Gastric endoscopic mucosal resection and polypectomy among patients with liver cirrhosis and esophageal varices in the setting of acute upper gastrointestinal bleeding

Background Gastric polyps are not infrequently reported among cirrhotic patients. Endoscopic resection of gastric polyps among patients with liver cirrhosis and esophageal varices carries the risk of post-polypectomy bleeding. This may explain why endoscopists are reluctant to its excision. The aim is to evaluate the incidence of immediate (intraoperative) and delayed (within 30 days) post-polypectomy bleeding among cirrhotic patients with esophageal varices and portal hypertension and determine its risk factors. Methods This study comprised 39 cirrhotic patients with portal hypertension and varices who presented with gastrointestinal bleeding, and they had gastric polyps detected during th endoscopic intervention to control the acute bleeding or during follow-up. All patients were exposed to the entire history, clinical examination, and basic laboratory workup. Esophagogastroduodenoscopy was done to combine bleeding control and polypectomy simultaneously. Results Immediate (intraoperative) post-polypectomy bleeding occurred in 38.8% of patients, and no delayed bleeding was reported. Most of the reported bleeding was mild and clinically non-significant, and it stopped spontaneously or endoscopically. Furthermore, no mortality was reported. The risk of immediate (intraoperative) bleeding significantly increased with advanced age, advanced liver disease, increased portal hypertension with large varices, and decreased platelet count; meanwhile, the sex of patients, size, location, and method of polypectomy did not significantly increase the risk of gastric post-polypectomy bleeding among cirrhotic patients with portal hypertension and esophageal varices. Conclusions. Among patients with cirrhosis and portal hypertension, gastric polypectomy simultaneously done during endoscopic intervention for esophageal varices is considered a safe maneuver.

Samsum ant venom modulates the immune response and redox status at the acute toxic dose in vivo

Background:Ant venoms express surface molecules that participate in antigen presentation involving pro- and anti-inflammatory cytokines. This work aims to investigate the expression of MHC-II, CD80 and CD86 on the polymorphonuclear cells (PMNs) in rats injected with samsum ant venom (SAV).Methods:Rats were divided into three groups - control, SAV-treated (intraperitoneal route, 600 μg/kg), and SAV-treated (subcutaneous route, 600 μg/kg). After five doses, animals were euthanized and samples collected for analysis.Results:The subcutaneous SAV-trated rats presented decreased levels of glutathione with increased cholesterol and triglyceride levels. Intraperitoneal SAV-treated animals displayed significantly reduced concentrations of both IFN-γ and IL-17 in comparison with the control group. However, intraperitoneal and subcutaneous SAV-treated rats were able to upregulate the expressions of MHC-II, CD80 and CD86 on PMNs in comparison with the control respectively. The histological examination showed severe lymphocyte depletion in the splenic white pulp of the intraperitoneal SAV-injected rats.Conclusion:Stimulation of PMNs by SAV leads to upregulation of MHC-II, CD 80, and CD 86, which plays critical roles in antigen presentation and consequently proliferation of T-cells. Subcutaneous route was more efficient than intraperitoneal by elevating MHC-II, CD80 and CD86 expression, disturbing oxidative stability and increasing lipogram concentration.

Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients / 中华创伤杂志(英文版)

Purpose:@#Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.@*Methods:@#The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38℃ or lower than 36℃, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.@*Results:@#Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.@*Conclusion:@#SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

Outcome of adjustable suspensory fixation for femoral graft in acl reconstruction

Background: The incidence of torn anterior cruciate ligament (ACL) has greatly increased, with today's increasing enthusiasm for sports activities. As a result, reconstruction of the torn anterior cruciate ligament became a common surgical procedure in orthopaedic surgery. Objective: To evaluate short term clinical outcome of adjustable suspensory fixation for femoral graft in ACL reconstruction. Methods: All patients treated for ACL reconstruction with an ipsilateral hamstring between March 2017 and March 2018 were evaluated. Subjects were assigned to TightRope™ (TR) femoral fixation. All patients were evaluated with the Lachman test, pivot-shift test, 2000 International Knee Documentation Committee (IKDC) knee examination. The subjective evaluation was performed using the Lysholm knee score. CT examination was performed to evaluate femoral and tibial tunnels enlargement at four different levels. All patients were assessed at a 12 month follow-up visit. Power analysis was performed a priori in accordance with the femoral and tibial tunnels enlargement values from the CT scans. Results: The group was homogenous at baseline with regard to age, gender, BMI, dominance and disease duration. At the final follow-up, no statistically significant differences were found according to subjective and objective clinical outcome measures. According to the femoral tunnel enlargement, no statistically significant difference was found between tunnel at operation and 12 months later. Conclusion: In transtibial ACL reconstruction, the use of adjustable-loop length device products, on the femoral side, led to better clinical and radiological results

