Role of fibrinogen in the attenuation of ischemia reperfusion and remote ischemic preconditioning / El papel del fibrinógeno en la atenuación de la isquemia-reperfusión y el preacondicionamiento isquémico remoto

Abstract Background: Ischemic reperfusion injury (IRI) is a common hazard involved in many human diseases, such as cerebral stroke, myocardial infarction, solid organ transplant dysfunction or failure, and vascular diseases. Understanding the molecular bases of this injury is essential for the prevention and control of these life-threatening conditions. Ischemic and remote ischemic preconditioning techniques (IPC and RIPC, respectively) have gained increasing importance in the clinical practice to protect against the IRI; however, the exact mechanisms of these techniques are not fully understood, which renders their clinical application query. Possible effectors: Nitric oxide (NO) has been reported by multiple studies to be an important mediator of the protective effects of those techniques. While the physiological concentrations of NO and fibrinogen (FB) are known to antagonize each other, the circulating levels of both effectors increase in response to RIPC. Hypothesis: While NO has potential anti-inflammatory effects, non-soluble fibrinogen (sFB) shows pro- inflammatory effects. However, the sFB may have the potential to act synergistically rather than antagonistically with NO toward the attenuation of the IRI. Conclusion: While increased FB is considered a risk factor for cardiovascular and inflammatory conditions that is also able to decrease the efflux of NO, and increase the NO oxidative metabolits and S- nitroglutathione, the increased sFB during the acute phase reaction might have other protective aspects that should be carefully investigated.

Resumen Antecedentes: La lesión por isquemia-reperfusión (LIR) es un riesgo común involucrado en muchas enfermedades humanas tales como derrame cerebral, infarto del miocardio, disfunción o falla de trasplante de órgano sólido, y enfermedades vasculares. Una comprensión de la base molecular de esta lesión es fundamental para la prevención y el control de estas enfermedades potencialmente mortales. Las técnicas de preacondicionamiento isquémico y preacondicionamiento isquémico remoto (PIR) han cobrado una creciente importancia en la práctica clínica para la protección contra la LIR, sin embargo, los mecanismos precisos de estas técnicas no se entienden plenamente, lo cual pone en duda su aplicación clínica. Posibles efectores: El óxido nítrico (ON) ha sido reportado por varios estudios como un importante mediador de los efectos protectores de estas técnicas. Si bien se sabe que las concentraciones fisiológicas del ON y fibrinógeno son antagónicas, los niveles circulantes de ambos efectores aumentan en respuesta al PIR. Hipótesis: Aunque el ON tiene posibles efectos anti-inflamatorios, el fibrinógeno insoluble muestra efectos proinflamatorios. Sin embargo, el fibrinógeno soluble puede tener el potencial de actuar de manera sinérgica en lugar de antagónica con el ON hacia la atenuación de la LIR. Conclusión: Aunque el fibrinógeno elevado se considera un factor de riesgo para las enfermedades cardiovasculares e inflamatorias, que también puede disminuir la descarga de ON y aumentar los niveles de metabolitos oxidantes del ON y de S-nitrosoglutatión, el aumento de fibrinógeno soluble durante la reacción de fase aguda puede tener otros aspectos protectores que deben ser cuidadosamente investigados.

Antimicrobial, antioxidant and anticancer potential of Streptomyces species isolated from the rhizosphere of Avicennia marina (Forssk.) Vierh

Free radicals produced through biochemical processes cause dangerous health problems due to their oxidative effect on cellular proteins and lipids. There is an urgent need for natural antioxidants to be used as therapeutic agents. Streptomyces are known as producers for antioxidants, in this study, two Streptomyces species were isolated from the rhizosphere soil of mangrove tree Avicennia marina (Forssk.) Vierh. The isolates were identified by conventional as well as molecular methods as Streptomyces atrovirens (MS5) and S. labedae (MR15). The ethyl acetate extracts of cell free production broth medium of the two isolates demonstrated potent biological activities against Gram positive and Gram negative bacteria and Candida albicans. Moreover, a radical scavenging activity in DPPH assay with significant inhibition percentage of 62 and 78%, respectively, was recorded. The IC50 values were 3000 and 241 ?g/mL (P <0.05) for S.atrovirens (MS5) and S. labedae (MR15), respectively. Streptomyces atrovirens extract showed anticancer activity against hepatocellular carcinoma cells (HepG-2) and colon carcinoma cells (HCT-116) cell lines with 61 and 50.6%, respectively, while S. labedae (MR15) showed anticancer activity against all the tested cell lines with 92.9 and 85.89% against (HepG-2) and (HCT-116) compared to the control cells and showed selective cytotoxicity. LC-MS/MS analyses revealed the presence of compounds with known antioxidant and anticancer activities such as Gamma Aminobutyric acid (GABA) and Indole-3-carboxyaldehyde, linoleic acid and phenyl chromen-4-one derivative with various intensities.

