Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101DETECTION OF AUTISITC LIKE TRAITS IN PATIENTS WITH SCHIZOPHRENIA AND BIPOLAR DISORDERS182368410.21608/zumj.2019.23684ENKhadija EmadDawoudYasser MohamedRayaAmira MohamedYossefAbdullah SaadIbrahimJournal Article20190106Background: Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. Subjects and methods: The subjects were78 adults of normal intelligence between 18 and 60 years of age (bipolar disorder, n=26; schizophrenia, n=26; healthy controls, n=26). Autistic-like traits/symptoms were measured using the Autism Spectrum Quotient (AQ) for adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Results: schizophrenic patients had higher level of autistic traits than bipolar patients and healthy control. On the other hand, bipolar patients had similar level of autistic traits as that of healthy control. Conclusion: These findings suggest the importance of evaluating autistic-like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.https://zumj.journals.ekb.eg/article_23684_fb7bcdd77e61e1d9ad6a08c106911f4d.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101LEFT VENTRICULAR DYSFUNCTION IN END STAGE RENAL DISEASE PATIENTS ON REGULAR HAEMODIALYSIS CORRELATED TO DIFFERENT VARIABLES9152368510.21608/zumj.2019.23685ENMohamedKewanTamerGodaYasserEl HindyAhmedHussinJournal Article20190106Background: Patients with chronic kidney disease (CKD) manifest an increased prevalence of cardiovascular morbidity and mortality compared with age-matched persons, and this relationship is directly proportional to the severity of CKD. After age, left ventricular hypertrophy (LVH) is considered to be the strongest independent predictor of cardiovascular disease and events, cardiovascular death and total mortality. In CKD patients, LVH contributes to diastolic dysfunction, congestive heart failure, arrhythmia and sudden death. Aim of the Work: The aim of this study is to clarify the relationship between ESRD and left ventricular dysfunction Methods: All patients were subjected to the following :: Complete history and physical examination, Routine laboratory investigations including: Complete blood picture,Blood urea and serum creatinine, Random blood suger, calcium, phosphors,, uric acid urine analysis, PTH Special investigations in the form of 2D echocardiography. Results: The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 24.https://zumj.journals.ekb.eg/article_23685_cc2964444a9fb91385f61224ac9db49e.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101SIX MONTHS OUTCOME OF LOCO-REGIONAL TREATMENT OF HEPATOCELLULAR CARCINOMA AT ADVANCED LIVER CENTER, ZAGAZIG UNIVERSITY17212368610.21608/zumj.2019.23686ENMohamed HassanIbrahimHussein MohammedHusseinSameh SaberBayoumiHeba SayedAbdel HamidJournal Article20190106Background: Hepatocellular carcinoma (HCC) represents one of the few cancers for which loco-regional treatments are recognised as being able to cure and/or prolong survival and are included in international guidelines. The treatment choice in patients with HCC is therefore driven not only by tumour staging, as in the great majority of cancers, but also by careful evaluation of liver function and physical status. We aimed to evaluate the outcome of loco- regional treatment of hepatocellular carcinoma at Zagazig University. Methods: From June 2017 to December 2017, 30 patients with HCC who Patients’ candidate for loco-regional treatment according to BCLC were included that followed prospectively in this study. Results: There was a significant improvement after treatment as regard albumin,total, direct bilirubin, INR, AFP and focal size , and a significant successful of treatment by 70% of the cases. Positive HCV is a significant risk factor for treatment failure. Conclusions: Loco-regional treatments have a significant role in patients with HCC at all stages. Literature data support the use of image-guided ablation, primarily RFA, as the first-line treatment in patients with very early and early-stage HCC.https://zumj.journals.ekb.eg/article_23686_73f1fce990fe6048ab5637984742c6f1.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101PREVALENCE OF HELICOBACTER PYLORI INFECTION AMONG CHILDREN WITH PROTEIN –ENERGY MALNUTRITION22302368710.21608/zumj.2019.23687ENAzza IbrahimEl-DesoukySahar Abd El-RaaofEl-ShaarawyShimaa MohamedSafwatJournal Article20190106Purpose:The study aimed to assess prevalence of H.pylori infection in children with Protein energy malnutrition (PEM). Method: The study included 75 infant and young children with malnutrition in a cross section study. We obtain a stool specimens and blood samples from children after consent from the parents, H.pylori antigen in stool, stool analysis and CBC is estimated. Conclusion: Increased the prevalence of H. pylori infectiona among children with PEM.https://zumj.journals.ekb.eg/article_23687_b5b7648d31835ecac807ca3f2cba81b5.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101EARLY AND MIDTERM FOLLOW UP AFTER EARLY TOTAL SURGICAL REPAIR OF ESOPHAGEAL ATRESIA WITH TRACHEO- ESOPHAGEAL FISTULA31382368810.21608/zumj.2019.23688ENAli MRefatAbdelmeged MohamedSalemEhabSobhyKhaledAlanwerDena Abd El AzizEl SammakJournal Article20190106Background / Study Objective: to asses and present our short and intermediate outcome i early repair of Esophageal Atresia with TracheΟ- Esophageal Fistula Patients: 24 patients diagnosed as EA with TEF treated at our hospital (Zagazig University Hospital, collected over a period of 4 years from Jan 2012 tell October 2016 Objectives: is to evaluate the short and long outcome of surgical repair of TracheΟesophageal fistula Methods: From Jan 2012 tell October 2016, All cases diagnosed as EA with TEF treated at our hospital where included in this study. The follow up period was 2 year in average, age, sex, weight at birth, associated anomalies, surgical approach, postoperative complications and outcome. Results: 24 newborns (16 males and 8 females) with EA/TEF were treated at our hospital with an average weight 2.1 kg (700 g to 3200 g). Aged from birth to 3 days. At the time of admission 1 (4.16 %) had aspiration pneumonia. Early esΟphago-esophageal anastΟmosis was decided for all cases Conclusion: Factors contributing to mortality included prematurity, low birth weight, presence of associated serious anomalies, and delay in diagnosis or aspiration pneumonia.https://zumj.journals.ekb.eg/article_23688_9970ffbded08be6b5c981b47b40a4784.