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The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test

Sameh Mohamed Mamoon Shaheen; Ehab Mohamed Abd Elkawi Elfekky; Sameh Mosaad Abdul-Wahab; Mohamed Ramzy Ragheb Mohamed

Cardiology Department, Faculty of Medicine, Ain Shams University, Egypt.

thinkmoragheb@gmail.com

Abstract: Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide and is associated with severe impairment in functional capacity. In patients with chronic HF and reduced ejection fraction (HFrEF), the PARADIGM-HF (Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan reduced the risk of the composite of cardiovascular (CV) death or first hospitalization for heart failure (HF) by 20% compared to enalapril during a median follow-up of 27 months. Remarkably, the trial showed also an early beneficial effect of sacubitril/valsartan by reducing the risk of 30-day readmission for any cause and HF by 26% and 38%, respectively. However, there is limited data on the short-term effect of sacubitril/valsartan on patient's functional performance. Objective: To evaluate if there is any short term effect of Sacubitril/Valarstan drug on the functional capacity of stable HF patients with reduced ejection fraction, which is measured by the simple non-invasive six minute walk test, in only 30 days period. Methods: This is a prospectively studied a cohort of patients with chronic HF, visited outpatients clinics in Ain Shams University Hospital and 6^TH October University Hospital From November 1, 2018 to June 1, 2019. The inclusion criteria were: a) left ventricular systolic dysfunction ≤ 40%, b) stable New York Heart Association (NYHA) functional class ≥II, and c) prior treatment with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). In eligible patients, according to current guidelines, treatment with ACEI or ARB was replaced by sacubitril/valsartan. All patients provided informed consent and the protocol was approved by the research ethics committee in Ain Shams University. Results: Mean age of the studied patients was 55.07 ± 10.16 years, 83.3% males, 83.3% with ischemic cardiomyopathy, and 66.7% on NYHA functional class III. The mean (SD) of LVEF, 6-MWT, systolic blood pressure and estimated glomerular filtration rate were 30.00 ± 3.12 %, 279.33 ± 45.78 m, 114.33 ± 6.12 mm Hg and 64.83 ± 4.62 ml/min/1.73 m², respectively. The starting dos sacubitril/valsartan was 49/51 mg. Compared with baseline, the 6-MWT distance increased significantly at 30 days (+Δ = 92 m (40 – 150); p ≤ 0.001. In this observational study, treatment onset with sacubitril/valsartan was associated with 30-day improvement in the distance walked in 6-MWT. Further controlled studies are needed to confirm our results. Conclusion: In this observational study, treatment onset with sacubitril/valsartan was associated with 30-day improvement in the distance walked in 6-MWT.

[Sameh Mohamed Mamoon Shaheen; Ehab Mohamed Abd Elkawi Elfekky; Sameh Mosaad Abdul-Wahab; Mohamed Ramzy Ragheb Mohamed. The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test. J Am Sci 2019;15(10):1-9. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 1. doi:10.7537/marsjas151019.01.

Keywords: Sacubitril/Valsartan; Six Minute Walk Test; Ejection Fraction

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Long and Short Term Evaluation of Freestyle Stentless Bioprosthesis by Cardiovascular Magnetic Resonance (CMR)

Ahmed Moneeb, Ahmed Samir Ibrahim, Emad Hamed, Abdallah Khaled Abdallah El-Fiky

Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Email: abdallah.fiky@hotmail.com ‏

