Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101THE EFFECT OF HEPATITIS C VIRUS INFECTION ON INSULIN RESISTANCE IN CHRONIC HEMODIALYSIS PATIENTS111457510.21608/zumj.2017.4575ENWalidAbd El HamidInternal Medicine Department, Faculty of Medicine, Zagazig University, EgyptEssamLotfyInternal Medicine Department, Faculty of Medicine, Zagazig University, EgyptYousefKadryInternal Medicine Department, Faculty of Medicine, Zagazig University, EgyptLamiaMohammedInternal Medicine Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20171212Background: Hepatitis C virus infection has strong relationship with insulin resistance in general population. Insulin resistance increases risk of cardiovascular events in chronic kidney disease patients.This work is intended to study the interrelation between Hepatitis C virus infection and insulin resistance among end stage renal disease patients on regular hemodialysis.<br />Methods: It included a total number of 90 subjects. They were divided into two groups: Group 1 (45 subjects Hepatitis C viruspositivepatientson regular hemodialysis), Group 2 (45 subjects Hepatitis C virusnegative patients on regular hemodialysis).All patients included in this study were subjected to the following: Full clinical assessment,Complete blood picture, alanine aminotransferase, aspartate aminotransferase, creatinine, blood urea, fasting plasma glucose, Coagulation profile, serum calcium, serum phosphorus, serum parathyroid hormone, Hepatitis C virusantibodies, human immunodeficiency virus antibodies, hepatitis surface antigen, fasting serum insulin and fasting serum C-peptide.<br />Results: Our study reported that no statically significant difference in Homeostatic model assessment of insulin resistance between the two studied groups. Homeostatic model assessment of insulin resistance has significant correlation to age, weight, body mass index,serum parathyroid hormone, serum creatinine, urea reduction ratio and serum ferritin.<br />Conclusion: We couldn’t detect any strong correlation between Hepatitis C virus seropositivity and insulin resistance in hemodialysis patients, but we detected strong relationship of insulin resistance to age, weight, body mass index, serum parathyroid hormone, serum creatinine, urea reduction ratio and serum ferritin in hemodialysis patients.https://zumj.journals.ekb.eg/article_4575_542e3a7145b824b375b1805899eb3d71.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101ARTHROSCOPIC MANAGEMENT OF SUPERIOR LABRUM ANTERIOR TO POSTERIOR (SLAP) LESIONS114457610.21608/zumj.2017.4576ENEl SayedMohamedOrthopedic Department, Zagazig University Hospitals, Egypt.MohamedShalabyOrthopedic Department, Zagazig University Hospitals, Egypt.AliAlfiOrthopedic Department, Zagazig University Hospitals, Egypt.AhmedFarhanOrthopedic Department, Zagazig University Hospitals, Egypt.Journal Article20171212Background: Superior labrum anterior to posterior (SLAP) lesions are labral tears that extend anteriorly from the posterior superior labrum, involving the long head of the biceps tendon originating from the glenoid labrum, and stopping before the anterior glenoid notch. Accurate diagnosis of suspected SLAP tears is confirmed by arthroscopy. Progress in arthroscopic techniques had made it possible to achieve accurate and safe repair in selected patterns of injury. Recent outcomes studies have shown good functional results and an acceptable rate of return to activity with treatment of SLAP tears by arthroscopy.<br />Aim of the work: The aim of this work is to evaluate the diagnosis, clinical outcome and management of superior labrum anterior to posterior (SLAP) lesions using arthroscopy.<br />Patients and Methods: This is prospective study consisted of twenty denovo patients who had done arthroscopy for the treatment of isolated SLAP lesions between (2011) to (2014). Inclusion Criteria: Adult denovo patients aged from (20-55) years old. All patients provided written informed consent to share in the study. Patients diagnosed by: thorough clinical examination (history, clinical presentation and examination), radiological diagnosis (plain x-ray & MRI), SLAP lesions that did not respond to non surgical treatment, and lastly SLAP lesions either isolated or associated with other lesions (Bankart lesion & rotator cuff lesions). Exclusion Criteria: Patients’ refusal to share in the study, Frozen shoulder, Failed previous surgery to patient with SLAP lesion.