Assessment of EEG Changes in Neonatal Sepsis at Al-Zahraa University Hospital’s NIC Unit

Background: EEG is one of the most sensitive instrumental techniques for identifying sepsis-related neurological complications and a valuable tool in the ICU when clinical assessment is difficult. Aim of the Study: To detect EEG changes in neonates with evidence of sepsis. Patients and Methods: This was a prospective observational study for detecting EEG changes in cases of proven neonatal sepsis. This study was conducted at the NICU of Al Zahraa University Hospital for a period from October 2019 to March 2020. Our studied neonates were 50. This study included full-term newborns (37 to 42 weeks of gestational age) with clinical and laboratory evidence of sepsis (early and late onset). Neonatal birth asphyxia, jaundice, congenital malformations, suspected inborn error of metabolism and neonates electrolytes disturbances were excluded from the study. We record EEG changes during 20 min By an electroencephalogram (EEG) with abioelectric amplifier (Deltamed, Bourgogne), (Philips) Screen. Results: Among our studied neonates (neonates with evidence sepsis), 44.0% developed clinical seizures, 81% of the seizures group had abnormal EEG, 35.7% of No seizures group had abnormal EEG. Among our studied neonates, 56% had abnormal EEG EEG abnormalities were as follow, 26%/ had low voltage, 30% had spikes, 22% had sharp waves. Conclusion: About 35% (one third) of neonates who didn’t develop clinical seizures had abnormal EEG, suggesting a poor correlation between clinical and electroencephalographic detection of seizures.

Mechanical Ventilation Outcomes at the NICU at EL-Zahraa University Hospital

Background: Mechanical ventilation (MV) is one of the most common therapies in the neonatal Intensive Care Unit (NICU) and is associated with increased morbidity and mortality. MV is a complex and highly specialized area in neonatology that has several complications related to different modes, techniques, and devices. Aim of the Study: To detect the causes of morbidity and mortality in mechanically ventilated neonates and to correlate the neonatal morbidity and mortality with gestational age, birth weight and duration of MV. Patients and Methods: This prospective observation analytical study was carried out on 110 neonates who were admitted to NICU at Al-Zahraa university hospital on MV during the period from March 2019 to March 2020. All neonates were followed up till the time of discharge with record of any complications during mechanical ventilation. Detailed medical history, examination to detect indication of MV and laboratory, radiological investigations were recorded. As regard the general characterization of studied neonates, 64 (58.2%) were males while the rest 46 (41.8%) were females, 50 (45.4%) were full term (37 - 42 wks), 42 (38.18%) were early preterm (28 - 33 wks), 18 (16.3%) were late preterm (34 - 42 wks). Results: Among (110 mechanically ventilated neonates, 58.2% were males, 41.8% were females. The most common indication for MV in the studied cases was respiratory distress syndrome (RDS) in 30% neonates. Ventilator associated pnemonia and Devices associated infection were the most common complications related to MV (19.1% and 11.8% respectively). While septic shock and multiorgan failure were the most common complications related to the underlying disease (24%). There is a significant negative association between gestational age, birth weight and mortality in mechanically ventilated neonates. the overall recovery was 59.1% among studied neonates. Conclusion: Respiratory disorders were the commonest indication of MV in NICU mostly RDS. Ventilator associated pneumonia and devices associated infection are common complications. Preterm and low birth weight neonates are vulnerable group for need of mechanical ventilation.

Evaluation of urea breath test as a diagnostic tool for Helicobacter pylori infection in adult dyspeptic patients