Abstract: Background: The aortic valve disease is a condition where main function of the valve which allowing the blood to pass from the main pump of the heart (left ventricle) into the main vessel of the body (aorta) in one direction is compromised either by stenosis or regurgitation. This condition is usually managed surgically by valve replacement with either biological tissue valve or metallic valve. Objective: Stentless xenograft bio-prosthesis may be the future valve of choice for aortic valve replacement. And since few studies have investigated the Medtronic Freestyle Stentless bio-prosthesis® (Medtronic Inc., Minneapolis, MN, USA) as a full root replacement, the study aim was to evaluate the long and short-term clinical outcome after aortic valve replacement with the Medtronic Freestyle bio-prosthesis (Medtronic Inc, Minneapolis, MN, USA), regarding distensibility and pulse wave velocity (PWV). Material and Methods: The study will include 50 patients who underwent aortic valve replacement using the Medtronic Freestyle Stentless bio-prosthesis® (Medtronic Inc., Minneapolis, MN, USA) and presented for evaluation by cardiovascular magnetic resonance (CMR) following the procedure at 1 year and 3 years intervals to evaluate aortic root stiffness by aortic distensibility, and pulse wave velocity (PWV). This will be a good indicator about the life span of this bio-prosthesis. The study was performed after approval of the Ethical committee of scientific Research, faculty of medicine, Ain Shams University. Results: The study suggests that the changes that happened regarding the pulse wave velocity (PWV) and distensibility during the 1 year and 3 years follow up was detectable. We compared the measures of the pulse wave velocity (PWV) and distensibility to the mean Pulse wave velocity (PWV) and distensibility of the normal population. The pulse wave velocity (PWV) increased in both measures while the distensibility decreased, suggesting an increase in the stiffness co-efficient of the Free-style aortic root. Conclusion: The use of Freestyle stentless bio-prosthesis seems as a good option for management of aortic valve diseases as well as aortic root diseases in elderly patients as It has a superb hemodynamics compared to mechanical prosthesis without the need for the long term use of anti-coagulants.

[Ahmed Moneeb, Ahmed Samir Ibrahim, Emad Hamed, Abdallah Khaled Abdallah El-Fiky. Long and Short Term Evaluation of Freestyle Stentless Bioprosthesis by Cardiovascular Magnetic Resonance (CMR). J Am Sci 2019;15(10):10-14]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 2. doi:10.7537/marsjas151019.02.

Keywords: Pulse wave velocity, cardiovascular magnetic resonance, distensibility

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Histological and Immunohistochemical Study on the Effects of Astragalus Membranaceus versus Adipose Tissue-Derived Stem Cells in Thioacetamide Induced Liver Fibrosis in Male Albino Rats

Seham Abdel Hamid El Kalawy¹, Mohamed Salah Elgendy², Laila Ahmed Rashed³, Abeer Ibraheem Abd Allah Omar¹, Maryham George Loka Yacoub²

¹Histology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

²Histology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt

³Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, Egypt

drmaryham_5682@yahoo.com

Abstract: Background: Liver fibrosis is one of the common complications of acute hepatitis. Thioacetamide (TAA) is a strong hepatotoxic agent inducing experimental liver fibrosis. Adipose derived mesenchymal stem cells (AD-MSCs) had potent antifibrotic and regenerative effects. Astragalus membranaceus (AM), one of the Herbal Chinese medicine, was reported to protect the liver and regulate its functions. Aim of work: Comparing the effect of AM versus autologous rat AD-MSCs on TAA-induced fibrotic rat liver and hepatic stellate cells (HSCs) activation, in adult male albino rats. Materials and Methods: Forty five male albino rats were divided into three groups: group I (control group), group II (untreated TAA group); received IP injection of 200 mg/Kg of TAA three times weekly for 8 weeks, group III (treated group); treated as group II. Then at the beginning of 5^th week till the end of 8^th week, each rat received either single daily oral dose (500 mg/kg) of AM (subgroup IIIa) or single IP injection of PKH26 labeled rat AD-MSCs (3x10⁶cells) (subgroup IIIb). Biochemical and statistical analysis of AST, ALT, Albumin and procollagen were done. Liver sections were subjected to H & E, Mallory trichrome stains and immunohistochemical stains for α-SMA & NF-κB. Morphometric measurement of mean area % of collagen, α-SMA and NF-κB were done followed by statistical analysis. Results: Histological, morphometric and statistical results revealed disorganization of the lobular architecture, features of hepatocyte injury and fibrotic changes in group II. The treated group showed improvement of the hepatic lesion, reduction of fibrosis and proper lobular organization. This improvement was more obvious in stem cells treated subgroup. Conclusion: Administration of AD-MSCs has more improving effect on TAA-induced liver fibrosis in rat than Astragalus where MSCs are more potent anti-inflammatory and anti-fibrotic.

[Seham Abdel Hamid El Kalawy, Mohamed Salah Elgendy, Laila Ahmed Rashed, Abeer Ibraheem Abd Allah Omar, Maryham George Loka Yacoub. Histological and Immunohistochemical Study on the Effects of Astragalus Membranaceus versus Adipose Tissue-Derived Stem Cells in Thioacetamide Induced Liver Fibrosis in Male Albino Rats. J Am Sci 2019;15(10):15-26]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 3. doi:10.7537/marsjas151019.03.

