is usually required to reestablish blood flow. To evaluate the role of sildenafil administered half an hour before reperfusion [detorsion] in preserving spermatogenesis and minimizing germ cell apoptosis. Thirty adult male albino rats were divided equally into three main groups. Group I as a control, group II subjected to left testicular torsion for 1 hour followed by detorsion and group III was injected intraperitoneally [I/P] with a single dose of 0.14mg/1ml of sildenafil solution 30 min before detorsion. All animals were sacrificed after 24 hours. Both testes of each group were extracted and processed for light and transmission electron microscopic study. Immuno-histochemical study using Fas-Ligand stain was done for detection of apoptotic cells. Morphometric measurements of the diameters of seminiferous tubules, number of germ cells and apoptotic cells as well as Leydig cells were performed and subjected to statistical analysis. Revealed that unilateral testicular Torsion/Detorsion [T/D] induced marked damage of both testes with more affection of the ipsilateral side. Both testes revealed defective spermatogenesis with wide areas of cell loss and absence of early spermatids. Morphometric results of both testes revealed significant increase of number of apoptotic germ cells together with a significant decrease of the number of both germ cells and Leydig cells as compared to control. Ultrastructurally, Sertoli cells of both sides revealed large cytoplasmic vacuoles with interrupted inter-sertoli junctional specialization. Primary spermatocytes of both sides exhibited shrunken nuclei with dense clumped chromatin and damaged cytoplasmic organelles. The early and late spermatids showed abnormal appearance. On the contrary, sildenafil-treated group revealed a protective effect of sildenafil on both sides. This was proved ultrastructurally and by the morphometric results, which showed significant increase of the number of both germ and Leydig cells with significant decrease of apoptotic germ cell number as compared with T/D group. Sildenafil pretreatment could be promising as an adjuvant therapy to surgical repair for rescuing the testis from ischemia/reperfusion. Hence, orchidectomy could be avoided

Factors associated with delayed hospital admission for patients with acute cerebrovascular stroke

This descriptive, study was designed to assess the level of pre-hospital delay and reasons for such delay in acute stroke patients, taking into consideration certain factors such as socio demographic status, availability of transport options at onset of symptoms. The studied sample included 103 stroke patient attended the medical emergency department of Assiut University Hospital Data were collected from patient, their relatives and hospital records. A questionnaire was administered that included questions about socio-demographics, self-reported risk factors and questions related to hospital arrival, severity of stroke and course of symptoms at arrival to emergency department reported by subjects or relatives. The rate of patients arriving at the hospital less than 3 hours after symptom onset was found to be 40.78% for this study. Approximately 88.35% of patients delayed going to the hospital because they were waiting for symptoms to go away while 38.83% of patients were not aware of the importance of seeking immediate medical help. There was a significant relationship between the use of ambulance transportation and length of time before arrival at the hospitals, though there was no statistically significantly relationship between the existence of stroke risk factors and hospital arrival delay. These results will likely be helpful to health care decision makers as they develop a model for stroke health care and community based training. Time elapsed from onset of symptoms to hospital arrival is influenced by lack of knowledge of stroke symptoms, contact with a local doctor, low threat perception and availability of ambulance services, Educational programs and stroke campaigns are needed to increase awareness of public and health care professionals and also arranging high speed, easily available ambulance services to reduce delay in hospital arrival

Association of tumor necrosis factor-A polymorphisms susceptibility to and clinical outcomes of rheumatic heart disease

Rheumatic health disease [RHD] remains a major public health burden in developing countries. Tumor Necrosis Factor [TNF-alpha] plays an active and prominent role in the pathogenesis of the rheumatic process and polymorphism at the promoter region of TNFalpha-308-A has been shown to be associated with RHD. To examine the association of TNF-alpha gene polymorphisms with RHD and valve damage and their influence on TNF-alpha production and disease outcome in children. A total of 130 children, 80 with RHD and 50 controls were enrolled in this work at Cairo University Hospitals, in the period between 2008 and 2009. They were genotyped for TNF-alpha polymorphisms using polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. Serum TNF-alpha was analyzed by solid phase sandwich enzyme linked immune-sorbent assay [sandwich ELISA]. Serum TNF-alpha was significantly increased in RHD compared to controls [P<0.001]. TNF-alpha-238 AA [P=0.036] and -308 AA[P=0.003] genotypes were more frequent in RHD patients and were associated with increased production of TNF-alpha [P<0.001] and [P=0.001], respectively. Both polymorphisms contributed to increased susceptibility for RHD [-308 AA and AG, OR=4.72 [2.03-11.05], P< 0.001], [-238AA and AG, OR = 2.33 [1.05-5.19], [P=0.035]. The presence of -308AA variant was associated with mitral [P=0.001] and multivalvular [P=0.003] lesions and was more prevalent in moderate [P=0.001] and severe [P<0.001] cases. The -238AA variant was associated with mitral [P=0.04] and severe cases [P=0.05] as compared to controls. TNF-alpha - 238G/A and 308 G/A polymorphisms were associated with susceptibility to RHD and increased production of TNF alpha. Both polymorphisms were associated with valve damage and a more severe outcome of RHD