In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helicobacter pylori(H.pylori)infection in humans.It is based on radionuclide-labeled urea.Various methods,both invasive and non-invasive,are available for diagnosing H.pylori infection,inclu-ding endoscopy with biopsy,serology for immunoglobulin titers,stool antigen analysis,and UBT.Several guidelines recommend UBTs as the primary choice for diagnosing H.pylori infection and for reexamining after eradication therapy.It is used to be the first choice non-invasive test due to their high accuracy,specificity,rapid results,and simplicity.Moreover,its performance remains unaffected by the distribution of H.pylori in the stomach,allowing a high flow of patients to be tested.Despite its widespread use,the performance characteristics of UBT have been inconsistently described and remain incompletely defined.There are two UBTs available with Food and Drug Administration approval:The 13C and 14C tests.Both tests are affordable and can provide real-time results.Physicians may prefer the 13C test because it is non-radioactive,compared to 14C which uses a radioactive isotope,especially in young children and pregnant women.Although there was heterogeneity among the studies regarding the diagnostic accuracy of both UBTs,13C-UBT consistently outperforms the 14C-UBT.This makes the 13C-UBT the preferred diagnostic approach.Furthermore,the provided findings of the meta-analysis emphasize the significance of precise considerations when choosing urea dosage,assessment timing,and measurement techniques for both the 13C-UBT and 14C-UBT,to enhance diagnostic precision.

Serum vascular endothelial growth factor as a tumor marker for hepatocellular carcinoma in hepatitis C virus-related cirrhotic patients

BACKGROUND Hepatocellular carcinoma(HCC)accounts for 8.2%of all cancer-related deaths worldwide.Being a vascular tumor,vascular endothelial growth factor(VEGF)plays a vital role in HCC pathogenesis,growth,and spread.AIM To determine the accuracy of serum VEGF and VEGF/platelet(PLT)as tumor markers in the early detection of HCC cases in patients with hepatitis C virus(HCV)-related liver cirrhosis.METHODS We conducted a case-control study with HCV patients from the outpatient and inpatient hepatology clinics.Patients were classified into three groups:(1)HCC group;(2)Cirrhosis group;and(3)HCV without cirrhosis(control group).Patients were clinically evaluated,and blood samples were drawn for the analysis;serum VEGF levels were measured by a specific VEGF human recombinant enzyme-linked immunosorbent assay kit.Data from the three study groups were compared by the one-way analysis of variance or Kruskal-Wallis test.Receivers operating characteristic curves were constructed to determine the optimal cut-off values of alpha fetoprotein(AFP),VEGF,and VEGF/PLT that provided the best diagnostic accuracy.The sensitivity and specificity at the optimal cut-off value of each biomarker were then calculated.RESULTS This study included one hundred patients(HCC,cirrhosis,and control groups:n=40,30,30,respectively).HCC patients had significantly higher serum VEGF and VEGF/PLT levels than the non-HCC groups(P=0.001).Serum VEGF and VEGF/PLT showed significant positive correlations with and HCC tumor size,stage,vascular invasion,and Child-Pugh classification.Moreover,a VEGF cut-off the value of 250 pg/mL provided 80%sensitivity and 81.7%specificity for discriminating HCC patient from non-HCC patients.Similarly,the ratio of VEGF/PLT provided sensitivity and specificity of 77.5%and 80%,respectively which is higher than the accuracy provided by AFP.The combination of AFP,VEGF,and VEGF/PLT increases the accuracy of diagnosing HCC to>95%.CONCLUSION In HCV patients,serum VEGF and VEGF/PLT separately or in combination with AFP are reliable biomarkers for early and accurate HCC diagnosis.

Presepsin and Procalcitonin as Potential Biomarkers for Early Diagnosis and Prognosis of Sepsis in Critically Ill Patients

Background: Sepsis has a poor prognosis for critically ill patients, even with intensive management. Early diagnosis of sepsis and detection of patients with worsening prognosis are important for immediate intervention to improve the clinical outcome. Objective: To investigate serum presepsin (PS) and procalcitonin (PCT) as early diagnostic and prognostic biomarkers for sepsis in critically ill patients. Methods: 60 critically ill patients with sepsis were subdivided into three groups of sepsis, severe sepsis and septic shock according to Acute Physiology and Chronic Health Evaluation II (APACHEII) and quick Sequential Organ Failure Assessment (qSOFA) scores. Patients were compared with 20 age and sex matched controls. Serum PS and PCT were measured by enzyme linked immunosorbent assay (ELISA). Results: Serum PS and PCT levels were significantly increased in septic patients than controls, and their increase was positively correlated with progression of sepsis severity till reached the highest levels in septic shock. Receiver operating characteristic (ROC) curve for predicting sepsis revealed that PS has the highest area under curve (AUC) (0.967) with 97.5% sensitivity, 85% specificity and cut-off of >635.5 pg/mL, followed by PCT that has AUC (0.946), 97.5% sensitivity, 95% specificity and cut-off of >319.7 pg/mL. C-reactive protein (CRP) showed the lowest AUC (0.902) with 75% sensitivity, 100% specificity and cut-off of >7 mg/L. ROC curve for predicting septic shock showed that PS has the highest AUC (0.969) with 90% sensitivity, 97.5% specificity and cut-off of >5500.6 pg/mL, followed by CRP that has AUC (0.945), 90% sensitivity, 87.5% specificity and cut-off of >63 mg/L. PCT showed the lowest AUC (0.889) with 90% sensitivity, 97.5% specificity and cut-off of >822.1 pg/mL. Conclusions: Serum PS and PCT were promising biomarkers for early diagnosis and prognosis of sepsis in critically ill patients, but PS was superior to PCT.

