Eyelid Blink Lagophthalmos and Blinking Velocity Changes After External Transcutaneous Dacrocystorhinostomy: A Prospective Study.

PURPOSE: To investigate the changes in eyelid blinking dynamics after external dacryocystorhinostomy (DCR). DESIGN: Prospective before-and-after study with follow-up. METHODS: Patients undergoing external DCR surgery for primary acquired nasolacrimal duct obstruction were observed using high-speed videography that recorded eyelid blinking of both eyes for a total duration of 4 minutes at a rate of 120 frames per second. These recordings were taken before the surgical procedure, on postoperative day 3, and then at 1 week, 1 month, and 3 months after the DCR surgery. A total of 3 random blinks were selected and isolated from each video recording for data analysis. For each blink, lagophthalmos and eyelid blinking velocity were calculated for the operated eye, and their values were then compared with those calculated for the contralateral, nonoperated eye. RESULTS: Data were obtained for 22 patients. Operated eyes showed large postoperative lagophthalmos on postoperative day 3, with a mean of 56.58% ± 52.63% of the palpebral fissure height. Gradual improvement of the lagophthalmos occurred over the next follow-up visits, and reached a mean of 31.24% ± 36.71% at follow-up visit 3 months postoperatively. The velocity of eyelid blinking showed a significant reduction for the operated eyes, with gradual improvement over 3 months. CONCLUSIONS: Postexternal DCR eyelid blinking changes included significant blink lagophthalmos with decreased velocity of eyelid blinking which gradually improved over the 3-month follow-up period. A longer follow-up period may be required to confirm if eyelid blinking lagophthalmos and velocity will return to baseline levels.

Heavy metal contents in salted fish retailed in Egypt: Dietary intakes and health risk assessment.

Background: In Egypt, salted fish is considered a typically processed fish, including salted sardine, salted mullet (feseikh), keeled mullet (sahlia), and herrings. High-quality protein, polyunsaturated fatty acids, vital amino acids, and trace minerals such as magnesium and calcium are all abundant in fish. However, eating salted fish can expose people to toxins found in the environment, such as heavy metals. Aim: In Zagazig, Egypt, four types of locally produced salted fish-salted sardine, feseikh, sahlia, and herrings-were tested for heavy metals, specifically lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg). Second, the assessed heavy metals linked to the Egyptian population's consumption of salted fish were used to calculate estimated daily intakes (EDIs) and potential health hazards, such as hazard quotient (HQ) and hazard index (HI). Methods: Samples of salted herrings, feseikh, sahlia, and sardines were gathered from the markets in Zagazig. Samples of salted fish were subjected to acid digestion and then heavy metal extraction. Atomic absorption spectrometers (AAS) were used to measure heavy metals. HI, HQ, and EDI were computed computationally. Results: With the exception of mercury, which was not found in the salted herrings, the recorded results showed that all of the tested metals were present in the samples that were evaluated. The herrings contained residual Pb and Cd contents that were highest, followed by sardine, feseikh, and sahlia, in that order. After sardine, herrings, and sahlia, feseikh has the greatest concentration. Sardine, feseikh, and sahlia had the highest quantities of mercury, in that order. A number of samples were found to be above the maximum allowable levels. There were no apparent hazards associated with consuming such conventional fish products, according to the computed HQ and HI values for the heavy metals under investigation based on the daily intakes. Conclusion: Samples of salted fish sold in Zagazig, Egypt, had high quantities of the hazardous elements Pb, Cd, As, and Hg. Due to the bioaccumulation and biomagnification characteristics of these studied metals, such data should be taken carefully even though the computed health hazards revealed no potential problems.

Health risk assessment of organochlorine pesticide residues in edible tissue of seafood.