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101SIMPLE URINE METABOLIC SCRENING IN CHILDREN WITH REFRACTORY EPILEPSY IN ZAGAZIG UNIVERSITY CHILDREN'S39442369110.21608/zumj.2019.23691ENFatma ElzhraaTawfikMohamed NaguibAbo-AlfotohMohamad AhmadArafaNaglaa AliKhalifaJournal Article20190106Background: Epilepsy is one of the most common serious neurological conditions and 20%to 30% of people with epilepsy have repeated seizures attacks that develop refractory epilepsy .The aim of the present study was to examine the inherited metabolic abnormalities in children with refractory epilepsy to provide early etiological and symptomatic treatment. Patients are to have refractory epilepsy if the application of two types of appropriate and tolerable antiepileptic drugs failed to completely prevent epileptic seizure following adequate duration of treatment and adequate doses of drugs Refractory epilepsy always has been a problematic issue in neurology particularly in the infantile period when the brain of children develops rapidly. An increasing number of children with refractory epilepsy are mainly focused on hereditary metabolic disorder .Since most inherited metabolic disorder are lacking in specific symptom, they are easily ignored or missed in clinical diagnosis. Methods: This study was applied to forty eight patients with refractory epilepsy by application of urine metabolic screen by using urine test strips ,Benedict test, ferric chloride test, Nitrosonaphthol test,Cyanide-nitroprusside test,2. 4 dinitrophenyl hydrazine test. Result: In our study regarding urine screening tests 42% of our cases had presented positive results in at least one of the urine screening tests. This denotes the importance of urine screening tests for early detection of metabolic diseases among cases of refractory epilepsy. Conclusion :Compared with the positive rate of the urine metabolic screening tests in high risk infants suggest probability of the presence of a metabolic disease, which will need further investigationshttps://zumj.journals.ekb.eg/article_23691_9238e8d99ff496dfe0300ab45e3520a8.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101EFFECT OF LOW DOSE INTRACORONARY STREPTOKINASE ADMINSTIRATION IMMEDIATELY AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION ON LEFT VENTRICULAR FUNCTION AS ASSESSED BY SPECKLE TRAKING ECHOCARDIOGRAPHY45542369310.21608/zumj.2019.23693ENAhmed ShafieAmmarMohammad MustafaAl-DaydamonyMohamed IbrahimAminAyman MohamedNagibJournal Article20190106Background: Reperfusion injury might be considered as the consequence of insufficient perfusion due to fibrin and fibrinogen deposition in the microvasculature. Therefore, streptokinase, being a fibrinolytic drug, injected in the culprit artery immediately after primary PCI can be a suitable solution for achieving better myocardial perfusion. Aim of study: To assess the impact of complementary low dose intracoronary streptokinase (ICSK) administration immediately after primary PCI on left ventricular functions. Patients and methods: This double blinded randomized controlled clinical trial included 64 patients within 12 h of presentation by first STEMI who were candidate for primary percutaneous coronary intervention (PPCI). They were randomized equally to 2 groups. Immediately after primary PCI the first group received 250 kU ICSK vs placebo in the second group. Evaluation of LV functions was done by comparing the baseline echocardiographic parameters including left ventricle (LV) global longitudinal strain (GLS) before and after PPCI. Assessment of ST segment resolution (STR) 90 min after primary PCI, enzymatic infarct size in addition to comparing post-PPCI TIMI flow grade, TIMI frame count (TFC), Myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMPG) between both groups. Successful reperfusion after PPCI was defined as patients who achieved (TIMI 3 flow, MBG 3, > 70% ST segment resolution) Results: Post-PPCI LV GLS and LVEF were significantly higher in ICSK group (P = 0.005, 0.02 respectively). Post PPCI E/e' was significantly lower in ICSK group (P = 0.007). Peak CK-MB, CK-MB area under the curve (AUC), Troponin-I (72-hr); representing the enzymatic infarct size, were significantly lower in the ICSK group (P = 0.015, < 0.001, < 0.001 respectively). STR > 70% after PPCI was significantly higher in ICSK group (P = 0.045). Post-PPCI TFC was significantly lower in the ICSK group (P = 0.05). Post-PPCI MBG & TMPG were significantly higher in ICSK group (P = 0.04, 0.03 respectively). Multivariate linear regression analysis showed that each of ICSK administration, pain to stent time interval, post-PPCI MBG were independent predictors for LV GLS improvement after PPCI. Multivariate logistic regression analysis showed that the likelihood of achieving successful reperfusion post-PPCI was also associated with ICSK administration [OR= 0.123, 95% CI (0.02 - 0.75), P = 0.024] and was inversely associated with pain to stent time interval [OR= 0.995, 95% CI (0.990-0.999), P = 0.015]. Conclusion: Low-dose ICSK given immediately after primary PCI significantly led to improvement of LV GLS and LVEF, E/e'. It also reduced the enzymatic infarct size and was an independent predictor of successful reperfusion and LV GLS improvement after PPCI.https://zumj.journals.ekb.eg/article_23693_bd6a94efe7c7bd60afa7ed12c2ebb513.