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Minia Journal of Medical Research
Number of Followers: 12  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2682-4558
Published by Minia University Homepage  [2 journals]
  • Optical coherence tomography angiography changes of the macula in early
           primary open angle glaucoma compared to healthy eyes

    • Abstract: Glaucoma is one of the distinguished causes of irreversible blindness. It affects about 3.54% of people over 40. Glaucoma is an optic neuropathy characterized by the progressive loss of retinal ganglion cells and their axons in the peripapillary retinal nerve fiber layer as well as distinctive changes in the optic nerve head (ONH). Visual field loss is a symptom of the damage as it progresses. Vascular insufficiency is one of the factors that may contribute to glaucoma. Given that the superficial retinal capillary plexus supplies RGCs, glaucoma could be associated with decreased superficial retinal microcirculation in the macular area. Purpose of the study: the current study aimed to evaluate the macular vessel density and GCC thickness changes in early POAG eyes and compare them with healthy eyes .patients and methods: The participants were divided into two groups according to visual field findings. Group1: included 20 eyes of 12 patients of early POAG. Group 2: included 20 eyes of 10 normal individuals. All participants underwent thorough ocular examination, OCT imaging of the ONH and OCT-A of the macula. Early POAG and healthy eyes data were compared. Results: GCC thickness and whole image vessel density (wiVD) in the superficial capillary plexus were lower in the early POAG group than in healthy eyes, whereas deep capillary plexus vessel densities did not differ significantly between both groups. conclusion the inclusion of OCTA in glaucoma diagnostics helps in the early detection of glaucoma and improves our understanding of ocular blood flow changes in the disease.
  • Assessment of Vitamin D Levels in Children With Chronic Suppurative Otitis

    • Abstract: : Objective: to detect vitamin D level in children with chronic suppurative otitis media (CSOM) in comparison to normal control group Materials and Methods: Prospective comparative case control study was conducted on 85 children aged from 3 to 16 years at Otorhinolaryngology department, Minia University Hospital divided into 2 groups: Group A (case group) Forty-five cases with CSOM and Group B (control group) including Forty healthy children with normal Tympanic membrane (TM). Serum samples were used to assay the level of 25(OH) vitamin D. Vitamin D deficiency was considered as 25(OH)D <20 ng/ml. Results:Eighty-five children, divided into forty-five cases suffering from CSOM (15 males and 30 females) (Case group) and forty children (20 males and 20 females) with normal tympanic membrane (Control group). The mean vitamin D level in case group was 27.4 ± 22.1 while in control group was 35.6 ± 15.9.In case group Vitamin D deficiency was detected in 24 cases (53.3%), insufficient in 5 cases (11.1%), and sufficient in 16 cases (35.6%) while in control group, Vitamin D deficiency was detected in 5 cases only (12.5%), insufficient in 10 cases (25%), and sufficient in 25 cases (62.5%) with significant difference of vitamin D deficiency between case and control group.Conclusion: Vitamin D level in children with CSOM was found to be significantly lower than that in control group with normal TM, so assessment of vitamin D level is very important in children with CSOM to decrease recurrent acute exacerbation and prevent complications.
  • COVID-19 IN Children

    • Abstract: : Objective: Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1–5% of all cases, and the risk for developing severe disease and critical illness is much lower in children with COVID-19 than in adults.The clinical severity of the infection varies from a simple cold to severe acute respiratory syndrome (ARDS) or even death. Multisystem inflammatory syndrome in children (MIS-C), a possible complication of COVID-19, has been described as a hyperinflammatory condition with multiorgan involvement similar to that in Kawasaki disease or toxic shock syndrome in children with evidence of SARS-CoV-2 infection.Methods: 148 children were selected for our study. The demographic data, clinical manifestation, and laboratory measurements were also collected from patient files . Results: There was a statistically significant difference between positive covid-19 cases and negative cases as regarding inflammatory markers (CRP , LDH, D.Dimer and ferritin) Keywords COVID-19 , Children. SARS-CoV-2 , inflammatory markers.
  • Bioinformatic analysis of some RAG mutations contributing to the primary

    • Abstract: Recombination activating genes (RAG) encode RAG1/2 proteins which catalyze formation of DNA double strand breaks (DSB) between variability (V), diversity (D) and joining (J) segments of genes encoding immunoglobulins (Ig) and T-cell receptors (TCR) and rejoining of these segments to allow the unlimited production of (Ig)s and (TCR)s and to maintain durable adaptive immunity. RAG1 structure is composed of enzymatically active core and regulatory non-core. Large numbers of RAG1 mutations were reported in primary immunodeficiencies. In this study, we aimed to analyze some of these mutations and compare the results with the clinical significance displayed on the online websites like NCBI and HGMD. For this purpose, a protein remodeling program called Pymol and other online computational tools like Fathmm, Polyphen-2, SVM-1, Provean, SIFT and CADD were used to recognize the special effect of each mutation on the protein 3D structure. Our findings showed that R507W, W522C, R737H, R778Q, R841W, A857V, F974L, R975W RAG1 mutations have damaging effect as displayed by the computational analysis and this result agreed with what mentioned in the websites. Additionally, H612R and R1006V were found to be more tolerable than others which also concurred with the websites. However, M435V RAG1 mutation has been described as pathogenic in NCBI while most computational programs defined it as benign. In conclusion, Pymol and the computational tools are in co-ordination with the clinical significance described by the mentioned websites except in case of M435V mutation.
  • Premature Hair Greying and Diabetes Mellitus

    • Abstract: Background: Hair greying is a natural age-related process. It is considered as a cosmetic, not a medical, condition. However, as the chances of developing a disease increase with age, many studies have postulated that hair greying could be a predictor of some aging diseases such as diabetes mellitus. Aim: The present study aims to reveal onset, pattern of hair greying and its correlation to diabetes mellitus among individuals with various age groups and of both sex in Minia governorate. Patients and methods: The present study was conducted on 5000 individuals answered a questionnaire Results:11.9% of premature hair greying cases were suffering from diabetes mellitus either type 1 or type 2 and were receiving a regular daily treatment (before and during onset of hair greying) either insulin for type 1 DM and/or oral hypoglycemic for type 2 DM Conclusion: premature hair greying can be considered an alarming factor for DM and others systemic diseases.
  • Gender variation of Vit. D levels in Hair and Serum

    • Abstract: Background: To put it simply, vitamin D is a prohormone. A healthy plasma vitamin D level is indicative of ‘good’ health. Vit D is necessary for calcium metabolism and bone mineralization due to its anti-inflammatory and immunomodulatory properties, and regulation of keratinocyte differentiation and proliferation. It also affects the hair cycle, and its role in hair loss is under constant research. Aim and objectives: to evaluate serum and hair levels of vitamin D according to Gender. Subjects and methods: In this cross-sectional research; Circulating 25(OH)D levels were recorded in 80 cases from Dermatology Outpatient Clinic of Minia University Hospital using ELISA kits. Results: In males; serum vitamin D levels was 17-31 ng/ml, with a mean ±SD 24.2 ± 3.4. In females; Serum vitamin D levels range between 17-30 ng/ml, with a mean ±SD 23.2 ± 2.8. In males, the hair vitamin D level was 0.1-1.86 ng/ml, with a mean ±SD 0.8 ± 0.4. In females; hair vitamin D levels range between 0.05-1.98 ng/ml, with a mean ±SD 0.8 ± 0.4. There was non-statistical difference between participants regarding hair and serum level vit D. Conclusion: No significant variations in serum and hair vit D among males and females.
  • Prevalence of Legionella Among Pneumonia Patients & Environmental Water
           Sample at Sohag University Hospital

    • Abstract: Background: Legionellae are aerobic, gram-negative, non-spore-forming bacteria. Over 56 distinct Legionella species are encompassing at least 70 serogroups, approximately half of which have been isolated from, or detected in clinical specimens, but all species are regarded as potential human pathogens. Aim of the study: To detect the prevalence of legionella among pneumonia patients in environmental water samples in Sohag University Hospital. Methods: This study was conducted on 100 newly diagnosed patients with pneumonia on environmental water samples taken from 10 water outlets over the period from December 2016 to December 2017 at Sohag University Hospital. The following were done to all subjects: full history taking, full clinical examination, urine culture on Buffered Charcoal Yeast Extract (BCYE) Legionella Urine Ag test (UAG) and water culture on BCYE. Results: They were 44 males (44%), 3 of them were positive for legionella culture and 56 females (56%), 2 of them were positive for legionella culture. Their age ranged from 26-85 years with mean value 58.04±11.51 years. Cases with Legionella showed a significantly higher prevalence of neurological manifestations; need more ICU admission and ventilatory support, more likely to be males and smokers, cardiac, having more chest pain or GIT manifestations, higher degrees of dyspnea. Conclusion: This study found that smokers, males, having CAP with an underlying COPD and non-productive cough, GIT and neurological manifestation should be considered for Legionella infection. Patients hospitalized for more than 10 days, who acquired HAP should be suspected for Legionella until prove otherwise.
  • Sleep disorders among Minia University hospital workers. Minia, Egypt

    • Abstract: Background: Sufficient sleep is necessary for optimal human health. Short-term sleep deprivation can negatively affect individuals’ alertness, mood, attention and concentration; long-term sleep deprivation is associated with chronic diseases and mortality.Aim of study: Measuring sleep quantity, assessing sleep quality and determining risk factors of sleep disturbance among Minia University hospitals’ workers.Subjects and methods: This study is a cross sectional study conducted for identification of sleep disorders among 311 Minia University hospitals’ workers; (104 doctors, 104 nurses and 103 clerks), using a questionnaire which included demographic characteristics, assessment of sleep, family work conflict (FWC) and emotional exhaustion. Results: Sleep score ranged (0-16) with mean (3.9 ± 4.01), about (92%) of the studied workers had a little frequency of sleep disturbance and (8%) had a high frequency of sleep disturbance, Sleep score was higher among doctors (6.08) than nurses (3.7) and Clerks (1.9) with statistically significant difference. FWC score (10-25) with mean (16.4 ± 2.5), Emotional exhaustion score (0-53) with mean (17.4 ± 16.9). Odds ratio for night shift work, FWC score and emotional exhaustion were (5.227, 1.450 and 1.083) respectively.Conclusion and recommendations: Minia University Hospitals' doctors and nurses suffered from high sleep score more than clerks and it can be a source of stress and mental pressure for them and their families. Night shift work had a major effect on sleep disturbance. Hospitals authorities and policymakers with planning and implementing measures such as reducing the duration of shift-work schedules and execution of regular time management courses.
  • Contribution of low level Self-esteem and self-efficacy in adverse mental
           outcome among secondary school adolescents in Minia city

    • Abstract: Background: Nowadays youth especially within secondary schools are exposed to different stressors in addition to academic stress causing psychological problems. Mental health and wellbeing have recently received public health attention especially among adolescents. Self- esteem and self-efficacy are main two components of the evaluative part of self-concept that contribute to mental well-being and psychosocial competence. This study aims to investigate whether self-esteem and self-efficacy serve as significant predictors of total difficulty score among Minia City secondary school students. Methods: A cross sectional design was conducted for the study with participation of 298 students in two randomly chosen secondary schools in Minia city during academic year 2021/ 2022. The measures used were standardized Strength and difficulties questionnaire for emotional problems (SDQ), Rosenberg self-esteem scale (RSES), General self-efficacy scale in addition to questions for student personal characteristics. Results: Students identified with low self-esteem constituted (27.5%) of total participants. Mean self-efficacy score was (28.75± 5.7). In univariate correlational analysis, Significant correlation was found between self- esteem, self-efficacy and total difficult score. In linear regression model, self-esteem, self- efficacy, gender, hours spent online, and perceived health issues strongly predicted emotional difficulties. Self-esteem was significant predictor for total difficulty in all models, with highest standardized coefficient B in model 3. Conclusion: Higher prevalence of low self-esteem (among more than quarter of students) compared to previous studies was found in this study. A confirmed finding is that low self-esteem was the most significant contributor. School intervention programs should be put in consideration to enable these students to learn how to face life challenges, teach them skills to maximize confidence and capacity building regarding their resilience. 
  • Socio-demographic Characteristics of Schizo-obsessive Patients

    • Abstract: Obsessive Compulsive symptoms (OCS) occur frequently in patients with schizophrenia spectrum disorders with a rate varying from 10% to 64% for OCS and from 7.8% to 31.7% for OCD. The aim of our study was to evaluate socio-demographic features and psychopathological profile of OCS in schizo-obsessive patients. patients with DSM-5 diagnosis of schizophrenia spectrum disorders and current typical OCS were evaluated for Socio-demographic features and Yale-Brown Obsessive-Compulsive Symptoms checklist was used to determine form and content of OCS. The mean age of patients was 28.6 years (SD±3.104). As regard marital status, 50% (n=25) of patients were single, 40%(n=20) were married and 10%(n=5) were divorced. The majority of patients came from rural areas and were illiterate. The most common obsessions were those of contamination followed by obsessions of need for symmetry and the most common compulsions were those of cleaning. Conclusion: Socio-demographic characteristics help in delineating the profile of schizo-obsessive patients.
  • 12 months outcomes of 12 young patients after mitral clip implantation

    • Abstract: :Background: Mitral Clip became a well-established interventional option for severe MR in elderly patients with high surgical risk.Objective: to present 12 patients younger than 65 years with high operative risk treated by TMVR.Methods: Evaluation of 12 patients younger than 65 years from a total of 250 patients treated by MitraClip® in Westfalen Heart Center, Germany.Results: Mean age was 57.1 ± 4 years, male gender was 66,7%. The high operative risk was estimated by STS score (mean = 8.76 ± 2.89). The severity of MR was detected by biplane vena contracta (bpVCW) in two perpendicular views (mean = 9.73 ± 1.89 mm). Transmitral mean PG was 1.68 ± 0.75 mmHg. 3 patients showed leaflet prolapse, 5 patients had mitral annular dilatation, 3 patients exhibited mitral leaflet thickening and one patient showed papillary muscle displacement as the main etiology of MR.Procedural success was achieved in all patients with 1 / 2 / 3 clips implanted in 25% / 75% / 0% of cases. Two grades or more reduction in the severity of MR (MR grade ≤ II/IV) was accomplished in 75% of patients. Mean postprocedural MPG remained within acceptable levels of 4.33 ± 2.31 mmHg. During follow-up, persistent symptomatic improvement was confirmed in all patients who had already shown symptomatic improvement and effective reduction of MR after the procedure. No procedure-related mortality during the first 30 days Conclusion: MitraClip® in patients younger than 65 years provides satisfactory outcomes at 1 year.
  • MicroRNA Hsa- 484 expression in Multiple sclerosis patients and its
           relation to radiological features

