Zoonoses are diseases and infections that are transmitted in nature between vertebrates and humans. Zoonoses consist of an interaction among at least three species: one pathogen and two hosts − animals and humans. This review aimed at shedding in depth light on zoonotic parasitic diseases in Egypt, with special reference to their relative incidence between humans, reservoir animals, sources of human infection and control policies. According to the available literature, many parasitic zoonoses are endemic in Egypt. In rural areas, intestinal parasitic zoonoses are widespread and are the leading cause of diarrhea, particularly among children. Some parasitic zoonoses are mainly found in certain areas in Egypt, for example, cutaneous leishmaniasis and zoonotic babesiosis in Sinai. Other locations in Egypt have a history of certain parasitic zoonoses, such as visceral leishmaniasis in the El Agamy area in Alexandria. Fortunately, control programs have led to a dramatic decrease in the prevalence of other zoonoses, such as intestinal schistosomiasis and fascioliasis in the country. In Egypt, animal reservoirs of parasitic zoonoses have been identified. These include rodents, stray dogs, and cats as well as domestic and farm animals and birds. Many vectors have also been revealed, typically mosquitoes and ticks, which pose real threats for disease transmission. Strict control strategies are needed to upgrade and complement current efforts at eradicating parasitic zoonoses in Egypt.

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Background Ascites is a major complication of liver cirrhosis that carries a poor prognosis. Diuretics are used in treatment of ascites in addition to salt restriction. Monitoring of diuretic response can be achieved by measurement of 24-h urinary sodium. Aim of the study The aim of the study was to evaluate the accuracy of using spot urinary sodium/potassium ratio as an alternative to 24-h urinary sodium in assessment of dietary sodium compliance in patients with liver cirrhosis receiving diuretics. Patients and methods Sixty patients presenting with liver cirrhosis and ascites were admitted at Cairo University Hospital. All the patients were subjected to full history taking, clinical examination, laboratory investigations including liver function tests, renal function tests, 24-h urine sample (for measuring of sodium) and spot urine sample (for sodium and potassium). The studied patients were divided into two groups: diuretic resistant group (those with 24-h urinary sodium <78 mEq) and diuretic sensitive group (with 24-h urinary sodium >78 mEq). The patients in diuretic resistant group were 18 patients (30%) and those in diuretic sensitive group were 42 patients (70%). Results Spot urine Na/K ratio was significantly lower in patients in the diuretic resistant group (2.4 ± 2.2) than in the sensitive group (4.7 ± 2.3) (P < 0.05). The cutoff point of Na/K ratio that showed highest accuracy was 3.0. Conclusion This study revealed highly significant correlation between 24-h urinary sodium and spot urine sodium/potassium ratio with sensitivity 75% and specificity 91.67% at cutoff point of 3.

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Kasr Al Ainy, the palace built by Ahmed Ibn Al Ainy, in the years (A.D.1466-1468) by the Nile shore in the area known till now as Mouth of Khalig. This palace played an important part in the history of Cairo and Egypt which extends till now. It was used as a governmental building, a Chateau, a military hospital and a primary school till the year 1837. Mohamed Ali Pasha introduced the European military system in Egypt and wanted to provide it with the medical aid. He assigned Dr. Clot Bey, from France to establish a medical school in Abu Za'abal to prepare doctors for the army in the year 1827. It was after 10 years that the medical school was transferred to Kasr Al Ainy as a medical school and hospital. Kasr Al Ainy witnessed all the changes that occurred in Egypt till now, serving all the Egyptians and non-Egyptians.