Plasma Asymmetric Dimethylarginine Levels in Neonates with Bronchopulmonary Dysplasia Associated with Pulmonary Hypertension

Background: Bronchopulmonary dysplasia (BPD) continues to be an important problem in neonates especially premature infants despite improved facilities of care, monitoring and treatment. Pulmonary hypertension (PH) is a major complicating factor and key cause of mortality in this population. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy result in arrest of the lung development leading to BPD with PH. Early recognition of PH in infants with these risk factors is important for optimal management. We tested the hypothesis that asymmetric dimethylarginine, would be greater in infants with bronchopulmonary dysplasia associated pulmonary hypertension than in infants with BPD alone. The Aim: The aim of the current study was to measure the Asymmetric dimethylarginine (ADMA) levels, arginine levels & the plasma arginine-to-ADMA ratio in newborn infants with broncho-pulmonary dysplasia, to evaluate echocardiographic parameters among neonates with bronchopulmonary dysplasia, to correlate between plasma ADMA & arginine-to-ADMA ratio and echocardiographic (ECHO) parameters in those patients and to compare full term & preterm neonates with bronchopulmonary dysplasia as regard to plasma ADMA level. Methods: A case-control study was carried out of ninety (90) newborns selected from those admitted to Neonatal Intensive Care Unit at Maternity & Children Hospital and Alzhraa University hospital during the period from October 2015 to March 2018. Neonates were divided into 2 groups: Patient with BPD with PH (cases group): It included 45 neonates with BPD & PH, 35 preterm neonates and 10 full term neonates. Patient with BPD only (Control group): It included 45 neonates with BPD without PH. These 45 neonates were divided as 22 preterm neonates and 23 full term neonates. Laboratory work was done in Alzhraa University hospital. Asymmetric dimethylarginine (ADMA) levels & arginine levels were measured using competitive enzyme linked immune-assay (ELISA). Results: Patients with both BPD and PH had greater plasma levels of ADMA than patients with BPD alone (P value 0.000). ADMA level > 186 ng/dl can predict development of PH in patient with BPD with sensitivity 100% and specify 100%. Preterm neonates with BPD had greater level of ADMA than full term neonates (P value 0.002). There was no statically significance difference between level of ADMA if withdrawn before or after 28 days of age (range of age at time of sampling in our study was 23 - 40 days) (P value 0.878), even ADMA level increased above the cut point early in the disease before we screened some cases by ECHO. There was no statically significance difference between level of arginine in cases and control groups with P value 0.530. The plasma arginine-to-ADMA ratio was lower in cases than in controls suggesting a greater likelihood of inhibition of nitric oxide production in patients with both BPD and PH than in patients with BPD alone (P value 0.000). ADMA level can predict severity of pulmonary hypertension in patient with BPD, as it was positively correlated with the grade of pulmonary hypertension (P value 0.006). ADMA level is higher in neonates with BPD and PH who died than those who survived;it can predict death in neonates with BPD &PH at cut off point > 643 ng/dl. Conclusion: ADMA increased in newborn infants with BPD, who developed PH. ADMA may have diagnostic and prognostic values. ADMA level was higher in preterm neonates than full term neonates and its level was correlated positively with severity of PH. ADMA levels were significant higher in infants with BPD with PH who died later than those who survived. There was no statically significance difference between levels of ADMA, whether it was drawn before or after 28 days of age (range 23 - 40 days). Echocardiographic screening and ADMA measurement could help in prevention of PH, diagnosis and early treatment of newborn infants suffering from BPD.