Comparative genetic characterization between isolated pox virus from dove and some avian pox strains

Avipoxviruses from different geographic regions of the world have been characterized to study their genetic and biological properties, but so far, no such work has been performed on Egyptian isolates. Lesions suggestive of avian pox; found on Egyptian wild dove; were used for isolation of pox virus in a previous study. The resulting virus was propagated in chorio-allantoic membrane [CAM] of specific pathogen free [SPF] Embryonated chicken eggs [ECE]. PCR was carried out on the DNA of the dove poxvirus [DPV], pigeon poxvirus [PPV] and a vaccinal strain of fowl pox virus [FPV], then restriction fragment length polymorphism [RFLP] assay was carried out on the resulting amplicons of 578 bp length; using EcoRV and NlaIII restriction enzymes. The restriction profile revealed that the dove pox virus is identical to the PPV and both are different from FPV. The results of immunoblotting analysis of the 3 pox viruses against chicken anti FPV revealed that in spite of the minor antigenic differences observed between them the DPV is closely related to the PPV. In conclusion the Egyptian wild doves are found to play a serious role in the epidemiology of PPV among pigeon flocks

effect of miswak and toothbrush on saliva total bacterial count and cariogenic bacteria

Miswak, a chewing stick prepared from the roots, twigs or stems of Salvadora persica. The beneficial effects of miswak in respect of oral hygiene and dental health are partly due to its mechanical action and partly due to its pharmacological actions. The aim of this study was to evaluate the effects of miswak sticks, miswak extract and toothbrush/toothpaste as antimicrobial agents on total bacterial count in the saliva, and to study the effect of miswak stick, toothbrush/toothpaste and saline on salivary Streptococcus mutans [S. mutans] and lactobacilli in vivo. The study clarified that there was a marked reduction in the total bacterial count among all groups. The reduction was 100%, 100%, 97.5% and 67.5% among users of miswak stick, miswak extract, toothbrush/toothpaste and saline [control], respectively. The results of the current study also showed marked reduction of S. mutans in 66.7% of the individuals using miswak and among individuals using toothbrush/toothpaste, whereas the reduction was only 29.2% among saline users. The reduction of lactobacilli was 62.5%, 58.3% and 54.2% by using miswak stick, toothbrush/toothpaste and saline, respectively. The difference was not statistically significant. It can be concluded that miswak has an antimicrobial effect comparable to the use of fluorinated toothpaste. It was clear from the current study that the Caries Risk Test [CRT] kit is a rapid and a simple, semi-quantitative method for counting lactobacilli and S. mutans, which can be used in dental clinics without the need for trained technicians. It is recommended that further studies can be performed on larger sample size of patients, at high risk of developing dental caries

[ effectiveness of counseling programme using educational and artistic activities for developing self concept and positive behaviors for preschool blind child]

The study aimed at identifying the effectiveness of counseling programme using educational and artistic activities for developing self concept and positive activities for developing self concept and positive behaviours for pre schoolblind child. The sample was [24] blind child from the ideal centre for blinds age [4:6]. The researcher prepared three tools to the study [self concept scale-an observation checklist for positive behaviours -a programme using educational /artistic activities]. The study used The experimental method [one group]. Results showed that-there are statistically significant differences between the mean scores at the self-concept scale and the observation checklist before and after using the study programme in favor of the post test, results show also that the programme is effective

effect of patients positioning on oxygen satration in the acute phase of ischemic stroke

Body position is known to influence respiratory function in normal subjects and those with respiratory pathology. Its effect on respiratory function after stroke has received little attention. It's generally thought that stroke morbidity is increased by inappropriate position during early recovery phase. So the present study was designed to identify changes in arterial oxygen saturation [SaO[2]] associated with different four positions of the patient in order to detect proper position which maintain the optimum level of SaO[2]. Quasiexperiment research design was applied in this study .This study was conducted in stroke intensive care unit of Neurological Department of Assuit University Hospitals. The subjects of this study consist of 60 patients with acute ischemic stroke within 48 hours following mild to moderate and sever stroke. Three tools were included in the study, tool of sociodemographic data, tool of the positions and tool of the Scandinavian stroke scale. The result of the present study revealed that there was statistical significant difference between SaO[2] and blood pressure of the patients before and after the positions. It was found also that total mean of SaO[2] during right side, supine and semi-setting position was nearly equal and there was statistical significant difference between left position and 3 other positions. So the study recommended the importance of changing patient's positions which improve ventilation and blood pressure. The importance of the use of positions tested [Rt.side, supine and semi-setting position] in the clinical practice to maintain SaO[2] in patients of ischemic stroke