Serum and ascitic fluid high sensitive C reactive protein as prognostic marker in patients with spontaneous bacterial peritonitis

Background: Spontaneous Bacterial Peritonitis (SBP) is the most frequent bacterial infection in cirrhotic patients with ascites. The mortality rate in those patients ranges from 40-70%.Aim: to assess level of serum and ascetic fluid polymorph nuclear leucocytes (PMN), high sensitive C reactive protein (hs-CRP) in patients with SBP before and after treatment. Methods: A cohort study was done on 114 patients SBP admitted in the Internal Medicine, Faculty of Medicine, Zagazig University during the period from December 2017 to September 2018. All patients were subjected to full history taking, thorough clinical examination, routine laboratory investigation, ultrasonography and ascitic fluid sampling. They was followed up for 5 days from starting treatment by parenteral third generation cephalosporin and peripheral blood (PMN), serum (hs-CRP), ascitic fluid PMN and hs-CRP were measured again.Results: the largest percentage of the patients were male, had posthepatitic C cirrhosis and child C score. There was statistically non-significant difference between antibiotic responders and non-responders regarding peripheral blood PMN before or five days after antibiotic use. There was statistically non-significant difference in ascitic fluid PMN, serum and ascitic fluid hs-CRP before treatment while the difference is significant between both groups regarding them five days after treatment. Percent change in serum hs-CRP was equal to that of ascitic fluid PMN. Percent change in ascitic fluid hs-CRP was comparable to that of ascitic fluid PMN. Conclusion: Serum and ascitic fluid hs-CRP level can be considered as alternative prognostic markers in cirrhotic patients with SBP

Evaluation of protocol of management of morbidly adherent placenta in maternity Zagazig university hospital

Background: Morbidly adherent placenta (MAP) defines the abnormal adherence of the placenta to the underlying uterine wall. It has a rising incidence world-wide. The risk of placental abnormalities increases in the presence of uterine scars due to cesarean delivery or gynecologic procedures. It may lead to massive obstetric hemorrhage resulting in serious complications such as DIC, transfusion related complications. Aim: Evaluation of protocol of management of patients with morbidly adherent placenta at Maternity Zagazig University Hospital and its effect on pregnancy outcome to find the best method of management to decrease associated morbidity and mortality.Patients and methods: This cohort study conducted on 120 patients diagnosed as having morbidly adherent placenta and were admitted to Zagazig University Hospitals.Results: In our study there were 48 cases (40%) managed by CS only and 72 cases (60%) managed by hysterectomy.Conclusion: well-planned caesarean hysterectomy with placenta left in situ adopting multidisciplinary approach is the recommended management option for MAP

Retrospective study to evaluate the results of medical thoracoscopy in diagnosis of exudative pleural effusion at chest department El-Hussein university hospital in the period from July 2013 to July 2018

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%

Objective: This study was carried out to analyze our five years experience of medical thoracoscopy in the management of undiagnosed exudative pleural effusion at chest department El-Hussein University Hospital

Materials and Methods: All patients with undiagnosed exudative pleural effusion who underwent thoracoscopy during the period between July 2013 to July 2018 at Al Hussein University Hospital were included in the study. All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, pleural fluid analysis and medical thoracoscopy with multiple pleural biopsies. All patients data, thoracoscopy results and complications were recorded

Results: Thoracoscopy was successful for giving final diagnosis in 122 patients [84.13%] from total 145 patients. Malignancies reported in 113 patients [77.9%] of patients and TB reported in 6.2% of patients. Mesothelioma was the most common diagnosis in 67 patients[46.2%] Minor complications occurred only in 14 out of 145 patients [9.65%], 4 patients [2.8%] developed cellulitis, 8 patients [5.5%] developed surgical emphysema, and 2 patient [1.4%] developed bleeding