<br />Results: In our study there was significant difference regarding UCLA score between pre and post operative as in preoperative 100% UCLA score was <27 Fair/Poor not satisfied, while in postoperative 90% UCLA score was > 27 Good/Excellent was satisfied, and only 10% UCLA was < 27 Fair/Poor not satisfied.<br />Conclusion: Treatment of SLAP lesions by arthroscopy is challenging and provides good functional outcome.https://zumj.journals.ekb.eg/article_4576_3cf7460e8a87ea99f66987de7cb342de.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101PROTECTIVE EFFECT OF MONTELUKAST AGAINST PENTYLENETETRAZOLE-INDUCED ACUTE SEIZURES AND KINDLING IN MICE110457710.21608/zumj.2017.4577ENZakiAbdel-kaderClinical Pharmacology Department, Faculty of Medicine, Zagazig UniversityNadiaKhorshidClinical Pharmacology Department, Faculty of Medicine, Zagazig UniversityDaliaAbd El MottelebClinical Pharmacology Department, Faculty of Medicine, Zagazig UniversityNisreenElwanyClinical Pharmacology Department, Faculty of Medicine, Zagazig UniversityJournal Article20171212Background: Montelukast, a selective reversible cysteinyl leukotriene1 (CysLT1) receptor antagonist, is used in treatment of asthma, exercise induced-bronchospasm, allergic rhinitis and urticaria. It was shown to protect against cerebral ischemia/reperfusion injury. Objectives: To examine the possible anticonvulsant effect of montelukast, either alone or in combination with a known antiepileptic drug "valproate" against pentylenetetrazole (PTZ)-induced seizures. Methods: 112 adult male Swiss albino mice were used in the study and divided into two main groups, each containing 5 subgroups (Gp). The first main group "acute PTZ model (PTZ-a)" contains: Gp1 "vehicle-treated group" was injected with saline (10 ml/kg, intraperitoneally "i.p." in a single dose ), Gp2 "acute PTZ-control" injected with a single dose of PTZ (60 mg/kg, i.p.), Gp3 injected with valproate (50 mg/kg, i.p.) 30 minutes before PTZ, Gp4 injected with a single dose of montelukast (10 mg/kg, i.p.) 30 minutes before PTZ and Gp5 injected with both montelukast and valproate 30 minutes before PTZ administration. The second main group "kindling model (PTZ-k)" contains: Gp1 was injected with saline (i.p.) every other day for 17 days, Gp2 "PTZ-kindled control" received 9 PTZ injections in a dose of (40 mg/kg, i.p.) on alternate days for 17 days, Gp3 injected with valproate (50 mg/kg, i.p.) for 17 days, 30 minutes before PTZ, Gp4 daily injected with montelukast (10 mg/kg, i.p.) for 17 days 30 minutes before PTZ and Gp5 received both montelukast (10 mg/kg, i.p.) and valproate (50 mg/kg, i.p.) daily for 17 days, 30 minutes before administration of PTZ. Results: Single and repeated PTZ administration produced stage 4 seizures associated with a significant reduction in the brain level of reduced glutathione (GSH), concomittent with significant elevation in the brain levels of malondialdehyde (MDA), inteleukin1β (IL1β), tumor necrosis factor α (TNFα) and leukotriene D4 (LtD4). The use of valproate alone and its combination with montelukast suppressed the incidence of stage 4 seizures in acute PTZ induced convulsion while montelukast, valproate and their combination decreased the percentage of animals reaching stage 4 seizures in kindled mice. In both PTZ acute and kindled models, montelukast, valproate and their combined administration significantly elevated brain level of GSH and significantly decreased brain levels of MDA, IL1β, TNFα and LtD4 as compared to PTZ control groups. Interestingly, co-administration of valproate and montelukast resulted in a significant elevation in the brain level of GSH concomitant with a significant reduction in the brain levels of MDA, IL1β, TNFα and LtD4 as compared to each of the valproate and the montelukast groups in both models. Conclusion: Montelukast, either alone or in combination with valproate protects against PTZ induced seizures via blockade of leukotreine receptors & amelioration of oxidative stress and inflammatory cascades.https://zumj.journals.ekb.eg/article_4577_a21a05a0c219a172ab45059d365f9054.