Impact of nursing intervention on urostomy patients outcome regarding practicing self-care

Urinary diversion operations [urostomy] patients require a great deal of emotional and physical adjustment. They usually face many problems such as loss of body function and relationship with others, and change in lifestyle. They need to adapt to the external appliance, stoma alteration in toileting habits, skin irritation problems, infection, and odor problems. Self- care for these patients is considered the most important factor that can minimize the complaints and complications. The aim of this study was to evaluate the impact of nursing intervention among urostomy patients regarding practicing self-care. The sample comprised 100 urostomy patients, divided into two groups: 50 study, and 50 control. For both groups, patients' knowledge about urostomy and related self-care performance were assessed before intervention, immediately after, and after six-months follow-up at outpatient clinic. Data were analyzed using Epi-info 6.04 computer software package. Findings revealed statistically significant improvements in knowledge and performance among patients in the study group, compared to the control group. The study group became more knowledgeable about the definition, function, anatomy, and physiology of urostomy, and in self-care performance. The rates of complaints and complications were found to be lower in the study group than in the control one. The study suggests that urostomy patients should receive their self-care training regarding urostomy during hospitalization. Follow-up at outpatient clinic is highly recommended as well

Effect of an educational protocol for patients' with ulcerative colitis on their related knowledge and self-care practices

Ulcerative colitis [UC] refers to a disease in which the lining of the colon becomes inflamed. In patients with ulcerative colitis, the immune system inappropriately targets the lining of the colon. Most cases are treated at home, which points to the importance of self-care in its management. This study aim was to determine the effect of an educational program on ulcerative colitis patients' knowledge and self-care practices. To conduct this study a sample of sixty in patients with ulcerative colitis was selected from the tropical medicine department in Assiut University Hospital. They were divided into two equal study and the control groups. The study group received an educational program. Data were collected using a patient assessment interview sheet. Pre-post comparisons of patients' knowledge and practice showed statistically significant improvements in the study group but not in the control groups, p<0.001. The study concluded that although ulcerative colitis is a chronic condition with no cure, it could be well controlled through proper patient education. Therefore, it is important for nurses to teach patients about the condition to enable them to take an active role in own health-care decisions and treatment. The study recommends implementation of the developed educational program for all patients with ulcerative colitis

interrelation of migraine, vestibular dysfunction and hearing impairment

Migraine is a relatively common neurological disorder. Neuro-otological symptoms were common in patients with migraines. The aim of this work is to identify the frequency of neuro-otological affection in migraine. The study includes forty-one patients with migraine, and 20 healthy volunteers. Each subject was submitted to full neurological, medical and audiological history and examination. Puretone audiometry, electronystagmography [ENG] tests, auditory brain stem response [ABR] and event related potentials [ERPs]. Dizziness was recorded in 56.1%, rotational vertigo in 31.7% and positional vertigo was occurred in 19.5%. Sense of imbalance, tinnitus and phonophobia were reported in 12.2%, 19.5%, and 29.3%, respectively. Abnormalities in at least one of ENG tests were found in 75.6% of patients that include abnormal results of positioning and positional in 34.1%, post head shaking test in 26.8%, saccade test in 19.5%, optokinetic test in 19.5%, pursuit test in 14.6%, unilateral caloric weakness test in 9.8% and spontaneous nystagmus test in 2.4%. Sensorineural hearing impairment was reported in 21.9%. Significant prolongation of mean interpeak latency of I-III of right ear at 90 dBHL with low repetition rate, III-V at 90 dBHL with high repetition rate and absolute latency of right wave V at 90 dBHL repetition rate compared with controls. No significant differences between patients and control in ERPs. Vestibular dysfunctions were frequently associated with common migraine also hearing impairment was reported in appreciable numbers of cases. Both central and peripheral vestibular affection were recorded in between attacks