Key Words: Liver fibrosis, Thioacetamide, Astragalus membranaceus, Adipose derived mesenchymal stem cells.

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The Surgical Correction by Endo Rectal Pull through of Hirschsprung's Disease: Evaluation of Late Outcome

Mahmoud Ahmed Elshafey¹, Amr Abdel-Hamid Abou Zeid², Dina Hany Ahmed, Amr Abdel Rhman Abdel Malek Mohammed¹

¹General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

²Pediatric Surgery Faculty of Medicine, Ain Shams University, Cairo, Egypt

Loving.medicine@gmail.com

Abstract: Background: Harold Hirschprong, a Danish pediatrician, is attributed to the first definitive description of the disease of his name. In the next 30 years, it has been reported that incomprehensible actions aimed at reducing sympathetic hyperactivity, at least temporarily, were successful in the treatment of HD. Complications can be classified either early (weeks to months) or late (months to years). Transanal Endorectal pull-through approach represents an important revolution in the treatment of Hirschsprung disease. Objectives: The aim of this study is to evaluate the post-operative late complications of Transanal Endorectal pull-through operation, clinically in-patient with Hirschsprung disease, we will focus on the fecal incontinence using Krickenbeck score. Patients and Methods: This retrospective cohort study was conducted on 20 children with Hirschsprung disease operated beyond during last 7 years in whom Transanal Endorectalpull through was indicated. For Patients with histopathologically documented HD underwent pull-through in the last seven years. Age > 4years (to be able to evaluate faecal continence). In addition, Patients were operated Trans anal pull through Soave and Swenson. Results: Our results showed that; as regard to enterocolitis was present in 16 patients (80%) and absent in 4 patients (20%). Patients with recurrent attacks of one to three times of enterocolitis was 12 patients (60%), patients with four to six times was 3 patients (15%) and patients with more than six times was 1 patient (5%). According to types of operation Transanal soave was done in patients (75%) and Trans anal Swenson was done in five patients (25 %). As regarding Voluntary bowel movements was, absent in 2 patients (10%) and present in 18 patients (90%). As regarding Soiling was, absent in 5 patients (25%) and present in 15 patients (75%) and divided in two grads, grade one in 12 patients (60%) and grade two in 3 patients (15%). As regarding Constipation was, absent in 4 patients (20%) and present in 16 patients (60%) and divided in two grads, grade one in 10 patients (50%) and grade two in 6 patients (30%).

[Mahmoud Ahmed Elshafey, Amr Abdel-Hamid Abou Zeid, Dina Hany Ahmed, Amr Abdel Rhman Abdel Malek Mohamme. The Surgical Correction by Endo Rectal Pull through of Hirschsprung's Disease: Evaluation of Late Outcome. J Am Sci 2019;15(10):27-34]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 4. doi:10.7537/marsjas151019.04.

Keywords: Transanal Endorectal Pull-through Hirschsprung; Anal canal; abdominal distension

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Outcome of Single Tibial Artery Angioplasty in Critical Limb Ischemia

Prof. Dr. Ashraf Elzoghby Elsaeed Elseginy¹, Prof. Dr. Ahmed Farouk Mohamed², Kamal George Asaad Soryal¹

¹General Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

²Vascular Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

kamal.g.asaad@gmail.com

Abstract: Peripheral arterial disease (PAD) presents with 12% to 20% of the elderly patients (aged 65 years and older). Critical limb ischemia (CLI) represents the most severe form of PAD; which is a severe obstruction of the arteries which markedly reduces blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers or sores. In daily practice, CLI patients often have significant lesions in both the anterior tibial artery (ATA) and the posterior tibial artery (PTA). In patients who have progressed to CLI, revascularization of the affected extremity through endovascular intervention plays a crucial role in staving off limb loss, prolonging survival, and improving their quality of life. The aim of this work was to evaluate the outcomes and advantages of single tibial artery angioplasty in critical limb ischemia. In this one arm observational prospective study; 40 patients were selected from the Department of Vascular Surgery- Ain Shams University Hospital from the period of June to December 2018. Patients were subjected to Duplex study and Computerized tomography (CT) angiography for investigation. Patients were treated by single vessel infra-popliteal PTA with or without stent and balloon. Post-intervention medical treatment included: Anti-coagulants & Anti-platelets. Outcome within one month. Complications, Length of stay in hospital & Mortality.