The Relation between Role of Serum Cortisol Level and Response to Various Respiratory Support Strategies among Preterm Infants

Introduction: Preterm infants are liable to various health problems including respiratory distress syndrome (RDS). There is variation in response to respiratory support. In preterm infants, cortisol hormone is secreted by the adrenocortical gland in response to stress. Objectives: To compare the serum cortisol levels in blood among preterm infants who needed different respiratory support strategies e.g. headbox, continuous positive airway pressure (CPAP), intubation surfactant extubation (INSURE) and mechanical ventilation (MV) and to correlate the cortisol levels to the severity of respiratory distress syndrome (RDS). Material and Methods: Observational prospective study that assessed the serum cortisol levels in preterm infants with RDS after initial respiratory support aged 28 - 34 gestational weeks that were admitted to the neonatal intensive care unit of Al Zahraa hospital of Al-Azhar University and Al-Estekama hospital between February 2019 and November 2019. Infants were classified into three groups, Group 1: 29 infants with severe RDS who needed a mechanical ventilator. Ten of them needed surfactant therapy. Group 2: 33 infants with moderate RDS who needed CPAP. Three of them needed surfactant therapy. Group 3: 28 infants with symptoms of mild RDS who needed headbox. None of them needed surfactant therapy. Blood samples were collected on the first day of life and were processed using the colorimetric ELISA method. Demographic and medical information was collected. Results: A total of 90 preterm infants were included. The serum cortisol reference was 4.3 - 22.4 mg/dl. Group 1 showed significantly higher serum cortisol levels compared to group 2 and group 3 (39.22 ± 9.91 mg/dl vs 28.96 ± 6.48 mg/dl vs 25.88 ± 5.42 mg/dl) respectively, (P-value = 0.001). Infants in group 2 who needed surfactant therapy had higher serum cortisol levels than those who did not need surfactant therapy (32.30 ± 5.92 mg/dl vs 28.33 ± 6.27 mg/dl). The serum cortisol levels were observed having a negative correlation with gestational age and birth weight. No significant differences were observed in terms of gender or type of delivery. Conclusion: Cortisol levels had a positive correlation with the severity of RDS who needed various respiratory support strategies.

Open Fracture Tibia Treated by Unreamed Interlocking Nail. Long Experience in El-Bakry General Hospital

Background: Internal splintage of open tibial fractures had gained acceptance as a preferred method of early stabilization of such injuries. Patients and Methods: Fifty-five patients had been operated upon. They were followed from July 2008 to March 2013 (56 months) with an average time of 39 months. The final results had been evaluated through a scheme including 7 parameters: pain, union, malunion, infection, range motions of nearby joints, implant and technical failure and activity and returning to the same work. Results: According to previous parameters, union was achieved in 52 cases (94.5%) at an average time of 20 weeks (16 - 52 weeks) with 5.5% incidence of nonunion. Excellent and good ranges of knee and ankle motions were achieved at final follow-up visit in 49 cases (89.09%). The incidence of complication was acceptable mainly malunion 7.3%, deep infection 12.7%, implant and technical failure 9.1% full activity and returning to the same work achieved in 89.1%. The overall net results of our series are as follows: excellent—19 cases (34.5%), good—27 cases (49.1%), fair—6 cases (10.9%) and poor—3 cases (5.5%). Conclusion: Utilizing unreamed interlocking nail for open tibial fractures is a good method of treatment particularly those of grade (II), and (IIIA).

Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen(CA)19-9, CA72-4], carcinoembryonic antigen(CEA), serine protease inhibitor Kazal-type 1(SPINK1), interleukin 1 beta(IL1-β), vascular endothelial growth factor A(VEGF-A), and prostaglandin E2(PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound(EUS) and EUS-fine needle aspiration(EUS-FNA) for characterization and sampling of different PCLs.RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance(59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively(P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance(P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

Evaluation of Plasma Urokinase-Type Plasminogen Activator Receptor and Interleukin 34 in Patients with Chronic Hepatitis C as Serological Fibrosis Markers

Background: Hepatitis C Virus (HCV) infection is a progressive disease that may result in chronic hepatitis, fibrosis and cirrhosis. Assessment of liver fibrosis is an essential factor in the management of chronic HCV. Objective: To evaluate plasma soluble Urokinase Plasminogen Activator Receptor (sUPAR) and interleukin-34 (IL-34) as serological markers of liver fibrosis in patients with chronic HCV. Methods: This case-control study enrolled 60 chronic HCV patients who were subdivided into three groups of mild, moderate and severe hepatic fibrosis depending on Fibrosis-4 score (FIB-4). Patients were compared with 20 age and sex-matched controls. Plasma sUPAR and IL-34 levels were measured by Enzyme Linked Immunosorbent Assay (ELISA). Results: Plasma sUPAR and IL-34 were significantly increased in HCV patients when compared with controls, and their increase was positively correlated with the progression of hepatic fibrosis. Plasma sUPAR and IL-34 positively correlated with Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT), and negatively correlated with hemoglobin concentration and platelet count. The output data of Receiver Operating Characteristic (ROC) curve to differentiate patients from controls revealed that sUPAR at cut-off > 186.2 ng/L and Area Under Curve (AUC) of 0.944 had (85%) sensitivity and (100%) specificity, and IL-34 at cut off > 16.4 ng/L and AUC of 0.942 had (75%) sensitivity and (100%) specificity. The output data of ROC curve to differentiate severe from mild to moderate hepatic fibrosis patients revealed that sUPAR at cut-off > 510 ng/L and AUC of 0.837 had (80%) sensitivity and (90%) specificity. While IL-34 at cut off > 55.3 ng/L and AUC of 0.844 had (85%) sensitivity and (80%) specificity. Conclusions: Increased plasma levels of sUPAR and IL-34 in chronic HCV patients with liver fibrosis and their increase was parallel to the degree of liver fibrosis. Plasma sUPAR and IL-34 can be used as serological markers of liver fibrosis in chronic HCV patients.

Challenge of managing hepatitis B virus and hepatitis C virus infections in resource-limited settings

The global burden of hepatitis B virus(HBV)and hepatitis C virus(HCV)infections and coinfection represents a major public health concern,particularly in resource-limited settings.Elimination of HCV by 2030 has become foreseeable,with effective direct-acting antiviral oral therapies and the availability of affordable generics in low-and-middle-income countries(LMICs).However,access to oral nucleos(t)ide therapy for HBV remains critical and is limited outside the existing global HIV program platforms despite affordable prices.Prevention of mother-to-child transmission of HBV through scaling up of birth dose implementation in LMICs is essential to achieve the 2030 elimination goal.Most individuals living with HBV and/or HCV in resource-limited settings are unaware of their infection,and with improved access to medications,the most significant barrier remains access to affordable diagnostics and preventive strategies.The coronavirus disease 2019 pandemic interrupted hepatitis elimination programs,albeit offered opportunities for improved diagnostic capacities and raised political awareness of the critical need for strengthening health care services and universal health coverage.This review underpins the HBV and HCV management challenges in resource-limited settings,highlighting the current status and suggested future elimination strategies in some of these countries.Global efforts should continue to improve awareness and political commitment.Financial resources should be secured to access and implement comprehensive strategies for diagnosis and linkage to care in resource-constrained settings to fulfill the 2030 elimination goal.

Reconstruction of Humeral Head Defect in Locked Posterior Dislocation Shoulder. A Case Series of Nine Patients