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Objective The aim of this study was to evaluate the role of sonomammography in the characterization of clinically palpable breast masses during pregnancy and lactation with differentiation of true and false (lobular hyperplasia/lactational changes) masses. Materials and methods One hundred patients with clinically palpable breast masses during pregnancy and lactation were evaluated by means of ultrasound (US). Mammography was performed only for 23 patients. Mammographic and sonographic findings were evaluated retrospectively. When US or mammography revealed a benign lesion, no further diagnostic evaluation was necessary. However, when US or mammography demonstrated a suspicious lesion, biopsy was performed. Results US showed lobular hyperplasia/lactational breast changes categorized as Breast Imaging-Reporting and Data System 2 (BI-RADS 2) in 13 cases, a lesion with the criteria of benignity categorized as BI-RADS 2 in four cases, BI-RADS 3 in 68 cases, BI-RADS 4 in three cases, and BI-RADS 5 in 12 cases. Mammography showed normal dense breast categorized as BI-RADS 1 in four cases, lesions with criteria of benignity categorized as BI-RADS 3 in six cases, BI-RADS 4 in two cases, and BI-RADS 5 in 11 cases. Trucut biopsy established the pathological diagnosis in 22 cases. Conclusion Most of the pregnancy-associated breast masses are benign. Nevertheless, a strict assessment of any lesion is required, to exclude malignancy and to rule out lactational breast changes/lobular hyperplasia that may present as lump. US is the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation.

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Background and objective Arteriovenous fistulas (AVFs) are the vascular access of choice for hemodialysis with a lower incidence of complications and longer survival than prosthetic grafts or central venous catheters. Our aim was to evaluate the role of color Doppler ultrasound (CDUS) in the detection and characterization of complications of AVF dialysis access. Materials and methods During a 9-month duration, we prospectively evaluated 25 patients with clinically suspected AVF complications using CDUS examination of the upper limbs. There were 11 (44%) males and 14 (56%) females, ranging in age from 8 to 70 years. All patients were examined after reconstruction of AVF for the assessment of vascular access complications. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. Results All 25 patients had shunt complications. Venous thrombosis was the highest among all complication (n=12, 48%), followed by stenosis (n=11, 44%), aneurysm and pseudoaneurysmal formation (n=5, 20%), and infection (n=1, 4%). Four patients had more than one complication. Sixteen (64%) patients had complicated fistulas requiring further intervention, either surgical management [reconstruction of new fistula (n=3), ligation (n=1), graft (n=1), and superficialization (n=2)] or radiological intervention [percutaneous transluminal angioplasty (n=5), thrombectomy (n=2), and percutaneous transluminal angioplasty and thrombectomy (n=2)]. Conclusion CDUS is a noninvasive diagnostic tool for early detection and localization of complications of AVFs that allows detection of possible causes of vascular access malfunction.

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Background Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of unknown reason or definite cure, heavily impacting the patient's mobility and overall quality of life. Purpose Through this study the authors propose safe, alternative phototherapies for the early management of MS. Study design This is a repeated-measures randomized control trial. Materials and methods Twenty-four patients with relapsing remitting MS, of both sexes, aged 25–45 years, completed the study; they were randomly assigned to four groups. Seven patients in the control group (group 1) received monthly intravenous infusion of 1 g solu-medrol therapy for MS; six patients in group 2 received solu-medrol plus low-intensity laser therapy (LILT) at 850 nm; six patients in group 3 received solu-medrol plus broadband ultraviolet B radiation (BB-UVBR) (280–320 nm); five patients in group 4 received solu-medrol and scanner LILT and BB-UVBR. All three groups received a total of 12 sessions over a period of 3 days/week. Expanded disability status scale (EDSS) and H-reflex latency were assessed before treatment, after treatment, and at 3 months’ follow-up. Results There was statistically significant reduction (P = 0.009∗∗) in H-reflex latency but not in H/M ratio (P ≥ 0.05) in the LILT group (group 2), whereas EDSS was significantly reduced (P = 0.011∗) by 1 point in the BB-UVBR group (group 3). These results were maintained 3 months after treatment. Conclusion This study suggests that LILT can efficiently reduce spasticity in the short term in patients with relapsing remitting MS. While BB-UVBR therapy alone is more efficient in ameliorating the disability status (EDSS), and combining LILT with UVBR, surprisingly, might have an undermining effect.