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101STEROID INHALATION VERSUS SURGERY IN TREATMENT OF POST-INTUBATION GRANULOMA15457810.21608/zumj.2017.4578ENWaelD.hospitals, General Organization for Teaching Hospitals and Institutes, EgyptEssamFathyhospitals, General Organization for Teaching Hospitals and Institutes, EgyptSameerAttyahospitals, General Organization for Teaching Hospitals and Institutes, EgyptMOHAMMEDELSHABBOURYhospitals, General Organization for Teaching Hospitals and Institutes, EgyptJournal Article20171212We are aiming from our study to compare the results of vocal process granulomas treated with inhaled steroids and surgical treatment. Intubation granuloma of the larynx is induced by endotracheal intubation, mainly managed by conservative medical treatment with observation. If no response to medical treatment surgical excision can be considered as a last line of treatment due to the reported recurrence with subsequent repeated surgeries and exposure to anesthesia. 30 granulomas were diagnosed in 24 patients: 6 bilateral and 18 unilateral. 15 granulomas in 12 patients in group A were treated with Steroid inhalation. 1 (6.6%) did not respond, 4 (26.6%) partially responded, and 10 (66.6%) completely responded, No cases had recurrence. In group B which treated surgically, of the 15 granulomas, 15 (100%) removed completely by micro laryngeal cold instruments. Partial recurrence occurred in 2 patients unilateral after 10 weeks 13.3%. Considerable recurrence has been developed in 3 more patients (unilateral) beside the first 2 granulomas (5 Granulomas) 33.3% recurrence after 50 weeks follow up. We advise to manage intubation granuloma of the larynx mainly by inhaled steroid as a first line of treatment.https://zumj.journals.ekb.eg/article_4578_0b46f5280dd7fcd705d368df2612e00a.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101ABBREVIATED COURSE OF RADIATION THERAPY WITH CONCURRENT TEMOZOLOMIDE FOR HIGH-GRADE GLIOMA17457910.21608/zumj.2017.4579ENWaleedHamodaThe Department of Clinical Oncology and Nuclear Medicine, Zagazig University, Egypt.YosraMetwalyThe Department of Clinical Oncology and Nuclear Medicine, Zagazig University, Egypt.NabilaAbd El-HakemThe Department of Clinical Oncology and Nuclear Medicine, Zagazig University, EgyptEmanEl-SebaiThe Department of Clinical Oncology and Nuclear Medicine, Zagazig University, EgyptJournal Article20171212Purpose: To evaluate efficacy and safety of hypofractionated radiotherapy concurrently with temozolamide in treatment of high grade gliomas.<br />Method: 54 patients with GBM enrolled and divided in two groups, the group A consists of 27 patients treated prospectively by three dimentional (3D) conformal radiotherapy at a dose of 40Gy / 15 fraction over 3 weeks and compared with the other group B which consists of 27 patients treated retrospectively at a dose of 60Gy / 30 fraction over 6 weeks, both groups received temozolamide concurrently with radiotherapy.<br />Results: Over all response was 59.3% in A group and 55.6% in B group without significant statistical difference in both groups. The median follow up in both groups was 11 months. 6th month PFS in group A was 58.6% and in group B 52.7% without statistical significant difference. 6th month OS in group A was 81.5% and in group B 85.2% without statistical significant difference. On univariate analysis of the prognostic factors of progression the extent of surgery, histological subtype and response to radiotherapy are significant predictors. There is no significant statistical difference in toxicity of treatment between both groups.<br />Conclusion: HRT concurrently with temozolamide may be used as an option in treatment of high grade glioma.https://zumj.journals.ekb.eg/article_4579_8f537fdf3240c3aed33b26a590b50aea.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101EFFICACY OF THE PERIOPERATIVE VENLAFAXINE VERSUS PREINCISIONAL PARAVERTEBRAL BLOCK ON POSTMASTECTOMY PAIN SYNDROME: RANDOMIZED TRIAL19458010.21608/zumj.2017.4580ENSamiaEl-WakeelDepartment of Anesthesia and Surgical Intensive Care,