A study comparing patient satisfaction and retention of CAD/CAM milled complete dentures and 3D printed CAD/CAM complete dentures versus conventional complete dentures: a randomized clinical trial / Um estudo comparando a satisfação do paciente e a retenção de próteses totais fresadas em CAD/CAM e próteses totais 3D impressas com tecnologia CAD/CAM versus próteses totais convencionais: um ensaio clínico randomizado

Objective: To compare the three different methods of complete denture fabrication assessing patient satisfaction and retention after insertion for six months' follow-up period. Material and Methods: The study was conducted in the Prosthodontic Department where a total of forty-eight patients were recruited from the outpatient clinics fulfilling the inclusion criteria. This study was designed as a randomized controlled clinical trial. All patients followed the steps of complete denture construction till jaw relation record. Then, all eligible patients were randomized to intervention and control groups. For intervention groups digital scanning, designing, manufacturing of complete dentures was done; 3D printing for first and milling for second intervention. For the comparator group, complete dentures were manufactured the conventional way. After 2 weeks of delivery of the dentures, patients received a patient satisfaction questionnaire, retention was measured by retention force gauge. Both readings were also recorded after 3 months and at 6 months. The mean and standard deviation values were calculated for each group in each test. The significance level was set at P≤ 0.05. Results: No statistical difference was found in terms of patient satisfaction and retention between the three groups at different time intervals. Conclusion: The manufacturing technique seemed to have no influence on patient satisfaction and retention with milled showing the least results.(AU)

Objetivo: Comparar três métodos diferentes de fabricação de prótese total avaliando a satisfação do paciente e a retenção após a inserção por um período de acompanhamento de seis meses. Material e Métodos: O estudo foi conduzido no departamento de Prótese onde um total de quarenta e oito pacientes foram recrutados das clínicas ambulatoriais atendendo os critérios de inclusão. Este estudo foi designado como um ensaio clínico randomizado controlado. Todos os pacientes seguiram as mesmas etapas de confecção de prótese total até o registro da relação maxilo-mandibular. Então, todos os pacientes qualificados foram divididos de forma aleatória nos grupos de intervenção e grupo controle. Para os grupos de intervenção foram realizados escaneamento digital, projeto e fabricação de próteses totais; Impressão 3D para o primeiro e fresagem para o segundo grupo de intervenção. Para o grupo de comparação, próteses totais foram feitas com o método convencional. Depois de 2 semanas após a entrega das próteses os pacientes receberam um questionário de satisfação e a retenção foi mensurada com um medidor de força de retenção. Ambas as leituras também foram registradas após 3 e 6 meses. Os valores de média e desvio padrão foram calculados para cada grupo em cada teste. O nível de significância foi estabelecido em P ≤ 0,05. Resultados: Nenhuma diferença estatística foi encontrada em termos de satisfação do paciente e retenção entre os três grupos em diferentes intervalos de tempo. Conclusão: A técnica de fabricação pareceu não ter influência na satisfação do paciente e retenção da prótese, com o grupo fresado apresentando o mínimo de resultados.(AU)

Effects of Locally Delivered Morin Hydrate on Iodoacetate-induced Temporomandibular Joint Osteoarthritis in Rats / Efeitos locais da indução de Hidrato de Morina na articulação temporomandibular de ratos com osteoartrite induzida por Iodoacetato

Objectives: morin hydrate has been reported to possess many beneficial pharmacological potentialities including antioxidant and anti-osteoarthritic effects. The anti-osteoarthritic properties of locally administrated morin have not been investigated. The objective of this study is to evaluate the locally delivered morin on the temporomandibular joint osteoarthritis in rat. Materials and methods: thirty young adult female Sprague Dawley rats were randomly arranged into three groups; control, osteoarthritis and osteoarthritis with morin. Both the iodoacetate for osteoarthritis induction and morin hydrate therapy were delivered unilaterally via intra-articular route. Results: morin reduced osteoarthritis manifestations with prominent thickening of both condylar fibrous layer and articular disc accompanied with discal cells hypertrophy that ultimately acquired chondrocytes features. The condylar cartilage matrix showed enhancement of extracellular matrix production with morin administration. Discussion: the present studyhas elucidated antiosteoarthritic effect of intra articular injection of morin hydrate. Although morin has managed to prevent the propagation and advancing some of the recorded osteoarthritic manifestations; however, it showed some failure in managing others. The administration of morin hydrate modulated the structure of the joint rather than restore it back to its typical configuration. Conclusion: the morin hydrate administration to osteoarthritic animals showed relieve in some of osteoarthritic features and modulated the structure of some joint components to compensate the unhandled manifestations (AU)