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Background Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR shows hour-to-hour variation that follows a specific pattern in asthmatics and in healthy individuals. Adequate data are not available on the diurnal variation in normal individuals who are students in professional courses and living a sedentary lifestyle. Hence, this study was undertaken to study the diurnal variation in PEFRs in healthy men in South India. Participants and methods PEFR was recorded in 50 adult healthy male students who were nonsmokers, between 18 and 23 years of age and studying in professional courses (MBBS, BDS, Nursing and MSc). Mini Wright's peak flow meter was used to measure the PEFR. PEFRs were recorded at 7-8 a.m., 10-11 a.m., 1-2 p.m., 4-5 p.m. and 7-8 p.m. for 2 consecutive days. Results On analysis of PEFR records of each individual, it was seen that there was an overall dip in the morning at 7-8 h PEFR, which increased during the daytime, peaking in the afternoon at 4-5 p.m. and eventually decreased in the night. Participants did not show the peak PEFR values at the same time point: 16% of participants had a rise in PEFR in the early morning hours; afternoon (1-2 p.m.) peak was observed in 22% of participants; and evening (4-5 p.m.) peak was observed in 36% of participants. Only 2% of participants showed a peak in the night time (7-8 p.m.) PEFR values. Conclusion This study provided the preliminary reference data of diurnal variation of PEFR in healthy adults. As there is a variation in the PEFR recorded during different time points of the day, it is advisable to record the PEFR at the same time point to compare the PEFR between individuals.

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Background and purpose Elderly primigravida and their offspring have traditionally been considered to be at increased risk of adverse maternal and neonatal outcomes because of associated pregnancy and labor complications. This study was designed to examine the efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida. Participants and methods Sixty elderly primigravida women (age range: 35-40 years) at 14 weeks' gestation were divided randomly into two equal groups (A and B). Group A performed antenatal exercises for 6 months, whereas group B continued their lifestyle after receiving specific advice for each trimester. The exercise program parameters were based on the American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy. Assessment of labor pain was performed using the Present Pain Intensity scale. Results Participants in group A showed a statistically significant difference in the intensity of labor pain when cervical dilatation was between 7 and 8 cm (P = 0.000), duration of first stage of labor (P = 0.026), and neonates' APGAR scores at the first and the fifth minute of life (P = 0.000) compared with participants in group B. There was no statistically significant difference between groups in the intensity of labor pain when cervical dilatation was between 3 and 5 cm (P = 0.775) and mode of delivery (P = 0.630). Conclusion Antenatal exercises are very effective in decreasing adverse effects and labor complications in elderly primigravida and their neonates.

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Objective The aim of this study was to evaluate the role of Cerebrolysin in muscle healing in vivo. Materials and methods Twenty adult albino rats were used in this study. Both right and left gastrocnemius muscles of the albino rats were cut at 60% of their length from their distal insertion through 75% of their width and 50% of their thickness and then sutured with simple sutures using absorbable catgut sutures. The gastrocnemius muscles of all albino rats were injected directly in the lesion with 100 ng/ml/kg of cerebrolysin at 1, 3, and 5 days after laceration. The sham control muscles were subjected to the same treatment but were injected with the same volume of physiological normal saline. One week after the injury the animals were killed and the gastrocnemius muscles were removed and processed for paraffin sectioning and stained with hematoxylin and eosin, Bcl-2 (B-cell lymphoma 2), and P53 (tumor suppressor gene) immune peroxidase stains. Results There was a significant increase in the mean myonuclei/myofiber diameter ratio and the size of the regenerating myofibers as an index of muscle regeneration in the cerebrolysin-injected group compared with the control. It is anticipated that cerebrolysin is a potent stimulator of muscle regeneration in vivo. It has also been found that regenerating myofibers were located both in the deep and the superficial areas of the injured site of muscles only when treated with cerebrolysin, thereby demonstrating greater initial healing when the injured muscle is treated with cerebrolysin. Cerebrolysin retarded apoptosis in neutrophils, macrophages, and other inflammatory cells by activating the anti-apoptotic Bcl-2 (B-cell lymphoma 2) protein leading to accumulation of these inflammatory cells. Conclusion This study has shown that injections of cerebrolysin into an injured muscle improved muscle healing in vivo. Also, documents the occurrence of a protective Bcl-2 in inflammatory neutrophils and macrophages, which were expressed in cerebrolysin-treated muscles, leading to enhancement of the effect of these inflammatory cells. We have also found that Inflammatory cells play a role in satellite cell activation and proliferation but, the tumor suppressor gene p53, which is recognized as a central regulator of cell cycle and apoptosis, had no role in muscle regeneration in this in-vivo study.