Conclusion: Medical thoracoscopy is an easy, safe procedure with high diagnostic sensitivity for pleural effusion of uncertain etiology

Bone mineral density in children with idiopathic nephrotic syndrome / Densidade mineral óssea em crianças com síndrome nefrótica idiopática

Abstract Objectives: To assess bone mineral density (BMD) in children with idiopathic nephrotic syndrome (NS) and normal glomerular filtration rate (GFR). Methods: Cross-sectional case-control study carried out on 50 children: 25 cases of NS (16 steroid-sensitive [SSNS] and nine steroid-resistant [SRNS] under follow up in the pediatric nephrology unit of Menoufia University Hospital, which is tertiary care center, were compared to 25 healthy controls with matched age and sex. All of the participants were subjected to complete history taking, thorough clinical examination, laboratory investigations (serum creatinine, blood urea nitrogen [BUN], phosphorus [P], total and ionized calcium [Ca], parathyroid hormone [PTH], and alkaline phosphatase [ALP]). Bone mineral density was measured at the lumbar spinal region (L2-L4) in patients group using dual-energy X-ray absorptiometry (DXA). Results: Total and ionized Ca were significantly lower while, serum P, ALP, and PTH were higher in SSNS and SRNS cases than the controls. Osteopenia was documented by DXA scan in 11 patients (44%) and osteoporosis in two patients (8%). Fracture risk was mild in six (24%), moderate in two (8%), and marked in three (12%) of patients. Conclusion: Bone mineralization was negatively affected by steroid treatment in children with NS.

Resumo Objetivos: Avaliar a densidade mineral óssea (DMO) em crianças com síndrome nefrótica idiopática (SNI) e com taxa de filtração glomerular (TFG) normal. Métodos: O estudo transversal de caso-controle foi feito com 50 crianças: 25 casos de SNI [16 sensíveis a esteroides (SNSE) e nove resistentes a esteroides (SNRE) com acompanhamento na unidade de nefrologia pediátrica do hospital da Menoufia University, centro de cuidados terciário] foram comparados com 25 controles saudáveis do grupo de controle com idade e sexo equivalentes. Todos os participantes foram submetidos a anamnese completa, exame clínico completo, exames laboratoriais [creatinina sérica, nitrogênio ureico no sangue (BUN), fósforo (P), cálcio (Ca) total e ionizado, paratormônio (PTH) e fosfatase alcalina (ALP)]. A densidade mineral óssea foi mensurada na região da coluna lombar (L2-L4) no grupo de pacientes com a absorciometria por raios X de dupla energia (DXA). Resultados: Os níveis de cálcio total e ionizado eram significativamente menores, ao passo que o fósforo sérico, a FA e o PTH eram maiores em casos de SNSE e SNRE do que nos controles. A osteopenia foi documentada pelo exame DXA em 11 pacientes (44%) e a osteoporose em dois (8%). O risco de fratura era leve em seis (24%), moderado em dois (8%) e acentuado em três (12%). Conclusão: A mineralização dos ossos foi afetada negativamente pelo tratamento com esteroides em crianças com SNI.

Molecular mechanisms of the anti-obesity potential effect of Moringa oleifera in the experimental model

Objective: To elucidate the molecular mechanisms of the potent anti-obesity effect of Moringa oleifera Lam. (M. oleifera) ethanolic extract and to clarify the link between these mechanisms and the associated metabolic and vascular risks in the experimental model of visceral obesity. Methods: M. oleifera ethanolic extract was orally administered at 600 mg/kg body weight in obese female rats daily for 12 weeks. At the end of treatment, body weight was deter-mined, and the atherogenic index, coronary artery index, glucose level, insulin resistance status, liver and kidney functions were assessed. Also, the mRNA of leptin, adiponectin and resistin in visceral adipose tissue was determined by quantitative real time-PCR. Results: The results showed that M. oleifera extract down-regulated mRNA expression of leptin and resistin, while it up-regulated adiponectin gene expression in obese rats relative to untreated obese control counterparts. This amelioration of genes expression was paralleled by a reduction in body weight and improvement of the atherogenic index and coronary artery index, as well as glucose level and insulin resistance value without adverse effects on liver or kidney functions, versus the untreated obese control ones. Conclusions: It is reasonable to assume that the anti-obesity, anti-atherogenic and anti-diabetic properties of M. oleifera are mechanistically achieved via working directly on the adipokines of the visceral adipose tissue. Therefore, M. oleifera may be a good thera-peutic candidate for the symptoms of metabolic syndrome.