Locked posterior dislocation shoulder is uncommon and frequently missed injury. It account for 2% - 4% of all shoulder dislocations. It is commonly associated with osseous defects in humeral head articular surface known as reverse Hill-Sachs lesion. Numerous surgical procedures invented to repair this defect with variable outcomes but evidence based management strategies are lacking. Among these procedures are: transfer of lesser tuberosity or subscapularis tendon, rotational osteotomy of humerus, osteochondral grafts. Salvage procedure as hemiarthroplasty or total shoulder arthroplasty used in huge non-constructable defect or very old neglected dislocation. In our case series, we treated 9 cases (2 females) of locked posterior shoulder dislocation with antero-medial humeral head defects ranging between 30% - 50% of head size. Open reduction of dislocation followed by transfer of the lesser tuberosity together with subscapularis tendon for reconstruction of the humeral head defect. The transfer was fixed with Ethibond suture size 5-0 (Ethicon, Inc. Somerville, New Jersy). The mean follow-up period was 14.5 months (range, 12 - 25 months). Seven cases had no pain or restriction of activities of daily living. No patient had symptoms of instability of the shoulder. According to UCLA Shoulder rating scale, there were 3 cases rated excellent, 4 cases rated good, one case rated fair and one case rated poor. It is concluded that reconstruction of the humeral head defect provides good pain relief, stability and function for patients with a locked posterior dislocation where the defect involves between 30% - 50% of the articular surface circumference. Our technique is simple, cheap and there is no need for second operation for hardware removal.

Comparison of Respiratory Outcome between Sustained Lung Inflation and Intermittent Positive Ventilation in Preterm Infants Requiring Resuscitation at Birth

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for intubation and subsequent respiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess the efficacy of initial sustained lung inflation compared to standard intermittent positive pressure ventilation (IPPV) in preterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that was conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September 2019. The study included 115 preterm infants between 26 - 32 weeks of gestation who needed resuscitation at delivery room. The infants were randomly allocated into 2 groups;SLI group: included the preterm infants who received the SLI at initial inflation pressure of 25 cm H2O for 15 seconds using the Neopuff/T piece. IPPV group: preterm infants who received standard resuscitation;IPPV using the self-inflating bag. The heart rate (HR), oxygen saturation (SpO2), oxygen requirement, and intubation rate as well as need of surfactant in the delivery room were assessed. All cases were evaluated after admission to the NICU for the need of mechanical ventilation in the first 72 hours of life, death in delivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post menstrual age (PMA). Results: The percentage of preterm infants who needed resuscitation was 25.5% from the total deliveries during the study period. 56.5% of them received SLI and 43.4% received conventional IPPV. There were no significant differences between the studied groups regarding gestational age, birth weight. Apgar score, heart rate, oxygen saturation was not significantly increased in the SLI group at fifth minutes of age. The percentage of infants who needed further resuscitation was 20% in SLI group and 12% in the IPPV group. There were no significant differences in need for surfactant, CPAP or ventilator among the studied groups. There were no significant differences in relation to complications as BPD, air leak or retinopathy and death between the two groups. Conclusion: This study showed that there was no advantage from use of SLI in delivery room using T-piece upon the conventional IPPV using self-inflating bag.

Infrapubic versus Penoscrotal Approaches for Implantation of Semi-Rigid Penile Prosthesis

Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.

Study of Vitamin D Status in Pneumonia among Children between 6 Months to 3 Years of Age

Background: In the developing world, pneumonia is not only more common than it is in Europe or North America;it is also more severe and considered the leading cause of under-five mortality. Effective management of pneumonia in children under 3-year-old-age is still challenging due to various causes. Some authors believed in non-calcemic role of vitamin D as a potential factor in the pathogenesis, prevention, or therapy of pneumonia in this specific age. Purpose: Investigate the Vitamin D status in pneumonia among children between 6 months to 3 years of age. Subjects and Methods: This study was conducted in a Pediatric point of care at Al-Zahraa University Hospital on 90 children aged 6 months to 3 years old;divided into two groups: group I (study group) including 47 patients presented with pneumonia and group II (control group) including 43 apparently healthy children of matched age and sex with no evidence of pneumonia. Serum vitamin D was estimated with specific inclusion and exclusion criteria. Results: The vitamin D level showed no significant difference between the two groups of the study. Conclusion: Possible role of vitamin D in disease process of pneumonia in children between 6 months to 3 years could not be assured.

