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Settling the debate: the vascular hypotheses of multiple sclerosisMaha Moustafa Ahmed Zakaria, Shaheera Youssef Mikhael, Azza kamal Abu-Hussein, Rania Ahmed Salah El-din, Hany Waheeb Abd El-malak, Hany Shawky Nadim. Anatomy Department , Ain Shams University

CCSVI is a series of stenotic malformations in the cerebrospinal venous outflow routes that is postulated to cause MS. The hypotheses assumed that CCSVI leads to iron deposition and iron deposits are suggested to be the triggering factor for inflammation and demyelination in MS. invasive endovascular treatment of CCSVI was initiated in more than 40 countries based on the previous theory. The present study was designed to validate this hypothesis by using a rat model of CCSVI. Bilateral jugular vein ligation (JVL) was performed on female albino rats (n=15), sham operated rats (n=15) were used as a control group, the rats were followed clinically for eight months to assess the development of neurological manifestations. At the end of the experiment, the rats were sacrificed and the brains were processed for: histological examinations using; H&E, silver impregnation and toluidine blue for semithin sections, special stains for iron and myelin and immunohistochemical localization of GFAP, CD68 and CD45 antibodies. The results were analyzed using image analysis techniques and statistical analysis was performed.

Results: the study revealed increased iron deposition in the white matter of the brains of the JVL group. Increase in the size and number of astrocytes was observed together with an increased immunoreactivity for GFAP. Mild edema and widening of perivascular space were detected as well. However, no signs of demyelination, inflammation or axonopathy were detected in the present study. Normal pattern of myelin was observed by Luxol fast blue stain and in semithin sections. No activated microglia or lymphocytes were detected by CD68 and CD45 successively. Silver stains showed no affection in the axons in the JVL group. Neurological examination was in accordance with the histological studies with no weakness or paralysis observed in the operated rats.

Conclusion: The present study showed that iron deposition in the JVL group as

Abstracts

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a model for CCSVI was not associated with histopathalogical findings typically found in MS, it was therefore recommended that the invasive endovascular treatment of CCSVI should be reconsidered and further controlled clinical studies be carried out to provide a better understanding of the pathogeneses of MS. ……………………………………………………………………………………………………………………………

Practical Ultrasound Use in Critical CareDr.Waleed Abdalla, M.D Lecturer of Anesthesia and ICU

The course focuses on hands-on-training of focused ultrasound scanning of a live model in small groups under the lead of a supervisor.

Learning goals of the course: At completion of the course, you become able to:

-Perform the four most important transthoracic cardiac views -Evaluate lung and pleura with respect to pleural effusion, and pneumothorax. -Perform a focused abdominal ultrasound examination including the identification of free fluid. -Perform ultrasound guided central and peripheral vascular access

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Coronary stentsDr.Mohamed Zahran, MD Lecturer of cardiology Director of Cardiac Cath. Lab ,Cardiovascular hospital, Ainshams University

Current status, recent advances and future perspectives.The lecture will discuss the historical background of coronary artery interventions starting by balloon dilatation and the updates with stenting until reaching the current generations as well as highlighting the future perspectives.

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Cardiac MSCT Dr.Amr Mansour

Computed tomography (CT) - a technique that can noninvasively fully evaluate cardiac structure function. The basic principle of CT technology is the use of

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ionizing radiation within a gantry rotating around the patient in which x-rays are detected on a detector array and converted through reconstruction algorithms to images.

The number of detector rows aligned in an array has increased from a single detector to 4, 16, and 64 (present standard technology) and now on to “wide” detectors of 256 to 320 rows.

The increase in the number of rows leads to wider coverage (more of the heart viewed simultaneously, e.g., 64 rows of 0.625-mm width produces approximately 4 cm of coverage, leading to shorter scan acquisition times and consequently reduced radiation exposure and contrast requirements.

Indications: A. Evaluation of chest pain in patients at low to intermediate pretest probability of disease and persistent chest pain after an equivocal stress test. B. Suspicion of coronary artery anomalies. C. Pulmonary vein evaluation can be performed, often before or after pulmonary vein isolation for atrial fibrillation. D. Evaluation of cardiac masses when other modalities such as TTE, TEE, or MRI are un revealing. E. Evaluation of pericardial disease when other modalities such as TTE, TEE, or MRI are unrevealing. F. Assessment of anatomy in complex congenital heart disease. G. Pre surgical evaluation, particularly before redo open heart surgery. I. Evaluation of aortic disease. MDCT is the test of choice for evaluating aortic aneurysm and suspected aortic dissection.J. Evaluation of suspected pulmonary embolism