    • Abstract: Background: Multiple sclerosis (MS) is an autoimmune disease that causes inflammatory demyelination in the central nervous system (CNS). The pathogenesis of MS involves interaction between a lot of factors including genetic, epigenetic and environmental factors. Many studies have focused on the role of micro-Ribonucleic acids in the pathogenesis of MS including miRNA 145 and miRNA 484.Objectives: The aim of this study is to evaluate the relation between the expression of micro-Ribonucleic acid 484 and the radiological features of MS patients. Patients and Methods: Plasma samples of 31 MS patients were analyzed using real time polymerase chain reaction technique to measure the relative expression of micro-Ribonucleic acid 484 in addition to MRI of those patients were analyzed for the number of T2 lesions in the brain and the spinal cord.Results: There was an insignificant positive correlation between miRNA expression and MRI T2 lesion number. Conclusion: miRNA -484 expression in MS patients is not significantly correlated with radiological features.
  • Gabapentin plus celecoxib as preemptive analgesia in complex spine surgery
           for improving perioperative patient anxiety and satisfaction, Is it
           effective' randomized double- blind controlled clinical trial

    • Abstract: Background: Preemptive administration of analgesic medication is more effective than medication given after the onset of the painful stimulus. This study aimed to evaluate the effect of gabapentin plus celecoxib as pre-emptive multimodal analgesia on anxiety score, patient satisfaction score, visual analog scale (VAS), and analgesic requirement. Methods: This randomized double-blind controlled clinical trial was carried out at Minia University Hospital. Fifty adult patients ASA I and II undergoing elective complex spine surgery. Patients were divided into two groups, 25 patients in each group; group A received 300mg gabapentin + 200mg celecoxib 2 hours before surgery; group B (placebo) received two placebo capsules orally 2 hours before surgery. Anxiety score, patient satisfaction, VAS, and perioperative analgesic requirements were assessed. Results: anxiety score was significantly lower in the study group compared with a control group (1.2±0.5) versus (3.8±1.7), respectively. The time for the first request for postoperative analgesia showed statistically highly significant longer duration in the study group compared to the control group, and the total dose of fentanyl required during the first 24 h post-operatively showed highly statistically significantly lower values in the study group compared to control group (P < 0.0001). There was a significant difference between the study and control groups in patient satisfaction and VAS (p=<0.0001 and p=<0.001) respectively. Conclusion: Preemptive administration of multimodal analgesia as a combination of gabapentin 300mg plus celecoxib 200mg 2hr preoperative in the patients undergoing complex spine surgery provided lower anxiety, analgesic requirement, and led to a high patient satisfaction score.
  • The importance of volumetric CT assessment of lung emphysema in COPD

    • Abstract: Background: Volumetric CT is preferable to pulmonary function tests for evaluating the distribution and types of emphysema in COPD patients because it is more accurate and can be performed during an acute exacerbation of COPD as well as in some cases where pulmonary function tests are contraindicated (if there are large emphysematous bullae the patient can develop pneumothorax). COPD is a major cause of death. Due to the fact that not all patients with airway symptoms seek medical care, the number of individuals affected by the disease is frequently underreported. COPD requires increased focus on early diagnosis. Methods: This study was conducted in Minia university hospital- Radiology department during the period from May 2021 to March 2022. On 30 Patients known with COPD collected from the outpatient chest clinic. Results: patient’s emphysematous changes on volumetric CT on the studied group in both lungs ranged between 5.6 – 48.0 % with mean value of 20.73±12.179 %. No statistical significant differences were found between current and ex smoker and between pulmonary function test and volumetric CT findings. Conclusion: The findings of the present study indicate that in the diagnosis and follow-up of COPD patients with emphysema, volumetric CT assessment of lung emphysema plays a critical complementary role with spirometry.
  • Patient Motivation for Seeking Bariatric Surgery, Minia City, Egypt.

    • Abstract: :Background: Bariatric surgery is becoming a common procedure to control the obesity problem. However, despite the prevalence of the surgery, little is known regarding the motivation of patients who seek out these procedures. The present study aims to identify reported reasons for bariatric surgery and determine if there is a difference between male and female response regarding the motives for seeking bariatric surgery. Methods: This cross-sectional study included 182 consecutive obese patients came for bariatric surgery at Minia University hospital from June to November, 2019. Patients asked to fill self-administered questionnaire preoperatively. Results: The mean age was 32.6±6 and 52% of the studied participants were males and 48% were females. The most patients seeking surgery are motivated primarily by medical condition (30.2%) and health concerns (20.3%). Females were concerned more by their appearance as a motive for seeking bariatric surgery, 34.5% compared to 0.0% of males. Females were embarrassed socially about themselves, 24.1% compared to 2.1% of males. However, males more likely to choose medical condition (41% vs 18.4 %, P=0.02) as their most important factor for seeking surgery. Conclusions: The appearance is the most important motive for the females and the physical health is the most important motive for the males.
  • Advanced magnetic resonance imaging (MRI) technique (double inversion
           recovery sequence) in the diagnosis of multiple sclerosis (MS) grey matter

    • Abstract: Background: Background: MS (multiple sclerosis) is an inflammatory demyelinating disease of the central nervous system. In spite of description of the grey matter involvement in MS, the conventional MRI sequences don’t have the ability of detection of MS cortical lesions. Aim of Study: To assess the diagnostic value of DIR sequence in the detection of MS lesions by comparing DIR with FLAIR and T2-weighted pulse sequences in the brain. Methods: This Cross Sectional Study was carried out in Radio-diagnosis Department, Faculty of Medicine Minia University. 30 MS patients aged (20 to 50) years were included. MR imaging was performed to all patients (T1WI, T2WI, FLAIR, DIR, DWI and ADC sequences are performed in axial planes in addition to sagittal planes for FLAIR and DIR). Results: A total of 30 patients were enrolled in this study, females 26 (86.7%) predominated males 4 (13.3%). The median number of cortical and juxtacortical lesions ± IQR detected by DIR sequence (3.00 ± 3.00) and (2.00 ± 2.00) respectively was significantly higher than that detected by FLAIR sequence (1.00± 2.00) and (1.00± 1.00) respectively and T2 sequence (0.00 ±1.00) and (1.00± 2.00) respectively, with (P-value<0.0001 & <0.0001) respectively. DIR identified significantly more infratentorial lesions in comparison to FLAIR (P-value <0.039), but detected lower number of lesions when compared to T2 sequence, but the difference was below the statistical importance (p-value<0.275). Conclusion: DIR brain imaging sequence had the highest sensitivity in the detection of cortical and juxtacortical lesions compared with FLAIR and T2 sequences.
  • Correlations between MRI brain volumetric measurements and IQ scores in
           Egyptian children.

    • Abstract: Background: The correlation between IQ scores and brain structures is still unclear. The brain volume may be one of the neurophysiological indicators for assessment of intelligence in children. This study aims to find the correlation between IQ score levels in Egyptian children and the MRI volumetric measurements of brain structures in aberrantly normal conventional MRI. Methods: A retrospective study included fifty-one children with normal conventional brain MRI studies were referred from Children and Maternity Hospital, Minya University in the duration from October 2018 to December 2019. Their ages were ranged from 2 to 14 years. Inclusion criteria: child has delayed speech, hyperactivity or learning disabilities in preschool age with aberrantly normal conventional MRI examination, exclusion criteria: Children with an abnormal MRI brain examination or have a contraindication for MRI techniques were excluded from this study. All children presented with delayed speech or with history of delayed speech as early clinical sign of delayed milestone They suspected to convectional MRI and volumetric MRI examination & IQ test (Stanford-Binet intelligence scales: fifth edition). Volumetric MRI assessed by automated online processing using ( pipeline. Result: 51 subjects were included in this study for an average age of 7.8±3.1year, the average IQ level was 64.69±13.9, with an average total brain volume 1227.96±204.26cm3. Despite positive correlation between IQ scores and brain radiographic measures, only total brain volume (p value = 0.024), intracranial cavity (p value = 0.041) and grey matter volume (p value = 0.009) had a statistically significant correlation with IQ levels. Additionally, males had a significant correlation between IQ scores and total brain volume (p value = 0.043) as well as grey matter volume (p value=0.012). Conclusion: Total brain volume is directly and significantly correlated with IQ scores in Egyptian children, especially in males. Further studies with more robust design are needed.
  • MRI and Carotid Duplex assessment of vulnerable carotid atheromatous
           plaques in acute stroke patients

    • Abstract: Background: Stroke is a global health problem that leads to disability. In 2005, stroke was responsible for 5.7 million (16.6%) deaths, and 87% of these deaths occurred in low-income and middle-income countries. Two-thirds of strokes are ischemic in origin and 50% of these are associated with severe internal carotid artery disease. The underlying predominant cause of carotid artery disease is atherothrombosis. Method: 20 patients with acute ischemic stroke were enrolled in this study. They were diagnosed clinically and radiologically by MRI brain, then referred to us to be assessed by carotid Duplex and carotid MRI. Results: All patients had carotid atheromatous plaques that show more than one criteria of the following, lipid rich necrotic core of the atheromatous plaque (90%), surface ulceration of the plaque (90%), thrombus on top (80%), hemorrhage in plaque (75%), only 35% had more than 90% stenosis of the carotid lumen by plaques. MRI assessment for carotid atheromatous plaques at acute ischemic stroke patients, it was evident that the right carotid arteries (CCA, ICA) were more affected 14 (70%), most of the atheromatous plaques had thin fibrous cap with lipid rich core 18 (90%), ulcerated surface18 (90%), calcification15 (75%), thrombus on top 16 (80%) as well as hemorrhage within the plaque 15 (75%) with statistically significant P value (0.01, 0.0001,  0.0001,  0.04, 0.001,0.04) respectively. Most atheromatous plaques 10 (50%) caused about 70-90 % luminal stenosis with statistically non-significant difference P value 0.4. Conclusion: Carotid duplex and MRI had complementary role in assessment of carotid atheromatous plaques in stroke patients.
  • A single preoperative dose of Gabapentin decreases postoperative pain in
           ambulatory anal surgeries

    • Abstract: Background: Anal surgeries are painful procedures despite advancements in postoperative pain management. Efficient post-surgical pain control is essential to patients’ recovery, it may contribute to fastening healing, patient mobilization, and reducing hospital stays. We aimed to evaluate the effect of single-dose gabapentin on postoperative pain in patients who underwent ambulatory anal surgeries. Methods: Prospective, randomized, double-blind controlled study; 50 patients were divided into two equal groups. All patients underwent ambulatory anal surgeries under spinal anesthesia with a plan to be discharged on the same day. Group G received 600 mg of oral gabapentin one hour before surgery, while group C received an oral placebo tablet one hour before surgery. The primary outcome was the severity of postoperative pain (visual analog scale 0 to 10 cm) was conducted at 0, 6, and 12h. The time for the first analgesic request, frequency of rescue analgesia in the first 12 hours, and postoperative sedation (Ramsay sedation score) at 0, 6, and 12h were monitored as secondary outcomes.  Results: The gabapentin group (G) showed significantly lower visual analog scale scores at 6, and 12 in comparison to the control group (C), and group G also showed a longer duration of analgesia and delayed analgesic rescue when compared with the control group. Ramsay sedation score showed insignificant differences between the two groups at 0, 6, and 12h postoperatively. Conclusions: A single preoperative gabapentin dose was effective in decreasing postoperative pain, prolonging the duration of analgesia, and decreasing the total opioid consumption, with no significant complications.
  • Ultrasound guided measurement of inferior vena cava diameter, common
           carotid artery diameter versus central venous pressure for estimation of
           intravascular volume status in critically ill patients.

    • Abstract: Introduction: Evaluation of intravascular volume status in critically sick patients at the bedside. The risk of organ failure and death may be impacted by how fluids are managed, which in turn affects systemic perfusion. When formulating a fluid management plan, clinicians often employ data from invasive hemodynamic monitoring in addition to that obtained from a patient's physical examination and laboratory assessment. The central venous pressure (CVP) is a widely used hemodynamic measure. Ultrasound is a non-invasive and cost-effective method that may aid in the diagnosis and treatment of critically sick patients in the intensive care unit.Aim of the workThe purpose of this research is to determine how fluid delivery affects IVC and common carotid artery (CCA) diameters, which are used to predict volume status in patients who are critically sick.Patients and Methods:After receiving clearance from the university ethics committee (approval number.133:2021) and the written informed consent of all Patients or first degree relatives, this prospective observational research was carried out between March 2021 and August 2022 at El-Minia University Hospital. We analysed 55 patients between the ages of 20 and 60, both sexes, who were admitted to our surgical Intensive care unit (SICU) with American Society of Anesthesiology (ASA) physical status II or III, were able to breathe on their own, were lying supine, and had a central venous catheter (CVC) placed because they needed constant monitoring and assessment of their intravascular volume status.
  • Clinical efficacy and safety of ND-YAG laser in hair reduction

    • Abstract: ABSTRACTBackground: Laser has become popular means of achieving hair reduction with improved quality of life. Meanwhile, different types of lasers show different clinical efficacy and safety according to the characteristic wavelength for each device and skin types of persons. Laser devices incorporating higher wavelengths have been developed to improve hair removal on dark skin, such as 1064 nm Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser. They not only provide deeper light penetration for targeting deeply located follicles but also allow for higher fluences to be used since absorption by melanin decreases when wavelength is increased and therefore the skin is heated less.Objective: This study aimed to assess the efficacy and safety of long-pulsed Nd: YAG laser on hair reduction. Patients and Methods: This study was carried out on 20 adult women who seek axillary hair reduction. These subjects were adjusted to receive 5 laser sessions with a 1- month interval. Clinical evaluation was done at 1 month after last session with detection of side effects of laser.Results: As regards Fitzpatrick skin type, 8 subjects (40 %) were skin type III and 12 subjects (60 %) were skin type IV. The hair count showed significant reduction (P<0.001) with hair reduction percentage of 64.3%. Regarding the side effects, there was significant pain during the procedure and encountered in 60% of cases. Conclusion: 1064-nm long pulsed Nd:YAG laser is safe and effective in hair reduction.Keywords: Hair reduction, axillary hair, long-pulsed Nd-YAG laser.
  • Reno-protective Role of Ginseng in Counteracting the Long-term Omeprazole
           Induced Adverse Effects in Albino Rats via Modulation of Inflammation,
           Apoptosis and Fibrosis

    • Abstract: Background: Omeprazole has long-term use adverse effects even though is commonly used. Aim: Evaluation of the possible renal protective effect of ginseng against the long-term omeprazole-induced adverse effects. Methods: Forty albino rats were divided into: C group (control), G group (ginseng), OM group (omeprazole) and OM-G group (omeprazole-ginseng). Renal functions and histological renal tissues were investigated. Results: The OM group had significantly high levels of urea, creatinine and 24-hours protein urea. A significant glomerular, tubular and interstitial injury was observed; congestion, inflammatory cell infiltration, tubular damage, increased collagen deposition and significant increases in COX-2 and caspase-3 immune expression. While adding ginseng with omeprazole resulted in marked improvement in these changes.Conclusion: Long-term use of omeprazole induced renal functional and morphological changes. All through induction of inflammatory reaction, fibrosis, cellular degeneration and apoptosis. By adding ginseng, these effects were ameliorated through its anti-fibrotic, anti-inflammatory, and anti-apoptotic effects.Keywords: Ginseng, Inflammation, Fibrosis, COX-2, Caspase-3.
  • Demographic data in COVID 19 patients