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Background Ulcerative colitis (UC) is a chronic inflammatory disease of large intestine. Overproduction of free radicals, lowered antioxidant capacity and abnormal apoptosis are involved in pathogenesis. Nebivolol, a β blocker with vasodilatory, antioxidant, anti-inflammatory effects, can play future role in therapies for UC. Aim of the study The purpose of this study was to evaluate the protective effect of nebivolol against acetic acid (AA)-induced UC in rats. Methods Male wistar rats were pre-treated orally with nebivolol 5 mg/kg/d, 10 mg/kg/day, for seven days, before and 3 days after induction of colitis (by intra-rectal administration of 2 ml of 4% AA). Colonic macroscopic scoring and histopathological examination were done. Colonic content of thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD) and myeloperoxidase (MPO) activities were assessed. Apoptosis was monitored by determining caspase-3 gene expression. Serum levels of interleukin (IL)1-β, SOD, TBARS and tumour necrosis factor (TNF)-α were measured. Results In AA- group, serum levels of TBARS, TNF-α and IL-1β were significantly increased. SOD activity was significantly reduced. Caspase 3 protein expression was upregulated. Colonic content of TBARS and the activity of MPO were elevated. GSH concentration and activity of SOD were significantly reduced, compared to control group. In nebivolol pretreated groups (5 and 10 mg/kg/d) and sulfasalazine group, all parameters were near normal. Nebivolol significantly decreased colonic macroscopic scoring and wet colon weight compared to AA group. The coloprotective effect of nebivolol was confirmed by histopathological examination. Conclusion Nebivolol has a protective effect against AA- induced colitis, through its anti-inflammatory, anti-oxidant and anti-apoptotic effects.

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Objective The aim was to find the correlation between duration of symptoms and computed tomography (CT) severity score in patients with novel coronavirus pneumonia. Patients and methods This study was conducted on 108 patients with proven COVID-19 pneumonia. Results A total of 108 patients were enrolled in this study with proven diagnosis of COVID-19 infection with 81 positive swabs (75%) and 27 negative swabs (25%). The 27 patients with negative swabs had typical features of fever, laboratory studies consistent with infection, and CT features of bilateral pneumonic changes. The study included 72 (66.7%) men and 36 (33.3%) women, with mean age of 52.1 (age range: 34–81 years) years. Patients were categorized according to the duration of onset of initial symptoms and the date of CT scans: stage 1 (0–4 days, n=36); stage 2 (5–9 days, n=30); stage 3 (10–14 days, n=15); stage 4 (15–21 days, n=9); stage 5 (22–28 days, n=3); and stage 6 (>28 days, n=15). Each stage average CT chest score of severity and average percentages of both lung opacities were shown. The authors found that CT severity score increases, as the duration of initial symptom increases, up to 9 days, from the onset of symptoms. CT score has a second peak at less than or equal to 20-day duration of symptoms and a third peak at more than 28 days, where a plateau is reached. Although patient’s clinical condition and oxygen saturation may improve, yet CT changes may persist with a high CT severity score for weeks thereafter. Conclusion CT severity score corresponds to the duration of symptoms only in the early stage of disease. In later stages, some patients develop residual lung affection after recovery from acute symptoms, yet lung changes take weeks to resolve, and in some cases, residual chronic changes may persist.

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Background and objectives Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy and many studies have shown strong correlation between HD dose and clinical outcome measured by Kt/V. This study was conducted to evaluate HD adequacy in patients with end-stage renal disease to identify the prevalence and causes of inadequate HD and the impact of HD adequacy on patient outcomes. Patients and methods This cross-sectional study was conducted on 100 patients in the HD unit at Tanta University Hospital. All patients gave their consent and were informed about the study purpose. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. Statistical analysis was carried out for all collected data using SPSS 18. Statistical significance was determined at a P-value less than 0.05. Results The results revealed inadequate HD dose in 60% of the study population. The results also showed that, with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings clearly showed a strong positive correlation between dialysis dose and Hb level, serum albumin level, normalized protein catabolic rate, and physical health. Conclusion A significant percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of the dialysis session, patients' complaints, and well-functioning vascular access.