Faculty of Medicine, Zagazig University.NeveenEl-AassarDepartment of Anesthesia and Surgical Intensive Care,
Faculty of Medicine, Zagazig University.TamerSolimanDepartment of Anesthesia and Surgical Intensive Care,
Faculty of Medicine, Zagazig University.RehamAamerDepartment of Anesthesia and Surgical Intensive Care,
Faculty of Medicine, Zagazig University.Journal Article20171212Background:Postmastectomy pain syndrome (PMPS) is a neuropathic pain syndrome that is known to develop after breast surgery.There is evidence that analgesic treatment in advance of surgical trauma (preemptive analgesia) may be more effective in controlling pain than administering analgesic therapy in response to pain after surgery.We compared the efficacy of venlafaxine, paravertebral block (PVB), and both of them on acute and chronic pain over 12 months following breast cancer surgery to evaluate which has better effect.<br />Subjects and methods:The study was carried out on 60 patients scheduled for radical mastectomy with axillary dissection. They were randomized into 3 groups to receive extended release venlafaxine 37.5 mg/d for 2 weeks starting the nightprior to surgery, PVB with 0.5% bupivacaine 1.5 mg/kg at T3 before general anesthesia,or both of them.Pain scores were recorded by visual analog scale (VAS) at rest and with movement at 0,6,12and 24 hours on the first postoperative day with comparison of the analgesic requirements between the 3 groups, and then at 1, 3, 6, 9, and 12 months.Complications were recorded in the 3 groups.<br />Results:The VAS scores were higher in venlafaxine group versus PVB and combined groups at 0, 6, 12, and 24 hours postoperative either during restorwith movement with significant increase in the total morphine consumption invenlafaxine group compared to the other 2 groups .At 1 ,3, 6, 9, and 12 months there was no difference in pain scores during rest,while with movement the pain scores were significantly reduced in PVB and combined groups in comparison with venlafaxine group at 9 and 12 months.No significant differences were noted<br />Among the groups with regard to edema or rate of complication.<br />Conclusion:Preincisional PVB with 0.5% bupivacaine 1.5 mg/kg at T3 before general anesthesia provides good acute postoperative pain relief than venlafaxine37.5 mg/d for 2 weeks starting the night prior to surgery.The efficacy of venlafaxine, PVB, or combination of them are similar after 6 months in reducing the incidence of PMPS,but after 9 and 12 months PVB and combined groups are more effective in decreasing pain with movement than venlafaxine.In addition, the combination of venlafaxine and PVB (group 3) had a similar effect as PVB (group2) with no obvious effect for this combination.More further studies could be conducted.https://zumj.journals.ekb.eg/article_4580_5b6ce457ae441f5aef3e392fb340af2d.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101PREDICTING INSULIN RESISTANCE USING THE TRIGLYCERIDE-TO-HIGH DENSITY LIPOPROTEIN RATIO IN EGYPTIAN ADULTS19458110.21608/zumj.2017.4581ENFaredAbd El HafezInternal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.MohamedSaadInternal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.HatemSalemInternal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.AymanM.NInternal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.FawzyEl-MessallamyAsmaaEshclinical Pathology Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20171212Background: There are several directly and indirect methods to assess insulin resistance. The gold standard method was the hyperinsulinemic-euglycemic clamp (glucose clamp) technique. Although HOMA (homeostatic model assessment) IR has been widely used in study of metabolic syndrome, Lack of standardized insulin assay has limited it is clinically assay. Triglycride-TO-High Denisity Lipoprotein ratio (TG/HDL) has been advocated as simple clinical indicator of insulin resistance, also it has been evaluated as predictor of diabetes and coronary heart disease.