-       Wound healing at three and six months (Complete or Incomplete).

Our results showed that:

1.      The mean of age was 60.525 ± 4.013 years. 26 patients (65%) were male while 14 patients (35%) were female. BMI was 23.075 ± 4.299 kg/m²

2.      Regarding the past medical history, hypertension was found in 30 patients (75%). Diabetes mellitus was found in 32 patients (80%). Smoking was found in 28 patients (70%). Cardiac diseases were found in 27 patients (67.5%). Renal diseases were found in 16 patients (40%). COPD was found in 8 patients (20%).

3.      Four patients (10%) had no prior intervention in this study while 9 patients (22.5%) had suprapopliteal angioplasty and 12 patients (30%) had infrapopliteal angioplasty. Bypass was done in 11 patients (27.5%) while 4 patients (10%) had minor amputations.

4.      The indications for intervention among the studied cases were rest pain in 3 patients (7.5%), ulcer in 16 patients (40%) and gangrene in 21 patients (52.5%).

5.      The anterior tibial artery was targeted for revascularization in 18 patients (45%) while the posterior tibial artery was the target in 14 patients (35%). The peroneal artery was revascularized in 8 patients (20%).

6.      Intraoperatively, complications occurred in 7 patients (17.5%); perforation occurred in 4 patients (10%) while dissection occurred in 3 patients (7.5%). The mean length of hospital stay among the patients was 2.95 ± 1.358 days.

7.      No complications were encountered during follow-up in 28 patients (70%). Restenosis was found in 4 patients (10%) while thrombosis was found 6 patients (15%). Kidney problems were encountered in 2 patients (5%) due to contrast administration.

8.      During follow-up, complete wound healing was found in 24 patients (60%) while incomplete healing was encountered in 16 patients (40%).

[Ashraf Elzoghby Elsaeed Elseginy, Ahmed Farouk Mohamed, Kamal George Asaad Soryal. Outcome of Single Tibial Artery Angioplasty in Critical Limb Ischemia. J Am Sci 2019;15(10):35-43]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 5. doi:10.7537/marsjas151019.05.

Keywords: Outcome, Single Tibial Artery Angioplasty, Critical Limb Ischemia

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Ultrastructural Changes in Cardiac Muscles after Long Term Administration of Amiodarone and Possible Protective Effect of Moringa oleifera Leaf Extract and Mesenchymal Bone Marrow Stem Cell on Adult Male Albino Rats

Eman E. El wakeel¹ and Amira Z. Mohamed²

¹ Anatomy and Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt.

²Microbiology Department, Faculty of Science, Tanta University, Tanta, Egypt.

eman.ismail@fmed.bu.edu.eg ; elwakeelazs@gmail.com

Abstract: Background and aim: Myocardial damage is one of the most common pathological findings in the world. It is vital to locate a productive common defensive factor against the myocardial damage. The present investigation was embraced to assess cardio-protective action of aqueous extract of Moringa oleifera (M. oleifera) leaf and mesenchymal cell-on histological architecture of cardiac muscles. Stem cell therapy holds a great promise for the repair of injured tissues. Mesenchymal stem cells (MSCs) and M. oleifera leaf have the potential to present a new trend of treatment. This work targeted to ponder the impact of bone marrow-MSCs and aqueous extract of M.oleifera leaf on amiodarone-induced myocardial damage in albino rats by histological methods. Materials and methods Forty-two adult male albino rats were used. The bone marrow-MSCs source was seven rats. Thirty-five rats were divided into the following groups: negative control group included seven rats that received no treatment; vehicle control group included seven rats that received polysorbate 80; seven rats involved in group received amiodarone orally for every day for 5 weeks and also group treated with M. oleifera leaf extract included seven rats that received extract 2h before orally uptake amiodarone and stem cell-treated group included seven rats that received stem cells after amiodarone stoppage. Myocardium specimens were histologically examined. Results Amiodarone group showed disrupted myocardial architecture, lysis of myofibrils, and significant ultra-structural changes in myocardium in the form of disorganized myofibrils, swollen destructed mitochondria, SER dilatation, and cellular infiltration with mononuclear inflammatory cells. Minimal microscopic changes of the myocardium were obtained in Bone marrow-MSCs and natural extract of M. oleifera leaf treated groups with preservation of the normal structure of the cardiac myocytes. Conclusion Mesenchymal stem cells (MSCs) and M. oleifera leaf can improve the deleterious effects associated with amiodarone-induced myocardial damage.