    • Abstract: COVID-19 illness has become a serious health issue that is harming healthcare systems around the globe. It is crucial to examine the epidemiological traits of COVID-19. The study aimed to show the demographic data and their associations with the laboratory and clinical data in COVID-19 patients. 46 COVID-19 patients and 20 normal controls were involved in this study. The subjects were submitted to routine laboratory investigations, including CBC, Random glucose level, renal function test, liver profile, CRP, Ferritin, and D dimer. The study indicated no significant difference in the demographic data between COVID-19 patients and healthy controls. Covid-19 subjects’ age was positively associated with blood urea and direct bilirubin levels. Increased Covid-19 patients’ age was linked to ferritin and D-dimer levels (p = 0.009 and p = 0.012).  Covid-19 patients’ gender correlated positively with hemoglobin levels. Age was a risk factor for the severity and clinical progression of the illness.                                                                                           
  • Concomitant ERCP and laparoscopic cholecystectomy for management of
           gallstones complicated by obstructive jaundice versus two sessions
           procedure comparative study, Minia university hospital experience

    • Abstract: Introduction: Choledocholithiasis is an important public health problem, since up to 18% of patients with cholelithiasis develop this complication of biliary lithiasis, stone extraction should be performed to avoid serious complications; the aim of this study is to compare one session procedure versus sequential sessions procedure for management of Choledocholithiasis.Patients and methods: This is a comparative clinical study that was done on 60 patients with combined gallbladder and CBD stones attending to Minia University Hospital of gastro enterology and hepatology between November 2021 and November 2022 surgery Patients were divided into two groups ,Group A:.30 of them were managed by one session procedure ,group: 30 patients was managed by sequential sessions procedure .Results:as regard number of ERCP and anesthesia sessions in both groups in group A mean number number was 1±0.0 in group B was 3,7±1.4 (p<0.001). In group (A), ERCP success rate (100%) , lap. Cholecystectomy failure rate 13.3% . In group (B), ERCP success rate 90%. lap cholecystectomy in failure rate 20% (p=0.024). The mean duration of hospital stay in group (A) was 2.0± 1.8 days and 7.0± 3.5 days in group (B) (p<0.001). as regard post-operative complications group A reported two cases pancreatitis while 13 cases in group (B) showed postoperative complications,(p=0.003). The mean cost of operation in group (A) was 32527± 11801 L.E and 55363± 20573 L.E in group (B), (p<0.001). Conclusion :- one session procedure was better than sequential sessions procedure as regard cost, hospital stay, and postoperative complication,
  • Posterior Mesh Rectopexy versus Resection Rectopexy in Complete Rectal

    • Abstract: Introduction: Rectal procidentia is a disabling condition. Surgical repair is the treatment of choice for candidates who have a full thickness rectal procidentia. Multiple procedures exist for the repair of rectal procidentia, however; none of them is most effective. Patients and methods: This study was carried out at Minia University Hospital as a prospective non randomized study that compared laparoscopic posterior mesh rectopexy (Group A; n = 20) with Recto-sigmoidectomy (Group B; n = 20) for complete rectal prolapse as regards complications; functional outcomes and sexual functions after surgery. Results: In the current study , the female to male ratio was 3: 2 and their ages ranged from 19-70 years with mean age of 41.2 years. The operative time in the resection rectopexy group was significantly longer than the rectopexy group. No significant difference between the two groups regarding intraoperative complications. Resection rectopexy Group had statistically significant drop in the constipation score than Posterior mesh rectopexy group with a mean score of 16.9 point(pre) and 2.3point(post) versus a score of 10.3point(pre) and 4.3point(post) respectively. There is no incontinence occurred in mesh rectopexy group but in resection rectopexy group; there were 6 patients developed incontinence with a range 0-20 point and mean 5.4 point The P-Value was 0.007 and it is statistically significant. Sexual functions are preserved in both groups. Conclusion: Although recto-sigmoidectomy seems to affect the continence ,it improves constipation scores more significantly in patients with chronic constipation than the mesh rectopexy. Sexual functions will be preserved in both operations.
  • Standardization of Questionnaire about Short-Term Quality of Life Outcomes
           Following Pediatric Septoplasty

    • Abstract: Background: Septal deviation is one of the commonest disorders in pediatric population, which may cause symptoms of obstructive sleep apnea, headache, epistaxis, hyposmia, and postnasal drip, nasal obstruction, and these symptoms affect the life quality in children. Aim: This study aim to is standardized questionnaire about sinus and nasal quality of life survey using Sinus and Nasal Quality of Life questionnaire (SN-5) following septoplasty in pediatric and to assess benefits differences by age and sex in these patients. Methods: 30 pediatric patients from 7 to 16 years old with severely deviated septum grade 2 in Cottle’s classification diagnosed by endoscopic examination and CT scan with medically unmanageable symptoms, closed endoscopic hemitransfixation septoplasty done for all patients. The pre- and post-operative SN-5 collected by the same questionnaire and in the Arabic translated one.Results: There was significant improvement in the nasal obstruction symptoms postoperatively using SN-5 and there is no detected relation between SN-5 and the age or the sex of the patientsConclusion: Septoplasty should be done in severely deviated septum which impacts normal nasal breathing and life quality in these patients as early as possible.
  • The Possible Therapeutic Role of Probiotic on Cyclophosphamide Damaging
           Effects in Adult Male Albino Rat Jejunum

    • Abstract: Background: Cyclophosphamide (CP) is extensively used as an antineoplastic drug but unfortunately, it is cytotoxic, to the intestinal mucosa. Probiotics have beneficial effects on the intestinal mucosa. Aim of the work: The current study aimed to investigate the possible protective effects of probiotics against the structural and biochemical changes that occur in the rat jejunum after CP administration, and to address some of the underlying mechanisms of these effects. Materials and methods: Thirty-six adult male albino rats were randomly divided into six groups: the C-group, Prob-group, CP-2D group, CP-2w group, Prob-CP-2D group, Prob-CP 2W group. Blood samples were collected for serum IL-10 level assay. Jejunum specimens were excised for histological, immune-histochemical, and morphometric studies. Other tissue specimens were proceeded for estimation of MDA and GSH levels. Results: The results showed marked morphological and biochemical changes in CP-2D group that decreased in CP-2W and Prob-CP-2D groups but still with a significant difference if compared to the control group. Moreover, the Prob-CP-2W group displayed a marked improvement of all previously mentioned data. Conclusion: It can be concluded that the administration of probiotics ameliorated the toxic effect of CP on jejunum through their anti-inflammatory, anti-oxidative, and anti-apoptotic effects.
  • Comparison of intraocular pressure and anterior segment parameters between
           pseudoexfoliation patients and healthy controls

    • Abstract: Background: pseudoexfoliation (PEX) syndrome is a common age-related disease characterized by the accumulation of grey-white extracellular fibrillary material on anterior segment structures. The aim of the study is to compare intraocular pressure, anterior chamber angle in pseudoexfoliative patients and normal population. Methods: The participants were divided into 2 groups: Control group: includes 16 healthy normal eyes. PEX group: includes 25 pseudoexfoliative eyes diagnosed by slit-lamp biomicroscopy. The study was conducted in the ophthalmology department at Minia University Hospital. All participants examed by slitlamp biomicroscopy, intraocular pressure measured by Gold mann applanation tonometry, Gonioscopy grading and Scheimpflug imaging using pentacam (OCULUS, Wetzlar, Germany) analysis under scotopic conditions.  Results: There are no significant differences of the anterior segment parameters, intraocular pressure or gonioscopy when comparing PEX cases versus controls except in the CCT.Conclusion: Assessment of anterior segment parameters is an important as CV measurements and corneal thickness might be indirect indicators of endothelial function in patients with PEX..
  • Hepatic Steatosis in obese individuals undergoing bariatric surgery

    • Abstract: Introduction: Metabolic associated fatty liver disease (MAFLD) is now a leading cause of chronic liver disease worldwide. The global prevalence of MAFLD among the obese  individuals is 6.3–33 %, increasing up to 75.8 % and even surpassing 96 %. Diagnosis of MAFLD depends on the presence of steatosis detected by liver biopsy or ultrasound. Aim of the study: Our aim was to assess the prevalence of hepatic steatosis in obese patients  before  bariatric surgery in our locality. Materials& Methods: This is a cross sectional study conducted in endemic medicine department Minia university hospital in the period from May to December 2022.It included 49 patients (≥18 years) with BMI ≥ 25 undergoing bariatric surgery , where clinical examination, anthropometric measurements, biochemical tests, ultrasonography and liver biopsy were taken at the same day of operation. Results: The study included 8 males and 41 females, with the mean age of 38 years and a range from 18 to 59 years. the prevalence of steatosis by liver biopsy were 27 case (55.11%) while by ultrasonography was 100 % Conclusion: hepatic steatosis is a common finding in obese patients undergoing bariatric surgery and can be detected by abdominal ultrasonography and liver biopsy.
  • Evaluation of incidence of structural valve deterioration in patients with
           Freestyle aortic valve

    • Abstract: Background: The Freestyle aortic root bio prosthesis is a complete porcine aortic root implanted by different techniques: sub coronary, root inclusion, or complete aortic root replacement. The choice among the three implant techniques depends on surgeon preference or upon the pathology encountered. Its implantation is done by open heart surgery. The study aimed to trace the prevalence of sub clinical leaflet thrombosis in patient underwent free style aortic valve replacement, and how far is the need for anticoagulation therapy to protect the patients from being involved in transient ischemic attacks (TIAs) or strokes. Method: This study enrolled 47 patients underwent Freestyle aortic valve and had MDCT at least with two follow up point interval post operative. We evaluated the cusp structure and possible sub clinical thrombosis using a retrospective ECG gated CT angiographic study. Results: We observed 22 cases with positive thrombus out of 47 with percentage of 46%, with negative relationship between thrombus formation and oral anticoagulant taking. The cumulative incidence of thrombus was increasing over years. Conclusion: Sub clinical thrombus formation is a common complication over Freestyle bioprosthetic valve and makes oral anti-coagulant taking mandatory
  • Effect of early intake versus known standard intake of cabergoline in
           prevention of development of OHSS in ICSI cycles

    • Abstract: Ovarian hyperstimulation syndrome (OHSS) is a dangerous iatrogenic complication of ovulation induction (1). Though it is a rare (2) or an uncommon (3) condition its true incidence is difficult to delineate as a strict consensus definition is lacking (3) . The incidence ranges from of 33 % in mild cases to 3-6 % in moderate cases while reaching only 1-2% in severe cases (4,5). These severe cases are life-threatening conditions that could be fatal. Furthermore, the pathophysiology of this condition is not fully clear, understanding it helps identifying preventive and treating modalities (6).This study was an interventional comparative clinical trial including eighty patients with high risk for ovarian hyperstimulation attended to the infertility clinic/ center of Obstetrics and Gynaecology department , El Minia University Maternity hospital , El Minia , Egypt and in private centers and undergoing ovulation induction using GnRH agonist down regulation protocol for ICSI cycles . Patients was divided into two groups according to the drug regimen used for OHSS risk prevention. The study was conducted between April 2019 and April 2020 after approval of the study protocol by the Ethical Committee of and all participants will sign an informed written consent form.
  • Pathophysiological mechanisms of type 2 diabetes mellitus and the effects
           of metformin treatment in adult male albino rats.

    • Abstract: Background: Type 2 diabetes mellitus (T2DM) is a chronic global disease characterized by serious complications. Evidence has shown that free radicals’ formation is involved in the pathogenesis of the disease and development of its complications. T2DM is associated with disrupted glucose and lipid homeostasis with abnormal insulin sensitivity and/or secretion. No single treatment regimen is absolutely 100% effective. Metformin is a first-line treatment for T2DM whose main actions are the suppression of gluconeogenesis and the improvement of glucose uptake and insulin sensitivity. However, the exact mechanism of action is not clearly understood. Therefore, the current study aimed to assess the protective effects of metformin against diabetic complications in rats with explanation of the possible underlying mechanisms. Methods: rats were allocated in 3 groups. group1: control (C) received normal pellet diet (NPD), group2: diabetic (D) received high fat diet (HFD) for 2 weeks then injected intra-peritoneally (IP) with single low dose of streptozotocin (STZ) (30 mg/kg), group3: diabetic metformin treated (DM) received metformin 500 mg/kg/day by gavage for 4 weeks. Rats were sacrificed after 4 weeks of treatment. Results: The damaging effect of STZ on the pancreatic beta cells resulted in T2DM that was evaluated by assessment of glucose, insulin, Homeostasis model assessment of insulin resistance (HOMA-IR), TGs, LDL, HDL, Urea, and malodialdehyde (MDA) in the diabetic rats ’serum. Conclusion: The results suggested the protective effects of metformin on ameliorating the diabetic effects
  • Language Disorders in Children with Chronic Cardiac Illness

    • Abstract: Objective: This study's objective is to collect baseline data on the prevalence and distribution of language disorders in children with chronic cardiac conditions in order to create a plan for early detection, accurate evaluation, and, if possible, intervention to manage these disorders.Patients and Methods: This study was carried out on 50 children aged from 2 to 7 years and 5 months, and classified into 2 groups: The (study group) included 25 children diagnosed with chronic cardiac diseases and the (control group) included 25 children without cardiac diseases. All children were assessed according to the language assessment protocol in the Phoniatrics Unit, Minia University Hospital.Results: Children with chronic cardiac diseases had lower scores in intelligence quotient and language indicating impaired neurocognitive function. There were 14 (56 %) of children with cardiac diseases had language disorders (48% DLD below average, and 8% MR).Conclusion: It was evidenced that children with chronic cardiac illness had lower scores in language.
  • Double stimulation (Duo Stim) versus conventional controlled ovarian
           hyperstimulation in improving pregnancy rate in poor responders undergoing

    • Abstract: Objectives: To compare conventional long protocol versus Duostim protocol to improve pregnancy rate in poor responders undergoing ICSI.Patients & methods: This prospective randomized study included fifty poor responders planned for ICSI in Minia infertility research unit (MIRU) between the period of January 2020 and Desember 2021. The participants were presented in two groups as follow: Group A: include 25 patients used the standard long protocol for controlled ovarian hyperstimulation & Group B: include 25 patients used the double stimulation protocol (Duo Stim) for controlled ovarian hyperstimulation.Results: Our results observed that both groups were comparable as regards to their baseline characteristics. The chemical pregnancy rate was insignificantly (P= 0.306) higher in the Duostim group than the long protocol group. It was 28% in the Duostim group and 16% in the long protocol group. The clinical pregnancy rate was insignificantly (P= 0.44) higher in the Duostim group than in the long protocol group. It was 20% in the Duostim group and 12% in the long protocol group.Conclusion: Duostim protocol is apromising protocol in poor responders
  • Association between smoking and urinary bladder cancer (BC): case control
           study in Minia, Egypt

    • Abstract: Background: Bladder cancer (BC) accounts for an estimated 500 000 new cases and 200 000 deaths worldwide each year in 2019.Aim: To determine the relation between smoking and development of BC in patients attending Minia Oncology centre and compare them with their control.Methods: Study included 100 BC patients attending Minia oncology centre and 100 control subjects matched by age and sex. Subjects par‌ticipating in the study filled in a questionnaire including questions about socio-demographic data, medical history and dietary and lifestyle factors.Results: Our results showed that studied BC cases had higher smoking index with mean of 7.77±3.76 compared to controls 3.08±1.88 (P=<0.001). Mean duration of years since quitting smoking was significantly higher in studied controls than in BC cases with mean of 12.8±2.9 and 9.1±2.1 respectively. Smoking index was a risk factor for BC with (OR= 1.29). Conclusion: BC is a common malignancy. The main risk factors were smoking, family history and dietary factors. BC will remain frequent because of the ongoing high prevalence of smoking. Smoking cessation programs and dietary modification should be encouraged and supported.
  • Chemical component separation with botulinum toxin type A in the
           management of complex midline ventral hernia: A prospective randomized
           controlled comparative study

    • Abstract: Introduction: The repair of complex ventral hernia poses a significant challenge, as there is currently no universally accepted evidence-based approach for its treatment. One of the primary issues that arise in such instances is the loss of domain, which leads to a subsequent rise in intra-abdominal pressure following the repair.Patient & Methodology: A prospective, randomized, controlled cohort study was carried out at the General Surgery theater and Section 11(A) of Cairo University Hospitals, as well as the Department of General Surgery, Faculty of Medicine, Minia University, spanning from March 2020 to March 2022. The research encompassed a cohort of 51 patients who underwent elective surgical intervention for Complex Midline Ventral hernia repair, with or without loss of domain. Results: our study comprised a total of 51 participants who were categorized into three distinct cohorts.Each group consisted of 17 patients.The first group was administered Botox exclusively, while the second group received Botox with PPP. The third group was subdivided into two subgroups, with five patients receiving PPP and 12 patients receiving no preoperative intervention. The incidence of intraoperative intestinal injury was 17.6% in the Botox group, 0.0% in the Botox with PPP group, and 29.4% in the control group. Recurrence was observed solely within the control group, with a prevalence of 5.8%. Conclusion: the employment of a combined approach involving Botox and PPP for preoperative preparation represents an efficacious method for complex ventral hernia repair. This technique serves to mitigate the risk of ACS, intraoperative intestinal injury, and postoperative recurrence.
  • Effect of artificial accelerated Aging on Translucency of CAD/CAM HT
           Zirconia and Reinforced Composite material at Two Different Thicknesses.