<br />Aim of the Work: To develop simple predictive method to evaluate insulin resistance using TG and HDL.<br />Patient and Methods: A total of 95 person were included in this study and divided in to five groups as follow: Group (1): 19 healthy Persons aged 45.4 + 11.2, Group (2): 19 Non diabetic high risk patients without cardiovascular complication aged 56.9 + 10.5, Group (3): 19 Non diabetic with high risk patients with cardiovascular complication aged 62.2 + 13.7, Group (4): 19 Diabetic patients without cardiovascular complication aged 60 + 16.7 and Group (5): 19 Diabetic patients with cardiovascular complication aged 63.9 + 12.2. All subjects were subjected to the following: Full history taking, full general examination, BMI, Waist circumference, HbA1C, Triglyceride, total cholesterol, HDL-C, LDL-C. Fasting insulin, Fasting blood sugar and HOMA-IR.<br />Results: the highest percentage of HOMA among the studied groups was in group 5 (94.7%) (5.8+2.6, P < 0.001) followed by group 4 (78.9%) (3.3 + 1.2, P <0.001) then group 3 (5.3%) (1.52 + 0.55, P <0.001) then other groups. There were highly significant positive correlation between HOMA & TG/HDL in group 4 & 5 (P <0.05) and insignificant correlation in group 1, 2&3.<br />Conclusions: There is a significant association between HOMA- IR and TG/HDL ratio suggesting that elevated TG/HDL ratio can be used to predict the presence of insulin resistance.https://zumj.journals.ekb.eg/article_4581_32e54bb3def7c9a31e6bc8574f8075fd.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101ROLE OF SERUM INTERLEUKIN – 10 AND INTERLEUKIN -28B GENE POLYMORPHISMS IN PREDICTING TREATMENT RESPONSE OF HEPATITIS C PATIENTS16458210.21608/zumj.2017.4582ENAbousreaaKamalClinical Pathology and *Internal Medicine Departments. Faculty of Medicine, Zagazic UniversityELnmerMohammedClinical Pathology and *Internal Medicine Departments. Faculty of Medicine, Zagazic UniversitySwelamElsayedClinical Pathology and *Internal Medicine Departments. Faculty of Medicine, Zagazic University.AshourAbdouClinical Pathology and *Internal Medicine Departments. Faculty of Medicine, Zagazic University.Journal Article20171212Background: Hepatitis C virus infection (HCV) is a global health problem which develops chronic hepatic diseases including liver cirrhosis and hepatocellular carcinoma. IL28B polymorphisms rs12979860 CC genotype and low serum level of interleukin10 were associated to protect the patients of HCV infection and rapid virological response (RVR) in HCV patients treated for four weeks with pegIFNα/ribavirin (IFNα/RIB).<br />Subjects and methods: The study was carried out on 49 Egyptian HCV patients, Patients with other types of viral hepatitis, unfavourable haematological picture & decompensated liver function including cirrhosis and Autoimmune hepatitis were excluded. Patients who responsing to IFNα/RIB after four weeks were classified as RVR (n = 18) and Non-RVR (n = 31). IL28B polymorphisms at rs12979860, the resulting genotypes are CC, CT or TT, and Serum IL10 was measured by standard sandwich enzyme-linked immune-sorbent assay technology for both groups.<br />Results: Il28B CC genotype was 67.4 % in responder group (RVR) 38.7% in non-responder group (non RVR) (p= 0.01), CC genotype with serum IL10 < 80 pg/mL was 72.2% in responder group and CT/TT with serum IL10 >80 pg/mL (p= 0.00).<br />Conclusion: the relationship of genotype CC of IL28B at rs12979869 and the effect of IFNα/RIB to maintain the serum level of IL10 decrease and to achieve better chances to cure the HCV patients from the virus.https://zumj.journals.ekb.eg/article_4582_9830290f7103fba9d3f34ea1c0c28fd6.