Study of CD[4+], CD[8+], and natural killer cells [CD[16+], CD[56+]] in children with immune thrombocytopenic purpura

Objective/background: To assess the percentage of CD[4+], CD[8+], and natural killer cells [CD[16+], CD[56+]] in children with immune thrombocytopenic purpura [ITP] at presentation and study their impact on disease chronicity

Methods: This case-control study was conducted at the Pediatric Hematology and Oncology Unit, Menoufia University Hospital [tertiary care center in Egypt]. The study was held on 30 children presenting with ITP; they were followed-up and classified into two groups: 15 children with acute ITP; and 15 children with chronic ITP. Patients were compared to a group of 15 healthy children of matched age and sex. Measurements of CD[4+], CD[8+], and natural killer cells [CD[16+], CD[56+]] by flow cytometry were assessed and compared in these groups

Results: CD[4+] and CD[4+]/CD[8+] were significantly lower in acute and chronic patients than the control group [p < 0.05 and p < 0.001, respectively], with no significant difference between acute and chronic patients [p > 0.05]. However, CD[8+] was significantly higher in acute and chronic patients than the control group [p < 0.05], with no significant difference between acute and chronic patients [p > 0.05]. Natural killer cell percent was significantly lower in acutepatients than the control group [p < 0.001], with no significant difference between chronic and control groups [p > 0.05]. Conclusion: ITP is associated with immunity dysfunction denoted by the increase in cytotoxic T lymphocytes and the decrease in natural killer cells patients than the control group [p < 0.001], with no significant difference between chronic and control groups [p > 0.05]

Conclusion: ITP is associated with immunity dysfunction denoted by the increase in cytotoxic T lymphocytes and the decrease in natural killer cells

Video of Totally Laparoscopic Modified Esophagogastrostomy Using a Spade Shaped Anastomosis Following Proximal Gastrectomy (SPADE Operation)

Proximal gastrectomy (PG) has been tried as a function-preserving surgery for management of early upper gastric cancer. However, Reflux symptoms and stricture limit its applicability. We designed an anastomosis between the distal part of the posterior esophageal wall and the proximal part of the anterior wall of the stomach to make an anti-reflux mechanism. We named it the SPADE operation owing to its spade-like shape and because it is an acronym for a spade-shaped esophagogastrostomy after PG, which creates a partially duplicated esophagogastric wall. This video illustrates the case of a 74-year-old man diagnosed with early gastric cancer in the high body of the stomach along the greater curvature. We performed a totally laparoscopic proximal gastrectomy and a SPADE operation. He was discharged on the 7th postoperative day with an uneventful postoperative course and resumption of diet without reflux symptoms.

pattern of tuberculosis in Aswan Chest Hospital, Egypt

Objective/background: Tuberculosis [TB] is a major health problem. The aim of this study was to examine the pattern of TB in Aswan Chest Hospital, Aswan, Egypt. Methods: This cross-sectional study was carried out using medical records from the TB registry in Aswan Chest Hospital. The investigated variables included demographic characteristics, type of TB infection, and affected organs. All data were coded and statistically analyzed

Results: The average age of the 557 patients infected with TB was 40.31 +/- 18.87 years; 58.2% of the cases were men and 41.8% were women. In both sexes, the highest number of TB patients was from the reproductive age groups

During the 5-year study period, the highest percentage of cases were new cases and the highest frequency of cases was during 2011 and the lowest frequency was during 2015

Pulmonary TB cases showed a sharp decline; however, there was a decrease in extrapulmonary TB cases during 2012 and 2013, with a slight rise in 2014 and 2015. Of the pulmonary TB cases, 82.5% were smear-positive TB

Conclusion: There was a decline in the total number of TB cases across the studied years and the most studied cases were pulmonary smear-positive and new cases. Younger people represented a large percentage of reported cases

Polypropylene Mesh for Recurrent Incisional Hernia: Different Operative Techniques.