    • Abstract: Objectives: Aimed to evaluate the effect of artificial accelerated aging on translucency of two aesthetic materials namely CAD/CAM, HT Zirconia and reinforced composite based materials at two different thicknesses.Materials and methods: high translucent zirconia and reinforced CAD/CAM composite. A total of forty disks specimens, shade A2, were prepared from two different CAD/CAM materials and ordered into two groups (n=20) according to type of material. Then each group divided to 2 subgroups according to thickness 0.3 and 0.5mm (n=10). Evaluation of translucency parameter done before and after artificial accelerated ageing for 5 hours in an autoclave at 134°C, 0.2 MPa utilizing a spectrophotometer. the Translucency Parameter (TP) was determined TP=[(ΔL*)2+(Δa*)2+(Δb*)2]1/2. Repeated measures ANOVA test was utilized to study the impact of material, aging, thickness in addition to their interactions on translucency parameter (TP). When the ANOVA test is significant, Bonferroni’s post-hoc test was performed for pair-wise comparisons. level of significance determined at P ≤ 0.05. Results: Regardless of thickness, Composite revealed statistically significantly greater mean TP than zirconia (P-value <0.001). Thickness had an impact on the translucency parameter of two materials. Within group comparisons revealed that for each of the two materials, 0.3 mm revealed statistically significantly higher mean TP than 0.5 mm (P-value <0.001). A statistically significant impact of aging on translucency parameter (P-value <0.001) was existing which aging showed statistically significantly decreasing in mean TP for both materials.Conclusion: the translucency parameter was significantly affected by type of material, thickness, and aging within the limitations of this study.
  • Evaluation of Infarction Pattern in Patients with Symptomatic Intracranial
           Atherosclerosis: TCCD and MRI Study

    • Abstract: Background: Intracranial atherosclerosis - or intracranial atherosclerotic disease (ICAD) - is a dynamic disease characterized by progressing atherosclerotic plaques in major intracranial arteries. Patients with ICAD have a 10 - 20% annual risk of stroke. This study aims at studying the demographic, clinical and imaging characteristics (emphasizing the infarction pattern) in patients with symptomatic ICAD. This cross-sectional study was conducted during the period between November 2021 and July 2022 on patients with acute ischemic stroke caused by intracranial stenosis recruited from the stroke units of Minia University and Kasr Alainy hospitals. All patients were subjected to complete history taking, general examination and meticulous neurological examination. All patients were subjected to brain MRI examination and vascular duplex scanning of extracranial and intracranial Carotid and vertebrobasilar systems. The research was conducted after the approval of the Ethical Review Committee of Faculty of Medicine, Minia University. Results: Forty two patients have been included in this study; 22 males and 20 females ranging in age between 40 to 90 years. Hypertension was the most common risk factor (59 %). The NIHSS ranged from 2 to 20. MCA was the commonest artery to be symptomatically stenotic (42.9%). Territorial pattern was the dominant pattern (59.5%) especially in the anterior circulation, and had the highest NIHSS scores. Conclusion: MCA was the commonest to have symptomatic ICAD. Territorial pattern was the dominant pattern. Territorial pattern had the highest NIHSS scores.  
  • Biochemical changes in type 2 diabetic patients comorbid with COVID-19

    • Abstract: Introduction: Uncontrolled Type 2 Diabetes Mellitus (T2DM) has been shown to be associated with an increased severity of COVID-19, it represents an important risk factor for adverse outcomes. Altered glucose metabolism was the basis of the viral infection, leading to a fatal inflammatory reaction, The relationship between COVID-19 and diabetes mellitus is complicated and bidirectional. Diabetes mellitus is considered one of the most important risk factors for a severe course of COVID-19. At the same time, severe COVID-19 infection, and its treatment with steroids, may have negative impact and side effects on diabetes itself, leading to worsening of hyperglycemia through increased insulin resistance and reduced β-cell secretory function.Aim of the study: Evaluate biochemical abnormalities in infected type 2 diabetic patients comorbid with COVID 19.Patients and Methods: The current study is a case control study was conducted on 89 persons, 35 males and 54 females of the same age group (40 :75 years) were selected from outpatient clinic of diabetes, Diabetes and Endocrinology unit, and Intensive care unit of Department of internal medicine at Minia University Hospital from December 2021 to May 2022.Results: D-Dimer levels significantly higher in diabetic with COVID-19 group than diabetic group with p value (>0.001).Serum cholesterol levels significantly higher in diabetic with COVID-19 group than diabetic group with p value (0.01).Conclusion: D-dimer is a good prognostic biomarker for outcome of type 2 diabetic patients infected with COVID-19. Keywords: Diabetes mellitus, COVID-19, Total cholesterol, D-dimer.
  • Neurological effects of COVID-19 in pediatric patients with the
           multisystem inflammatory syndrome in children (MIS-C).

    • Abstract: Background: In December 2019, people residing in the Chinese region of Wuhan were reported to have developed a severe form of pneumonia brought on by a novel coronavirus that is now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since then, cases of COVID-19, have been documented from every nation in the world. Objective: To assess the neurological impact in paediatric patients with COVID-19-associated Multisystem Inflammatory Syndrome in Children (MIS-C). Methods: Patients who were admitted to Minia University Hospital's Pediatric Intensive Care Unit (PICU) isolation unit between December 2020 and July 2022 were included in this cross-sectional study. We investigated at a total of 368 patients, of which 62 had PCR results that were positive for covid. Results: Convulsions was demonstrated among the patients by 20 (31.7%), p-value<0.0001. followed by DCL was 18 (28.2%)p-value<0.0001. Headache was also demonstrated among the patients also by 18 (28.2%)p-value<0.0001. Weakness was also demonstrated among the patients 18 (28.3%)p-value<0.0001. While, drowsiness among patients was (9 (14.52%), p-value<0.0001. Hypertonia, hyperreflexia, hypotonia, hyporeflexia, 4 (3.5%) and2 (1.7%) respectively. The majority of the patients had abnormal ground glass opacities on their chest scans (CO-RADS III). The number of patients who had neurological manifestations show significantly increased mortality. Conclusion: paediatric patients with SARS-CoV-2 infection may have life-threatening neurological disorders, even if only neurologic symptoms are present, patients should be tested for SARS-CoV-2 due to its prevalence in children. In addition, many of these patients arrived at the hospital unaware of COVID-19 exposure and positivity, so testing is necessary.
  • Assessment of Sleep Quality In patients With Interstitial Lung disease In
           Minia University Hospital

    • Abstract: It's common for people with interstitial lung diseases to have problems in sleeping. Lack of sleep or poor quality sleep has been associated to an impaired quality of life, an increased risk of death, and even tragedy in children with ILD.Consider the Big Picture: Patients at Minia university Hospital who have been diagnosed with interstitial lung diseases will be surveyed to assess their sleep quality.Research Strategies and Human Subjects With a diagnosis of lung disease, 110 patients were recruited between December 2019 and December 2021 at Minia University Hospital's inpatient sector or intense outpatient plan of such chest department. Data collected included demographic boundaries (age, sex, body mass index [BMI] and occupational history). The pulmonary capacities were evaluated. Patients assessed their own sleep using a quiz (Pittsburgh sleep quality index PSQI, Epworth sleepiness scale ESS, and STOP BANG) to provide feedback on its quality. The subjects were also required to walk during 6 minutes (6-MWT).The average age of our sample of 110 patients with ILD was 51.9 ±14.5, but 81.8% were female. There were sixty-three patients (57.2%) who complained about having poor sleep. Both the Epworth sleepiness scale and the mass index showed significantly different distributions across the groups. When comparing the high-quality sleep group to the low-quality sleep group, the high-quality group had significantly higher rates both of BMI and Epworth sleep scale (p0.0001 and p0.02, respectively).This means that people with ILD have bad sleep patterns regardless of their health.
  • Receptor for advanced glycation end products (RAGE) as a novel biomarker
           for differentiating drowning from postmortem submersion

    • Abstract: Background and objective: Drowning is the death caused by fluid blocking the airway leading asphyxiation. One of the most difficult challenges in forensic medicine is making the diagnosis of drowning. Drowning is considered one of the most common causes of unnatural deaths worldwide. Determining whether a body entered water before or after it died is crucial in the practise of forensic medicine. The objective of this study was to differentiate drowning from post mortem submersion using receptor for advanced glycation end products (RAGE).Methods: Twenty adult male albino rats were used in this study. They were split into 2 groups (drowning and postmortem submersion). There were ten rats per group. Each rat's lungs were meticulously sampled, and PCR was used to assess RAGE expression.Results: RAGE expression showed a significant difference between drowning and postmortem submersion groups.Conclusion: RAGE could be a helpful biomarker for differentiating drowning from postmortem submersion.
  • Integrated lung and inferior vena cava ultrasonography for dry weight
           assessment in pediatric patients on regular hemodialysis: A single center

    • Abstract: Background: Adequate assessment of fluid status is an imperative objective in the management of HD patients. An accurate assessment of dry weight is challenging. Objective: The aim was to assess applicability of clinical using integrated lung and IVCCI ultrasonography to assess dry weight and the adequacy of fluid removal in hemodialysis children Patient and method: 60 patients classified into Group I who their dry weight adjusted by using integrated lung U/S and IVCCI. Group I (a) same group when dry weight adjusted by using clinical judgment.Result: Results revealed improvement in clinical scores (orthostatic giddiness and breathlessness scores), blood pressure measurements and BNP serum levels when dry weight adjusted by integrated lung–IVC USG than when was adjusted by clinical judgment.Conclusion: Adequacy of volume removal after a HD session can be assessed counting the number of residual B-lines on LUS and measuring IVCCI and integrated lung–IVCCI USG could be a valuable method for monitoring dry weight in pediatric dialysis patientsKeywords: Dry weight, Hemodialysis, lung and IVCCI ultrasonography.
  • The Effect of Using Local Injection of Methotrexate in Management of
           Cesarean Scar Pregnancy in Minia University Maternity Hospital

    • Abstract: A cesarean scar pregnancy (CSP) is a rare and potentially life-threatening form of ectopic pregnancy. Therefore, the accurate and early diagnosis of CSP is very important for prognosis. Although MTX-based chemotherapy has been recognized as a relatively convenient and safe method of treatment, there have been no reports on the efficacy of local or systemic therapies for CSP, Aim and objectives; to determine the efficacy, acceptability and complication of using local injection of MTX in management of ceaserean scar pregnancy, Subjects and methods: This was a prospective study, was carried out on CSP patients treated at our Department of Obstetrics and Gynecology, Minia maternity and children university hospital, during the period of 2022 – 2023. A diagnosis of CSP relied on routine sonographic criteria. The protocol for treating CSP in our hospital was suction evacuation and chemotherapy with MTX, Result; there is a significant difference between success and failure treatment patients regarding initial β-hCG, Conclusion; single-dose local injection of MTX seems to be a safe, effective, and fertility-preserving treatment method for CSP treatment as a first-line treatment without surgical treatments. The presence of high β-HCG level at the beginning of treatment increase treatment failure. For this reason, local MTX can be applied as a safe and effective method in all technically applicable CSP cases
  • Selenium level in a sample of thyrotoxic Egyptian patients.