Evaluation of BCG Vaccine Immunogenicity in Relation to Vitamin D Status in a Group of Egyptian Children

Background: Vitamin D has an immuomodulatory role in vaccine response and this may be mediated via its action on antigen presenting cells with the most potent effects on dendritic cells. Aim of work: was to determine if there is an association between circulating 25(OH)D concentrations and BCG vaccine cytokine response (interferon gamma) level. Methods: A cross sectional study included 80 infants aged 4 - 9 months from the pediatric outpatient clinic of Al-Zahraa university hospital (40 with normal weight and 40 with underweight). Participants were subjected to history taking, clinical examination, and laboratory investigations, particularly 25 hydroxy vitamin D [25(OH)D] and BCG vaccine-induced interferon gamma (IFN-γ). Results: The study showed that the underweight group had a lower socioeconomic level and higher percentage of breastfeeding compared with the normal weight group. Most infants in our study received vitamin D supplementation (80% and 62.5% in normal and underweight groups, respectively). The average serum level of 25(OH)D was relatively high (>100 ng/ml) in both normal and underweight groups. The mean levels of IFN-γ in response to BCG vaccine were not significantly different between the normal and underweight groups of infants in our study. Also, there was a statistically-significant moderate correlation between serum levels of 25(OH)D and BCG vaccine-induced IFN-γ in both normal (r = 0.58) and underweight (r = 0.64) groups. Conclusion: A good vitamin D status was observed in all studied infants irrespective of their nutritional status and significant correlation with BCG vaccine induced IFN-γ.

Biplanar Open-Wedge High Tibial Osteotomy with Locking Plate for Treatment of Osteoarthritic Varus Knee

Aim: To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat unicompartmental knee arthritis with varus deformity in active lifestyle patients. Patients and Method: 48 patients (19 females) with monocompartmental gonarthrosis of the knee combined with varus malalignment, 41 with bilateral affection and 7 cases with unilateral gonarthritis (total 89 knees). Mean age: 53 years (range from 42 to 61 years). They were treated and followed from June 2010 to May 2014 (35 months). Biplanar opening high tibial osteotomy technique was used and fixed by low profile locked T-plate (21 cases) and low profile anatomical proximal tibial plate (27cases). Pre-operative mean varus deformity was 16.5° (9° - 19°). We utilized Lysholm score and Knee Society Score for evaluation of preoperative and follow-up data. Results: The average correction angle was 11.50 ± 2.50° (7° - 19°). Preoperative posterior tibial slope was 8.04° ± 1.30° and at last follow-up 9.15° ± 1.60°, respectively (p = 0.437). The joint space distance increased from 4.05 ± 1.30 mm to 4.83 ± 1.33 mm (p < 0.001). The average time to complete bone union was 14.69 ± 1.5 weeks. There were no cases of delayed union or non-union. No major complications like broken plate, nerve injury, or blood vessel injury occurred. No progression of degenerations developed in the three compartments of the knee at final follow-up. The mean score on the Lysholm-Gillquist knee functional scoring scale was 45.5 ± 21.7 preoperatively, and it improved to 77.0 ± 23.9 (p < 0.001). There was no obvious difference in the range of motion before and after operation. The average knee score improved from 51.19 ± 11.82 to 93.49 ± 5.10. Conclusion: Biplanar opening high tibial osteotomy fixed with locking compression plate gives good results for symptomatic unicompartmental gonarthrosis with genu varum. Also this technique can be applied for medial compartment degeneration of the knee without deformity with good functional outcomes.

Light and Electron Microscopic Study of the Effect of Orlistat on the Liver of Adult Male Albino Rats and the Possible Protective Role of <i>β</i>-Carotene

Orlistat is a safe and effective drug to treat obesity by acting as a pancreatic and gastric lipase inhibitor, resulting in reduction in fat absorption. There is also concern that it may be linked with an increased threat of serious hepatic incidents. The present work was carried out to study the effect of orlistat on the histological, immunohistochemical and electron microscopic structure of the liver in the adult male albino rats and the possible protective role of β-carotene administration. Forty adult albino rats were subjected to experiment for two weeks as follows: group 1 (control), group II, each animal received 0.52 mg/kg bw/day β-Carotene, group III, each animal received orlistat 32 mg/kg/day, and group IV received β-Carotene, 1hour before the administration of orlistat at same dose of group II & III. The liver from each animal was dissected out and processed for histological, (light and electron microscopic study). The result of Hep-Par1 for immunohistochemistry was statistically analyzed. The results showed that orlistat treated group displayed variable disturbance of liver architecture, from dilatation, congested central and portal veins, branching of bile ductules, mononuclear cellular infiltration, areas of hemorrhages, cytoplasmic vacuolation and pyknotic nuclei. The most obvious changes were that degenerative changes in hepatocytes led to depletion of glycogen content of hepatocytes. Hep Par-1 revealed a wide area of negative immune expression around the central vein and in some hepatocytes. Other hepatocytes expressed weak reaction. Ultrastructure examination displayed hepatocytes with swollen mitochondria and others with an electron-dense matrix. The combined treatment of β-Carotene and orlistat led to a marked improvement in most of the previously mentioned changes. It was concluded that orlistat-induced hepatic toxicity. Thus, clinicians should cautiously monitor their patients for signs of hepatic dysfunction. Using an antioxidant such as β-Carotene decreased the toxicity of orlistat.