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101ROLE OF TUMOR NECROSIS FACTOR ALPHA AND BASIC FIBROBLAST GROWTH FACTOR IN THE PATHOGENESIS OF VITILIGO:AN IMMUNOHISTOCHEMICAL STUDY BEFORE AND AFTER MELANOCYTE TRANSFER BY SANDPAPER TECHNIQUE19458310.21608/zumj.2017.4583ENNagwaDiabDepartments of Dermatology and Pathology.Faculty of medicine,Zagazig universityMagdaAssafDepartments of Dermatology and Pathology.Faculty of medicine,Zagazig universityMohamedToamaDepartments of Dermatology and Pathology.Faculty of medicine,Zagazig universityMohamedElghareebDepartments of Dermatology and Pathology.Faculty of medicine,Zagazig universityJournal Article20171212Background: Vitiligo is an acquired depigmentation of skin and mucous membranes. Many theories explain its pathogenesis. Keratinocyte dysfunction in vitiligo may be a possible link between the various pathological changes occurring in vitiliginous skin. Keratinocytes produce several mediators, cytokines and growth factors that support or inhibit the growth and/or melanization of surrounding melanocytes. Basic fibroblastic growth factor (bFGF) is proposed to be a paracrine mitogen for human melanocytes.Tumor necrosis factor α (TNFα), is suggested to be as an early paracrine inhibitors of melanocyte.In this study,we evaluated the keratinocyte 's TNFα and b-FGF in vitiligo patients before and after treatment with melanocyte transfer by sandpaper technique.<br />Methods: This study was carried out on two groups, 17 vitiligo patients ,and 17 healthy persons as control. Skin biopsies were taken from the patients before and after treatment with melanocyte transfer from the lesional and perilesional skin .Skin biopsies were taken also from skin of the normal control individuals. These biopsies were prepared for histological evaluation and immunohistochemical(IHC) staining forTNFα b-FGF.Evaluation of IHC slides was done by a subjective method(i.e. eyes of an expert pathologist) and an objective method(Image analyser) before and after 3 months of treatment with melanocyte transfer by sandpaper technique.<br />Results: There was a statistically highly significant increase of b-FGF staining in lesional and perilesional skin of the patient's group in comparison with their staining in normal control. Regarding TNFα staining of lesional and perilesional skin,there were a statistically significant increase and a statistically highly significant increase respectively with its staining in the normal control. The clinical results of the melanocyte transfer by sandpaper technique,after 3 months of follow up, were as follow,47.1%of patients showed mild improvement,35.3%of patients showed good improvement,and 17.6% of patients showed no improvement.TNFα staining of lesional and perilesional skin,evaluated subjectively, showed a statistically highly significant increase after treatment with melanocyte transfer in comparison with their staining before treatment.Regarding b-FGF staining ,subjectively evaluated,there was a statistically highly significant increase after treatment in lesional skin and a statistically highly significant decrease after treatment in perilesional skin.Using image analyser as an objective method of evaluation,there was a statistically significant increase of TNFα staining of lesional and perilesional skin after melanocyte transfer in comparison with their staining before treatment.On comparing b-FGF stainings after treatment with their corresponders before treatment by image analyser,there was a statistically significant decrease of b-FGF staining in lesional skin after treatment and there was no significant change in perilesional skin before and after treatment.<br />Conclusion:change in the microenvironment of vitiliginous skin is evident .These changes in the cytokines,growth factors affecting the melanocytes may be a joint step in the pathogenesis of vitiligo between an intial step (supposed to be oxidative stress and apoptosis in keratinocytes) and an eventual step marked by destruction of the melanocytes.https://zumj.journals.ekb.eg/article_4583_5df40180f731f3ac0317301b8390a250.