Contraindications:

Absolute contraindications : A. Renal insufficiency. B. Known history of anaphylactic contrast reactions . C. Pregnancy D. Clinical instability

Relative contraindications : A. Contrast (iodine) allergy. B. Recent intravenous iodinated contrast administration. C. Hyperthyroidism. D. Atrial fibrillation or any irregular heart rhythm. E. Inability to breath hold for at least 10 seconds. F. Morbid obesity G. Severe coronary calcium

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Safety: A. Radiation exposure : Radiation doses of cardiac CT scans vary greatly depending on the scan parameter settings, scan range (cranial-caudal length of the scan),gender (women receive more radiation due to breast tissue), and patient body habitus (obesity increases exposure). B. Contrast nephropathy :

Clinical Applications : 1.Coronary calcium 2.Coronary CT angiography and Bypass graft imaging , Stent patency: 3.Coronary artery anomalies 4.Cardiac morphology/function , and Mass 5.Pericardial diseases 6.Congenital heart disease 7.Diseases of the aorta 8.Evaluation of pulmonary veins :In the context of electrophysiology interventions such as pulmonary vein isolation (PVI) 9.Evaluation of pulmonary embolism 10.Valvular heart disease 11.Surgical planning 12.Peripheral arteries 13.Emerging Applications: Detection of myocardial scar and viability

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Preoperative assessment of the cardiac patient prior to non cardiac surgeries Dr.Dina Adel Ezz El Din Cardiology Lecturer

Cardiac patients need special attention during non-cardiac surgeries , the hemodynamic consequences of general anesthesia are more pronounced in the cardiac patient, that’s why all cardiac patients require proper meticulous evaluation before operations , this evaluation is not only based on investigations but primarily based on the clinical status of the patient , the functional capacity and the level of activity the patient can achieve without developing symptoms , the clinical data and the relevant investigations required such as the ECG , CXR ,Echocardiography and stress ECG if needed should all be interpreted by the cardiologist to come up with a plan for each patient before going to the operating theater, the plan should be individualized according to the needs of every patient depending on the basic cardiac anatomy , the functional status of the cardiac valves , the ventricular function and the pulmonary artery pressure ,this thorough evaluation of the cardiac patient before non cardiac surgery will minimize mortality ,enable proper care of the patient and provide sufficient

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information about the hemodynamics of the patient to the anesthesiologist to be able to give these patients the best pre intra and postoperative care that they need .

…………………………………………………………………………………………………………………………… Cystic Fibrosis: The Present and The FutureDr. Nermine Mounir, MD Assistant Professor of Chest Diseases

Abstract:

Cystic fibrosis is a common inherited disease that has a high frequency in Caucasians. The disorder affects all exocrine glands, with symptoms involving the lungs and pancreas usually dominating the clinical picture. Even though the gene responsible for CF and its gene product, an integral membrane glycoprotein, have been identified, two aspects of the disease make CF particularly difficult to diagnose and manage.

First, there is tremendous variability in the degree and pattern of involvement of organs in different persons. In addition, we lack information about the precise details of the molecular and cellular pathogenesis of the disease.

In this lecture there will be navigation through this severe underestimated disease, with clinical approach to it and the future prospects.

…………………………………………………………………………………………………………………………… Pulmonary Embolism between Reality & FutureDr Riham M. Hazem M. Raafat Lecturer of Chest Diseases

Discussing:

- Recently identified predisposing factors of VTE

- Simplification of clinical prediction rules of PE

- Risk stratification for PE

- Treatment of PE & Aims of Early discharge

- Efficacy & Safety of reperfusion treatment

- Diagnosis of CTEPH

- Treatment of CTEPH

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- PE recent management in pregnancy & cancer …………………………………………………………………………………………………………………… Diagnostics in cutaneous Lymphoma Mona Abdel-Halim Ibrahim Lecturer of Dermatology Cutaneous lymphoma is a type of lymphoma presenting in the skin. Cutaneous affection may be primary or secondary to nodal or systemic lymphoma. Primary cutaneous lymphoma can be divided into cutaneous T cell lymphoma (CTCL) constituting 75%; while cutaneous B cell lymphoma constitutes 25%. Mycosis fungoides is the commonest type of primary CTCL. Its presentation is very similar to benign skin diseases either clinically and/or histopathologically and this usually leads to delayed diagnosis in most cases. Recognition of the disease at its early stage is a rate limiting step in proper management and in improving disease outcome. Multidisciplinary approach-including dermatologist, hematologist, oncologist & pathologist- is mandatory for accurate diagnosis and disease staging. …………………………………………………………………………………………………………………… Overview of Lymphatic Filariasis in Eastern Mediternean Region, current situation and prospects of elimination