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101USE OF DUPLEX ULTRASOUND IN THE EVALUATION OF PATIENTS WITH CLINICAL SUSPICION OF DEEP VENOUS THROMBOSIS ON THE LOWER EXTREMITIES55632369710.21608/zumj.2019.23697ENWaleed TarekSobhyKhaledLakouzAhmedAbdelazemRanniaEl-MolaJournal Article20190106Background : This study verify the role of duplex Doppler venous examination (DDVE) in assessment of possible alternative diagnoses when DVT of lower extremity is excluded in patient with painful swollen lower limb which is a common clinical presentation with DVT ; However ,not frequently a range of pathologies are instead diagnosed. Objective : The aim of this work is to study the alternative diagnoses identified during duplex Doppler venous examinations (DDVE) of the lower extremities and their significance in patient management.The painful swollen lower limb is a common clinical presentation, with deep vein thrombosis (DVT) often the top differential. Methods : This study was carried out at Radio diagnosis Department, Zagazig University Hospitals, The present study was carried on 42 patient with a painful swollen lower limb or lower limb edema. Diagnostic work up was done including ultrasound and duplex Doppler US. Results : A total of 392 lower extremity venous Doppler examinations were reviewed and evaluated in 362 patients. Deep venous thrombosis was observed in 114 patients .Among the remaining 254 patients with unconfirmed DVT, 96 positive alternative diagnoses in 96 patients [representing 37.8% of patients negative for DVT (96/254) and 26.5% of all studied patients (96/362)] were identified. Conclusion: The clinical diagnosis of DVT is challenging. Unilateral complaints such as painful swelling of the leg, with or without accompanying redness, are common symptoms of many conditions besides DVT .Duplex ultrasonography of the lower extremity has become the first-line diagnostic test to detect DVT, with a sensitivity of 91% to 96% and a specificity of 98% to 100<br />and also to assess other alternative diagnosis.https://zumj.journals.ekb.eg/article_23697_991ba75bf0117a2813987fbc92a75373.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101ROLE OF SERUM HOMOCYSTEINE AND VENOUS DOPPLER ULTRASONOGRAPHY IN VENOUS INSUFFICIENCY IN BEHCET'S DISEASE AT ZAGAZIG UNIVERSITY HOSPITALS64702369910.21608/zumj.2019.23699ENHala AliMostafaAmany RashadAhmedAhmed AbdElazizElsammakDoaa ElsayedKamalJournal Article20190106Background: Lower extremity venous thrombosis (LEVT) is the most frequent form of vascular involvement in Behcet's disease. Up to 17% of the mortality in Behcet's disease is reported to be associated with venous involvement such as pulmonary embolism or Budd–Chiari syndrome (BCS). Early recognition and appropriate management of vascular involvement in BD is essential to reduce associated morbidity and mortality. Homocysteine (hcy) may play a role in BD patient with venous affection. Objectives: To find out the role of homocysteine and venous Doppler ultrasonography in detection of venous insufficiency (VI) in BD patients. Subjects and Methods: A case control study, 50 patients with Behcet's diseaseand 50 age and sex matched healthy controls were included. Serum homocysteine (by ng/l) was determined by ELISA. Also measurement of VI by venous Doppler ultrasonography in lower limbs of Behcet's patients and controls. Results: In this study there was statistically significant difference between serum homocysteine level among BD patients and controls (p < 0.05). There was a significant difference between serum homocystiene levels in BD patients with venous versus non venous affections, p<0.05. There was a significal positive correlation between serum hcy levels and VI grades by Doppler US. Conclusions: Behcet's disease patients with hyperhomocysteinaemia and VI diagnosed by Power Doppler US should be considered as a strong indicator of pathological venous involvement.https://zumj.journals.ekb.eg/article_23699_51c76426bea6ce68a8b81c38a34fba0c.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101ESTIMATION OF SERUM INTERLEUKIN-18 IN HEPATITIS C PATIENTS IN ZAGAZIG UNIVERSITY HOSPITALS71782370010.21608/zumj.2019.23700ENManal MohammadEl-AminMohamed NaguibEl-KhashabHoda AbdeenIbrahimAfnan AnisEl-WakeelJournal Article20190106Background: HCV is a contagious blood-borne virus that attacks the liver and can be deadly despite often having no visible health warnings. IL-18 is an important proinflammatory cytokine secreted from Kupffer cells. It is involved in the pathogenesis of HCV infection through modulating immune functions by regulating IFN-γ production and promoting the development of Th1 immune responses. Objective: The aim of this study is to measure serum level of Il-18 in chronic hepatitis C patients and compare between Il-18 levels and the degree of liver fibrosis. Subjects & Methods: This is a case control study. It was conducted in Clinical Pathology and Tropical Medicine Departments, Faculty of Medicine, Zagazig University Hospitals during the period from June 2017 to August 2017. Eighty four subjects were included in this study; they were classified into three groups as follows: Group 1: composed of 28 (17 males,11 females) apparently healthy subjects their ages ranged from 27 to 61 years old . Group 2 :composed of 28 patients (15 males,13 females) with HCV infection diagnosed as HCV RNA positive serum by RT-PCR with normal liver enzymes(ALT,AST), their ages ranged from 25 to 63 years old. Group 3 :composed of 28 patients (16 males,12 females) with HCV infection diagnosed as HCV RNA positive serum by RT-PCR with elevated liver enzymes (ALT,AST) their ages ranged from 29 to 64 years old. Formal consent was obtained from all individual and the study protocol was approved by the Zagazig medical research ethical committee. Seven ml of venous blood was withdrawn by sterile venipuncture and used for routine investigations including, complete liver function tests, HCV antibodies by ELISA and HCV-RNA by RT-PCR and IL-18 serum level by ELISA technique. Results: Group III showed highly statistically significant increased ALT and AST when compared to both group I and group II. There were high statistical significant differences between the three studied groups as regard Albumin level, Prothrombin time, Concentration (%) and INR. There was statistical significant increase in viral load by PCR in Group III compared to Group II. There were high statistical significant differences between Group III compared to both Group I and Group II in IL-18 level. there were statistical significance increase in IL-18 level with increase degree of liver fibrosis in both Group II & Group III. There was positive significant correlation between IL-18 level and AST in Group III. There was positive high significant correlation between IL-18 level and viral load in Group III. Conclusion: Serum IL-18 is significantly increase in chronic HCV patients and is correlated with liver fibrosis staging determined by fibroscan. So, IL-18 can be used as a non-invasive pro inflammatory marker for detection of the chronicity and severity of liver fibrosis in CHC.https://zumj.journals.ekb.eg/article_23700_7a1d82117f10a3e243a50b42b58c5a3f.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101ASSOCIATION BETWEEN PROTEINURIA AND ACTIVE HELICOBACTER PYLORI INFECTION IN NON-DIABETIC PATIENTS79842370210.21608/zumj.2019.23702ENMohamed NagahBalatMohamed AliFahmy ZanatyNeveen GeorgeEL-AntounyHaythem KamalAhmedJournal Article20190106Background: The incidence Helicobacter pylori infection and its possible relationship to different diseases are a focus of attention nowadays. Therefore, the aim of this study was to examine the association between proteinuria and active Helicobacter pylori infection in middle age non-diabetic patients. Material and Methods: A Case-control study was conducted on118 subjects and included 59 patients who suffered from H. pylori infection from October 2017 to April 2018. 59 patients were negative H. pylori infection included and served as a control group. Demographic and clinical data were collected. Results: The infected H. Pylori group showed a significant higher ACR compared to the control group. In addition, infected H. Pylori group showed a significant lower hemoglobin and albumin compared to the control group. Conclusion: Patients having H. Pylori infection show a significant elevation in the urinary albumin/creatinine ratio and a significant anemia suggesting a role of H. Pylori infection in the pathogenesis of proteinuria and anemia.https://zumj.journals.ekb.eg/article_23702_35b3d9c34935e68ecb147a13888d3be5.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101EFFICIENCY EVALUATION OF PIRFENIDONE IN EGYPTIAN IDIOPATHIC PULMONARY FIBROSIS PATIENTS85912370310.21608/zumj.2019.23703ENRamadan MNafeeWaheed MShomanMohammed M NAboZaidDaliaAbd El WahedJournal Article20190106Background:. Idiopathic pulmonary fibrosis (IPF) is a complicated disease in which histopathological abnormalities in the form of, proliferation of mesenchymal cell, fibrosis, overproduction and disorganization of collagen deposition, extra cellular matrix changes with distortion of pulmonary structure and the appearance of subpleural cysts , with accumulation of both myofibroblast and fibroblast. Pirfenidone has been available in Japan since 2008.In 2011, the approval by the European Medicine Agency (EMA) was indicated by the efficacy of pirfenidone in decreasing lung function deterioration in IPF patients. Aim of the Study: The aim of the study is to study the efficiency and safety of Pirfenidone in a group of IPF Patients. Ethical aspects: The thesis protocol was approved by IRB committee, Faculty of Medicine, Zagazig University. Subjects and Methods: This study was carried on 40 adult patients with IPF. Patients were divided into: Group (A): 20 patients accepted to be treated with pirfenidone. Group (B): also 20 patients they have been treated with conventional treatment for IPF Results: Mean change in distance walked during 6MWD test was 0.05 ± 56.24 for group (A) and −12.65 ± 67.86 for group (B). Mean decline in predicted FVC was −0.89 %± 14.55 for group (A) and −5.48% ± 10.89 for group(B) there were progression of the disease according to HRCT in 60% in group(A) and 70% in group(B), , while only 10% in group (A) showed regression of the disease with statistical significant differences between two groups. Conclusion: Pirfenidone didn't improve health related quality of life in IPF patients, Pirfenidone did not affect oxygenation in treatment group after 3 months therapy , Pirfenidone has good impact on radiological presentation of IPF patients. Pirfenidone not only slow loss in FVC but also improved it in one third of treated patients, GIT upset is the main adverse effects of pirfendone which are mild.https://zumj.journals.ekb.eg/article_23703_368e1e90f1b754b341228e56090278a7.