Objetivo: Relata-se que o Hidrato de Morina possui diversas potencialidades farmacológicas benéficas, incluindo efeitos antioxidantes e anti-osteoartríticos. As propriedades antiosteoartríticas da morina administrada localmente não foram investigadas. O objetivo deste estudo é avaliar a Morina administrada localmente sobre a osteoartrite da articulação temporomandibular em ratos. Material e métodos: Trinta ratos adultos jovens de linhagem Sprague Dawley foram dispostos aleatoriamente em três grupos: grupo controle, grupo com osteoartrite e grupo com osteoartrite e Morina. Tanto o Iodoacetato para a indução da osteoartrite como a terapia com Hidrato de Morina foram administrados unilateralmente por via intra-articular. Resultados: A Morina reduziu as manifestações da osteoartrite com espessamento proeminente tanto da camada fibrosa condilar como do disco articular acompanhado de hipertrofia das células discais que acabaram por adquirir características condrócitas. A matriz da cartilagem condilar mostrou um aumento da produção de matriz extracelular com administração de Morina. Discussão: O presente estudo elucidou o efeito antiosteoartrítico da injeção intra-articular de Hidrato de Morina. Apesar da Morina ter impedido a propagação e o avanço de algumas das manifestações osteoartríticas registadas, mostrou algumas falhas na manipulação de outras. A administração de Hidrato de Morina modulou a estrutura da articulação em vez de restaurar à sua configuração típica. Conclusão: A administração de Hidratode Morina em animais osteoartríticos mostrou alívio em algumas das características osteoartríticas e modulou a estrutura de alguns componentes da articulação em compensação às manifestações não tratadas. (AU)

Anesthesitic management for insulinoma resection in a patient having chronic inflammatory demyelinating neuropathy / Manejo anestésico para resección de insulinoma en un paciente portador de neuropatía desmielinizante crónica

Chronic Inflammatory Demyelinating Polyneuropathy associated with hypoglycemia 2 to insulinoma is unusual, and to our knowledge, very few patients have been reported in literature. Despite varying presentations in these patients, the clinical characteristics are usually the same. The syndrome usually occurs after several episodes of protracted hypoglycemia. The neuropathy is nearly always symmetrical. We report anesthetic management for a young female patient presenting with CIDP & repeated hypoglycemic episodes during a 2-year period scheduled for insulinoma enucleation.

La polineuropatía desmielinizante inflamatoria crónica asociada con hipoglicemia secundaria a insulinoma es inusual y, hasta donde sabemos, muy pocos pacientes han sido reportados en la literatura. A pesar de las diferentes presentaciones en estos pacientes, las características clínicas suelen ser las mismas. El síndrome generalmente ocurre después de varios episodios de hipoglicemia prolongada. La neuropatía es casi siempre simétrica. Presentamos el manejo anestésico para una paciente joven que se presenta con polineuropatía desmielinizante inflamatoria crónica y episodios repetidos de hipoglicemia durante un período de 2 años programado para la enucleación de insulinoma.

Group B Streptococcus Colonization, Antibiotic Susceptibility, and Serotype Distribution among Saudi Pregnant Women / 감염과화학요법

Background@#Group B Streptococcus (GBS) comprises the normal flora of the female urogenital tract and can be transferred to neonates during delivery, causing invasive diseases.This study was performed to investigate the colonization rate, antibiotic susceptibility, and serotype of GBS among Saudi pregnant women. @*Materials and Methods@#In this cross-sectional study, vagino-rectal swabs from 400 pregnant women were collected over a period of one year. Identification of GBS isolates and determination of their antibiotic susceptibility were performed using the Microscan Walk Away system. The isolates were then typed using both latex agglutination and capsular genebased multiplex polymerase chain reaction assays. @*Results@#Sixty (15.0%) subjects were colonized by GBS, with serotype Ia as the dominant type (30.0%) followed by serotype III and V (25.0%, each). Only 43 (71.7%) isolates were typed by latex agglutination, whereas the remaining isolates were not typable or were non-specifically typed as compared to the genotyping assay, which revealed the specific type of each GBS isolate. The highest resistance rates were observed for erythromycin and clindamycin (16.7%, each), which were mainly restricted to the prevalent serotypes. @*Conclusion@#This study is the first to report the distribution of GBS serotypes based on molecular genotyping in Saudi Arabia. GBS colonization was evident among pregnant women, and resistance to erythromycin and clindamycin was predominant among serotypes Ia, III, and V. Molecular genotyping using capsular gene-based multiplex PCR provided reliable typing of the investigated GBS isolates in terms of sensitivity and specificity as compared to conventional serotyping using latex agglutination.