    • Abstract: Background: Selenium is an essential trace mineral that supports many body processes. It can help improve cognition, immune system function, and fertility and plays a key role in maintaining thyroid hormone metabolism and DNA synthesis and protecting the body from oxidative damage and infection. Objective: to detect selenium level in a sample of thyrotoxic Egyptian patients and to detect whether it's level is affected in thyrotoxic Egyption patients with and without thyroid eye disease.Patients and Methods: This prospective case-controlled-hospital-based study was carried out in out patient clinic of internal medicine department faculty of medicine Minia university from August 2021 to June 2022. the study included 50 subject divided into 2 groups :group1 which involved 35 Egtptian thyrotoxic patients (20 females and 15 males), group2 Consisted of 15 apparantly healthy subjects (10 females and 5 males) . patients were excluded if any of them were critically ill other thyroid diseases rather than thyrotoxicosis -any patient who was critically ill or recently admitted to ICU ,all included patients were subjected to history taking , clinical examination, laboratory investigation in the form of TSH,FT3,FT4,Selenium level and selenium by ELISA .Results : the study domanastrated apredominant female gender and serum selenium level was significant low in this sample of thyrotoxic Egyptiian patients with and without eye disease as compared to control group.Conclusion : Serum selenium levels was low in this sample of Egyptian thyrotoxic patients and may has a role in thyroid eye disease. Key words: thyroid, eye disease, selenium .
  • A RED system guiding stent to accurately mimic the pre-planned distraction
           vector; a case report study new after resubmission

    • Abstract: . The RED system is one of the most effective midface distractors in maxillary deficiency of cleft patients. However, determining the correct vector and accurately transferring it to the patient is incompetent and time consuming. We designed a new guiding stent that allowed the precise replication of the virtual pre-planned vector prior to commencing the general anaesthesia. Thus, improving the outcome, facilitating the procedure and dramatically reducing the operative time. The purpose of this study was determining the best vector via virtual surgery, virtually mounting the haloframe of the red system and the oral device in place,accurately mimicking the preplanned red haloframe and oral device to the actual patient position via the guiding stent,and to facilitate preanesthetic mounting,disassembly to allow osteotomies then reassembly again in the same position. One patient with midface hypoplasia due to cleft lip and palate underwent maxillary distraction osteogenesis using a rigid external distraction device in combination with the proposed removable stent that was fixed onto the maxillary teeth and the face to provide accurate vectorial guidance to the proposed advancement. Initial records showed severe maxillary hypoplasia and negative overjet. No complications inserting or removing the splint post-surgically, including pain or discomfort, were observed. The use of the removable stent has proved to be a highly effective guiding tool to manage the severely hypoplastic maxilla, eliminating unwanted advancement ,reducing operative time and obtaining more accurate results
  • Value of D-dimer, P-selectin, and fibrinogen as biomarkers for patients
           with Covid-19

    • Abstract: Background: Due to coronavirus's simple means of transmission, COVID-19 spread like wildfire. The use of biomarkers in emergency departments for corona virus infection screening and early diagnosis is gaining more attention. Aim and objectives: This study aimed to evaluate D-dimer, fibrinogen and p-selectin levels in hospitalized Covid-19 patients and its correlations with other routine investigations for predication of their prognosis. Subjects and methods: On 40 covid-19 patients, levels of D-dimer, fibrinogen, and soluble P-selectin in both ICU and non-ICU patients were measured and correlations with other routine investigations were done. Results: According to D-dimer, p-selectin, and fibrinogen among the groups under study, there was a statistical significance increase in D-dimer and p- selectin in both ICU(p<0.001, 0.0001) and non- ICU (p=0.014,0.0001) when compared with control. But, fibrinogen was decrease in non-ICU when compared with control group (p=0.0001) and then start to increase in ICU patients when compared with non ICU patients (p=0.029). Conclusions: All physicians are extremely concerned about the worldwide emergency of COVID-19 disease. Therefore, readily available biomarkers including D-dimer, fibrinogen, and p-selectin are useful for determining and suspecting the fate of COVID-19, particularly in patients who are hospitalised.
  • Erector Spinae Plane Block For Control Of Stress Response In Multiple Rib

    • Abstract: Bachground : Rib fractures are seen in more than 50% of patients presenting with blunt chest trauma and are associated with significant morbidity, long-term disability and mortality. More recently, ultrasound-guided fascial plane block techniques, such as the erector spinae plane block and serratus anterior plane block, have emerged as alternatives that are purported to provide excellent analgesia while being simpler and theoretically safer to perform. Methods: the patients will be allocated into two groups:Group C (control group)Patients of this group received intravenous paracetamol 1gm/8h plus liometacin amp/12h andGroup E (ESPB group) were undergo erector spinae plane block. . Results; marked reduction in pain score, prolonged time to 1st analgesic request, lowest rescue fentanyl consumption,decrease cortisol level with better hemodynamic stability , patient satisfaction and less top up doses of fentanyl without any complications related to block technique when compared with patients received normal analgesics. Conclusion: that ultrasound guided continous erector spinae plane block with bupivacaine (15 ml) resulted in more effective analgesia for multiple ribs fracture with control of stress response.
  • Liver abnormalities and clinical outcome of covid -19 infected patients

    • Abstract: Liver harm is discovered in up to half hospitalized COVID19 patients and result either from actions of SARS-CoV2 or from medicine treatment. the current paper introduces Associate describes the pathways by SARS-CoV-2 resulting in liver injury. this will be caused by direct binding of the virus and native actions in cholangiocytes, however might also indirectly result from the final state of drive and general inflammation in COVID-19 patients. Aim of the study: The aim of the current study to evaluate liver abnormalities and the effect of these changes in prognosis of patients infected with Covid-19 in Minia University hospital.Materials& Methods: This study is a a prospective study, during the period from May to December, 2021.This study included 325 patients with covid-19 Minia university hospitals.Results: Significantly increased levels of TB and DB (p<0.0001*) were seen in patients with abnormal liver enzyme levels and liver injury as compared to patients with normal levels and normal liver . Significant increase in the levels of AlT and AST was(p<0.0001*) CRP and ferritin p<0.0001) peaks were observed on 2nd and 3rd day of admission respectively. positive correlation was found between the levels of these inflammatory markers and liver function parameters in covid 19 patient .Conclusion: More than half of patients admitted to the hospital with SARS-CoV-2 infection had an abnormal liver function which was found to be associated with raised levels of inflammatory markers. Significantly higher proportions of patients with liver disease and were at higher risk of progressing to severe disease.
  • Impact evaluation of Diabetes Mellitus in postcovid patients in Minia
           university hospitals

    • Abstract: Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19), infected more than 126 million individuals, and caused more than 6 million fatalities globally. Diabetes is chronic endocrine/metabolic disease with heterogeneous etiologies, clinical presentations, and associated complications. caused mainly by insulin deficiency and/or insulin resistance. It remains unknown whether diabetes alone or in conjunction with accompanying illnesses contributes to the poorer prognosis. Patients and Methods: This study is a retrospective observational study, during the period from May 2021 to May 2022. This study included 300 laboratory-confirmed SARS-Cov-2 infections. Attended the isolation wards in our internal medicine department at Minia university hospitals.Results: We found that in individuals with COVID-19. Diabetes and COVID-19 may interact in both directions, as SARS-CoV-2 infection may exacerbate pre-existing diabetes and may predispose non-DM people to develop diabetes. In addition, SARS-CoV-2 pancreatic cell invasion induces -cell autoimmunity in susceptible individuals, resulting in type 1 diabetes and Increased COVID-19 severity.Conclusion: In individuals with COVID-19. Diabetes and COVID-19 may interact in both directions, Also, newly diagnosed diabetes In this study. Diabetes was more prevalent in individuals with severe COVID-19, also as regards the comorbidities, Diabetes patients have a higher rate of complications such as cardiovascular disease, pulmonary disease, cancer, and other chronic conditions .Also, In our study, the individuals with NIDDM had greater inflammatory markers additionally, the complications were obvious to be much more in recently diagnosed diabetics
  • Intracorporeal Versus Extracorporeal Anastomosis In Laparoscopic Right
           Hemicolectomy In Right Sided Colonic Cancer

    • Abstract: Introduction: Laparoscopic right hemicolectomy is currently considered the standard of care in benign and malignant right colon disease This chapter describes the technique for laparoscopic right colectomy technique, with a focus on ileo-colic anastomosis, highlighting the differences between intracorporeal and extracorporeal anastomosis fashions in terms of clinical outcome and surgical safety.Patients and methods: prospective and retrospective study study was conducted in Minia university hospital including 10 patients with Right sided colonic cancer who underwent laparoscopic right hemicolectomy,. 5 cases with Extracoropreal type and 5 cases with intracorporeal type of ileocolic anastomosis from Dec. 2019 to june. 2022.ResultsOperative time was The operative time (199 min vs. 183 min; p = 0.109) wasslightly higher in the ICA group than in the ECA group; however, this difference was statisticall not significant. Wound infection (10% of patients ICA group vs. 20% of patients in ECA group) overall intestinal leakage occurred in 2 cases 20% of all cases one case with IC anastomosis and one case with Extracorporeal anastomosisConclusionTheres no big differences between types of anastomosis that held on our cases Slightly good results in intracorporeal type of anastomosis than extracorporeal type
  • Ascitic and plasma D-dimer as a prognostic biomarker for predicting
           hospital mortality in cirrhotic patients with spontaneous bacterial

    • Abstract: Background: D-dimer is a specific test for the presence of fibrinolysis. Its abnormality reflects the activation of coagulation and fibrinolysis systems in vivo . chronic liver disease is associated with disordered hemostasis, it could be associated not only with defects in coagulation but also of clot lysis. Estimation of D –Dimer provide insight into possible derangements in the fibrinolytic pathway.Objective: Aim of this study was, (1) Evaluate serum D-dimer in cirrhotic patients with and without ascites to assess the relationship between ascites and the hyperfibrinolytic state in liver cirrhosis. Additionally, we assessed the effect of SBP on serum and ascitic fluid concentration of D-dimer.(2) Role of D-dimer in predicting the in-hospital mortality in liver cirrhosis. Patients & Methods: This study is a prospective study. It was conducted on 60 patients from the Department of Internal Medicine in Minia University hospital included patients hospitalised with decompensated liver cirrhosis and ascites This study was conducted on four groups, where full history taken, clinical examination, biochemical tests, ultrasonography .Results: There is diagnostic performance of serum and ascitic D dimer in diagnosing of SBP, and there were significant role of serum D dimer in prediction of 3 months mortality based on MELD score.Conclusion: D-dimer good diagnostic performance for SBP among patients with liver cirrhosis.D dimer levels of liver cirrhosis patients were found significantly associated with the degree of liver dysfunction. Furthermore, higher D dimer levels predicted an increased risk of in hospital mortality as a result of liver cirrhosis.
  • Prognostic Value of Bioactive Adrenomedullin in Critically Ill Patients

    • Abstract: This study's objective is to assess the prognostic value of the serum level of admission bio-ADM in critically ill patients. In this observational prospective study, patients who were admitted to Minia University Hospitals' medical critical care unit between December 2020 and November 2021 underwent a complete blood count, CRP , renal and liver function tests and blood culture. All patients had their bio-adrenomedullin levels evaluated by ELISA at the time of admission. The work included 114 patients who were subdivided into 3 groups: non-septic group including SIRS patients with negative blood culture (n=44), mild sepsis group including patients with SOFA score ≥2 without organ dysfunction (n=26), and severe sepsis group including sepsis patients with organ dysfunction (n=44). There was a significant difference in distribution of the quartiles of bio-ADM between survivor and non-survivors. Most of the non-survivors in our cohort were in the 4th quartile of bio-ADM (38.9%) while 45% of the survivors were in the 1st quartile of bio-ADM. The levels of Bio-ADM were positively correlated with CRP (r-value: 0.65, p-value < 0.001) and SOFA score (r-value: 0.63, p-value < 0.001). Using receiver operating characteristic (ROC) curve to determine the prognostic accuracy of bio-ADM, CRP, and SOFA score revealed higher area under curve (AUC) for bio-ADM (0.78, 95% CI: 0.69-0.86) followed by CRP (0.66, 95% CI: 0.56-0.76) and SOFA score (0.63, 95% CI: 0.52-0.73). The best cut-off for bio-ADM to predict ICU mortality in our cohort was 121.5 pg/ml with a sensitivity of 85% and a specificity of 61%.
  • The effect of endoscopic sphenopalatine ganglion block on hemodynamics in
           functional endoscopic sinus surgery (FESS) operation.

    • Abstract: :Functional endoscopic sinus surgery (FESS) is considered one of the most common surgical procedures. General anesthesia (GA) is usually required during FESS. Regional analgesic techniques can be used during GA that inhibit the intra- and post-operative detrimental stimuli.Purpose of the study: To evaluate the efficacy of injection of local anesthetics in the sphenopalatine ganglion endoscopically trans-nasally on hemodynamics during endoscopic sinus surgery (FESS) under general anesthesia.Basic procedures: This prospective randomized, double-blind controlled study was conducted on 60 adult patients of both sex who were undergoing general anesthesia for elective bilateral FESS. The patients were allocated into three groups (20 patients in each group). Group I received sphenopalatine ganglion block by 2ML saline injection alone (C group) as a control group, Group II received sphenopalatine ganglion block by local anesthetic injection 2 ML bupivacaine 0.5% (B group) & Group III received sphenopalatine ganglion block by (1.5 ML bupivacaine 0.5% + 0.5 ML MgSo2 10%) as (group M). Observed variables included hemodynamic parameters (HR&MAP). Main findings: The results have shown that the regional anesthesia in Group B&M could achieve a stable hemodynamic profile with no need for using risky hypotensive drugs and B blockers. Principal conclusion The use of SPGB before sinus surgery has been shown to be a safe, easy, less invasive, and practical approach for controlled hemodynamics.
  • Bleeding phenotypes in primary immune thrombocytopenia patients.

    • Abstract: :Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts with or without mucocutaneous bleeding. Like the majority of autoimmune diseases, ITP is an organ-specific disease and abnormalities in the regulation of immune system have been shown to play an important role in the initiation and/or perpetuation of the disease [1].Aim of the study: The aim of this study was to investigate the demographic characteristics, comorbidities associated with chronic medications, bleeding phenotypes in primary immune thrombocytopenia patients according to the chronicity of the disease.Patients & Methods: This current study is a cross-sectional hospital based analytic study. It was carried out at the hematology unit / internal medicine department of El- Minia University Hospital.It was conducted on a group of patients with ITP who were admitted at the hematology unit / internal medicine department or attended the hematology outpatient clinic of El- Minia University hospital since August 2021 till September 2022.It included 33 subjects, where clinical examination, biochemical tests, ITP bleeding score 2016, and ultrasonography were performed on them whose ages range from 16 to 73 years.Results: Life threating bleeding is more common in acute conditions than chronic ones with higher bleeding score (p value = 0.03) Conclusion: Chronic patients may have protective effect from life threating bleeding but higher associated comorbidities.Keywords: ITP, Bleeding score, life threating bleeding, chronicity .
  • Study Of Inflammatory Infiltrate in Vitiligo

    • Abstract: Background Vitiligo is a multifactorial disease which is characterized by apparently healthy milky white macules and patches due to loss of functioning melanocytes from the epidermis, mucous membranes and sometimes hair follicles.Objectives evaluation of the inflammatory cell infiltrate in vitiligo patients. Methods Forty-six nonsegmental vitiligo (NSV) patients had been included in this study. Histological hematoxylin and eosin staining of the mononuclear infiltrate were evaluated by microscopic examination.Results The inflammatory infiltrates in the marginal skin were significantly abundent when compared to the non leisonal skin (p=0.005*). On the other hand, the difference between the marginal skin and the leisonal skin was insignificant (p=0.083). Conclusion The inflammatory infiltrate of non-segmental vitiligo is more abundant in the marginal skin than the non leisonal skin. The active lesion's margin is regarded as a critical site for active melanocyte destruction by the inflammatory infiltrate; thus, marginal infiltrates are abundant in active lesions.
  • Role of Plates in Multiple Level Anterior Cervical Disc Fusion,
           comparative study

    • Abstract: Background: ACDF is a standard procedure for cervical disc prolapse, addition of anterior plating is increasingly becoming a viable option for neurosurgeons especially in multiple level cervical disc prolapse.Aim: Comparing between patients who complained of multiple level cervical disc prolapse who underwent ACDF without plates v with plates.Patient and Methods: This clinical & radiographic retrospective study was performed on 20 patients with multiple level cervical disc prolapse. Half of these patients underwent ACDF without plates and the other Half underwent ACDF with anterior plating.Results: Age if patients involved in this study ranged from 30 to 68 years old in both groups with a mean of 47 and 52 respectively. Regarding sex of patients, in the first group 5 were male and 5 were female while in the second group 7 were male and 3 were female. All complained of Neck Pain, 17 had Brachialgia and 3 with the first group 9 patients had double level prolapse and one with triple level prolapse while in the second group 5 patients had double level and 5 had triple level disc prolapse. Regarding neck & arm pain, all patients showed significant improvement with no significant difference between two groups.There were no major complications encountered. Conclusions: Both procedures were comparable in achieving pain relief and functional improvement. Although the plate method was superior to the cage alone method in terms of fusion rate and reduced cage subsidence than that of cage alone, short-term outcome was almost the same.
  • Association of induced intraoperative hypotension with acute kidney injury
           after functional endoscopic sinus surgery