[Eman E. El wakeel and Amira Z. Mohamed. Ultrastructural Changes in Cardiac Muscles after Long Term Administration of Amiodarone and Possible Protective Effect of Moringa oleifera Leaf Extract and Mesenchymal Bone Marrow Stem Cell on Adult Male Albino Rats. J Am Sci 2019;15(10):44-57]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 6. doi:10.7537/marsjas151019.06.

Keywords: amiodarone, myocardial damage, mesenchymal stem cells.

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Comparative Study to Outcome of Conventional versus Ligasure Hemorrhoidectomy

Dr. Amr Mohamed El Hefny, Dr. Abdel Rahman Mohamed El Ghandour, Mohamed Adel Mohamed Salman

General Surgery Department, Faculty of Medicine- Ain-Shams University, Cairo Egypt

midosalman14@gmail.com

Abstract: Ligasure Hemorrhoidectomy is a sutureless, closed hemorrhoidectomy technique dependent on a modified electrosurgical unit to achieve tissue and vessel sealing. It is safe and effective. In this study, compared with conventional excisional hemorrhoidectomy, LigaSure hemorrhoidectomy was superior and more advantageous in terms of short operative time, minimum blood loss, less postoperative pain, faster wound healing and less postoperative complications. It is simple, safe, and easy to learn procedure. The major limitations for this study were the small sample size and short follow up of the patients as compared to previous studies. The basic disadvantage with the LigaSure technique in our locality is its expensive cost but this disadvantage has been noted with all new techniques. Even though encouraging preliminary results of the studies are available about this new surgical technique with less number of complications but we need to do more prospective trials comparing the two groups of Ligasure to the traditional one with large sample size and long term follow ups for recurrence to conclude its definite good efficacy, so that it will become a good option of treatment for third and fourth degree heamorrhoids.  LigaSure hemorrhoidectomy could be the gold standard procedure for all symptomatic piles.

[Amr Mohamed El Hefny, Abdel Rahman Mohamed El Ghandour, Mohamed Adel Mohamed Salman. Comparative Study to Outcome of Conventional versus Ligasure Hemorrhoidectomy. J Am Sci 2019;15(10):58-65]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 7. doi:10.7537/marsjas151019.07.

Keywords: Comparative; Study; Outcome; Conventional versus; Ligasure Hemorrhoidectomy

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Routine versus Selective Plasma Exchange before Thymectomy in Myasthenia Gravis

Prof. Ahmed Anwar Ahmed Elnoury, Dr. Hatem Yazeed Sayed Ahmed Elbawab, Dr. Hany Hassan Mohamed Elsayed, Dr. Ahmed Mohamed Mohamed Mostafa, Ahmed Abdul Fattah Mohamed Elnabawi Said

Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

cts220@yahoo.com

Abstract: Elective thymectomy without preoperative plasmapheresis in myasthenia gravis patient regardless of a history of myasthenic crisis did not affect the overall outcomes when compared with preoperative plasmapheresis and may reduce catheter-related and post-operative complications. Therefore, preoperative plasmapheresis may be unnecessary in all elective thymectomies, even though patients have a history of crisis. However, patients who have history of myasthenic crisis more than one time or a significantly low motor power grading of extremities, or bulbar involvement, should be considered for preoperative plasmapheresis. The results of this study do not represent patients who have a myasthenic crisis before emergency or urgent surgery, repeated myasthenic crisis, or bulbar.

[Ahmed Anwar Ahmed Elnoury, Hatem Yazeed Sayed Ahmed Elbawab, Hany Hassan Mohamed. Routine versus Selective Plasma Exchange before Thymectomy in Myasthenia Gravis. J Am Sci 2019;15(10):66-74]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 8. doi:10.7537/marsjas151019.08.