First report of an outbreak of cerebral coenurosis in Dhofari goats in Oman / Primeiro relato de um surto de coenurose cerebral em cabras Dhofari em Omã

Abstract This study documented the first outbreak of cerebral coenurosis in goats in Salalah, southern Oman. Deaths of 130 (16.6%) adult native goats in a herd (n=780) were reported from January to June 2017. Affected goats showed various nervous signs ended by death. Investigations for thiamine deficiency, polioencephalomalacia, caprine arthritis encephalitis, and listeriosis were negative. Upon necropsy, multiple (1-4) thin-walled cysts 2-3.5 cm in diameter containing clear fluid with numerous clusters of protoscolices in the cerebrum and cerebellum had replaced the brain parenchyma, causing space-occupying lesions. Parasitologically, the recovered cysts were Coenurus cerebralis, based on the arrangement of protoscolices, and the number and size of their hooks. Morphologically, each protoscolex had four suckers and a rostellum with double-crown hooks. The large and small hooks were 157.7±0.5 µm and 115±0.6 µm in length, respectively. Histopathologically, the parasite destroyed the affected tissues associated with multifocal to diffuse lymphocytic, non-suppurative meningoencephalitis; ischemic neuronal necrosis; and malacia. This is the first report of cerebral coenurosis in livestock in Oman, which should alert the local public health authorities for the application of prevention and control measures.

Resumo Este estudo documentou o primeiro surto de coenurose cerebral em cabras em Salalah, Oman. A morte de 130 (16,6%) caprinos adultos nativos (n=780) foi relatada de janeiro a junho de 2017. As cabras afetadas mostraram distúrbios neurológicos, que culminaram em óbito. Investigações para deficiência de tiamina, polioencefalomalácia, encefalite por artrite caprina e listeriose foram negativas. Na necropsia, múltiplos (1-4) cistos de paredes finas com 2-3,5 cm de diâmetro contendo líquido claro com numerosos aglomerados de protoescólices no cérebro e no cerebelo haviam substituído o parênquima cerebral, causando compressão nas estruturas adjacentes. Os cistos recuperados foram identificados como sendo de Coenurus cerebralis, com base no arranjo dos protoescólices, e no número e tamanho de seus ganchos. Morfologicamente, cada protoescólice tinha quatro ventosas e um rostelo com dupla coroa de ganchos. Os ganchos grandes e pequenos tinham 157,7±0,5 µm e 115±0,6 µm de comprimento, respectivamente. Histopatologicamente, o parasita causou a destruição dos tecidos afetados associada à meningoencefalite linfocítica não-supurativa, que variou de multifocal a difusa, necrose neuronal isquêmica e malacia. Este é o primeiro relato de coenurose em ruminantes no Oman, o que deve servir de alerta para as autoridades locais da área de saúde para a aplicação de medidas de prevenção e controle.

Delivery of BACE1 siRNA mediated by TARBP-BTP fusion protein reduces b-amyloid deposits in a transgenic mouse model of Alzheimer’s disease

Systemic delivery of nucleic acids to the central nervous system (CNS) is a major challenge for the development of RNAinterference-based therapeutics due to lack of stability, target specificity, non-permeability to the blood–brain barrier (BBB),and lack of suitable carriers. Using a designed bi-functional fusion protein TARBP-BTP in a complex with siRNA, weearlier demonstrated knockdown of target genes in the brain of both AbPP-PS1 (Alzheimer’s disease, AD) and wild-typeC57BL/6 mice. In this report, we further substantiate the approach through an extended use in AbPP-PS1 mice, which upontreatment with seven doses of b-secretase AbPP cleaving Enzyme 1 (BACE1) TARBP-BTP:siRNA, led to target-specificeffect in the mouse brain. Concomitant gene silencing of BACE1, and consequent reduction in plaque load in the cerebralcortex and hippocampus ([60%) in mice treated with TARBP-BTP:siRNA complex, led to improvement in spatial learningand memory. The study validates the efficiency of TARBP-BTP fusion protein as an efficient mediator of RNAi, givingconsiderable scope for future intervention in neurodegenerative disorders through the use of short nucleic acids as genespecific inhibitors.