    • Abstract: Background; although surgical field visualization is important in functional Endoscopic sinus surgery (FESS), the complications associated with controlled hypotension for surgery should be considered. Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear, Aim and objectives; early evaluation of acute kidney injury (AKI) following induced hypotension during FESS operation using kidney biomarker as NGAL , Subjects and methods; This prospective cohort study was conducted in anaesthsia and intensive care department in Minia University Hospital in the period from April 2021 To April 2022, after obtaining Institutional Ethical Committee approval and written informed consent from patients.A total number of twenty male & female patients aged 18-60 years with BMI 23-27 and ASA physical status I & II who were candidate for (functional endoscopic sinus surgery) FESS under the effect of hypotensive anaesthesia, were enrolled in this prospective cohort study, Result Demographic data of the studied population (n=20), including 11 males (55%) and 9 females (45%), and mean of age of 36.50 ±10. Regarding Comparison between urea and creatinine levels by Wilcoxon Signed Ranks Test. There was a significant difference between preoperative and 3 hour postoperative NGAL in the studied group Conclusion; NGAL is the most sensitive biomarker that can detect early acute kidney injury.
  • Sedation and Analgesia Practice in Pediatric Intensive Care Units of Cairo
           University Children Hospitals

    • Abstract: The aim of this study is to analyze the current approaches in sedation and analgesia practices among pediatric intensive care units’ (PICUs) patients. Methods: This is a descriptive prospective study reviewing 80 pediatric patients admitted to PICUs of Cairo university hospitals over 6 months, describing their sedo-analgesia practice, indication, duration, dose, effect and side effects.Results: Eighty pediatric patients were enrolled, with a median age of 5.5 months, 51% of them were females (n= 41), and their weight ranged from 2.4 kg to 80 kg with a median of 6 kg. Pneumonia (53.8%) was the most common indication for admission with 49 patients needed mechanical ventilation showing the highest percentage (60%) among the indications of the sedation. Fentanyl used in 43.8%, 36% of patients needed multimodal medications, good sedation achieved in (67.5%), reduction of pain ranged from 44.44% to 100%. The median duration of PICU stay was 9.5 days. Vomiting presented in 15 % representing the most common side effect of sedo-analgesic use. Vital signs were found to be statistically significant indicator in assessing the efficacy of sedation and analgesia.Conclusion: The practice of adequate sedation and analgesia in PICUs is a fundamental tool; it improves our patients’ vital signs, reduces pain, facilitates synchronization with mechanical ventilation and decreases the length of stay in post-operative patients. Enhancing the proper use of sedation and analgesia in PICUs for better patient’s care, also, the importance of daily sedation interruption practice and its impact on patient’s outcome should be emphasized in further studies.
  • Vital signs after local anesthesia administration with lidocaine
           two-percent in pulpotomy for children under age of four

    • Abstract: Background: The aim of study is to evaluate vital signs after administration of lidocaine 2% for pulpotomy anestheticefficacy pulp therapy in primary molars in young children below four years.Methods: 100 young children under age of four years seeking pulpotomy of primary molars which performed afterbuccal infiltration injection. lidocaine hydrochloride 2% with epinephrine 1:100 000. The intervention was articainehydrochloride 4% with epinephrine 1:100 000 was deposited. Children's blood pressure and heart rate was assessedbefore and after treatment.Results: No statistically significant difference was found before LA injection and after finishing clinical procedures.Regarding the heart rate (HR), no statistically significant difference was detected pre- and postoperatively.Conclusion: lidocaine hydrochloride 2% with epinephrine 1:100 000 for treatment of children between the age of 3and below 4 years old did not significantly increase the vital signs before and after injectionKeywords: buccal infiltration, lidocaine, local anesthesia, blood pressure
  • The perceptual Evaluation of the Voice in Morbid Obesity

    • Abstract: Introduction: The human voice is a complex phenomenon. The anatomofunctional features, psychological traits, social and professional aspects all influence human vocal quality. Voice disorders, also known as dysphonia, affect 3%-9% of the population. Obesity is epidemic threat. All systems in the body are affected directly or indirectly to various degrees. Due to the physical–pathological modifications related to obesity that compromise all of the body’s systems, evaluation of the vocal behavior of obese patients has become a subject of interest. One of these alterations is the corporal disposition of excessive fat, abnormal fat deposits observed on the uvula, soft palate, lateral and posterior walls of the pharyngeal walls, and posterior region of the tongue, all of which are structures belonging to the vocal tract. Aim of the study: to cast more light on the effect of obesity on voice in patients of morbid obesity. Methods: this study consisted of a random sample of 50 morbid obese patients. Each patient was subjected to the following survey study including this data (Patient Interview , history taking, Auditory Perceptual Assessment (APA), general examination (BMI and NC)). Results: A total of 50 obese women were included, average age 36.8 years, weight (132.6±20.5 kg), BMI (52.3±9.4kg/m2), and neck circumference (40.5±1.9). Gastro esophageal reflux symptoms (53.3%) prevailed. Conclusions: Obesity lead to an important increase in anthropometric parameters. The voice become hoarser, lower pitch and less stable and patient need to use more effort to overcome the increase in respiratory resistance. Keywords: obesity, respiration, phonation, BMI, NC.
  • Transpedicular screws with posterolateral fusion versus with posterior
           lumbar interbody fusion in lumbar spondylolisthesis

    • Abstract: Background: Spondylolisthesis occurs when there is an anterior slippage of one vertebral body relative to its caudal vertebral body. The ideal surgical treatment remains controversial. Some neurosurgery surgeons PLIF but others prefer PLF. Aim: The aim of the work is to compare the prognosis and outcome between PLIF & PLF in spondylolisthesis.Patient and Methods: This is a prospective study which was conducted on 40 patients with spondylolisthesis who were admitted to Minia university hospital between March 2020 and September 2021, and were randomly assigned in to 2 groups: 20 patient in each group, the 1st underwent PLIF while the 2nd underwent PLF.• Results: In PLIF: the mean age was 47.85 (27-61 years). In PLF: the mean age was 46.7 (28-63 years) . all patients were presented with low back pain while radicular pain was present in 65% and 75% in both groups respectively. 85% of patients had a single level lithesis either L4-5 or L5-S1 and 15% had double level lithesis in the PLIF group these percentages were nearly the same in the PLF group with 80% for single level lithesis and 20% percent with double level lithesis. The outcome in the two groups was excellent in 65% and 50% respectively, good in 20% in both groups , fair in 10% and 25% respectively and poor in only 5% of each group. Complication rates were low. Conclusions: PLIF had advantages in fusion rates , reduction of pain with no other significant difference regarding other points of comparison.
  • Hair straighteners

    • Abstract: Background: Hair plays an important role in one's personality and builds confidence. Now-a-days, chemical and physical hair relaxers are used very commonly in the society. The adverse effects occurring with the use of the professional hair relaxers are not well documented.Aim of the work: Our study aims to assess the adverse effects caused by chemical hair straighteners.Materials and Methods: The sample was restricted to females. This study was carried out on sixty female subjects who underwent chemical hair relaxers once or more. A questionnaire was given to the volunteers who matched our criteria then the data was documented, tabulated and statistically analyzed using SPSS computer program version 24 for frequency, distribution and significance rates. Results: Adverse effects reported by the sample after undergoing the procedure were found to be high (95.56%). Out of which the followings were the common adverse effects reported; frizzy hair, dandruff, hair loss, thinning and weakening of hair and greying of hair.Conclusions: From our study, it can be stated that most of the samples had adverse effects, which was as high as 95.56%. So, we can conclude that usage of chemical hair relaxers can cause adverse effects to the hair.
  • The Effect of Microneedling on Acne Scars

    • Abstract: The Effect of Microneedling on Acne Scars Moataz Bellah M. El-Domyati MD, Rasha T. A. Abdel-Aziz MD, Maha Mohamed-Elsayed MSc. Department of Dermatology, STD’s and Andrology, Faculty of Medicine, Minia University, Minia, Egypt Background: Postacne scarring is disfiguring. Multiple modalities for treatment of acne scars have emerged and microneedling with dermaroller is one of them.Objectives: To evaluate the efficacy of microneedling treatment for atrophic facial acne scars.Methods: Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Patients were photographed at baseline as well as one and three months from the start of treatment.Results: Compared to the baseline, patients’ evaluations revealed significant clinical improvement in atrophic post-acne scars in response to skin microneedling (p= 0.02).Conclusion: Microneedling is a simple and cheap, means of treatment modality for acne scars remodulation with little downtime, satisfactory results and with the advantage of being a relatively risk-free.Key words: Acne scars, Microneedling.
  • Different approaches for pancreaticoduodenectomy rather than the
           conventional Whipple procedure

    • Abstract: Introduction: Pancreatico duodenectomy (PD) is the only potentially curative therapy for malignancies of the pancreatic head and periampullary region. Despite this complicated surgical operation is mature, the low R0 resection rate remains the major obstacle to improving the prognosis of pancreatic cancer [1].Patients and methods: This prospective descriptive study was performed on all patient’s candidate for PD for pancreatic head and duodenal cancers in the NCI, and ELMENIA University Hospital during the period from January 2021 till January 2023.ResultsOur study showed that, the operating time ranged from 220 to 340 minutes (mean 277.70 ± 37.70 minutes), the mean Blood loss (ml) were 725.75 ± 291.68, the PRBC transfusion requirement (units) ranged from 0 to 6 with mean 3.05 ± 1.74, the ICU stays (days) ranged from 4 to 12 with mean 8.95 ± 2.40 and the mean hospital stay (days) were 17.03 ± 6.81. Our study showed that, there were 40 (100.0%) of Patients had Pseudo-aneurysm, 10 (25.0%) of Patients had complication and 4 (10.0%) of Patients were with re-exploration. Our study showed that, there were 3 (7.5%) of Patients had Pulmonary complications, one patient with cardiac complications and 6 (15.0%) patients with Other Complication. ConclusionPancreaticoduodenectomy (PD) is the only potentially curative therapy for malignancies of the pancreatic head and periampullary region. Despite this complicated surgical operation is mature, the low R0 resection rate remains the major obstacle to improving the prognosis of pancreatic cancer
  • Effect of intratracheal lidocaine spray on recovery from general
           anesthesia after Eye surgery: A randomized double-blinded study

    • Abstract: Background : Local anesthesia for eye surgery is increasingly popular, but there will always be a need for general anesthesia. Cough during emergence from general anesthesia is considered critical event as it may lead to surgical bleeding laryngospasm hemodynamic instability and could be life threatening in patients who are at risk of complications related to increase in intracranial or intraocular pressure.Objectives:To detect the effect of intratracheal lidocaine on cough reflex in eye surgery.Study designProspective randomized double blind controlled study will be conducted on 80 adult patients MethodsThis study involved 80 patients who are undergoing general anesthesia for elective keratoplasty and retinal detachment. The patients will be allocated into 2 groups (40 patients on each group). 40 patients Received (5ml) 2% of lidocaine was sprayed down the intratracheal tube of patients while 40 patients Received 5ml saline in medical spray bottle was sprayed down intratracheal tube of patients. observed variables included hemodynamic parameters, intraocular pressure, postoperative cough, surgeon satisfaction and complications related to drugsResultsThe results have shown that lidocaine was more effective in attenuating cough in eye surgery, and provide satisfactory analgesic effect after surgery Conclusionlidocaine was more effective in attenuating cough in eye surgery, and provide satisfactory analgesic effect after surgery
  • Knowledge, Attitude &Practice on screening of cancer cervix among
           women in Minia Governorate

    • Abstract: Globally, cervical cancer is the fourth most commonly diagnosed cancer among women, with about 570,000 new cases in 2018, representing 6.6% of all female cancers. Approximately 311,000 women died from cervical cancer worldwide in 2018, with over 85% of these deaths occurring in low- and middle-income countries, Aim and objectives; to assess knowledge, attitude &practices about screening of cancer cervix among women in Minia governorate, Subjects and methods; This descriptive cross-sectional study was conducted on 6300 women attending the outpatient clinics of Minia Maternity University Hospital, Result; 66.9% of the subjects will advise another woman to do VIA, 48% recommend a VIA for all women, 41.1% were Willingness of nearest female neighbors to get VIA, 53.3% will undergo a VIA test in future, 50.7% will plan to do VIA however, knowing the risk. 28.1% thing they have risk of cancer cervix, and 16.1% knew that Pap smear can predict another disease than cancer cervix, Conclusion; knowledge, attitude and practice regarding cervical cancer screening among females were significant to decrease the burden and to prevent the incidence of Cervical Cancer. Effective information, education and communication strategies are required to improve the level of awareness of women on Cervical Cancer,
  • Ministerntomy to attack Upper Thoracic Lesions

    • Abstract: backgroundSurigcal intervention and access to the upper dorsal vertebrae through the anterior approach is difficult due to the anatomy of the region and the structures surrounding the upper dorsal spine, we go into precise detail about the mini-sternotomy approach in treating traumatic, infectious, and metastatic upper Dorsal vertebral body pathologies.Aim of the workour experience in using the ministernal approach in treatment of anterior upper dorsal pathologies.Patients and methodssThis is a retrospective study on 10 patients with dorsal myelopathies due to traumatic, infection and metastases with D1 to D4 vertebral body involvement from 2018 treated with a mini-sternal approach in Minia university hospital.ResultsFollow up was for 12 months in mean. Frankel grade was used to assess patients after operation and showed improvement in 70% of cases while 30% showed no improvement. Mean operative time was 110 minutes and no intraoperative complications were encountered. ConclusionInfectious, metastatic, and traumatic lesions involving the anterior high dorsal spine can be treated safely with the mini transsternal approach, which is also the only one that allows for early and precise exposure of the anterior dura. With great functional patient outcomes, this approach bypasses the anatomical limitations of the region and provides enough space for the best restoration and maintenance of spinal alignment in the cervico-dorsal region transition zone.
  • Clinical Evaluation of Photobiomodulation Therapy on Regeneration of
           Necrotic Mature Permanent Teeth

    • Abstract: Introduction: Regenerative endodontics was suggested as alternative treatment for necrotic mature permanent teeth to overcome the drawbacks of conventional treatment methods and showed better results when combined with photobiomodulation therapy (PBMT), so the aim of this study was to evaluate the clinical effect of photobiomodulation therapy on regeneration of necrotic mature permanent teeth. Materials and Methods: 24 patients with age 9-13 were selected and randomly divided into two groups; control group (n=12), patients were treated with regenerative endodontics procedures (REPs) using blood clot scaffold, and study group (n=12), patients were treated with the same REPs as control group then treated with PBMT. In each group evaluation of pain, swelling, sinus tract, mobility, and cold sensibility test were performedResults: Data analysis revealed that there was resolution of pain, swelling, and sinus tract in all cases during the follow up periods from the start to the end, no recurrence or pathological signs changes were detected clinically. Also, it revealed normal physiologic mobility of all subjects before and after revascularization procedures. For cold sensibility test, 6(60%) of cases in each group showed positive responses with no significant difference between both groups (p=1). There was a significant difference between values at different intervals in each group (p<0.001).Conclusion: The results of this study showed that photobiomodulation therapy could accelerate the clinical success of regeneration of necrotic mature permanent teeth.
  • Analysis of Cesarean Section Rates in Minia University Maternity and Child
           Hospital Using Robson Classification; A cross–section study