Fish is one of the most valuable foods with high-quality animal protein. However, aquaculture, or ingesting contaminated food, allows organochlorine pesticides (OCPs) to enter the fish's body, and therefore, it negatively impacted public health. One-hundred and twenty random samples of Clupea harengus (C. harengus), Mugil cephalus (M. cephalus), Sardinella aurita (S. aurita), Oreochromis niloticus (O. niloticus), Neptunus pelagicus (N. pelagicus) and Sepia savigngi (S. savigngi) (n = 20 each) were collected from local markets in Mansoura city, Egypt. Samples were checked to see whether any residues of OCPs with the application of risk assessment due to their consumption by Mansoura citizens. The findings indicated that summation hexachlorocyclohexane (∑HCH) in examined seafood samples ranged from 0.27 ± 0.13 in N. pelagicus to 61.61 ± 52.03 µg.kg-1 in S. aurita. Also, the γ-HCH isomer was considered the more prominent among isomers. Hexachlorobenzene (HCB) was found in five different species, with mean values of 2.03 ± 1.85, 1.5.7 ± 1.17, 0.94 ± 0.87, 0.35 ± 0.06, and 0.18 ± 0.06 µg.kg-1 in C. harengus, S. aurita, M. cephlaus, O. niloticus, and S. savigngi. Moreover, summation of Heptachlors (∑HPTs) was 10.19 ± 7.63, 1.27 ± 0.26, 2.58 ± 0.11, 0.95 ± 0.12, 0.21 ± 0.11 and 0.32 ± 0.03 µg.kg-1 of wet weight in examined C. harengus, M. cephlaus, S. aurita, O. niloticus, N. pelagicus, and S. savigngi. Aldrin and dieldrin residues were 3.75 ± 1.31 and 4.86 ± 1.33 µg.kg-1 in C. harengu, meanwhile they were 1.61 ± 0.77 and 0.78 ± 0.04 µg.kg-1in M. cephalus. Dichlorodiphenyldichloroethylene (pp-DDE) was dominant in all examined species within different concentrations 5.08 ± 4.12, 0.98 ± 0.10, 3.07 ± 0.91, 0.93 ± 0.27, 0.08 ± 0.01 and 0.35 ± 0.02 µg.kg-1 in C. harengus, M. cephlaus, S. aurita, O. niloticus, N. pelagicus and S. savigngi, respectively. We concluded that all examined seafood samples were lower than the recommended maximum residue limit. Also, the estimated daily intake was less than the permitted daily intake. Non-carcinogenic indices of target hazard quotient and hazard index for OCPs in all examined species were less than 1.

Impact of manual removal of the placenta and intrauterine cleaning during elective cesarean delivery on maternal infectious morbidity and blood loss.

OBJECTIVE: to assess the impact of manual removal of the placenta and intrauterine cleaning during elective cesarean delivery on maternal infectious morbidity and blood loss. METHODS: This prospective multicenter trial was conducted on 436 pregnant women at term who were intended for elective cesarean delivery and allocated into four groups; group 1 (n = 110) who underwent manual removal of the placenta with intrauterine cleaning, group 2 (n = 106) who underwent manual removal of the placenta without intrauterine cleaning, group 3 (n = 108) who underwent spontaneous placental delivery with intrauterine cleaning and group 4 (n = 112) who underwent spontaneous placental delivery without intrauterine cleaning. Maternal operative blood loss, the rate of endometritis and surgical site infections (SSIs) was assessed and recorded. RESULTS: There was no significant difference between the four groups regarding drop of hemoglobin concentration, drop of hematocrit value, re-operation, re-admission to hospital, duration of hospital stay, the rate of endometritis and SSIs as well as maternal acceptability in terms of overall discomfort, overall satisfaction with delivery and recommendation to other women (p > .05). Intrauterine cleaning was associated with a significantly shorter duration of discharge of lochia and rapid return to daily activity compared to non-intrauterine cleaning (p < .05). CONCLUSION: Manual removal of the placenta and intrauterine cleaning have no deleterious impact on maternal blood loss and infectious morbidity after elective cesarean section. Also, intrauterine cleaning was associated with faster cessation of lochia and faster return to daily activity.

The protective efficacy of soursop fruit extract against hepatic injury associated with acetaminophen exposure is mediated through antioxidant, anti-inflammatory, and anti-apoptotic activities.

In the current report, we examined the potential beneficial role of soursop fruit extract (SSFE) on liver injury induced by a single paracetamol (APAP) overdose (2000 mg/kg). Thirty-five Wistar albino rats were randomly divided into five groups as follows: control, SSFE, APAP, SSFE+APAP, and silymarin (SIL)+APAP. APAP intoxication was found to elevate alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin levels. Moreover, it increased the levels of malondialdehyde, nitrites, and nitrates and depleted glutathione, superoxide dismutase, catalase, glutathione reductase, and glutathione peroxidase. APAP intoxication inactivated the nuclear factor erythroid 2-related factor 2 (Nrf2) defense pathway and upregulated the expression of heme oxygenase-1 (HO-1). APAP administration enhanced the activation of nuclear factor-kappa B (NF-κB), the elevation of tumor necrosis factor-alpha and interleukin 1-beta levels, and the upregulation of inducible nitric oxide synthase mRNA expression. In addition, APAP activated the overexpression of Bax protein, increased release of cytochrome c, and the downregulation of Bcl-2 protein. Finally, APAP-induced overexpression of transforming growth factor-beta (TGF-ß) further suggested enhanced liver damage. On the other hand, SSFE pretreatment attenuated these biochemical, molecular, and histopathological alterations in the liver, which might be partially due to the regulation of hepatic Nrf2/HO-1 and downregulation of NF-κB and TGF-ß.