Aims: To locate the plane of mesh insertion whether it is onlay, inlay, sublay, or underlay. Design: Prospective study Place and Duration: Done at Bani suef hospital between May 2011 till May 2012 with follow till May 2014. Methodology: Twenty two patients, six were males sixteen were females with recurrent incisional hernias were included in the study with a mean age ± SD of 44 years ± 11.87, there were 14 patients presented after the first recurrence (Groups 1, 2), 7 patients after the second recurrence (Groups 3, 4) and only one for the third recurrence. There were no significant difference between patients presented by 1st and 2nd recurrence concerning the age, sex and level of hernia. To all patients a polypropylene mesh was applied, 12 onlay, 2 inlay, 5 sublay and 3 underlay. Results: There were two serosal lesions and only one perforation. There were 4(18%) patients with seroma, 1 (4.5%) with haematoma, 4 (18%) with infection, 3 (13.6%) with DVT, 1 (4.5%) with non fatal PE, and 1 (4.5%) respiratory failure. The highest incidence of complications were in the onlay repair, the lowest in the underlay repair. The patients were followed for two year, there were 6 recurrence (27.2%), most of them were in the onlay repair with the highest incidence in the inlay repair. The incidence of recurrence in the onlay to inlay was statistically non significant (P<0.5), the onlay to the sublay was significant (P<0.05) and the onlay to the underlay was highly significant (P<0.02). Conclusion: It is to be concluded that when a patient with recurrent incisional hernia is in need for repair, it is better to avoid inlay technique, not to do the underlay and the onlay techniques, and recommended to do the sublay approach.

Molecular study on methicillin-resistant Staphylococcus aureus strains isolated from dogs and associated personnel in Jordan

Objective:To determine the prevalence, genetic relatedness, and pattern of antimicrobial susceptibility in methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA) isolated from household dogs, farm dogs, and stray dogs, compared to isolates from their associated personnel. Methods: MRSA was isolated from 250 nasal swabs (150 swabs from dogs and 100 swabs from humans). PCR assays were used to detect the presence of both the nuc and mecA genes, which confirmed the identity of S. aureus isolates and the presence of methicillin resistance, respectively. Disk diffusion was used to determine the antibiotic susceptibility against 15 antimicrobial agents along with an E-test that determined the minimum inhibitory concentration for oxacillin. Pulsed field gel electrophoresis was conducted to determine the genetic relatedness of MRSA isolates from dogs to those from associated and unassociated personnel. Results:The prevalence of S. aureus in dogs and humans was 12.7%and 10.0%respectively, while the prevalence of MRSA isolates in dogs and humans was 5.3%and 5.0%, respectively. The prevalence of MRSA isolates in household dogs, farm dogs, and stray dogs was 7.8%, 4.7%, and 0.0%, respectively. MRSA isolates demonstrated a significantly higher rate of multi-resistance against three or more antimicrobial agents than methicillin-susceptible S. aureus (MSSA). Trimethoprim-sulphamethoxazole and chloramphenicol were the most effective antibiotics against all MRSA isolates. Pulsed field gel electrophoresis revealed a strong association between dog MRSA isolates and MRSA isolates from strongly associated personnel. Conclusions:MRSA is prevalent in house dogs, as well as in dog rearing centers and among their strongly associated personnel. A strong association was found between the MRSA isolates from dogs and those from humans who are in close contact. In addition, MRSA isolates showed a high rate of multi-resistance compared to MSSA isolates.