Occurrence of antibiotic resistant Campylobacter in wild birds and poultry

Aims@#Campylobacter is a major cause of gastroenteritis in humans worldwide, particularly in developed countries and is reported to show an increased trend in antibiotic resistance. The purpose of this study was to determine the occurrence of Campylobacter in wild birds, poultry and in poultry environments in Selangor, Malaysia as well as to determine the rate of antibiotic resistance among Campylobacter isolates from poultry and wild birds. @*Methodology and results@#The wild birds were trapped near poultry farm areas and in open areas which were more than 5 km away from poultry farms (refered to as open environment). Of 57 wild birds trapped near the farm environment, 17.5% were positive for Campylobacter and out of these, 90% were Campylobacter jejuni. Of a total of 77 birds in the open environment, 22.1% were positive for Campylobacter and of these 88.7% were C. jejuni. The poultry farms consisted of 3 chicken and 2 duck farms. About 60% of the chickens and 44.8% of the ducks were positive for Campylobacter of which 80% were C. jejuni, while 20% were Campylobacter coli. The Campylobacter isolates were subjected to antibiotic susceptibility test using disk diffusion method against 12 antibiotics. All the isolates (100%) from wild birds around poultry houses were resistant to at least one antibiotic. @*Conclusion, significance and impact of study@#The findings showed 93% of the isolates from wild birds were resistant to at least two antibiotics. Campylobacter isolates from poultry in the farms were resistant to at least one antibiotic. The antibiotic resistant Campylobacter is of public health importance.

Impact of endometriosis-related adhesions on quality of life among infertile women

Background: Endometriosis is considered the most common cause of pelvic adhesions in women. Endometriosis- associated adhesions could result in the formation of fibrous bands, which contain endometriotic glands, stroma and scarring. The aim of this study was to identify the impact of endometriosis-related adhesions on quality of life among infertile women

Materials and Methods: This descriptive study was conducted at Endoscopic Unit, in Zagazig University Hospitals, Egypt. Oral consent for participation in this study was taken from 109 women who were candidates for laparoscopy as infertile cases and were diagnosed with endometriosis. They were classified into two groups namely, group I [n=41] who had endometriosis with adhesions and group II [n=68] who had endometriosis without adhesions. A structured interviewing form, adhesion scoring method of the American Fertility Society, and Global Quality of Life Scale were used to collect required information

Results: The prevalence of adhesions resulted from endometriosis was 37.6%. Demographic characteristics of the women with endometriosis-related adhesions were not significantly different from those of women without endome- triosis-related adhesions. The most common location for endometriotic adhesions was adnexal adhesion [51.2%] fol- lowed by adhesion of anterior abdominal wall [24.4%]. Quality of life was significantly impacted by endometriosis- related adhesions [P=0.002]

Conclusion: A high percentage of studied patients had a moderate degree of adhesions. Adhesions caused by endo- metriosis had an impact on quality of life of the studied women

Assessment of retinal nerve fiber layer thickness using optical coherence tomography in patients with type 2 diabetes mellitus

Background: Diabetic retinopathy (DR) is the most common ocular complication of diabetes mellitus (DM) and considered one of the leading causes of blindness in developed countries. Diabetic retinopathy is predominantly amicroangiopathy in which high glucose levels can make small blood vessels particularly, vulnerable to damage. Objective: The aim of this work was to assess the thickness of peripapillary retinal nerve fiber layer (RNFL) measured by Swept Source optical coherence tomography (SS-OCT) in patients with Type 2 Diabetes Mellitus (DM). Patients and Methods: The study was an observational cross-sectional study. The study was conducted on 40 eyes of diabetic patients from the outpatient clinic in ophthalmology department of Al-Azhar University Hospitals. All patients were subjected to a complete ophthalmic examination including OCT. Results: The current study showed a negative correlation between parameters related to DM (duration of DM, and state of glycemic control measured by HbA1C) and all the parameters related to RNFL, and RGCL thickness but this correlation was statistically insignificant, and there was statistically significant decrease in superior RNFL thickness in patients with mild DR than patients with no DR, however, this difference was statistically insignificant in all parameters related to RGCL thickness in the two groups. Conclusion: Optical coherence tomography (OCT) provides non-invasive, quantitative and objective measurement of RNFL thickness, optic nerve head, and RGCL thickness with high resolution and accuracy. This could be the method of choice for monitoring the neurodegenerative changes in DR