Keywords: Routine; versus; Selective Plasma Exchange; Thymectomy in Myasthenia Gravis

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Role of Diffusion Weighted MRI in the Differentiation between Post Treatment Changes and Residual/Recurrent Head and Neck carcinoma

Dr. Gamal Eldin Mohamed Niazi, Dr. Allam Elsayed Allam, Dr. Mena Elerian Youssef Ekladious and Ibrahim Abd Elrahim Elhussein

Radiology Department, Faculty of Medicine, Ain Shams University, Egypt.

abrahoma250@gmail.com

Abstract: Background: Squamous cell carcinoma are presents almost 90% of the Head and neck tumor and it shows different biological behaviors according to location. Imaging techniques are commonly required in order to define tumor’s locoregional extension recurrences of the head and neck area. In Europe, ”European Journal of Cancer 2015 had mentioned that MRI is increasingly becoming the preferred examination method as it provides additional information on tumor extension, muscles and lymph nodes involvement, and skull base and intracranial invasion. Objectives: The aim of this study is to illustrate the value of diffusion weighted images with ADC measurement in the differentiation between post treatment changes and residual/recurrent carcinoma of the head & neck. Materials and Methods: This was a prospective study of 42 treated head and neck cancer patients. The patient cohort consisted of a wide spectrum of head and neck sites, including the oral cavity, oropharynx, larynx, hypopharynx, paranasal sinuses, orbits, salivary glands, and infra-temporal fossa. Qualitative analysis of the diffusion images and quantitative analysis of the corresponding ADC maps was performed and the data were correlated with histopathological findings and clinical examinations MR images were performed on a 1.5 T system (Acheiva 1.5 Tesla, Philips Medical Systems) by using a 16 channel sense neurovascular head and neck coil. All patients underwent DWI and CE MRI examinations in addition to conventional MRI. Type of Study: Prospective study, study Setting: Ain shams University hospital, study Population: This study will include 42 patient known with head and Neck carcinoma that received radiotherapy/chemotherapy. Results: In this study there are 4 cases of false negative by DWI while by biopsy was found to be positive. All of them in the oral cavity. Two of these cases was found in the base of the tongue, one in the glottic and the other at the sub mandibular region, because all of them at areas which affected by motion of respiration and reflexes may be affect the accuracy. Also some cases have very few malignant cells, which may be technically challenging. The results of this study was similar to other studies with the difference in the ADC cut off point could be attributed to different imaging parameters yet the relatively low sample size could be also contributing factor. Conclusion: Combined qualitative and quantitative analysis of DWI is a useful non-invasive technique to differentiate recurrent head and neck malignancies from post-treatment changes using a threshold ADC value.

[Gamal Eldin Mohamed Niazi, Allam Elsayed Allam, Mena Elerian Youssef Ekladious and Ibrahim Abd Elrahim Elhussein. Role of Diffusion Weighted MRI in the Differentiation between Post Treatment Changes and Residual/Recurrent Head and Neck carcinoma. J Am Sci 2019;15(10):75-81]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 9. doi:10.7537/marsjas151019.09.

Keywords: Diffusion Weighted MRI, Post Treatment Changes, Residual/Recurrent Head and Neck carcinoma

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A study of visfatin serum level in patients with Systemic Lupus Erythematosus (SLE)

Mekky Abd El-Monem Aly¹, Mohamed Farouk Mosa¹, Hatem Galal Abd Allah² and Abd Allah Hamdy Mohammed Abozeid¹

¹Departments of Clinical Pathology and ²Rheumatology, Al-Hussein University Hospital, Faculty of Medicine, Al Azhar University, Cairo, Egypt.