Prof. Dr. Khaled M. Abd Elaziz Prof. of Community, Environmental and Occupational medicine, Faculty of medicine

Lymphatic Filaraisis has been Endemic in Egypt Since Pharonic times. A Chronic parasitic disease that leads to final permanent disabilities. The 23 countries in the Eastern Mediterranean Region can be divided into three groups depending on the status of transmission of lymphatic filariasis: 1. Countries with ongoing transmission which need an intervention programme to interrupt transmission: Egypt, Sudan and Republic of Yemen; 2. Countries with a past history of lymphatic filariasis transmission or for which the information is not clear: Djibouti, Islamic Republic of Iran, Oman, Pakistan, Somalia and Saudi Arabia; 3. Countries with no record or past history of lymphatic filariasis transmission: the remaining 14 countries. This technical report contains an insight for the current situation of Lymphatic Filariasis in Eastern Mediternean Region. It displays also the future prospects of elimination in affected countries

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AIR QUALITY IN AIN SHAMS UNIVERSITY SURGERY HOSPITALM.Y. EL AWADY 1, A.T. ABD EL RAHMAN2, L.S. AL BAGOURY1AND I.M. MOSSAD1 Department of Community, Environmental, and Occupational Medicine1,and Department of Microbiology and Immunology2, Faculty of Medicine,Ain Shams University

Abstract

Through air sampling, it was possible to evaluate microbial contamination in environments at high risk of infection, and to check the efficiency of ventilation system and the medical team’s hygiene procedures. This study measured the concentration of particulate matter (PM) 2.5 or less microns and microbiological organisms in operating rooms (OR),intensive care units (ICU) and emergency rooms (ER) in Ain Shams University Surgery Hospital, and to assess ventilation characteristics in operating rooms in the hospital.

The passive air sampling was done from ICUs, ORs, and ERs in Ain Shams University Surgery Hospital. Also for each operating room, an observational checklist was done to record other factors that may affect air quality in the room. The evaluated air quality indices were: suspended (PM) 2.5 micrometer or less, culture media and microbial identification of bacteria and fungi, and temperature and relative humidity . The results showed that the highest mean found for bacterial (105.70±30.49) and fungi concentration (7.50±5.30) was in ER. The three settings did not differ statistically as regard levels of PM 2.5, temperature, and relative humidity. A positive correlation exits between bacteria and fungi concentration on one hand and relative humidity on the other. Diphteroid, CONS, MRSA, S. aureus, and Anthracoid were the most frequent isolated bacterial types, while Penicillium and Asperigillus fumigatus were the most frequent isolated fungi. In operating rooms, the percent of unmasked persons present and the temperature positively influence the ba cterial count, while ventilation condition is negatively influencing fungi count, and the number of persons present in the operating room positively affects the PM level.

Key words: Egypt, University Hospital, Air pollution, Microbes

…………………………………………………………………………………………………………………………… Patient perceptions of health care service quality at Abha hospital for maternity and pediatric, Saudi ArabiaIsmail A .Nanees1,2, Alalyani Mesheil,1 Emarah Hanan 1, Assiri G. Ebtehal1, Al Mousalat A.Fatma1.

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1Department of public health, applied medical science college, King Khalid university 2Department of community medicine, Faculty of Medicine ,Ain Shams University

Introduction: The degree of perceived patient satisfaction can be used as a means of assessing the quality of health care. It reflects the ability of the provider to meet the patients’ needs..

Objective: To assess patient perceptions of health service quality provided by the outpatient clinics at Abha hospital for maternity and pediatric.

Methods: This cross sectional study was conducted at Abha hospital for maternity and pediatric. .A convenience sample was used to select patients who attended outpatient clinics (N=200). An adapted SERVQUAL questionnaire was used to collect data about the five dimension of services quality (Reliability , Tangible , Responsiveness , Assurance and Empathy) as perceived by patients

Results : About 74.4% of the patients were satisfied with the outpatients services. As regards reliability dimension ,the mean score was (3.74±0.7) and the hospital kept its records accurately was the most influential in this dimension. The mean tangible dimension score was (3.6±0.6), the hospital has up-to-date equipment is the most influential in this dimension. The mean responsiveness dimension score was (3.5±0.7), the hospital management takes immediate response to the complaints of patients is the most influential in this dimension. The mean assurance dimension score was (3.87±0.6), hospital maintains the confidentiality of information and data on patient is the most influential in this dimension. The mean Empathy dimension score was (3.73±0.6) , Hospital staffs take into account the customs and traditions of community when providing medical service is the most influential in this dimension.