Laser versus radiotherapy in the treatment of early glottic carcinoma

Background: Laryngeal cancer is one of the most common types of head and neck malignancy, although its optimal primary treatment is still a matter of debate. Methods: Typical patients with laryngeal SCC (90% at least) are males, over 45 years and heavy smokers. Hoarseness, voice changes, dysphagia, odynophagia, neck mass, dyspnea, referred otalgia and aspiration are the symptoms seen in laryngeal carcinoma. Glottic carcinomas are usually diagnosed earlier and hoarseness is the most common typical symptom. Results: All patients had completed the study. After comparison of the result between the 2 treatment groups, transoral laser excision shows better results than radiotherapy. There is significant difference between laser and radiotherapy in post-operative complications regarding granuloma tissue formation, tumor recurrence and web formation. In laser excision of laryngeal carcinoma, 10% of cases have post-operative granuloma while in radiotherapy, 66.6% of them have post-operative granuloma, but no cases has tumor recurrence while in radiotherapy, 33.3% of them have tumor recurrence. In laser excision of laryngeal carcinoma, 10% of cases have post-operative web formation while in radiotherapy, 22.3% of them have post-operative web formation. There is statistically significant difference between laser and radiotherapy in post-operative satisfaction about the voice (voice quality). Radiotherapy shows better results than laser in voice satisfaction. Conclusions: As regard the study, transoral laser excision of early glottic carcinoma shows better control rate and decrease recurrence and complications than radiotherapy. Keywords

Clinical audit in the management of mild pre-eclampsia in upper egypt

Background: Clinical audits based on standard criteria have been used in developed countries in order to improve the management of certain diseases, but have been nowadays introduced in assessment of diseases in developing countries as pre-eclampsia and eclampsia

Study Design: a retrospective study

Objective: To assess the clinical audit in the management of mild Pre-eclampsia in Upper Egypt

Setting: Obstetrics and Gynecology department, Sohag General Hospital

Duration: From 1st of January 2015 to the end of December 2015

Patients and methods: This clinical audit study was conducted on 108 pregnant women who had mild pre-eclampsia from those admitted to Obstetrics and Gynecology department of Sohag General Hospital. Patients were diagnosed as mild preeclampsia according to ACOG criteria, 2013 of mild preeclampsia

Results: About 33% of studied cases developed featured of severe pre-eclampsia. Vaginal delivery was only in 31.4% of cases. The clinical audit was nearly adherence to standards of mild pre-eclampsia management but was very poor in asking about symptoms of severe disease only obtained for 7.4% of cases, family history was neglected completely, lower limb examination was fairly done in 60.2% of cases, pelvic examination was done in 74.1% of cases and no case had chest or heart examination. 24 hours protein collection and protein creatinine ratio were not done. Only 9.3% of cases were assessed and managed by consultants and 90.7% of cases were assessed and managed by obstetric specialists

Conclusions and Recommendations: Accesses to prenatal care, early detection and diagnosis of pre-eclampsia, well monitoring and suitable management are crucial elements in the pre-eclampsia prevention regarded to maternal death. Potential areas for further improvement in quality of care for management of cases with mild pre-eclampsia related to standardizing management guidelines, greater involvement of specialists in the management and continued medical education on current management of disease for junior staff

Recent management of abdominal aortic aneurysm

Background: Abdominal Aortic Aneurysms had always been one of the most serious causes of mortality in the past decades until recently. Thanks to the modern advances in medicine and the technological revolution in Imaging and endograft Industry, treatment of Abdominal Aortic Aneurysms no longer imposes that high mortality risk it previously had

Objective: This study aims to review currently available evidence aiming at designing an approach for the management abdominal aortic aneurysm

Subjects and Methods: We are planning to search Medline, Plumbed, Cochrane databases using the keywords: "management", "abdominal", "aortic", "aneurysm". Any studies published in English with subjects with surgical and endovascular management of abdominal aortic aneurysm will be included up to 1/3/2017

Results: The present systematic review confirmed this belief. EVAR patients had a significantly lower 30-day mortality, shorter hospital and ICU stay, less blood loss or blood transfusion requirement, fewer postoperative cardiac and respiratory morbidities, less colonic ischaemia, and fewer overall postoperative problems compared to open repaired aneurysm patients

Impact of laparoscopic ovarian drilling [LOD] on ovarian reserve and ovarian stromal blood flow using two-dimensional [2D] power doppler in anovulatory women with polycystic ovary syndrome [PCOS]

Aim of the Study: This study aimed to determine the effect of LOD on ovarian reserve and ovarian stromal blood flow changes, by using Two-Dimensional [2D] Power Doppler Ultrasongraphy in anovulatory women with Polycystic Ovary Syndrome [PCOS] and whether this could explain the mechanism of action of LOD

