Post-burn scar malignancy: 5-year management review and experience.

The study spotlights a severe uncommon post-burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post-burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split-thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome-the assessment with follow-up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow-up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non-melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low-grade malignancy, and well-planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow-up for an early sign of disease recurrence is paramount.

Predictors of Neurological Presentations of COVID-19 Infected Patients in South Egypt, Aswan Governorate: A Single Center Study.

BACKGROUND: COVID-19 is a complex multisystem disease comprising multiple organ dysfunctions including neurologic manifestations. Some COVID-19 patients may present neurologic symptoms as the initial presentations of the disease. OBJECTIVE: We aim at investigating the frequency and the predictors of neurological manifestations in patients with confirmed COVID-19. METHODS: A retrospective cross-sectional single-center study analyzed COVID-19 positive patients with neurological manifestations from March to June 2020, in Aswan Governorate, Egypt. Demographic data, clinical, radiological and laboratory findings, comorbidities, and treatments were collected and analyzed. RESULTS: Out of the 905 confirmed COVID-19 patients; 422 patients (46.6%) had neurological manifestations and fulfilled the study inclusion criteria, 223 patients (52.8%) had central neurological disorders (CNS), 107 (25.4%) had peripheral neurological disorders (PNS), and 92 (21.8%) patients had non-specific neurological disorders. Age >50 years, diabetes mellitus, CORAD> III and smoking were predictors for neurological system affection. CONCLUSION: COVID-19 infection has been associated with numerous neurological deficits, especially in elderly patients. Central nervous system disorders were the most prevalent deficit with predominance of cerebrovascular events.

Platelet Indices as a marker for early prediction of erectile dysfunction in diabetic patients.

Erectile dysfunction is one of the major concerns in diabetic patients. Platelet Indices including mean platelet volume, platelet count and platelet distribution width are important biomarkers for platelet activation and pathophysiology of atherothrombosis. Measurement of Platelet Indices may early predict erectile dysfunction in diabetic men. This study aimed to measure Platelet Indices in diabetic patients with erectile dysfunction and to correlate between them and erectile dysfunction especially of vasculogenic type. The study included 30 diabetic patients with diagnosed erectile dysfunction and 20 normal males as a control. Each patient was evaluated by history, International Index of Erectile Function-5, general and local examination, HbA1c, pharmaco-penile duplex ultrasonography and blood sample to measure Platelet Indices. Platelet distribution width and mean platelet volume were significantly higher in patients than controls (p < 0.001). Their levels were significantly higher in vasculogenic erectile dysfunction than other types (p < 0.001). No statistically significant association regards the platelet count (p > 0.05). We concluded that Platelet Indices are high in diabetic patients with erectile dysfunction especially those with vasculogenic aetiology. They can predict erectile dysfunction in diabetic men early, and so they may be considered as cheap, available and useful biomarker for early diagnosis of vasculogenic erectile dysfunction in diabetic patients.

Transthoracic Ultrasound in the Detection of Interstitial Pulmonary Fibrosis in Patients with Rheumatic Connective Tissue Diseases.

INTRODUCTION: Rheumatic connective tissue diseases are commonly complicated with interstitial lung disease that is responsive to anti-inflammatory therapy and generally carries a better prognosis if diagnosed early. PURPOSE: The aim of our study was to determine the diagnostic value of lung ultrasound in the detection of interstitial pulmonary fibrosis in patients with rheumatic connective tissue diseases. METHODS: Sixty two subjects with rheumatic connective tissue diseases diagnosed according to the American College of Rheumatology criteria for each disease were enrolled (4 males, 58 females; mean age: 47.5 ± 8.9 years; range: 21 to 76 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection in order to predict the degree of lung fibrosis. The modified transthoracic ultrasound assessment was performed at 10 intercostal spaces level. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by a radiologist and a pulmonary disease specialist. RESULTS: A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement (Spearman's correlation coefficient = 0.68, p < 0.001), (LR = 70.4, p < 0.001) was found. When compared with standard high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, and positive and negative predictive value of transthoracic ultrasound was 69.9%, 84.8%, 93.5%, and 49.7%, respectively. CONCLUSIONS: Our study showed that the modified transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with rheumatic connective tissue diseases.