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101EPIGENETIC STUDY OF DNA METHYLATION IMPACT ON CHILDHOOD ASTHMA IN ZAGAZIG UNIVERSITY HOSPITALS921002370510.21608/zumj.2019.23705ENDina MohamedShokryRabab MohamedEl-behedyAmal SaeedAbd El-AzeemMona HamedHasanin JehadJournal Article20190106Background: Asthma is the most common chronic inflammatory disorder of the airways in children, with rising incidence during last few decades which brings heavy burden to the whole society. The underlying molecular mechanisms leading to asthma remain largely unclear. In complex diseases such as asthma, DNA methylation offers a potential mechanism for environmental modification of genetic responses. Objective: Our study aimed to investigate the association of methylation at the ADRB2 promoter region with asthma development in Egyptian children and further effect on their level of asthma control. Subjects and methods: Our case control study included 80 children, distributed as two groups: 64 asthmatics as cases and another 16 healthy children as control group. The cases were further sub-divided into three sub-groups according the level of asthma control (based on GINA guidelines in 2015): 28 were well controlled asthmatics, 24 were partly controlled asthmatics and 12 patients were uncontrolled asthma. Blood-derived DNA samples from all children and assays of ADRB2 gene methylation was done using polymerase chain reaction. Pulmonary function testing, Skin prick testing and serum total IgE levels were measured using ELISA for all cases. Results: The DNA methylation at ADRB2 promoter gene was significantly higher in the asthmatic children than in non-asthmatic group. Moreover, it was also higher in uncontrolled group in comparison to partly controlled and uncontrolled groups. Our data revealed a significant relationship between methylated DNA in patients with positive skin prick test and those receiving steroid therapy. ROC analysis revealed that methylated DNA can excellently differentiate asthmatic patients from healthy controls with AUC of 0.84 for DNA methylation. The optimal sensitivity and specificity to differentiate asthmatic children from controls were (87.5% and 81.5% at a cutoff expression value >1). ROC analysis revealed that methylated DNA can differentiate uncontrolled or partially controlled asthmatic patients and controlled asthmatic patients with AUC of 0.891 for DNA methylation. The optimal sensitivity and specificity were (86.1% and 89.3% at a cutoff expression value >2.2). Conclusion: our study suggested that increased methylation at the ADRB2 promoter area is associated with increased asthma susceptibility and poor asthma control which put it as a possible diagnostic and prognostic biomarker for asthma assessment in the near future.https://zumj.journals.ekb.eg/article_23705_5dd2af19916a8264aafe45576f5309b1.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101ROLE OF P-SELECTIN IN PATIENTS WITH SLOW CORONARY FLOW1011092370810.21608/zumj.2019.23708ENNahla I.El-AttarAzaaMohyiAssalMohamedE. AminRowidaM.S. SleemJournal Article20190106Background: sP-selectin is a marker for atherosclerosis and inflammation. It provides prognostic information on cardiovascular events, as reported in the literature. The aim of the present study was to evaluate sP-selectin as a biomarker for cardiovascular mortality in an elderly primary healthcare population, with a focus on possible sex differences Objective: To evaluate role of P-selectin as a marker of platelets activation in coronary slow flow patients. patients: A case control study, where seventy two patients underwent cardiac catheterization for suspected coronary artery disease. There were divided into patients group (primary coronary slow flow patients) and controlgroup(normalcoronaryangiography) . Methods:All patients were subjected to history ,physical examination and laboratort investigation included CBC serum glucose,lipid profile and immunophenotyping of platelets activation(p selectin CD 62p by flowcytometery). Results: We have two groups: Group1 (patients group): Patients with primary coronary slow flow phenomenon = 36 patients. Mean age of cases 49.33±4.99 years with range of (34-55) years .In patients group there was 24 male and 12 female. Group II (control group): Patients with normal coronary angiography = 36 patients. Mean age in control group 51.44±3.36 years with range of (43-55) years. Conclusion: The results of the present study revealed that there is very high statistically significant difference in P-selectin level between group 1 (primary coronary slow flow patients) and group 2 (normal coronary angio patients) and there is statistically significant association between P-selectin and TIMI frame count in coronary slow flow.https://zumj.journals.ekb.eg/article_23708_d87f791059b03649f22aee11ef7a0f48.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101PLATELET RICH PLASMA AS A NOVEL TREATMENT FOR CARPAL TUNNEL SYNDROME1101152371210.21608/zumj.2019.23712ENEsam TawfeeqAtwaAsmaa MohamadHosny EshIbrahim TharwatAbd El AlYasmin MAwadJournal Article20190106Background: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Platelet-rich plasma (PRP) therapy is a simple, low cost and minimally invasive method that contains a natural concentrate of autologous growth factors. It was found that PRP has therapeutic effects on many neuropathies which synergizes nerve regeneration, but its effects on carpal tunnel syndrome are unclear. The aim of wok is to evaluate the effectiveness of PRP injections in carpal tunnel syndrome clinically and electrophysiologically. Subjects & Methods: We performed this clinical trial study on 18 patients with idiopathic mild to moderate carpal tunnel syndrome who received single injection of PRP into the carpal tunnel. Nerve conduction studies (NCS) were carried out, Visual Analogue Scale (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) were administered to patients immediately before treatment, one and three months after treatment. Results: PRP injection showed significant improvement of patients as regard VAS, symptom severity scale (SSS) and functional status scale (FSS) of BCTQ after one and three months of injection. Also, we found that PRP injection showed significant difference in distal motor and sensory latency, amplitude of compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) and sensory conduction velocity of the median nerve after one and three months of injection Conclusion: local injection of the PRP proved to be available safe choice therapy for carpal tunnel syndrome. Key words: carpal tunnel syndrome; platelet-rich plasma; nerve conduction studieshttps://zumj.journals.ekb.eg/article_23712_1f96b532e9745e35287ae44f4022c008.