Patients and methods: This study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Al-Hussein University Hospital, El-Sayed Galal Hospital and EL-Sheikh Zayed Especialized Hospital in the period between November 2016 and February 2018. This study included 30 anovulatory polycystic ovary women with clomiphene citrate [CC]-resistant and 30 fertile women as the control group. Laparoscopic ovarian drilling was done. Serum levels of hormonal profile were measured [AMH, LH, FSH, LH/FSH ratio and total testosterone], ovarian stromal blood flow Doppler indices [RI and PI] and occurrence of ovulation or pregnancy

Result: In this study we reported our findings regarding the effects of LOD on AMH, hormonal profile and ovarian stromal blood flow in women with PCOS with clomiphene resistance. These results suggested that the measurement of AMH, LH, LH/FSH ratio, total testosterone, ovarian volume and ovarian stromal blood flow by Doppler were in discrimination of PCOS from potentially normal women. The data in our study suggested that there were no significant differences as regard AMH, hormonal profile except total testosterone, ultrasound ovarian findings and ovarian stromal blood flow before and after LOD, but there were significant differences as regard total testosterone before and after LOD. Also, there was good predictive value for AMH after LOD for ovulation and clinical pregnancy

Conclusion: Measuring AMH for anovulatory women with PCOS undergoing LOD may be a useful tool in evaluating the outcome of LOD, but ovarian stromal blood flow 2D Doppler indices did not show significant changes predicting ovulation or pregnancy rate after LOD

Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection

Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection

Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs

Patients and Methods: our study was done over one year period from October 2017 to October 2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included [8 male, and 14 female] with age range [14m- 16 yrs.]. We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection

Results: in our case group; the most common underlying disease was ALL-B cell [n=6, 40%], followed by ALL-T cell [n=2, 13.3%], AML [n=2, 13.3%], aplastic [n=3, 20%], hepatobalstoma [n=1, 6.7%] and auto-immunodeficiency [n=1, 6.7%]. Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection [53.3% vs. 0% respectively, p=0.015], followed by consolidation [40% vs. 57.1%, p=0.45] and ground glassing [26.7% vs. 14.3%. Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection

Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics

Retropupillary fixation of iris-claw intraocular lens versus trans-scleral suturing fixation for aphakic eyes without capsular support

Background: many reasons can lead to an aphakia without sufficient capsular support for a posterior chamber intraocular lens, such as intraoperative complications during phacoemulsification, intracapsular cataract extraction, ocular trauma and lens dislocation caused by various reasons

Aim of the Work: was to compare retropupillary fixation of an iris-claw IOL [artisan aphakia lens] with transscleral suturing fixation of aposterior chamber IOL for aphakic eyes without sufficient capsular support as regards safety, visual recovery and complications of the procedure

Material and Methods: this a prospective interventional case series study included a total of 45 eyes of 42 patients of the age group 13-60 years, selected from those attending the Ophthalmology Department at Al-Azhar University Hospitals according to the inclusion and exclusion criteria

Results: in group A, the duration ranged from 15 to 45 min with a mean of 30.30 +/- 6.06min, in group B, the duration ranged from 35 to 85 min with a mean 60.60 +/- 12.41min. The P-Value was< 0. 001. The IOP showed at day 1 postoperative was higher in group B 20.06 +/- 4 than group A A16.40 +/- 3.9 p value was 0.012, however IOP was nearly at the same level at the end of the follow up period 15.23 +/- 3.63 in group A and 15.23 +/- 3.63 in group B with p value 0.713

Conclusion: the results of our study indicated that IC-IOL and SF-PCIOL implantations are both satisfactory in correcting aphakia without sufficient capsular support to hold an IOL in the posterior capsule

Comparative study between ultrasound guided pectoral nerves block and thoracic epidural as analgesia in breast surgeries

Background: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain

These procedures cause significant acute pain and may progress to chronic pain states in 25-60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Acute postoperative pain due to insufficient or ineffective pain control is a major risk factor for the development of chronic pain after breast surgery. This condition includes paresthesia, intercostobrachial neuralgia and phantom breast pain

Aim of the Work: we aimed at comparing the analgesic effectiveness and safety of pectoral [Pecs] block versus thoracic epidural in breast surgeries

Material and Methods: The present study was conducted to compare the efficacy and safety of the Pecs II block with thoracic epidural [TE] on sixty female patients ASA I-II, their ages ranged from 18- 65 years old scheduled for unilateral breast surgery. The patients were allocated randomly into two groups [n=30] according to type of regional anesthesia administrated. [Pecs block or TE]