Evaluation of Urinary Hepcidin as a Marker for the Early Diagnosis of Iron Deficiency Anemia in Children

Background: Iron deficiency is an essential element, because nearly all living organism urine hepcidin levels could potentially be used in the determination of iron requirements and be an accurate indicator of physiological IDA. Aim: The present study aimed to evaluate the role of urinary hepcidin as an early diagnostic marker of iron deficiency anemia in children. Methods: This study included 45 children. Their age ranged from 6 to 16 years with hemoglobin levels ≤ 11.5 gm/dL and ferritin levels ≤ 20 ng/mL. The diagnostic performance of urinary hepcidin was estimated by analyzing the receiver operating characteristic curve. Diagnostic cut-off point with a high predictive value for iron deficiency was selected. Results: This study showed no statistically significant difference between the two studied groups regarding to demographic data. There were decrease in serum iron, ferritin, hemoglobin and Red blood cells (RBCs) indices in patient than the control group. There was non-significant decrease in urinary hepcidin in the study group compared to control group. The sensitivity and specificity of urinary hepcidin in diagnoses of iron deficiency anemia was 57.8 and 62.2 respectively with positive predictive value (63.3) in our study. There was positive correlation between urinary hepcidin and mean corpuscular volume (MCV), (r = 0.221), (p = 0.036), with the cut of value < 63.33. Conclusion: We concluded that the decrease of urinary level of hepcidin was non-significant in iron deficiency anemia compare to control group and needed further researches.

Ischemia Modified Albumin and C-Reactive Protein in Children with β-Thalassemia Major

Background: Beta-thalassemia is a hereditary haemoglobinopathy caused by defective hemoglobin (Hb) β-globin synthesis, leading to excess α-globin chains that cause hemolysis and impair erythropoiesis. Ischemia modified albumin (IMA) is not a signal protein and not generated in pro-inflammatory state alone but rather an end product of oxidative stress. Objectives: The aim of the study was to evaluate ischemia modified albumin (IMA) and C-reactive protein (CRP) in children with β-thalassemia major and its relation to different iron chelators. Patients and Methods: The study was carried on 40 children diagnosed as beta-thalassemia major recruited from the outpatient clinic and the pediatric department, at Al-Zahraa University Hospital, Faculty of medicine for Girls, Al-Azhar University and EL Minia Insurance Hospital. They were 20 male and 20 female, aged from 4 - 11 years. Another 40 apparently healthy children age and sex matched as control group. CRP and IMA were determined for all participants. Results: There were significant increases in serum CRP, IMA and ferritin levels in patients group compared to control group. There were significant decreases of IMA and CRP levels of thalassemic patients on chelation deferiprone (DFP) compared to deferasirox (DFX) P-value (<0.01) for each. There was a significant positive correlation between serum ferritin and both CRP and IMA levels in thalassemic children (r = 0.40, p < 0.01), (r = 0.44, p < 0.01) respectively. There was a significant positive correlation between IMA and CRP in beta-thalassemic patients (r = 0.31, p = 0.02). Conclusion: IMA, CRP and Serum ferritin were higher in children with β-thalassemia major than controls. Moreover, IMA and CRP levels in thalassemic children on deferiprone (DFP) were significantly lower compared with children on deferasirox (DFX). So it could be considered as useful markers in the follow up assessment of thalassemic patients for early detection of complications.