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101STERLE WATER INJECTION VERSUS DICLOFENAC SODIUM AS A POST CAESARIAN SECTION PAIN RELIEVER110458410.21608/zumj.2017.4584ENAhmedElbohotyDepartment of Obstetrics and Gynecology, faculty of medicine, Ain shams University, Cairo, EgyptMohamedBeheryThe International Islamic Center for Population Studies and Researches, ART Unit, Al-Azhar University, Cairo, Egypt.AhmedHashadDepartment of Obstetrics and Gynecology, faculty of medicine, Ain shams University, Cairo, EMarwaYousefDepartment of Obstetrics and Gynecology, faculty of medicine, Ain shams University, Cairo, EgyptJournal Article20171212Background: Childbirth is an important experience in a woman life, so high quality postoperative analgesia is important because the mother has to recover from major intra-abdominal surgery for proper caring of her newborn baby. Analgesic medications are either pharmacological or non-pharmacological methods. Pharmacological methods commonly used for postoperative pain relief after caesarean section either opioids or non-opioids and non-pharmacological methods include many techniques that reduce painful stimuli, as used for management of low back pain in labor. Sterile water injection is a simple and inexpensive way to provide a medication – free option to women who want to either avoid or delay use of opioid or non-opioid analgesia<br />Methodology: 94 women who had attended the maternity hospital at Ain Shams University hospital from June 2013 to the end of December 2014 and indicated for Caesarian section, were randomized into 2 groups: group I (n=47) included women who received post Caesarian section subcutaneous injection of 0.5 ml sterile water, and group II (n=47) received intramuscular 3ml of 75mg Diclofenac sodium. Assessment of pain score in total subjects for need additional analgesia and assessment of maternal side effects was conducted in both groups.<br />Results: there are statistically significant difference between both groups as regard onset of pain relief (23±9.9 and 16±6.4) in group 1 and 2 respectively with P-value(<0.001).Also 13 cases in group І needed additional analgesia while no cases needed in group ІІ (28% and 0%) respectively with P-value <0.001.As regard appearance of side effects 5 cases showed side effects(flushing and stinging pain) in group 1 and no recorded side effects in group 2(11% and 0%) respectively with P-value =0.022.<br />Conclusion: sterile Water was found to be safe, simple and efficient method of pain relief after caesarean section and free from major negative side effects which associated with other methods. In spite of these advantages, non-steroidal analgesics seems to has the priority in view of potency, rapid analgesia and the less side effects.https://zumj.journals.ekb.eg/article_4584_6196c2b0b0a11b5473b5e185b82760de.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101ANALGESIC EFFICACY OF ULTRA-SOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK WITH TOTAL ABDOMINAL HYSTERECTOMY19458510.21608/zumj.2017.4585ENIsmailAbd El GawadAnesthesia Department Al Azhar University, Cairo EgyptAymanEmaraAnesthesia Department Al Azhar University, Cairo EgyptSaidAbd El HameedAnesthesia Department Al Azhar University, Cairo EgyptMohammedElsayedAnesthesia Department Al Azhar University, Cairo EgyptJournal Article20171212Background: Pre-incisional bilateral Ultra-sound guided transverses abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents for postoperative analgesia. The aim of this study is, assess the effectiveness of Ultra-sound guided TAP block on requirement of intra-operative fentanyl and post-operative analgesia in patients undergoing total abdominal hysterectomy. Subjects and Methods: Eighty patients ASA physical status I and II, were randomly allocated into two groups (40 patients each), group TAP: received bilateral Ultra-sound guided TAP block with 20ml bupivacaine 0.25% in each side and group GA: received Ultra-sound guided TAP with same volume of normal saline. both groups given standardized GA. Intra-operative fentanyl requirements and postoperative pain using visual analogue score (VAS) at 30 min.1, 2, 3, 6, 12 and 24 h post-operatively were assessed and if VAS ≥3, patients received i.v. pethidine as a rescue analgesic and time to first request of analgesia was recorded. Results: Intra-operative fentanyl requirement reduced in TAP group compared to GA group; it was 100.4±21.6 and150.3±24.3 mcg respectively. Time to the first analgesic request was