Results: The results of the present study demonstrated that, Pecs block caused hemodynamic stability, decreased the intensity of post-operative pain, reduced post-operative analgesic requirement, prolonged the time needed for first request of analgesia, decreased PONV. Therefore it can be considered as quite safe procedure and effective as well for intraoperative and postoperative pain control in breast surgeries

Conclusion: Whether it is more superior to thoracic epidural depends on the type and extent of surgery. For surgeries involving the axilla, Pecs block is required as part of axillary compartment block but for medial breast incisions, thoracic epidural offers denervation of anterior branches of the intercostal nerves, which Pecs block does not confer

Incidence and prognosis of acute renal failure in patients with severe sepsis and septic shock

Background: Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Acute kidney injury [AKI], previously called acute renal failure [ARF] is an abrupt loss of kidney function, Generally it occurs because of damage to the kidney tissue caused by decreased kidney blood flow [Kidney ischemia] from any cause. AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects on other organ systems, including death

Aim: The aim of the study is to show the incidence and prognosis of acute renal failure in patients with sepsis and septic shock

Patients and methods: This prospective randomized study was conducted on patients who were admitted to ICU in Ain Shams University Hospitals. Forty patients were included in this study and an informed written consent was obtained from patients and/or relatives. All patients were adult, more than 18 years old, admitted to ICU suffering from severe sepsis or had septic shock for monitoring, management and follow up to their condition in period of six months. All patients were more than 18 years old that were critically ill either in severe sepsis or had septic shock. We excluded patients less than 18 years old, patient or relatives who refused to be included in this study, and if he/she has a history of previous kidney troubles or dysfunction. All patients were subjected to assessment of the demographic data of the patient, causes and site of infection, pathogenic bacteria as declared by different cultures, APACHE 2 score on admission, all patients were managed as declared by ICU, protocol for septic patients, hemodynamic monitoring was done daily, routine lab investigation daily, coagulation profile had to be done on days 0, 3, 7 of admission, SOFA score on days 0, 3, 7 of admission, renal functions include blood urea and creatinine clearance test had to be done daily, any deterioration of renal function was reported, and if the patient was in need for renal replacement therapy or dialysis, this would be reported

Results: Forty patients were included in this study, their ages with a mean of 58.37 +/- 15.66 years. 23 patients [57.5%] were males and 17 patients [42.5%] were females. The most frequent risk factors were hypertension [62.5%] followed by diabetes [52.5%]. The incidence of AKI was 60% of patients and the need for renal replacement therapy [RRT] was 9 [22.5%]. Outcome of admitted patients in ICU was 23 [57.5%] survived patients and 17 [42.5%] non-survived patients. The study showed that there were no statistical significant differences between AKI and Non-AKI patients except for; gender [male], BMI, gram –ve bacterial infection, creatinine, BUN, creatinine clearance, history of ACE administration, use of vasopressors, APACHE II score at admission and mortality were statistically significant [p < 0.05]

Conclusion: The incidence of AKI was 60% of patients in our study. The development of septic AKI adversely affected clinical outcomes. Moreover, the severity of AKI was associated with increased short-term mortality as observed in ICU patients. The study showed that there were no statistical significant differences between AKI and Non-AKI patients except for; gender [male], BMI, gram - ve bacterial infection, creatinine, BUN, creatinine clearance, history of ACE administration, use of vasopressors, APACHE II score at admission and mortality were statistically significant [p < 0.05]

Role of magnetic resonance urography in diagnosis of pediatric obstructive uropathy: a surgeon perspective

Background: Obstructive uropathy is a group of different pathologies. Congenital obstructive uropathy represents a major cause of renal failure in infants and children. Urinary tract obstruction is defined as any condition that impairs urinary drainage from the pelvicalyceal system and leads to increased pressure and reduced urine flow rate

Objective: The aim of this study was to assess the role of combined static and dynamic Magnetic Resonance Urography in the management of pediatric obstructive uropathy and to compare it with our basic investigations

Patients and Methods: This study was conducted on the pediatric patients presented to Pediatric Surgery Department in cooperation with Radiology Department, Ain Shams University Hospitals, presented with upper urinary tract dilatation detected by ultrasonograghy

Results: There was a high agreement between MRU and our standard imaging data as regard detection of urinary tract obstruction giving the MRU no superiority to the basic imaging in this field. Combined MRU showed the highest accuracy among other investigations in identification of the level of obstruction. Dynamic MRU and renal scintigraphy in our study yielded similar results for identification of split renal function

Conclusion: This study provides evidence that combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys to be used as a single modality for the comprehensive evaluation of urinary tract obstruction