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101STUDY OF PERIPHERAL NEUROPATHY IN CHILDREN WITH TYPE 1 DIABETES MELLITUS AT ZAGAZIG UNIVERSITY HOSPITALS1161252485510.21608/zumj.2019.24855ENMohamed ElsayedAmerHossam MostafaKamalAhmed GalalSiamJournal Article20190116Background: Diabetic peripheral neuropathy (DPN) plays a key role in morbidity and mortality in patients with type 1 and type 2 diabetes mellitus. The study was designed to assess frequency of diabetic peripheral neuropathy among the diabetic children and to evaluate the role of nerve conduction study (NCS) in diagnosis of DPN in children with type 1diabetes mellitus in comparison to neurological examination. Subjects and methods: A cross sectional study was conducted in Pediatrics Department, Zagazig University Hospitals. Forty type-1 diabetic children were subjected to complete history taking, complete general and full neurological examination, Michigan Neuropathy Screening Instrument (MNSI), laboratory investigations and NCS. Results: The estimated frequency of diabetic peripheral neuropathy was 42.5% among the diabetic children. We found a statistically significant moderate agreement between (NCS) and Michigan Neuropathy Screening Instrument, Kappa= 0.564(95% CI, 0.321 to 0.807), (P<.001). The percent of children with microalbuminuria, fairly and poorly controlled diabetes was statistically significantly higher in PN-children than non PN-children (P<.05).Duration of diabetes was the most important factor in prevalence of PNP (odds ratio=2.1 [95% CI 1.3 to 3.4]). Conclusion: NCS are the gold-standard method for the detection of subclinical DN which is frequent in diabetic children . https://zumj.journals.ekb.eg/article_24855_56dbeac9f4dc3d06f63894bb2a19dec4.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101EVALUATION OF ORAL PREGABALIN IN TREATMENT OF PREMATURE EJACULATION1261312488110.21608/zumj.2019.24881ENMohamed RefaatAl-NaggarMohamed DardiriEL HaririAbdulrahman HefnyHashemJournal Article20190116Background: Premature ejaculation (PE) is the most common form of male sexual dysfunction. Treatment modalities include behavioral therapy and medical therapy. No therapy is approved by the FDA for treatment of PE. Pregabalin exerts a negative effect on sexuality by reducing central nervous excitatory transmission via sodium and calcium channel inhibition and potassium (k) channel activation and by unbalancing dopamine serotonine ratio. The aim of this work was to assess the efficacy and safety of oral on demand pregabalin in treatment of premature ejaculation (PE).Methods: This study was conducted on 96 married male patients with primary premature ejaculation (lifelong). All patients were recruited from the andrology outpatient clinic at Al-Azhar University Hospitals (Cairo).The patients were randomly assigned to three groups: Group A: This group included 36 patients. They will receive 150 mg pregabalin 1 – 2 hours prior to sexual intercourse. Group B: This group included 30 patients. They will receive 75 mg pregabalin 1 – 2 hours prior to sexual intercourse. Group C: This group included 30 patients, all of them received identical placebo capsules. All patient will be subjected to the following:Full history: including age, baseline estimated ILET, erectile dysfunction, medical diseases and medications. Local and general physical examination. Couples were encouraged to engage in coitus twice a week and record estimated intravaginal ejaculation latency time (perceived IELT OR PIELT) every time for 2 weeks and report any side effects suspected to be drug related. Results: There was no statistically significant difference between group A, B and C regarding base PIELT. PIELT significantly increased after treatment in group A receiving 150 mg pregabalin. Patients in group B showed mild improvement in their PIELT after receiving 75 mg pregabalin. This improvement was statistically significant. There was no statistically significant difference between Base PIELT and PIELT after treatment among group C patients. There was statistically significant difference between group A and C regarding after treatment PIELT. There was no statistically significant difference between group B and C regarding PIELT after treatment. Comparing post treatment ejaculatory time in different groups, PIELT significantly improved in group A rather than placebo group. This was not present in group B. There was significant improvement in PIELT of group A rather than group B. Conclusion: This is the first report of an oral pregabalin used for the treatment of PE in men. On demand oral pregabalin 150 mg 1 – 2 hours prior to sexual relation, looks to be effective pharmacotherapy of PE. The effect of pregabalin is minimal and may be augmented with higher daily doses. Longer-term safety studies, and those comparing pregabalin with on demand tramadol and dapoxetine are essential to determine the place of pregabalin in the treatment of this distressing condition.https://zumj.journals.ekb.eg/article_24881_370839ba697cb8603b11ca93dce15720.