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Ivermectin, the FDA-approved broad-spectrum antiparasitic drug, has recently shown excellent antiviral effects against many viral infections. This effect was especially important in the current pandemic infection of COVID-19. There are reports that ivermectin inhibited the replication of the virus in vitro in 48 h. Studies have been done on other viral infections and on this virus in vivo and in vitro. The results showed that it affects the viral replication by its effect on the protein transfer between the cytoplasm and nucleus inside the host cells. More information is still needed to approve its use in the treatment and prevention of COVID-19 pandemic, which will necessitate more studies to adjust the dose and mode of administration.

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Introduction Coroner autopsies are post-mortem examinations performed at the instance of the law. The aim of this study is to determine the pattern and causes of death in coroner autopsies performed by a police pathologist. Materials and methods Autopsy registers and reports of the pathology section of police clinic Benin City, Edo State, Nigeria, from 2008 to 2012 were reviewed with respect to their demographic features, cause and manner of death. Results A total of 982 coroner autopsies were performed during the period, involving 773 males and 209 females, yielding a sex ratio of 3.7 : 1. The age group 20-29 years was the most commonly involved, accounting for 28.5% of cases. Accidental deaths were the commonest type of deaths (41.3%), followed by deaths because of homicides (40.8%); natural death was a distant third cause, accounting for 14.6%, whereas suicides and undetermined deaths accounted for 1.2 and 2.1%, respectively. Road traffic accidents were responsible for most accidental deaths (85.7%). Homicidal deaths were mainly by gunshots (66.5% of cases). Cardiovascular system diseases were the leading cause of natural death, with myocardial infarction and complications of hypertension each accounting for 44.4%. Conclusion Efforts to reduce road traffic accidents and control the number of guns in the hands of civilians should be intensified. The incidence of myocardial infarction is on the rise and health education is advocated to help reduce its adverse effects.

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Background Parasitic infection has grown to be one of the most significant causes of morbidity and mortality worldwide. Nitazoxanide, a new antiparasitic drug, is believed to have a remarkable effect. This work aimed to study the in-vitro effects of nitazoxanide on Echinococcus granulosus, as an example of helminthic infection, and Blastocystis spp., as an example of protozoal infection, compared with the standard drugs in use. Materials and methods Hydatid protoscoleces and Blastocystis spp. were isolated and cultivated each on its specific medium. Nitazoxanide and standard drugs (albendazole for hydatid or metronidazole for Blastocystis spp.), or a combination of nitazoxanide and the standard drug for each were added to separate cultures, and parasite motility and viability were assessed. Furthermore, electron microscopic study for both parasites was carried out. Results The results showed a directly proportional relationship between number of dead protoscoleces and the tested nitazoxanide concentration; 50% of protoscoleces were killed (LD50) at 6 h incubation with 15 μg/ml of nitazoxanide, compared with LD50 of albendazole that was 30 μg/ml at 6 h. For Blastocystis spp., LD50 was 2 μg/ml after 48 h, whereas that for metronidazole was 10 μg/ml at the same culture duration. On combining nitazoxanide and the standard drugs, it showed variable effect, especially against Blastocystis spp. Conclusion These advantageous results toward nitazoxanide may allow trying the drug for both helminthic and protozoal infections.

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Back ground and objective Wuchereria bancrofti is responsible for 90% of cases of lymphatic filariasis throughout the tropics and in some subtropical areas worldwide, including Egypt. To combat this disease, the WHO has launched a program aiming to eliminate lymphatic filariasis by the year 2020 in all the endemic countries using mass drug administration (MDA) to interrupt the disease's transmission. The aim of the present work was to study W. bancrofti infection in selected endemic areas in Egypt by performing parasitological examination and enzyme-linked immunosorbent assay (ELISA) antigen detection test, and to analyze the demographic, clinical, and MDA data of the study population in relation to W. bancrofti infection. Patients and methods A total of 300 blood samples were collected from residents in endemic areas in five governorates. Parasitological examination and Og4C3 ELISA test were performed to identify W. bancrofti infection. Results Microfilariae were identified in one individual while circulating filarial antigens (CFAs) were detected in 10 individuals. Statistical analysis of the collected data showed that CFAs were significantly higher in the male population than in the female population, whereas analysis regarding other demographic, clinical, and MDA data showed no statistical significance. Conclusion The study results showed that CFAs are still detected in endemic communities in Egypt, and that the prevalence is higher in the male population than in the female population. Although the Og4C3 ELISA test is a useful research tool for the study of W. bancrofti infections, its cost and format hinder its wide use in endemic areas.