    • Abstract: The rate at which caesarean sections are performed is widely recognised as an indicator of the overall quality of maternal health services. The World Health Organization has recognised the Robson ten-group categorization system as the definitive method for assessing the frequency of caesarean sections. The purpose of this research was to calculate the C-section rate and analyse it using the Robson grading scale. Discussion of a Topic and Procedures: Minia University's Mother and Child Hospital served as the study's cross-sectional site. The information for all births that occurred between April and September of 2022 was gathered from medical records. The total rate of caesarean sections was determined, and women's births were categorised into one of eleven Robson categories. As an end result, we looked at data from 3,860 births. There were 2188 caesarean sections (56.6% of total births) and 1672 spontaneous vaginal delivery deliveries (43.3%). The highest proportion of C-sections come from Group 5, which has been isolated as a major clientele for the procedure. The Robson method indicated that high-risk groups had a much higher incidence of caesarean section. It is important to do in-depth research on the Robson groups of interest in order to identify potentially risk factors as well as to take advantage of targeted interventions in order to reduce the prevalence of caesarean sections. Better outcomes may be achieved by a combination of auditing existing treatment methods and areas for further research on caesarean section reason and outcomes .
  • Corneal crosslinking in keratoconus

    • Abstract: ABSTRACTPurpose: To describe visual and refractive outcomes of conventional versus accelerated corneal cross linking in keratoconus. Methods: A prospective descriptive interventional case series. 20 eyes were evenly allocated into two groups. First group (20 eyes) was treated with conventional corneal collagen crosslinking (CXL) and the second group was treated using was treated with accelerated corneal collagen crosslinking (CXL). Results:Both groups showed statistically improvement in BSCVA, which was insignificantly different between both groups over the follow-up period.oth groups with conventional and accelerated corneal collagen crosslinking (CXL) showed statistically improvement in BSCVA, which was insignificantly different between both groups over the follow-up period.oth groups with conventional and accelerated corneal collagen crosslinking (CXL) showed statistically improvement in BSCVA, which was insignificantly different between both groups over the follow-up period.oth groups with conventional and accelerated corneal collagen crosslinking (CXL) showed statistically improvement in BSCVA, which was insignificantly different between both groups over the follow-up period.Conclusion:Both groups with conventional and accelerated corneal collagen crosslinking (CXL) showed statistically improvement in BSCVA, which was insignificantly different between both groups over the follow-up period.
  • Combined general -spinal anesthesia versus combined general - epidural
           anesthesia for Laparoscopic Hysterectomy

    • Abstract: Background and Aim of the work:General anesthesia(GA) is the preferred anesthetic technique for laparoscopic hysterectomy(LH). However, laparoscopic surgery is accompanied with marked stress response, Adding regional techniques,to GA was used to overcome these significant hemodynamic effects .The aim of our study is to compare the effect of combined spinal-general anesthesia with that of combined epidural-general anesthesia on hemodynamic stress ,Requirement of Isoflurane, analgesics and vasodilators,recovery profile ,VAS score at recovery, the time for first analgesic request, surgeon’s satisfaction, and intraoperative and postoperative complications. Methods:This was a prospective randomized controlled study including 105 female patients,aged 45-65 years old,belonging to ASA I or II grade who underwent LH.They were randomly assigned to one of three equal groups.Group S-GA received spinal combined with general anesthesia; group E-GA received epidural along with GA; and group GA received only general anesthesia. Intraoperatively, cardiovascular parameters and SpO2 were recorded.operative field assessed by surgeons ,isoflurane ,nitroglycrine and opoid consumption were recorded also post operative pain, intra and postoperative complication.Results: S-GA and E-GA groups showed stable hemodynamic parameters (MAP and HR) at pneumoperitoneum and during surgical manipulation. However, MAP decreased significantly at postinduction in groups S-GA and E-GA.Intraoperatively, consumption of isoflurane, opioid and nitroglycerine infusion was higher in group GA .groups S-GA and E-GA showed better operative field ,pain scores ,fast recovery and longer postoperative analgesia .Incidence of postoperative complications was low.Conclusion:spinal or epidural anesthesia, combined with general anesthesia was an effective for attenuation of the hemodynamic stress response associated with peumoperitoneum without increasing side effects
  • Short term outcomes of single anastomosis sleeve jejunal bypass for the
           treatment of morbidly obese patients

    • Abstract: abstract Introduction: Single anastomosis sleeve jejunal (SASJ) bypass is a recently developed bariatric technique. This procedure aims to keep passing to the duodenum to reduce the associated nutritional deficiency and to allow endoscopic treatment of choledocholithiasis. This study aimed to evaluate the efficacy of the SASJ bypass in the treatment of morbidly obese patients.Patients and methods: 50 morbidly obese patients underwent SASJ bypass, All patients were followed up at 1, and 6 months. We evaluated BMI, post-operative complications, and obesity-related comorbidities. Results: The mean age of enlisted cases was 35.2 years, and the mean BMI was 49.8kg/m2. Of the patients, 37(74%) had type two DM ,and 16(32%) were hypertensive. 10(20%) cases had osteoarthritis, 12(24%) cases had obstructive sleep apnea, and 4(8%) cases had GERD.Intraluminal bleeding occurred in two cases (4%). and three patients developed biliary gastritis (6%). One patient (2%) developed DVT. The %EWL was 58.2% after 6 months Normalization of blood glucose level occurred within 6 months after surgery in 86.4 % of diabetic patients. Hypertension improved in all hypertensive patients. Conclusion: Laparoscopic SASJ bypass is an effective, safe, and technically easy operation for treating morbid obesity and comorbid conditions with less nutritional deficiencies.Keywords: SASI · Loop bipartition · metabolic surgery · Sleeve jejunal bypass.
  • Risk factors of otitis media with effusion

    • Abstract: background: otitis media with effusion is a typeof chronic non-suppurative otitis media that means presence of fluid in the middle ear cavity. which is a common disorder in childhoodAim of the study :is to know the commonest causes and risk factors for secretory otitis media to help us in its prevention and to provide better treatment for it according to etiological factors.patient and methods:143 patients who had otitis media with effusion presented to our clinic confirmed by tympanogram were included in this study , aged from 4-16years .all the patients underwent otoscopic examination,Anterior rhinoscopy and oral cavity examination was done.The children had tympanometry to confirm clinical diagnosis. Imaging in the form of x-ray nasopharynx lateral view was done. results :the age ranged from4 years to16 years There were 71 males and 72females.According to our study, there was a strong relation between adenoid hypertrophy and otitis media with effusion. It is a very important etiological factor 102 children of otitis media had hypertrophied adenoid (71.3%%).there were 97 children of otitis media with effusion who had history of recurrent upper respiratory tract infection. which is an important etiological factor.conclusion :There is a strong relation between adenoid hypertrophy and secrettory otitis media. Adenoid hypertrophy is a very common etiollogical factor. This must be taken into consideration in management of persistent otitis media with effusion. Also recurrent upper respiratory inffection is associated with otitis media with effusion, so protection of the children against it helps in prevention of secretory otitis media.
  • Efficacy of try-in paste and resin cement shades in prediction of the
           Final Color of multilayer Zirconia Veneers (An In-Vitro Study).

    • Abstract: Objectives: Aimed to study the efficacy of using try- in paste resin cement shades, in prediction of the final perceived color of Cercon Veneer.Material and Methods: tetragonal zirconia polycrystal stabilized with 5 mol% yttria and 9 wt.% yttria, Variolink Esthetic (LC) System kit for resin cement, and tetric N-ceram composite resin. A total of thirty CAD/CAM Cercon disks (diameter = 10mm), shade A2, and thickness of 0.5mm (n=30) fabricated. The ceramic groups were ordered into three subgroups, n=10 for each, according to the shade of luting cement used, then each subgroup ordered into two equal classes n=5 for each, according to the type of cement (final cement or try in paste). Thirty samples of resin background disks fabricated using a Teflon mold (10 x 3) mm to acquire a uniform background to resemble the prepared tooth substrate. The specimens' color was assessed by fixing them onto a grey background. Color parameters assessment was performed utilizing a spectrophotometer according to the CIE Lab color system. Results were then statistically analyzed using Shapiro-Wilk test to assess the normality of distribution, and two-way Anova. Results: One way ANOVA test used for quantitative data between the 3 groups succeeded by post hoc LSD analysis between each two groups in 0.5 mm thickness, there was significant increase in ΔE in light shade compared with natural shade. there was insignificant difference between others.Conclusion: Caution should be taken when using a try-in paste to determine the final restoration's color and addition test should be done.
  • Comparison of Ultrasound and fluoroscopy guidance in selective lumbar
           nerve root injection for treatment of radicular pain

    • Abstract: Chronic low back pain with lumbar radicular pain is one of the leading causes of disability worldwide. Fluoroscopy guided selective nerve root injection (SNRI) has been a well-established method for treatment of lumbar radicular pain. But, it has been suggested that ultrasound can be an effective tool for guidance in this type of injection with the advantage of avoidance of radiation exposure. Purpose of this study: to evaluate the efficacy of ultrasound-guided selective lumbar nerve root steroid injection in comparison with fluoroscopy guided injections for the treatment of lumbar radicular pain. 74 patients with unilateral lumbar radicular pain undergoing selective lumbar nerve root injection were divided into ultrasound group or fluoroscopy group. SNRI was done to inject the affected nerve roots under ultrasound guidance or fluoroscopy guidance. We assessed Visual analogue scale (VAS) and Oswestry disability index (ODI) and analgesic requirement for all patients before the injection, at one week, two weeks, one month, two months and three months after the injection. We also recorded the complications during and after the procedure. VAS scores, ODI and analgesic requirements were significantly lowered in both groups when compared to baseline, and there was no significant difference between the two groups. Also, no major complications were recorded in both groups. Conclusion: Ultrasound guidance is as effective as fluoroscopy guidance, as it showed no significant difference in VAS scores, ODI and analgesic requirement without increase in complication rate and the reduction in radiation exposure affecting the patients and the medical care providers.
  • Supine percutaneous nephrolithotomy post operative hospital stay

    • Abstract: Background: Since it was first used in 1976, percutaneous nephrolithotomy (PCNL) has become the industry standard treatment for significant renal calculi. Initially, as mentioned sixty years ago, only the prone position was used for percutaneous access to the kidney. Valdivia provided the first account of supine positioning in PCNL. Both positions have since been adopted by PCNL. To enhance the surgical results, modifications to the initial supine position were created. The advantages of each supine position were discussed for five different supine postures (full supine, Valdivia, Galdakao-modified Valdivia, Barts-modified Valdivia, and Barts flank-free modified supine positions). In this study, we evaluated the results of supine PCNL surgery.Methods: All patients were evaluated at baseline to complete diagnosis of renal stones, evaluation of previous line of management if present, confirm indication for surgery and fitness for surgical procedure, where patients selected for operative procedure had been counseled and written consent is obtained for the surgical procedure, then admitted patients will be assigned to certain hospital admission number.Results: This study was conducted on 53 patients (31male & 22 female), age range 18 to 65 years old. there were 58.5% of the studied cases were males and 41.5% were females. The mean age was 36.09 ± 12.14 SD with range (18.0 – 65.0). There were 13.2% of the studied cases had Co-morbidities and 86.8% had no Co-morbidities. The current study showed that mean hospital stay was 2.23 ± 0.64 SD with range (2.0 – 5.0).

    • Abstract: Hemangiomas and vascular malformations are benign lesions that can occur at any organ. Currently various medical and surgical options are available for the treatment of hemangiomas including intra lesional bleomycin, laser therapy, cryotherapy, corticosteroids and surgical excision . Recently bleomycin injections is commonly used as a sclerosing agent for the treatment of vascular malformations, compared to the surgery, intra lesional bleomycin injection is a simple, practical non invasive method of treatment. Aim of the work: To evaluate the role of ultrasound and fluoroscopy guided intralesional bleomycin injection (IBI) for treatment of superficial hemangiomas and vascular malformations. This study will be conducted in the interventional radiology unit, department of Radiology, Faculty of Medicine, Minia University. This study is including thirty patients presented with superficial hemangiomas and vascular malformation. There was statistically significant difference in the study regards Relation between response with demographic data, Relation between response and site of lesion, Relation between response with Doppler findings and Relation between response with number of sessions. There was no statistically significant relation between response and size of lesion. Bleomycin appears to be safe, effective and has some antitumor activity and also bleomycin has local sclerosing effect on endothelial cells of hemangiomas and vascular malformation.
  • The Possible Toxic Effects of Glutathione Intramuscular Injection on
           Ovaries of Female Albino Rats (Experimental Study)

    • Abstract: Background and objective: Glutathione can alter the depigmentation of skin and convert eumelanin to pheomelanin during melanogenesis. As a result, glutathione has become one of the most used skin-whitening agents, and women have become obsessed with it. So, the purpose of this study was to see how intramuscular glutathione injection can affect the ovaries of female albino rats. Methods: 50 female albino rats were involved. The animals were divided into two groups; A: the control group and B: the glutathione-injected group, which received glutathione intramuscularly three times per week for three consecutive weeks at a dose of 30 mg/day. The injected group was subdivided into four subgroups based on how soon after the last dose the rats were sacrificed (B1: immediately, B2: after 24h, B3: after one week and B4: after two weeks). Ovarian tissue samples were collected from all groups. Each sample was subjected for histopathological examination and estimation of estrogen and progesterone by ELISA. Malondialdehyde (MDA) and reduced glutathione (GSH) levels also were detected. Results: MDA level was significantly higher in subgroups of group B than group A, while GSH level was significantly reduced. The histopathological examination revealed that glutathione injections led to edematous stroma and luteoma. As regard hormones levels, there was significant increase in all (B) subgroups compared to control group. In this study, ovarian changes caused by the prooxidant behavior of glutathione, were reduced partially after two weeks. Conclusion: External glutathione may function as a pro-oxidant and have negative effect on the ovaries.
  • Assessment of WALANT Anaesthesia in Flexor Tendon Repair of the Hand

    • Abstract: Background: A large number of hand surgeons are now using wide-awake local anesthesia with no tourniquet (WALANT) instead of traditional surgery using a tourniquet and sedation. Lidocaine and epinephrine plus sodium bicarbonate are the drugs injected for both anesthesia and hemostasis.Methods: This prospective study was performed in Minia University Hospital, Plastic and Reconstructive Surgery Department on 30 Patients undergoing hand primary flexor tendon repair surgery based on inclusion and exclusion criteria.Results: Thirty patient were involved in our study. Satisfactory results were achieved in 83.8% of the cases. The duration of surgeries was 45-180 minutes. During this duration there was no pain or blood loss. For the blood loss, the mean ± SD was 64.2±15.5. No necrosis occurred due to epinephrine use in any case. There was a significant difference in VAS score value & VAS grades during WALANT injection, at 3hrs postoperative and 6hrs postoperative compared with during operation and 1hr postoperative with a P value <0.001. Conclusion: The use of the wide awake technique (WALANT) with avoidance of tourniquet provides an optimal hemostatic field with low blood loss, suitable for long operations with lower pain (VAS score) in the involved cases. Keywords: wide awake technique (WALANT), Flexor tendon repair, VAS score.
  • Controlled Evaluation Study of Serum Level of Zinc and Iron in Patients
           with Androgenetic Alopecia (REVISED)

    • Abstract: ABSTRACTBackground: Androgenetic alopecia (AGA) is androgen-dependent alopecia resulting from the conversion of terminal hair into vellus hair. Zinc is one of the most studied trace elements in hair disorders and Iron is one of the trace elements used in the treatment of AGA.Aim of the Work: To evaluate the serum levels of zinc and iron in male and female patients with AGA and to compare the findings with normal controls.Patients and Methods: The study was conducted on 60 AGA patients (30 males and 30 females) and 40 healthy volunteers (20 males and 20 females). We measured serum zinc and iron for all participants.Results: Serum zinc (µg/dL) and iron (µg/dL) levels were statistically significantly lower in female AGA (FAGA) patients compared to controls. There were non-significant differences in serum levels of zinc and iron seen in the male AGA (MAGA) group compared to controls.Conclusions: Serum levels of zinc and iron were lower in FAGA patients than in normal controls and adding zinc and iron to female patients with AGA is recommended.