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101FREQUENCY, PATTERN AND PROGNOSTIC SIGNIFICANCE OF THROMBOCYTOPENIA IN MEDICAL INTENSIVE CARE UNITS1321482490910.21608/zumj.2019.24909ENOsama AhmedKhalilMonkez MotiehYousifAbdallah Abdel-AzizAbdallahMohammed Hosam EddinMoradEssam AdelAbdel-RahmanSameh Abdel-SalamElgendyJournal Article20190116Background: The incidence of thrombocytopenia in intensive care units (ICUs) has been found to be 13 - 44%. We chose to study the incidence, risk factors and transfusion requirements of thrombocytopenia in tertiary care ICUs. Objective: The purpose of this study to determine the period prevalence of thrombocytopenia whether admission thrombocytopenia (AT) or new onset thrombocytopenia (NOT) among Egyptian patients in medical ICU of Zagazig university hospital. To identify pattern of thrombocytopenia in critically ill patients including etiology, severity and timing pattern. To identify the impact of thrombocytopenia on the patients' outcome in MICU. Methods: This study was conducted in the Medical Intensive Care Unit (MICU) of the Internal Medicine Department Zagazig University Hospitals, Egypt, in the period extending from March 2017 to March 2018. Results: The study included 400 patients admitted consecutively to MICU of internal medicine hospital in Zagazig university fulfilling the inclusion criteria, sixty-six patients were excluded from the study because of incomplete data (17 patients), loss of follow up within the ICU (24 patient). 359 patients were eligible for analysis, those patients were classified into two groups. Conclusion: Thrombocytopenia is a frequent laboratory finding among critically in patients, which is generally correlated to the severity of illness. Most cases of thrombocytopenia are detected at time of admission and the rest of them develop during ICU stay. Among our Egyptian patients the most common cause of thrombocytopenia on admission is the chronic liver disease with liver cirrhosis, while the most common cause of thrombocytopenia which develop during ICU stay is sepsis. Thrombocytopenia is generally associated with higher APACHE II score when compared to normal platelet count indicating that it is associated with higher degree of morbidity and expected higher mortality rate.https://zumj.journals.ekb.eg/article_24909_9d69606f298d70ca38b005fd94a0becf.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101THE EFFECT OF DIABETES ON THE RELATION OF EPICARDIAL FAT THICKNESS TO THE SEVERITY OF CORONARY ARTERY DISEASE In ACUTE NON- ST ELEVATION MYCARDIAL INFARCTION PATIENTS1491542491110.21608/zumj.2019.24911ENMohamed WafaieAboleineenWaleed SalemEl-AwadyMarwa MohamedGadDina AliAhmed FerganyJournal Article20190116Background: there is a strong relationship between epicardial fat thickness and severity of coronary artery disease. The impact of diabetes on severity of coronary artery disease (CAD) is well known. The possible impact of diabetes on the relationship between EFT and severity of CAD was not fully investigated. Patients and Methods: The study included 52 patients with NSTEMI (mean age: 54.3±6.7years). Patients were classified into two groups according to presence of diabetes (diabetic group (24 patients) and non-diabetic group (28 patients)). EFT was measured by transthoracic echocardiography on the right ventricle in individuals having the left lateral decubitus position GENSINI score was used to define the severity of CAD. Results: Diabetic patients had higher EFT values compared with non-diabetics (p < 0.05). EFT is independently associated with diabetes and GENSINI score in all patients (p < 0.05, for all). When patients were divided into two groups, as diabetic and non-diabetic, the association between EFT and GENSINI score was stronger in diabetic patients compared with non-diabetics (r = 0.6618; p< 0.001vs. r = 0.330; p = 0.04). Conclusion: Epicardial fat thickness is associated with GENSINI score in both diabetic and non-diabetic patients suffering from NSTEMI. Furthermore, there is a stricter relationship between EFT and GENSINI score in diabetic patientshttps://zumj.journals.ekb.eg/article_24911_9ddb4740fc6a86f145e87897292a0acb.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101SERUM MATRIX METALLOPROTEINASE-2 AS A BIOMARKER FOR DIAGNOSIS OF IDIOPATHIC EPILEPSY1551632491210.21608/zumj.2019.24912ENAli MohamedSolimanMahmoud El SayedEl EbearyTarek Abdel RahmanGoudaAhmed AhmedEbiedJournal Article20190116Background: Epilepsy is a common serious neurological disorder. Medical histories and electroencephalogram (EEG) are not always sufficient for epilepsy diagnosis; therefore, exploring novel methods for the accurate diagnosis of epilepsy is of great importance. Recent studies indicate that Matrix metalloproteinases (MMPs) especially MMP-2 is sensitive to seizures thus; MMP-2 may be a potential biomarker for epilepsy diagnosis. Subject and method: Thirty four epileptic patients older than 2 years subjected to: Detailed medical history, general and neurological examination, routine laboratory studies, EEG , Brain magnetic resonance imaging (MRI), and serum MMP-2 level measurement . Thirty four age and sex matched healthy controls were selected and their serum MMP-2 were obtained. Results: serum MMP-2 levels were statistically significantly low in patient with idiopathic epilepsy compared to control group .Levels were less in patient with focal epilepsy than those with generalized epilepsy.Serum MMP-2 was lower in drug resistant epileptic patients and highest in newly diagnosed patients with negative correlation observed between duration of epilepsy and MMP-2 levels. Sensitivity of MMP-2 as biomarker was 85.29% with 97.06 % specificity. Conclusion: MMP-2 levels decreased in patients with epilepsy especially those with focal seizures. This tool may be a helpful diagnostic biomarker for epilepsy with a good sensitivity and specificity.https://zumj.journals.ekb.eg/article_24912_bcfa8b55bd5108c65a2f77dc37e61538.