Email: ahsnakeman2015@gmail.com

Abstract: Background: Systemic Lupus Erythematosus (SLE) (also, known as Lupus) is a chronic inflammatory autoimmune disease. Visfatin is an adipokine which is secreted mainly from white adipose tissue (WAT) and is a pre B cell colony enhancing factor (PBEF) that regulates immunity and inflammation. So, it can trigger many autoimmune and inflammatory processes thus may affect SLE disease course and prognosis. Objective: Measurement of serum visfatin level in Lupus patients and healthy persons to assess its possible role in SLE. Subjects and methods: This study included 30 patients with SLE and 30 healthy volunteers with matched age and sex. So, we had two groups, patient and control. We assessed serum visfatin level in both groups by enzyme linked immunosorbent assay (ELISA). Results: As regard serum visfatin level, there was a highly statistical significant difference between control and patient groups. Results also showed a highly statistical significant positive correlation between visfatin and erythrocyte sedimentation rate (ESR) as well as C reactive protein (CRP) in patient group. Conclusion: All Lupus patients recorded high concentration of circulating visfatin and the more the ESR and CRP, the more would be the serum visfatin concentration. So, visfatin might have an important role in both inflammatory and immune processes involved in SLE. Hence, this indicates its possible role in SLE progression. Recommendation: More studies are needed to investigate this adipocytokine and its role in systemic inflammatory and immune processes in SLE. Also, more studies are required on large number of patients. Further studies could be valuable about visfatin inhibitors which might have a role in the prevention of SLE progression and complications.

[Mekky Abd El-Monem Aly, Mohamed Farouk Mosa, Hatem Galal Abd Allah and Abd Allah Hamdy Mohammed Abozeid. A study of visfatin serum level in patients with Systemic Lupus Erythematosus (SLE). J Am Sci 2019;15(10):82-86]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 10. doi:10.7537/marsjas151019.10.

Key words: SLE, Adipokines, Visfatin.

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Correlation between visfatin serum levels and chronic hepatitis C infection in Egyptian patients

Mekky Abd El-Monem Ali, Ahmed Osama Mohamed Dorrah, Mohamed Farouk Mosa and Abo bkr El-Sdek Saber Ahmed El-Brbry

Department of Clinical Pathology, Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University, Egypt.

abobkrelsdeksaber@gmail.com

Abstract: Background: Chronic hepatitis C infection (CHC) is common all over the world and remains a  significant disease burden for many patients. Apart from its hepatotropic characteristic, replication of HCV in diseased extra hepatic organs may have direct cytopathic effects, this leading to a wide range of extra hepatic manifestations. Cytokines activation, which interacts with innate and/or adaptive immune responses, is a major hidden player of the scenario. Visfatin is one of the members of the adipokines family that regulates immunity and inflammation. Visfatin has been cloned as pre-B cell colony-enhancing factor (PBEF). It has the ability to activate leucocytes and induce cytokines and adhesion molecules production. Objective: It was the assessment of visfatin in chronic hepatitis C patients and find out the relation between them. Subjects and Methods: This study included 30 patients with CHC and 18 healthy individuals as a control group. We assessed serum visfatin levels in both with other routine laboratory investigations. Results: There was a highly statistical significant difference between all patients and control groups as regard serum visfatin level (mean of serum visfatin in patients and control groups were 39.23± 11.35and 9.67± 2.14 respectively, p= < 0.001) visfatin was negatively correlated with the necro inflammatory state of the disease. Conclusion: Chronic hepatitis C patients showed marked elevation of circulating visfatin levels and it negatively correlated with the necro inflammatory state. This identifies subjects with worse inflammatory state and therefore it may be used as a marker for the rate of development of chronic hepatitis C complications.

[Mekky Abd El-Monem Ali, Ahmed Osama Mohamed Dorrah, Mohamed Farouk Mosa and Abo bkr El-Sdek Saber Ahmed El-Brbry. Correlation between visfatin serum levels and chronic hepatitis C infection in Egyptian patients. J Am Sci 2019;15(10):87-91]. ISSN 1545-1003 (print); ISSN 2375-7264 (online).

http://www.jofamericanscience.org. 11. doi:10.7537/marsjas151019.11.

Keywords: Chronic hepatitis C, visfatin, liver

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Interleukin-1β-511 and interleukin-6 gene polymorphisms in Egyptian children with febrile seizures

Hadeer Mahmoud Abdel Ghaffar¹; Hanaa Hassan El Dash¹; Shahira Morsi El Shafie²; Nashwa Mamdouh Samra¹, Huda Ahmed Yossif Mohammed¹; Noha Khalifa Abdel Ghaffar²

¹Pediatrics Department, Faculty of Medicine, Fayoum University, Egypt.

²Clinical Pathology department, Faculty of Medicine, Fayoum University, Egypt.