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Background Type-2 diabetes mellitus (T2DM) is a progressive and chronic disease characterized by both β-cell dysfunction and increased insulin resistance. Vitamin D is a crucial factor in the development of T2DM because it is necessary for normal insulin secretion. Despite ample sunshine, vitamin D deficiency is common in the Middle East. Objective To report the vitamin D status and its impact on the people in Riyadh City, Saudi Arabia, with T2DM. Patients and methods The study was carried out on 100 patients of 31–79 years old with T2DM. According to their vitamin D status, they were classified into three groups: group 1 (deficient, vitamin D: <20 ng/ml), group 2 (insufficient, vitamin D: 20–30 ng/ml), and group 3 (normal, vitamin D: >30 ng/ml). All were subjected to history taking, clinical examination, and assessment of fasting blood samples of serum concentrations of 25-hydroxy vitamin D [s-25(OH)D], blood glucose, glycated hemoglobin, lipid profile, liver enzymes (alanine transaminase and aspartate transaminase), urea and creatinine. Results Inadequate vitamin D level was observed in 80% of the participants, with a mean s-25(OH)D of 18.3±10.9 ng/ml. S-25(OH)D correlated negatively with fasting blood sugar (FBS) (P=0.008), with cholesterol and low-density lipoprotein (P=0.012 and 0.003, respectively). The low vitamin D status was strongly associated with poor glycemic control (P=0.001) and in females (P=0.002). There was no significant association between s-25(OH)D level and different age groups. Conclusion There is an overwhelming prevalence of vitamin D deficiency in our sample of Saudi diabetic patients. Association of low vitamin D status with poor glycemic control and atherogenic lipid profile suggests a role of vitamin D in the control of T2DM and dyslipidemia and the importance of early detection of its deficiency and vitamin D supplementation.

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Rationale The aim of this study is to determine the relationship between metabolic syndrome and the extent of coronary artery disease (CAD) in young adults presenting with acute coronary syndrome. Background Metabolic syndrome is associated with subsequent development of type II diabetes mellitus and cardiovascular disease. Individuals with metabolic syndrome are at a higher risk of developing myocardial infarction and CAD. Patients and methods This study was carried out at Kasr Al Ainy Hospital at Cairo University and the Sohag Specialized Cardiac and Digestive System Center. One hundred and twenty-two patients presented with acute coronary syndrome during the period of the study from January 2011 to January 2012. Eighty-five were men (69.7%) and 37 were women (30.3%). Patients were classified into two groups according to the presence or absence of metabolic syndrome to determine the effect of metabolic syndrome on severity of coronary lesions in comparison with nonmetabolic patients. Correlation was assessed between the number of metabolic risk components and coronary lesion severity using the SYNTAX score. Results The metabolic risk score was determined; patients with a significant metabolic score of at least 3 risk score constituted 66.4% of the total cohort (n = 81 patients). Patients were subjected to coronary angiography. Totally occluded vessels were found in 33.3% of metabolic syndrome patients and in 26.8% of non metabolic syndrome patients (P < 0.05). The SYNTAX score was used to assess the severity of CAD; it was found to be statistically significantly higher in patients with metabolic syndrome than those without (P = 0.001). Conclusion Patients with metabolic syndrome have more severe CADs. Preventive measures against metabolic syndrome and its components are very important and could help avoid the large economic burden of secondary prevention.