    • Abstract: Background: During a caesarean section, there is some debate over whether or not to exteriorize the uterus. Routine uterine exteriorization does not seem to be supported by enough evidence. It's still unclear whether this practice ought to be become standard operating procedure. Our goal was to compare the outcomes of Caesarean deliveries in which the uterine incision was repaired externally vs inside.Methods: A prospective Randomized and single-blinded trial spanned from February to December of 2022. Two groups, A and B, with A receiving repairs after exteriorization and B receiving in situ repair. Intraoperative internal bleeding, postpartum anemic, transfusion rate, mean operating time, perioperative wound infection rate, and postoperative nausea and vomiting are be measured. Results: A statistically significant increase in the frequency of nausea and vomiting among some of the women who had exteriorization compared to those whose uteri had repaired in-situ. Average preoperative haematocrit, postoperative haematocrit, estimated blood loss (575 vs 577 ml, p = 0.942), transfusion rate (15.3% vs 17.9%, p = 0.518), postpartum anaemia, operative time, and surgical site infections rate were not significantly different between the exteriorization and in situ groups. Conclusion: Exteriorization and in-situ repair of uterine incisions are equal in terms of intraoperative blood loss, postoperative anaemia, and infections at the surgical site, although the former is linked to significantly more nausea and vomiting than the latter. The results could not definitively prove that one was superior to the other.Keywords: Uterine excision, uterine in situ repair, and caesarean section
  • Importance of MRI in Pre-operative evaluation of rectal cancers as regard
           sphincters invasion and adjacent organs infiltration and its effect on
           surgical decision

    • Abstract: In this article, we will discuss how magnetic resonance imaging (MRI), the gold standard for imaging rectal cancer, has improved clinical staging of head and neck cancer malignancy. High-resolution T2-weighted object detection (T2WI) MRI is the gold standard due to its superior tissue contrast precision when imaging tumor tumor in the sagittal, longitudinal, and coronal planes.Both Patients and TechniquesBetween March 2021 and February 2023, 60 patients with endometrial cancer were gathered from the Urology Outpatient Clinics at Minia University Hospital and the National Cancer Institute for this prospective cohort research.The ages of the Cases varied from 23 and 72 years, with 27 men and 33 females participating (mean 50.8 years). Substantial consensus (Kappa 0.721) was found between MRI and surgical findings regarding tumor infiltration of the sphincters and subscapular muscle; MRI's sensitivity for the prediction of body invasion was 95% for both external and internal sphincter infiltration; its specificity was 93.8%; its PPV was 94%; and its NPV was 92%. As for MR's predictive abilities, they were calculated to be 95% sensitive, 83% specific, with a positive predictive value of 70% and a predictive values of 92%, respectively.In conclusion, sphincter complex expansion and penetration to surrounding organs may be accurately assessed by rectal MRI, allowing for more effective therapy of patients with cancer and better outcomes.Rectal cancer, MRI, sphincter invasion, subscapular muscle, neighboring organ infiltration, Low Midline resection, locoregional rectal cancer, and Neoadjuvant chemoradiotherapy are some of the significant terms here.
  • Combined Use Of MRI Morphological Criteria And Apparent Diffusion
           Coefficient (ADC value) In Diagnosis Of Probably Benign and Suspicious
           Breast Lesions (BI-RADS3 and 4) in Correlation with Histopathology

    • Abstract: Background: This prospective clinical study is aimed to evaluate the diagnostic value of morphological criteria, the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions in correlation with histopathology.Method: The study includes 25 females with 25 breast lesions. Routine conventional MRI protocol of the breast was conducted including T2WI, T2 SPAIR and DWI. We used contrast administration in only 10 patients of this study group and DCE-MRI was conducted on them. We compared the conventional unenhanced images to the DCE-MRI by radiologists to detect and characterize breast lesions then we compared the results with the final reference diagnoses supplied by the histopathology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. Results: The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 100%, 85.7%, 94.7%, 100%, and 96% respectively. On the other hand, those for the DCE-MRI were 100%, 75%, 85.7%, 100%, and 90% respectively.Conclusion: The unenhanced MRI of the breast can be an available, reliable, and effective alternative for breast DCE-MRI. Also it can be used with comparable accuracy to DCE-MRI when contrast administration is not suitable or contraindicated.
  • Immunohistochemical Expression of TRIP13 in Transitional and Squamous cell
           carcinoma of Urinary Bladder Carcinoma

    • Abstract: Background: Urinary bladder carcinoma (UBC) is the 9th most common cancer globally. Thyroid receptor-interacting protein 13 (TRIP13) is a member of the AAA+ ATPase family. The upregulation of TRIP13 has been shown to be involved in the development and progression of different tumors, including UBC. Method: The current study included 50 formalin-fixed, paraffin-embedded tissue specimens of UBC. Tissue sections have been subjected to haematoxylin and eosin staining and immunohistochemical staining for TRIP13 expression. TRIP13 expression was estimated and its associations with clinicopathological factors were evaluated. The prognostic significance of TRIP13 was evaluated using univariate and multivariate COX regression analyses. Results: In the present study, 62% (n=31) of the cases showed ‘negative/low’ TRIP13 expression, whereas 38% (n=19) showed ‘high’ TRIP13 expression. A significant association was found between TRIP13 expression and tumor grade, stage, lymph node metastasis (LNM) and distant metastasis (P=0.012, 0.007, 0.045, <0.001, and 0.004 respectively). In addition, TRIP13 was remarkably correlated with poor prognosis.
  • Effect of mast cell stabilizer on lipopolysaccharides induced acute lung
           injury in rats

    • Abstract: Acute lung injury (ALI) describes a form of parenchymal lung disease representing a wide range of severity from short-lived dyspnea to terminal failure of the respiratory system or acute respiratory distress syndrome (ARDS). No sufficient data is addressing the role of oxidative stress and the effect of mast cell stabilizer on lipopolysaccharides (LPS) induced ALI model. This study aimed to investigate the effect of ketotifen on LPS-induced ALI in rats with an explanation of possible underlying mechanisms. Rats were allocated into 4 groups: (1): control group, (2): ketotifen group (received ketotifen 1 mg/kg/day orally for 2 weeks), (3): LPS group received LPS 5mg/kg intratracheal single dose at 5th day ,and (4): ketotifen+LPS group: received both ketotifen plus LPS in the same previous doses. Rats were sacrificed after 2 weeks. The lung oxidative damage effect of LPS was evaluated by measuring the lung tissue level of malonaldehyde (MDA) and histopathological assessment. ALI induced by LPS revealed statistically significant improvement in rats treated with ketotifen compared with LPS alone group. These results suggest that ketotifen can protect against LPS-induced ALI. Ketotifen effects rely, at least partially, on its antioxidant effect.
  • Comparing a vessel sealing system with the conventional technique in
           axillary lymph node dissection for primary breast cancer

    • Abstract: :Objective: This study aimed to compare the efficacy and safety of the newest bipolar vessel sealing system (BVSS; LigaSure™ Small Jaw) to that of conventional technique in axillary dissection. Patient and Methods: Eighty-nine patients with breast cancer were randomized to a conventional dissection surgical technique (CONV group; n = 45) by scalpel and monopolar cautery or that using a vessel sealing system (BVSS group; n = 44). Results: in conventional group, mean drain volume was 851.1±96.2 ml ml and 370±152 ml in ligasure group with a p-value <0.001, which is statistically significant. In conventional group, mean number of days till drain removal was 10.6 ± 1.9 days and 6.2 ± 0.8 days in ligasure group with a p-value of 0.001 which is statistically significant.Conclusions: Our results suggest that BVSS is a more effective device when compared to the conventional techniques in axillary dissection.Keywords: Breast cancer, Vessel sealing system, Axillary lymph node dissection, Randomized controlled trial
  • ultrasonography in prediction of difficult airway intubation in obese
           patients in emergency operations

    • Abstract: Background: Unexpectedly challenging laryngoscopy may still be a significant issue despite the adoption of several clinical index tests for airway evaluation.Patients and method: this a prospective single center, double blind Cohort study, included as many eligible patients over period of 6 months whom were obese patients without clear anatomical abnormalities undergoing urgent surgeries and receiving general anesthesia, 349 patients included and divided to Control group (c) who were non obese patients, Obese group (O) with BMI >30 kg/m2. Aim of the work: evaluate the efficacy of ultrasonography for predicting difficult intubation in patients who need emergency surgical treatment and are obese.Results: a significant difference recorded between the two groups as regard the weight which was higher in obese patients (92.1±6.2), and consequently the BMI was (34.8±4.9). Also, a significant difference in the clinical assessment between two groups, incidence of difficult laryngoscopy DL (20.3%) of obese patients, Conclusion: In obese individuals, ultrasonography might foretell a more challenging laryngoscopy.
  • The Added Values Of Duplex Study And Cranial Ultrasonography In Clinically
           Suspected Preterm Brain Injury

    • Abstract: Our study was conducted on 50 premature infants (than 32 weeks) with clinically suspected preterm brain injury. All patients underwent cranial ultrasonography using high-resolution sonography machines at NICU of Minia University Hospitals. Radiological investigations were done for all cases and controls including transcranial sonar, and transcranial Doppler studies of ICA, MCA and ACA for mean velocity, PSV and resistive index. Grading system for germinal matrix haemorrhage/ intra ventricular haemorrhage (GMH/IVH) by Volpe is based on cranial ultrasound scan (CUS). Grade I refers to haemorrhage confined to the subependymal GM, and grade II as haemorrhage within the lateral ventricle without ventricular dilation and/or haemorrhage occupying less than 50% of the ventricle. Grade III haemorrhage is defined by ventricular dilation and/or haemorrhage occupying more than 50% of the ventricle, while grade IV is ventricular haemorrhage with periventricular hemorrhagic infarction. 40 % had GMH/IVH in the US. Among those 35.3% were grade 1, 29.4% were grade 2, 23.5% were grade 3, while 11.8% were grade 4. Associated pathology found among these cases included: 10 % had cerebellar haemorrhage,. 15 % had signs of brain edema by Doppler (an early finding) among them 5 % had progressed to just periventricular echogenicity (PVL – grade I), whereas 10 % progressed to periventricular cystic leukomalacia at TEA (PVL – grade II – IV). The positive cases had a significantly lower age and weight than the negative. Transcranial Doppler findings revealed higher mean velocity and lower PI & RI in preterms.
  • ''Placenta accreta spectrum disorders: the management options
           and outcome in one year study (2022) in Minia maternity and children
           University hospital: Observational case series study.''

    • Abstract: Background; PAS is a condition that might endanger life. The occurrence of PAS is projected to rise more over time given the rising frequency of cesarean sections globally , Aim and objectives; to assess the effectiveness of various care strategies for placenta accreta spectrum patients from January 2022 to December 2022 at Minia Maternity & Children University Hospital, Subjects and methods;The current investigation was conducted from January 2022 to December 2022 on all patients at Minia maternity and children University hospital who were either suspected of having or were officially diagnosed with placenta accreta, Result; Among the studied women, 15 (14.7%) were managed by Hysterectomy. While the remaining 87 women were managed by Conservative surgical options. There was a statistically substantialconnection between GA and hysterectomy, women who underwent hysterectomy were with younger GA as compared with those who managed by Conservative surgical options. There were non-statistically significant differences with other studied variables regarding mode of management, Conclusion; PAS can be managed by Conservative surgical options and Hysterectomy. As a result, practitioners need to be aware of the difficulty in making the diagnosis and the difficulties in treating this disorder. key words; GA gestational age, GHTN gestational hypertension, CS cesarean section.
  • Visual Acuity Evaluation in Diabetic Macular Oedema with Foveal Hard

    • Abstract: IntroductionDiabetic retinopathy (DR) is one of the main causes of blindness in the middle-aged individuals. (Yau et al., 2012) The primary cause contributing to loss of vision in diabetic patient is diabetic macular oedema (DME).(Williams et al., 2004) Hard exudates are deposits of lipo-protein that is build up as a result of a disintegration of the inner BRB.(Zhou et al. 2018)Aim of The StudyAssessment of visual acuity (VA) in patient with diabetic macular oedema with foveal hard exudatesPatients and Methods The study was a case control study. The study included 100 eyes from 100 DME patients that divided into 2 groups. The study was conducted at Ophthalmology department, Minia University Hospital in Egypt between february 2022 and August 2022.ResultsPresence of hard exudates in fovea in DME was associated with significant decrease of BCVA so Presence of hard exudates in fovea in DME was a bad prognostic sign for DME.Conclusion Presence of hard exudates in fovea in DME affected macular function determined by BCVA and it was a bad prognostic sign for DME.
  • Short-Term Scar Outcome of Burned Patients Treated by NPWTi: A Preliminary

    • Abstract: Background: Negative Pressure wound therapy with instillation (NPWTi) combines the advantages of both sub-atmospheric pressure therapy and instillation of wound-decontaminating and infection-controlling solutions. In this paper, we present our experiment in utilizing NPWTi for superficial partial, deep partial, and full-thickness burn wound management in the Minia University Hospital Burn Unit. Methods: Twenty patients were included in a prospective study of burn wounds. The burn area was divided into two parts; the control part & study part; the control part was managed by occlusive dressing, while the study part was managed by NPWTi. NPWTi was initiated by instilling normal saline with a soaking time of 5 minutes, followed by 8 hours of NPWT at 75 mmHg for children and 100 mmHg for adults. One month after complete healing, all cases were assessed using the Photographs & POSAS Scar Scale.Results: The study results revealed faster healing time and significant scar outcomes.Conclusion: NPWTi is a valid tool for the management of burns with promising and satisfactory scar outcomes.
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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