Investigation of mRNA expression changes associated with field exposure to DDTs in chickens from KwaZulu-Natal, South Africa.

The objective of this study was to identify potential mRNA expression changes in chicken livers associated with environmental exposure to dichloro-diphenyl-trichloroethane (DDT) and its metabolites (DDTs). In particular, we focused on genes relating to the immune system and metabolism. We analyzed liver samples from free-ranging chickens in KwaZulu-Natal, South Africa, for contamination by DDTs. This area predominantly uses DDT in its malaria control program, and homes are sprayed annually with the pesticide. Genes relating to the immune system and metabolism were selected as potential genetic biomarkers that could be linked to higher contamination with DDTs. RT-qPCR analysis on 39 samples showed strong correlations between DDTs contamination and mRNA expression for the following genes: AvBD1, AvBD2, AvBD6 and AvBD7 (down-regulated), and CYP17, ELOVL2 and SQLE (up-regulated). This study shows for the first time interesting and significant correlations between genetic material collected from environmentally-exposed chickens and mRNA expression of several genes involved in immunity and metabolism. These findings show the usefulness of analysis on field samples from a region with high levels of environmental contamination in detecting potential biomarkers of exposure. In particular, we observed clear effects from DDT contamination on mRNA expression of genes involved in immune suppression, endocrine-disrupting effects, and lipid dysregulation. These results are of interest in guiding future studies to further elucidate the pathways involved in and clinical importance of toxicity associated with DDT exposure from contaminated environments, to ascertain the health risk to livestock and any subsequent risks to food security for people.

Vaginal hysterectomy versus laparoscopically assisted vaginal hysterectomy for large uteri between 280 and 700 g: a randomized controlled trial.

OBJECTIVE: To compare surgical outcomes, postoperative complications and costs between vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy in cases of large uteri. METHODS: Prospective randomized controlled trial done at Ain Shams University Maternity Hospital, where 50 patients were recruited and divided into two equal groups (each 25 patients). First group underwent vaginal hysterectomy, and the second underwent laparoscopically assisted vaginal hysterectomy. RESULTS: Patient characteristics were similar in both groups. As for surgical outcomes, estimated intraoperative blood loss (P = 0.90), operative time (P = 0.48), preoperative hemoglobin (P = 0.09), postoperative hemoglobin (P = 0.42), and operative complications (P = 1.0) did not differ between the two groups. The hospital costs (converted from Egyptian pound to U.S. dollars) were significantly higher in case of LAVH group [VH: $1060.86 ($180.09) versus LAVH: $1560.5 ($220.57), P value <0.001]. No significant difference exists in the duration of postoperative hospital stay between the two groups [VH: 49.92 h (28.50) versus LAVH: 58.56 (27.78), P = 0.28] or the actual uterine weight measured postoperatively [VH: 350.72 g (71.78) versus LAVH: 385.96 g (172.52), P = 0.35]. CONCLUSION: Both vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy are safe procedures in cases of large uteri with no significant difference between them except in terms of costs as VH appears to be more cost effective. CLINICAL TRIALS.GOV: NCT02826304.

Endometrial Injury May Increase the Pregnancy Rate in Patients Undergoing Intrauterine Insemination: An Interventional Randomized Clinical Trial.

OBJECTIVE: This study aimed to investigate the effect of endometrial injury using Pipelle catheter in the follicular phase (cycle day 5, 6, or 7) of the stimulation cycle on pregnancy rates in patients undergoing intrauterine insemination. METHODS: This prospective randomized controlled study was carried out in the Assisted Reproductive Technology Unit of Ain Shams University Maternity Hospital, Cairo, Egypt, from July 1, 2013 to August 31, 2015. Three hundred sixty women, 20 to 35 years of age, with patent fallopian tubes, mild male factor infertility, or unexplained infertility were recruited. Participants were allocated randomly into 2 groups: experimental arm and control arm. Women in the experimental arm underwent endometrial biopsy using a Pipelle catheter on day 5, 6, or 7 of the stimulation cycle combined with intrauterine insemination. Women in the control group underwent intrauterine insemination with no endometrial biopsy done. The primary outcomes were the clinical and chemical pregnancy rates. RESULTS: Data of 344 participants were statistically analyzed. The chemical pregnancy rate was 23.66% in the experimental arm and 10.85% in the control arm (P = .002). The clinical pregnancy rate was 18.93% in the experimental arm and 7.42% in the control arm (P = .003). CONCLUSION: Endometrial injury using a Pipelle catheter in the stimulation cycle may improve pregnancy rates in women undergoing intrauterine insemination.