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Objective The aim of the present study was to evaluate the impact of thrombotic microangiopathy (TMA) on renal involvement in patients with lupus nephritis (LN). Patients and methods This study included 50 systemic lupus erythematosus patients with LN who had been referred for renal biopsy. Patients underwent clinical and laboratory assessment for disease activity and damage. The biopsy specimens were classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, activity and chronicity indices, and assessed for renal TMA lesions. Results TMA was found in 7/50 LN patients (14%). Patients with TMA lesions had significantly higher systolic and diastolic blood pressure (P = 0.018 and 0.019, respectively), higher serum creatinine (P = 0.031), lower estimated glomerular filtration rate (P = 0.023) and higher consumption of C3 (P = 0.002) than that of those without TMA lesions. Lupus anticoagulant positivity was significantly more frequent in patients with TMA (P = 0.001). There was a significant association between the detection of TMA and LN class IV. LN patients with TMA had significantly higher renal activity indices (P = 0.022). Chronicity index was higher in patients with TMA, but it did not reach a statistical significance. Conclusion TMA is not an uncommon vascular change in patients with LN, especially in those with diffuse proliferative glomerulonephritis (class IV LN). It is associated with lupus anticoagulant positivity, C3 hypocomplentemia and higher renal biopsy activity index. TMA was significantly associated with renal impairment and systemic hypertension. Thus, TMA may be an important cause of renal injury and renal dysfunction in a subset of patients with LN, a histological entity associated with worse renal prognosis.

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Introduction Atrial fibrillation (AF) represents an important public health problem. Catheter ablation has emerged as effective therapy. Recurrence after ablation is still around 20–40%. The long-term use of anti-arrhythmic drugs (AAD) after AF ablation has been traditionally reported to reduce late AF recurrences; but has never been supported by randomised trials. Objective To test if routine continuation of the previously unsuccessful AAD beyond blanking period reduces AF recurrence at one year after AF ablation. Patients and method This randomised controlled clinical trial was conducted between January 2013 and January 2015 in Critical Care Medicine Department – Cairo University. Patients with symptomatic, drug refractory AF were enrolled. All patients underwent pulmonary vein isolation ± left atrial ablation according to AF type. The previously unsuccessful AAD was continued for at least 3 months after ablation, after which patients were randomised to either continue or stop that drug. Patients were regularly followed up for at least additional 9 months. The primary endpoint was reduction of AF recurrence. Secondary endpoints included identification of predictors of recurrence and rate of complications. Results Thirty-one patients with paroxysmal (80.6%) and persistent (19.4%) AF were enrolled. Pulmonary vein isolation was achieved in all patients. Seventeen patients were randomized to continue AAD (54.8%) beyond blanking period. After 12 months, there was no statistically significant difference of AF recurrence between the two groups (35.3% vs. 21.4%, P=0.46). The same was observed for paroxysmal AF patients (30.8% vs. 8.3%, P=0.32). Persistent AF and early AF recurrence were associated with late recurrence. Only 2 patients had major complications. Conclusion Routine continuation of previously unsuccessful AAD did not reduce AF recurrence, over a period of 12 months. Persistent AF and recurrence during blanking period were associated with later recurrence.

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Background Obesity is a modern-day epidemic. Pulmonary function tests are likely to be compromised to varying degrees in these individuals, thus affecting their artificial ventilation under general anesthesia. It is thus important to study the pattern of pulmonary function in these individuals in a group likely to undergo surgery for varying reasons. Participants and methods A total of 30 male participants between 45 and 60 years of age attending the surgical outpatient clinic with a BMI of more than 25 kg/m ² who qualified as obese were included in the study, and a similar number of participants with BMI less than 25 kg/m ² were randomly selected as controls. Flow-volume loop, forced expiratory volume in the first second (FEV ₁ ), forced vital capacity (FVC), and FEV ₁ /FVC were recorded using a computerized spirometer. Results FEV ₁ , FVC, and FEV ₁ /FVC ratio measured in obese patients were significantly reduced (P < 0.05) compared with normal BMI individuals. Conclusion The incidence of restrictive tendency is higher in obese individuals compared with controls. As the changes in respiratory mechanics due to obesity are almost completely reversible, early intervention in such patients will ensure lesser chance of complications on the operation table and postoperatively. With the advent of computerized spirometry, analysis of flow-volume loops is indeed of great help to the obese.