Importance of bleeding history in preoperative risk assessment

Background: Health care workers have a primary responsibility to do no harm to all patients. Like every procedure, surgery of any type carries varying types and intensity of risk. One of these risks is on-towards bleeding. Prevention of this risk is a major challenge. In many settings, health care workers embark on laboratory tests and feel secure. International guidelines have been proposed that emphasize to take preoperative bleeding history and advocate a rationale approach to the use of coagulation tests. To see how far the practices are compliant with standard recommendations, we examined frequency of obtaining bleeding history and doing coagulation test/screen during preoperative assessment

Material and Methods: Practice of preoperative bleeding history taking and doing coagulation screen was studied in 735 patients for six months duration. Findings are compared with BCSH guidelines and other studies

Results: Bleeding history was obtained / documented in 156 [21.2%] cases out of 735. In 141[19%] patients out of 735 patients undergoing surgery, coagulation screen was tested. In 9.9% of those tested, a justification for doing the coagulation test was found

Conclusion: In preoperative settings, bleeding history is significantly ignored and there is an over use of lab facilities in assessing the bleeding risk. There is a space for improvement by implementing the guidelines and sensitizing the surgical/anesthesia teams about the importance of structured history taking. Important points to be considered during proper history taking, have been proposed

Effect of follicular flushing during oocyte retrievalon clinical outcome of assisted reproductive technology

Is to determine whether follicular aspiration and flushing increase the number of oocytes yield and pregnancy outcome over aspiration alone in women undergoing ICSI. Prospective randomized controlled trial. One hundred eighty five infertile women who underwent ICSI were included in the study. They were randomized into two groups 92 cases in [aspiration and flushing group] and 93 cases in [aspiration only group],during the period from September 2011 to September 2013. Controlled ovarian hyperstimulation using long GnRH agonist was the standard protocol, hCG administrated 10000 iu when three or more follicles were at least 18 mm in largest diameter, Trans-vaginal follicular aspiration performed 34-36 hours after hCG trigger. In the aspiration alone group, a 16 gauge single lumen needle used, with suction continue until a small amount of blood stained fluid appeared in the tubing or flow stop, When flushing accompany aspiration of follicular fluid in the study group, the same needle used with a double-way tap allowing flushing of [2 ml] of embty follicleby Earl's medium till oocyte retrieved or maximum two times. The study observed 60.5 % oocyte recovery rate with aspiration only compared with 80.9 % with follicular aspiration and flushing.Operative time [minutes] was significantly longer among flushing group, the retrieval time was 1.3 fold higher among those undergoing follicular flushing. Pregnancy was non-significantly more frequent among flushing. Implantation rates non-significantly more frequent among flushing group than non-flushing group [31.6% versus 26.3%, P= 0.424] and ongoing clinical pregnancy non-significantly more frequent among flushing group [27.4% versus 21.1%, P= 0.31]. Conclusion, flushing non-significantly increase implantation and clinical pregnancy outcome and associated with a significant increase in the procedure time for oocyte retrieval, so patient groups where a small number of oocytes are available for retrieval may represent patients most likely to benefit from follicle flushing as only one extra oocyte may affect the outcome

Evaluation of heat shock protein70 expression in liver biopsies of chronic hepatitis C Egyptian patients

Background/Aim: Heat shock protein 70 [HSP70] is a member of heat shock protein family It has strong cytoprotective properties that prevent cell death triggered by stressful stimuli The aim of this work was to study the immunohistochemical expression of HSP70 in chronic HCV biopsies among Egyptian patients

Methods: Immunohistochemical stain using HSP70 was performed on 30 chronic hepatitis C needle biopsies, with different degrees of disease severity

Results: Positive HSP70 immunoreactivity was detected in 12/30 [40%] of the chronic hepatitis specimens with weak to moderate intensity. No statistically significant difference was detected between the mean of HSP70 expression and the following parameters; age, gender, necroinflammatory grade and stage of fibrosis [p=0.109, p=0.874, p=0.342 and p=0.182] respectively

Conclusion: Detection of HSP70 in chronic hepatitis specimens suggested that chronic inflammation and fibrosis act as stressful conditions which result in induction of HSP70 expression. HSP70 prevents stress induced apoptosis which may enhance viral replication by preserving the viral factory. Therefore, we can suggested that HSP70 may act as a therapeutic target to treat HCV infection by targeting host proteins as opposed to viral proteins to minimize the development of resistance to therapy

Serum microrna-29a and microrna-361-5p as potential diagnostic biomarkers for active pulmonary tuberculosis