Efficacy and safety of post-cesarean section incisional infiltration with lidocaine and epinephrine versus lidocaine alone in reducing postoperative pain: A randomized controlled double-blinded clinical trial.

OBJECTIVE: Aim was to assess the efficacy and safety of incisional infiltration of lidocaine and epinephrine vs. lidocaine only to reduce postcesarean section (C/S) pain. MATERIAL AND METHODS: It was a prospective, randomized, controlled, double-blinded clinical trial that was conducted in two tertiary hospitals in Egypt and included 153 women undergoing C/S under general anesthesia. They were randomly divided into the following two groups: Group I (control group, number=78), in which the wound was infiltrated before skin closure with 20 mL of 2% lidocaine, and Group II (study group, number=75), in which the wound was infiltrated before skin closure with 20 mL of 2% lidocaine and epinephrine. The primary outcomes were the time to first analgesic (TFA) request (minutes) and the postoperative pain scores that were measured using a visual analogue scale (VAS). The secondary outcomes included the duration of C/S, onset of mobilization, onset of breastfeeding, duration of hospital stay, local or systemic side effects of lidocaine and epinephrine, postoperative pyrexia, and postoperative wound infection. RESULTS: The pain score determined using VAS after 1 and 2 h was significantly decreased in Group II than in Group I. However, at 4.8 and 16 h, these results were significantly reversed in Group II than in Group I. The cumulative postoperative opioid consumption was significantly less in Group II than in Group I (50 vs. 90 mg). The onset of mobilization, onset of breastfeeding, and duration of hospital stay was significantly shorter in Group II than in Group I, whereas the TFA request was significantly longer in Group II. CONCLUSION: Administering epinephrine with 2% lidocaine prolongs the anesthetic effect and reduces the opioid analgesic dose postoperatively required, thereby enhancing patient recovery.

Hematopoietic stem cells: do they have a role in keloid pathogenesis?

Keloids are slow growing neoplasms characterized by benign proliferation of fibroblasts that is due, at least in part, to altered cytokine profiles. Stem cells were claimed to play a role in skin tumor development. However, their role in keloid formation is unclear. The current study investigated the immunoreactivity of CD34 and c-KIT antibodies in 30 cases with keloid lesions together with normal skin biopsies of 30, sex and age-matched subjects representing the control group. Examined keloid sections showed positive dermal stromal immunoreactivity for CD34 in 76.7% of cases. CD34 expression intensity and H score were upregulated in keloid tissue relative to normal skin (p < 0.0001, p = 0.0002, respectively) and in perilesional relative to lesional tissue (p = 0.03, p < 0.001, respectively). c-KIT showed positive dermal stromal expression in all cases. Dermal c-KIT expression intensity and H score were upregulated in keloid tissue relative to normal skin (p < 0.008, p < 0.001, respectively) and in perilesional relative to lesional tissue (p < 0.0001, p < 0.001, respectively). Lesional skin showed more staining of basal keratinocytes when compared to perilesional tissue (p < 0.0001). Hematopoietic stem cells may share in keloid pathogenesis. Further studies are warranted to gain firmer conclusion about the exact role played by these cells and the significance of their perilesional accumulation. The future therapy of keloid scars may have to target this stem cell population in order to deprive these tumors of their regenerative cell pools.

Heavy metal residues in canned fishes in Egypt.

A total of 75 random canned fish samples, 25 each of canned (canned tuna, sardine and mackerel) during 2009, were collected from Zagazig Markets for determination of lead, cadmium, zinc, copper and tin residues using atomic absorption spectrophotometer. The obtained results revealed that the mean values of the lead residues in the examined canned tuna, sardine and mackerel were 0.127 +/- 0.02, 0.013 +/- 0.004 and 0.023 +/- 0.01 (ppm) respectively. The mean concentrations of cadmium residues were 0.022 +/- 0.001, 0.048 +/- 0.003 and 0.027 +/- 0.003 ppm, respectively. While in case of zinc, the residual levels were 1.97 +/- 0.12, 2.369 +/- 0.32 and 1.126 +/- 0.24 ppm, respectively. Copper residual levels in the examined samples were 0.293 +/- 0.08, 0.221 +/- 0.03 and 0.08 +/- 0.02 ppm, respectively. In case of tin, the residual levels were 1.496 +/- 0.30, 1.209 +/- 0.26 and 0.379 +/- 0.11 ppm respectively.