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Introduction Scleroderma, or systemic sclerosis (SSc), is a chronic connective tissue disease that has been classified as one of the autoimmune rheumatic diseases. The usual hallmarks of SSc are autoimmunity, inflammation, widespread small-vessel vasculopathy affecting multiple vascular beds, and progressive interstitial and vascular fibrosis in the skin and internal organs. Aim of the work The aim of the study was to determine the disease characteristics and frequency of different clinical manifestations among Egyptian patients. Patients and methods Seventy-five patients with SSc, all fulfilling the criteria of the American College of Rheumatology for classification of scleroderma, were selected for this study. They were being followed up in Cairo University Internal Medicine department. The patients' data were collected by a review of their medical records. We compared the frequency of symptoms in scleroderma patients with both diffuse cutaneous and limited cutaneous sclerosis (dcSSc and lcSSc). Results Fourteen patients out of 75 (18.7%) had dcSSc and 61/75 (81.3%) had lcSSc. We found that within the limited subtype 11/61 (18%) were male and 50/61 (82%) were female, with a male to female ratio of 1: 4.6. Within the diffuse subtype, 3/14 (21.4%) were male and 11/14 (78.6%) were female, with a male to female ratio of 1: 3.7. Raynaud's phenomenon was the first presenting manifestation (in 77.3%), followed by arthritis (in 12%) and skin tightness (in 9.3%). Conclusion SSc is more common in the female population than in the male population. lcSSc is more common than dcSSc.

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Introduction Systemic lupus erythematosus (SLE) is an immune-complex mediated autoimmune disease characterized by protean clinical manifestations and fluctuating disease course. It was proposed that progression and flares of lupus and lupus nephritis are due to decreased production of lipoxin A4 (LXA4) and enhanced production of leukotrienes by the renal tissue and/or infiltrating leukocytes and macrophages. Objective The aim of this study was to assess the levels of serum LXA4 in SLE patients and in healthy controls, and to correlate them with various clinical and laboratory data as well as renal biopsy and disease activity indices. Patients and methods Forty adult female SLE patients were included in this study. The SLE patients were divided into two groups: group I included 20 patients without nephritis and group II included 20 patients with nephritis. Forty apparently healthy age-matched women served as the control group. Patients and controls were assessed for serum LXA4 using enzyme linked immunosorbent assay. Disease activity was assessed using systemic lupus erythematosus desease activity index (SLEDAI) and renal SLEDAI. Renal biopsy was performed for patients with lupus nephritis. Results SLE patients showed a higher median level of serum LXA4 compared with the control group (0.24 vs. 0.15 ng/ml), but with no significant statistical difference (P = 0.097). Moreover, there was no statistically significant difference in serum LXA4 between SLE patients with and without nephritis and the control group (P = 0.142). There was no significant correlation between serum LXA4 and various clinical and laboratory data, as well as renal biopsy and disease activity index. Conclusion LXA4 was suggested to be an important biomarker to search for in SLE. Our study showed no significant statistical difference between SLE patients and the control group as regards serum LXA4. Assessment of urinary LXA4 is recommended as it may be more valuable than serum LXA4 in reflecting organ affection in SLE, as well as disease activity, and comparing it with serum LXA4 level.

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The global health crisis of novel coronavirus 2019 (COVID-19) pandemic has overwhelmed all medical disciplines, including nephrology. This review focuses on how kidneys are affected by COVID-19 infection and discusses some etiologic, pathogenic, and clinical aspects of kidney involvement in COVID-19 infection, including clinical outcome. Special strategies are required to improve clinical outcome and should be regularly updated based on gained knowledge and evidence.

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Mature cystic teratoma of the ovary is a common germ cell tumor among women. Teratomas are more frequently seen in younger women. In teratoma, all three germ cell layers are present, and hence any type of histological tissue can develop. As regards the type of tissue present, it may be mature or immature. In monodermal teratoma, one of the tissues may predominate, such as thyroid tissue in struma ovarii and neuroectodermal tissue in carcinoid tumor. Here, we present a case report in which a young woman presented with ovarian mass diagnosed histopathologically as mature ovarian teratoma having mostly neurologic elements such as glial tissue, melanotic cells, choroid plexus, and struma ovarii, and along with that fat and respiratory epithelium were also identified. Ovarian teratoma is composed of derivatives of three germ cell layers, but in some cases monodermal component such as struma ovarii can be seen with neurogenic components and mesodermal components.

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