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101STUDY OF INTERLEUKIN-33 IN IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDREN1641702491310.21608/zumj.2019.24913ENNaglaa A.KhalifaMervat AbdallahHeshamMervatShaabanSamar NageebAhmedJournal Article20190116Background: Immune thrombocytopenia (ITP) is an immune-mediated hematologic disorder in which increased platelet destruction and decreased platelet production lead to thrombocytopenia and, thus, mucocutaneous bleeding. The interleukin-1 (IL-1) family is involved in many human diseases by regulating innate immunity and inflammation. As a new IL-1 family member found in 2005, IL-33 and its receptor play important roles in inflammation, cancer, allergy and autoimmune diseases and are potential therapeutic targets. The aim of this work was to evaluate IL-33 among active ITP patients and remission in relation to control. Methods: This is a case control study This study was conducted in the Outpatient Clinic of Hematology Unit of Pediatric Department and Clinical Pathology Department at Zagazig university hospitals during the period from October 2017 to April 2018, on Twenty two ITP Patients during their regular follow-up visits and Twenty two age and sex-matched healthy children as a control group. Forty four subjects were included in this study; they were classified into two groups as follow: Control group and Patient group: Each group was subjected to the following: History, examination and Laboratory workup including IL-33.Results: There was no statistically significant difference between cases and control regarding sex and age.Purpura, ecchymosis and mucous membrane bleeding (90.9%,81.81% and72.7% respectively) were the most common clinical data among ITP cases group. Less common splenomegaly and lymphadenopathy were (4.54% and .0%) respectively. There was no statistically significant difference between cases and control regarding HB, RBCs, WBCs and lymphocytes %.Mean value of Platelets was significantly lower among cases than controls (28.14, 288.64 respectively) P=.000.Mean value of IL-33 was significantly lower among cases than controls (24.68, 47.18 respectively) P=.000.There was statistically significant difference between acute ITP patients and chronic ITP patients regarding IL-33 (P value=.000).There was statistically significant difference between acute ITP patients and controls regarding IL-33 (P value=.000).There was no statistically significant difference between chronic ITP patients and controls regarding IL-33 (P value=.769).There were no statistically significant positive correlation between IL-33 and [age (r=.057, P=.714), HB (r=.095, P=.540) and RBCs (.249, P=.103]. While There were statistically significant positive correlation between IL-33 and [WBCs (r=.398, P=.008), lymphocytes % (r=.377, P=.012) and Platelets (r=.537, P=.000).Conclusion: This study concluded that, IL-33 may contribute to the pathogenesis of ITP. It could be a potential biomarker that diagnose and provide a new therapeutic target for ITP therapy.https://zumj.journals.ekb.eg/article_24913_cb1d82ce5112a7a882a22713665b3bdd.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143125120190101ROLE OF MAGNETIC RESONANCE IMAGING IN EVALUATING TYPICAL AND ATYPICAL MENINGIOMAS .1711862491410.21608/zumj.2019.24914ENMohamed KhaledShawkyMohamed IbrahimTeamaHazim IbrahimTantawyDina Abdel AzizEL SamakJournal Article20190116Background: Meningioma is the most common primary non-glial intracranial neoplasm . It occurs in adults between the ages of 40–70 years of age and tend to occur more often in women, the reported average age for females is 42 and that for males is 52 . Meningiomas are benign but locally aggressive tumor, they are found in the following anatomic sites in descending order of frequency: parasagittal region, falx, cerebellar convexity, olfactory groove, tuberculum sellae, sphenoid ridge, petrous face (CPA), tertorium, lateral ventricle, clivus as well as other sites . Objective: The aim of this study is to evaluate the role of MRI in evaluating typical and atypical meningiomas and predicting its pathological behavior. Methods: This study was carried out at Radio diagnosis Department, Zagazig University Hospitals, The present study was carried on 24 patients of typical and atypical meningiomas. Results : We studied 24 cases, 15 of them were typical and only 9 cases were atypical /malignant. Using routine MRI sequences, the meningiomas were diagnosed and DW images were performed using factor of b-0 and b-1000. Apparent diffusion coefficient (ADC) values were measured in the lesion and in the normal white matter. Atypical and malignant types tend to have atypical features by routine MRI such as: heterogeneous signal intensity, heterogeneous pattern of enhancement, irregular tumor margins, marked amount of peri-focal edema, bone or parenchymal invasion. Three or more of above mentioned atypical features could not be seen in the typical meningiomas being unique for atypical and malignant group. Diffusion weighted imaging which is a part of normal brain imaging protocol has a great role in differentiating typical from atypical meningiomas. In this study, typical meningiomas tended to have a larger ADC values & NADC ratios than atypical and malignant ones. Only one case of pathologically proven rhabdoid malignant meningioma (Grade III) has high ADC value & NADC ratio (features of typical type). Conclusion: Our results indicate that The distinction between benign and atypical / malignant meningiomas is neither easily nor reliably accomplished to date when assessing the imaging features of meningiomas on routine MR images.DWI is helpful in distinguishing benign from malignant and atypical meningiomas. Mean ADC values of atypical/malignant meningiomas were significantly lower compared with benign meningiomas. Mean NADC ratios in the atypical/malignant group were also significantly lower than the benign group.https://zumj.journals.ekb.eg/article_24914_1068d16c66c298b1a324d81d6d1495f0.pdf