E-mail: hudaelkadi@gmail.com, hudaelkadi@yahoo.com, hudaelkadi@fayoum.edu.eg

Abstract: Purpose: to determine whether interleukin-1β-511 promoter polymorphism (IL-1β-511 C/T) and Interleukin-6 gene polymorphism (_597) (IL-6), contribute to the susceptibility of Febrile Seizures (FS). Method: A case-control study was conducted on 91 children. It included 49 patients with FS and 42 healthy control subjects. They were subjected to full medical history, general and neurological examination and E.E.G. IL-1β (_511) polymorphism and IL-6 (_597) polymorphism genotyping by RFLP (Restriction fragment length polymorphism) were done for all participants. Results: Twenty-six patients (53.1%) had complex FS. IL-1β (_511) gene polymorphism and IL-6 (_597) gene polymorphism were more statistically significant in FS. IL-1β (_511) gene polymorphism was more sensitive specific and accurate in FS than IL-6 (_597) gene polymorphism. Conclusions: Our data support the contention that interleukin-6 and Interleukin-1β single-nucleotide polymorphisms play a role in the etiopathogenesis of febrile seizures. Neither Interleukin-1β (_511) gene polymorphism nor interleukin-6 (_597) gene polymorphism is affected by type of FS (whether simple or complex).

[Hadeer Mahmoud Abdel Ghaffar; Hanaa Hassan El Dash; Shahira Morsi El Shafie; Nashwa Mamdouh Samra, Huda Ahmed Yossif Mohammed; Noha Khalifa Abdel Ghaffar. Interleukin-1β-511 and interleukin-6 gene polymorphisms in Egyptian children with febrile seizures. J Am Sci 2019;15(10):92-97]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 12. doi:10.7537/marsjas151019.12.

Keywords: Febrile convulsion; IL-1; IL-6; simple and complex FS.

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Evaluation of De Epithelization technique in management of pilonidal sinus disease

Prof. Dr. Abdel El Salam Amer Emad, Dr. Mohamed Hassan El Kasser, Ahmed Mohammed Eid

General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract: Pilonidal sinus disease (PSD) is a common disorder of the sacrococcygeal region. The incidence is reported in 6 per 100,000 individuals. However, the etiopathogenesis is still unclear. Further, it has recently been suggested to be an acquired disease by some authors. Treatment of pilonidal sinus is still controversial and different surgical methods have been applied. However, rates of complications and recurrences vary, and yet there is no consensus on a specific technique. Different surgical methods have been compared for many years. The main factors to be considered to form an ideal treatment procedure are practical surgical technique, shorter length of stay at the hospital, short recovery period, fewer postoperative complications and pain, low rates of recurrence. In all techniques (primary closure or flap), a cavity is created after the excision of the pilonidal cyst accompanying healthy tissue; this should be filled or closed, or else it causes is a technical problem, which is frequently encountered, and can result in complications such as “dead space”, hematoma, wound infection, and wound separation during the early postoperative period. The main drawback is the complication of wound healing. Hypoesthesia and cosmetic problems of the sacrococcygeal region are also seen, especially in flap technique, at the late period. This method is defined as a flap or graft of thinned cutaneous layer. Aesthetic surgeons usually perform this method for mammaplasty. Basically, in this method, after de-epithelization of the cutaneous tissue is performed, cutaneous flap and fatty tissue are inverted to create the breast protrusion. De-epithelialized skin grafts are used for many indications. The aim of the study is to describe and discuss the “de-epithelialization technique” as a new approach in PSD treatment. Methodology: a total of 40 adult patients with PSD were randomly allocated intraoperatively to undergo deepithelization technique. Results: According to our scale evaluating outcome, deepithelization technique is effective and safe with least post operative complications regarding pilonidal sinus disease. Conclusion: De-epithelialization of skin is easy. Our new technique provides a short operation time, short duration of hospital stay, and less postoperative morbidity. The major advantage of this technique is the absence of any need for hospitalization. It allows a quicker return to daily activities and reduces costs. Also, this method has a satisfying aesthetic outcome.

[Abdel El salam Amer Emad, Mohamed Hassan El kasser, Ahmed Mohammed Eid. Evaluation of De Epithelization technique in management of pilonidal sinus disease. J Am Sci 2019;15(10):98-105]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 13. doi:10.7537/marsjas151019.13.

Keywords: Evaluation; Epithelization; technique; management; pilonidal; sinus; disease

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