Discontinuation of contraceptive use

This chapter presents a summary of the most important findings of this study, as well as the recommendations of the study based on these findings upon which some policy implications are suggested for Planners and policy makers. The study found that side effects are the main reasons for discontinuing use of pills, IUDs and Injectable. The showed that about 48% of pill users discontinued the use. About 25% stopped using due to side effects. 11% stopped using because of the desire to get pregnant and 8% stopped using due to method failure, and this attitude is assured by those who got pregnant while using condom. For condom, there were more than half of condom users who discontinued the use. 16% of them discontinued use because of method failure and 9% discontinued use in order to get pregnant. For injectable, half of injectable users stopped using; about 39% of them stopped using due to side effects and 5% stopped using due to the desire to be pregnant. For period abstinence method, about 36% of women reported that they stopped using this method because they had already got pregnant while using this method followed by those who stopped using because they wanted to be pregnant and because of the desire for more effective method than period abstinence

Impact of trimetazidine on doxorubicin-induced acute cardiotoxicity in mice: a biochemical and electron microscopic study

Doxorubicin [Dox] is an effective broadly used anti-tumor drug. However, its therapeutic success is limited due to the development of acute and chronic cardiotoxicity. Therefore, the purpose of this study was to evaluate the effect of trimetazidine [TMZ] on Dox-induced acute cardiotoxicity in mice using biochemical and electron microscopic approaches. Thirty male mice weighing 30 gm +/- 5gm were used. They were equally divided into 3 groups. Group I represented the control group. Animals of group II, were intraperitoneally [IP] injected with a single dose of Dox [15mg/kg]. In group III, the mice were IP injected with TMZ [2.5mg/kg/d] for 5 days before single injection of the same dose of Dox. Thirty hours after Dox injection, animals were anaesthetized. Blood samples were obtained and serum was separated for measurement of cardiotoxicity indices [creatine phosphokinase isoenzyme [CK-MB], lactate dehydrogenase [LDH] and aspartate aminotransferase [AST]]. Hearts were dissected and each was divided into two halves, one half was used for measurement of myocardial oxidative stress [thiobarbituric acid reactive substance [TBARs], nitrate /nitrite [NOx]] and myocardial antioxidant activity [glutathione [GSH]] level. The other half was processed for electron microscopic study [EM]. In group II, there were significant increase in CK-MB, LDH, AST, TBARs and NOx and a significant decrease in GSH. Electron microscopic examination revealed severe toxic effect on the cardiac muscle in the form of myofibrillar lysis, cytoplasmic vacuoles, oedema, dilatation of sarcoplasmic reticulum, mitochondrial damage, increased number of 2ry lysosomes, widening of the junctions forming the intercalated discs and mononuclear cellular infiltrate between the disorganized cardiac myocytes, whereas group III revealed marked improvement in all biochemical parameters and EM study revealed almost a similar myocardial histological profile to the control group. In conclusion, TMZ ameliorates Dox-induced acute cardiotoxicity in mice by reduction of myocardial oxidative stress and preservation of endogenous antioxidant activity

Light and electron microscopic study of the effect of sodium valproate on the quadriceps femoris muscle of rat and the possible protective role of L-carnitine

Sodium valproate [VPA] is a broad spectrum antiepileptic drug. Patients especially children who receive VPA for a long time present with myalgia and exercise intolerance. The aim of the present study was to elicit the effect of VPA on the skeletal muscle and the possible protective role of L-carnitine. Fifty male albino rats were used in this study. The animals were divided into two groups: group A [control group] and group B [experimental group] which was subdivided into 4 subgroups: group B1 and B2 received VPA only [50 mg/kg/day], for 1 and 2 months respectively. Group B3 and B4 received VPA and L-carnitine [300 mg/kg/day] for 1 and 2 months respectively. At the end of the experiment blood samples were collected to evaluate serum VPA levels. Quadriceps femoris muscles [QFM] were dissected and processed for light and electron microscopic [EM] study. In group B1, some QFM fibers showed loss of their striation or longitudinally splitted. Some intermediate muscle fibers appeared to be deficient in succinic dehydrogenase enzyme[S-DH] activity. EM study revealed many lipid droplets and enlarged degenerated mitochondria in-between the myofibrils. The mean serum VPA level was 101.6 +/- 7.88 micro g/ml. In group B2 the majority of muscle fibers were degenerated with mononuclear cellular infiltration and marked decrease in S-DH activity in all types of muscle fibers. Disorganized myofibrils, megamitochondria and lysosomes were seen. The lipid and glycogen granules were increased. There was a non significant increase in the mean serum VPA level [105.01 +/- 6.34 micro g/ml]. On the other hand, there was a highly significant decrease in the mean serum VPA level in group B3 [85.39 +/- 5.93 micro g/ml] and B4 [86.23 +/- 8.39 micro g/ml]. No histological changes were observed in these two groups except that some mitochondria were enlarged in group B4. In conclusion, the use of L-carnitine has a great role in protection against VPA-induced myopathy and it should be prescribed for all patients treated with VPA for long time