Tuberculosis [TB] remains a major global health problem. More effective biomarkers for use in TB diagnosis, prevention, and treatment, are urgently needed. We aimed to detect expression of microRNA [miR]-29a and miR-361-5p in sera of patients with active pulmonary TB, attempting to evaluate their role as potential biomarkers for the early diagnosis of pulmonary TB infection. using real-time PCR [RT-PCR], relative expression levels of miR-29a and 361-5p were analyzed in serum samples from patients with active pulmonary TB [n=20], patients with pulmonary infection caused by bacteria other than M .tuberculosis [n=15], and healthy subjects [n=15].The receiver operating characteristic [ROC] curve was used to evaluate the diagnostic effect of each miRNA. We found the expression of serum miR-29a was significantly elevated in TB infected patients compared to other bacterial infection group and healthy subjects [P<0.01].On the other hand, there was no significant difference of miR-361-5p expression [P=0.05].MiR-29a exhibited a good distinguishing efficiency in discriminating the TB infected group from the control groups, but miR-361-5p exhibited a poor distinguishing efficiency. The present study demonstrated that the expression of miR-29a in serum was highly significantly elevated in TB infected patients. The diagnostic performance of miR-29ais better than miR-361-5p for pulmonary TB. We recommend large scale studies to investigate the molecular role of both miRNAs in TB infection. Also, further studies are needed to assess the diagnostic efficiency of miR-29a as a biomarker for different situations including protection by vaccination, discrimination of latent and active disease, assessment of treatment outcome, and relapse risk

Value of morrow procedure in surgery of discrete membranous subaortic stenosis

Subuortic stenosis constitutes up to 20% of all farms of left ventricular outflow had [LVOT] obstruction in children. Although the resulting significant left ventricular hypertrophy and aortic insufficiency are clear indications for surgery, controversy persists whether to remove the membrane in symptom-free patients with an isolated membrane or not. In addition to the timing of surgical repair, the surgical technique remains an area of discussion. In this study, we try to evaluate the impact of early surgical interference as well as surgical technique on the early and mid-term outcome. 44 patients with a mean age of 9.26 years [range, 2.4-28 years] underwent surgical resection for discrete membranous subaortic stenosis [DMSS]. For the purpose of the study, the patients were divided into two groups. Group I consisted of 31 patients who underwent membranectomy combined with routine transoortic myectomy. Group II consisted 13 patients to whom only excision of the subaortic membrane was done [membranectomy] without any myotomy or myectomy. Group II was done in Assuit University Hospital between 2001 and 2003. Group I was done in Paediatric cardiothoracic surgery unit [Children Hospital. Assuit University] between 2009 and 2013, in early postoperative results, the mean LVOT gradient in group I was statistically significantly lower than that of group II [p=0.000]. Aortic regurge [AR] improved in all patients of group I but progressed in five patients of group H. Mid-term follow up showed better results in group I than group II early resection of DMSS, before development of significant left ventricular hypertrophy and aortic insufficiency is advisable. Resection of the obstructing membrane together with generous myectomy of the LVOT is a safe and effective treatment in terms of more significant reduction of LVOT gradient; both early and in mid-term follow up, with lower incidence of recurrence and significant improvement of associated aortic incompetence

Bronchial asthma among school students of Sohag district

Respiratory system diseases are common among school students but there were no previous community based studies conducted to show the prevalence of bronchial asthma among school students in sohag governorate, also for the assessment of the school classroom environment affecting those diseased students. A cross sectional study was done and randomly chosen classroom from each school from the 50 sampled schools was selected. This study in 2408 students from different grades who completed a prepaired questionnaire and went thorough history taking, physical examination and pulmonary function test for suspicious cases for bronchial asthma with special interest to FEV1 improvement of more than 15% after inhaled sulbutamol. Prevalence of bronchial asthma was [4.81%]; [3.40%] in urban schools and [1.41%] in rural schools with statistically highly significant difference between urban and rural [P<0.001 and 0.002 respectively]. The mean classroom density was [44.6 students per classroom]. About the classroom ventilation, windows area constitutes >/= 1/4-1/5 of the classroom area in [90%] of the schools; [95%] of urban schools and [86.7%] of rural schools. There was significant difference in the prevalence of asthma among urban and rural area school students. Prevalence was high among families with positive history of bronchial asthma. Most of school students who were diagnosed as bronchial asthma had other allergic diseases like eczema and allergic rhinitis and eye allergy