also reduced in TAP group compared to GA group; it was112.5±5.4 min.vs.23.4 ± 2.3 min respectively. VAS at most post-operative measurement points and pethidine requirement were reduced in TAP group compared to GA group; (41.7 and 92.3 mg respectively).There were no recorded complications attributed to the TAP block procedure. All TAP group patients were highly satisfied with their postoperative analgesic regimen. Conclusion: TAP block provides effective intra and postoperative analgesia, prolongs time to the first analgesic request and reduces total intra and postoperative analgesic consumption with minimal PONV after total abdominal hysterectomy.https://zumj.journals.ekb.eg/article_4585_0319a030ce218db42fa1b14de516bf0f.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101SURGICAL TREATMENT OF POST BURN DEFORMITIES OF ORAL COMMISSURE AND LOWER LIP17458610.21608/zumj.2017.4586ENAhmedAhmedReconstructive and Plastic surgery Division, General Surgery Department, Faculty of Medicine, Al-Azhar University Hospital, Damietta, Egypt.Journal Article20171212Background: The lip is affected by burn injury. The complications of post burn scarring of the lip are often resulting in aesthetic deformity and psychological troubles in patient’s particularly adult females. A burn disturbed the aesthetic features and lines of the lip. The aim of work is to choose the suitable method of treating post burn deformities of oral commissure and lower lip. .<br />Subjects and Methods: We admitted 24 patients to our hospital from June 2007 to July 2012. They were complaining of deformity of lower lip, contracted commissure either as a single lesion or as a part of face or as a part of the body. Age of our patients ranged from 3-60 years with average age 24.38 years. The surgical methods may be full thickness skin grafts (nine cases), tissue expansion (13) cases, local flap (one case) and scar revision (one case).<br />Results: We noticed that there were three elements that determine the surgical methods of treating deformities of lower lip: condition of the surrounding skin, extent and shape. We have already discussed and evaluated the various techniques of reconstruction. 19 out of 24 patients proved to be a success.<br />Conclusion: full thickness skin grafts have a certain percentage of morbidity in the form of partial loss. The possibility of contamination is inevitable in some patients with bad eating habits.https://zumj.journals.ekb.eg/article_4586_42a3c392869899add955f430759ce0df.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121620171101HEPATIC ELASTOGRAPHY AND FIB-4 SCORE VERSUS LIVER BIOPSY FOR ASSESSMENT OF LIVER FIBROSIS IN CHRONIC HCV PATIENTS1114121110.21608/zumj.2017.41211ENEssam A.WahabTalaatFathySamehSaberHanan S.AhmadJournal Article20170716Background: Chronic HCV infection is a major global health problem. Liver biopsy still the gold standard tool for assessment of hepatic fibrosis, however, real time hepatic elastography assessment and FIB-4 score calculation may be valuable alternatives. Aim of the work: Clarifying whether, hepatic elastography assessment and FIB4-score calculation are good and acceptable alternatives for Liver biopsy for assessment of liver fibrosis in patients with chronic HCV infection. Patients and Methods: The study was carried out through seven months duration on sixty-five HCV infected patients who were eligible for standard of care direct acting antiviral medications. Routine laboratory workup, abdominal US, transient hepatic elastography assessment, FIB-4 score calculation and liver biopsy were done for all participants. Results: ANOVA study of participant's age, Hb %, platelets count, albumin, ALT and AST among fibrosis stages diagnosed by LB showed no significant differences regarding participant's age and Hb%, while, a significant difference regarding serum albumin (p =0.05) and highly significant difference were found regarding platelets count, serum ALT and AST (p=0.001, Key words: Hepatic elastography; FIB-4 score; Liver biopsy; Liver fibrosis; Chronic HCVhttps://zumj.journals.ekb.eg/article_41211_76d3b2620cb34f929a6ae2bfee9767e4.pdf