Conclusions and recommendations : Assurance dimension had the highest overall mean rating; followed by reliability, empathy, tangibles, and finally responsiveness. It is recommended to train hospital staffs to improve provision of medical service on time without delay , provision of comfortable and convenient waiting places and understanding the patients needs. Further study is recommended to include all governmental and private hospitals.

Key words: Patient satisfaction – Dimensions of health services – outpatient clinics -

Corresponding author: Prof. Dr Nanees Ahmed Ismail ……………………………………………………………………………………………………………………………

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Long-Pulsed Nd:YAG 1064nm Laser in the Treatment of Onychomycosis Author: Prof. Dr. Hoda Ahmed Monieb, Professor in Dermatology and Venereology Department Coauthors: Dr. Mary Fikry Matta Mikhail, Lecturer in Dermatology and Venereology Department Dr. Eman Mohamed Akmal Ahmad, M.B. B.CH, Faculty of Medicine

Abstract:

Onychomycosis is both a cosmetic and medical problem and its systemic treatment has many limitations. The aim of this clinical study was to explore and evaluate the use of long-pulsed Nd:YAG laser 1064nm (Candela, Wayland, MA, USA) in the treatment of onychomycosis. Twenty Egyptian patients (18-60 years old) with 65 nails affected by onychomycosis were recruited consecutively from the Dermatology outpatient clinic, Ain-Shams University Hospitals over a period of 6 months. We excluded patients on topical or systemic anti-fungal therapy in the preceding 6 months, permanent or semi-permanent discoloration of the nail plate, any generalized skin disease, immunosuppressed patients and pregnant patients. Mycological examination of nail scrapings by direct KOH (20%) and culture was done together with photographing the nails before, one month and 3 months after treatment. Distal and lateral subungual onychomycosis was the commonest clinical type (85%) and yeasts represented 90% of the isolated fungi. Each patient received 4 laser sessions spaced 1 week apart. We used a fluence of 50J/cm2, a pulse duration of 30ms, spot size 3mm and the cryospray was switched off. The nail plate was fully covered with laser irradiation 3 times in each session. After one month, 15 (75%) patients turned mycologically negative while 5 (25%) remained positive. However, 3 out of the 5 mycologically positive patients turned negative at the 3 months follow-up visit. This means that 90% of the patients and 52 (80%) of the nails achieved mycological clearance. Only mild pain was reported by all patients during and shortly after the sessions. This study concludes that long-pulsed Nd:YAG 1064nm is a safe and effective treatment for single and multiple finger or toe nail onychomycosis.

Keywords: Onychomycosis, Nd:YAG laser

Conflict of interest: None declared . …………………………………………………………………………………………………………………………… Mesotherapy

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Mona Mohamed Atef Lecturer of Dermatology

Mesotherapy is a minimally invasive technique that consists of intradermal injection of variable mixtures of natural plant extracts, homeopathic agents, pharmaceuticals, vitamins and other bioactive substances in microscopic quantities through multiple dermal punctures.

Applications in dermatology:

-Body: localized fat deposits, cellulite, body contouring and stretch marks -Rejuvenation (fine wrinkles, skin tightening and photoaging) -Hair: telogen effluvium, androgenetic alopecia -Hyperpigmentation and melisma -Scars

Techniques of injection: -Intra-epidermal -Papular -Nappage -Point by point technique

Contraindications: -Pregnant and lactating females-Insulin dependent diabetes mellitus -History of bleeding disorders, strokes, thrombo-embolic phenomena and recent cancer -Patients on medications for cardiac arrhythmias, asprin, warfarin, heparin……-Severe heart, renal or severe chronic systemic disease -Active skin infections.

Side Effects: -Pain is typically minimal during and after superficial injections-Bruising, edema and allergic reactions due to chemicals used -Skin necrosis, atrophy and lipodystrophy -Atypical mycobacterial infections and other infections as HIV, hepatitis etc -Facial and scalp ulcers and scarring -Lichenoid eruption -Post-inflammatory hyperpigmentation -Nodularity and irregularity after lipolysis-Liver toxicity and demyelination of nerves due to large doses of phosphatidylcholine have been reported-Rare: Koebnerization in psoriasis, localized urticaria pigmentosa , granuloma

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annulare, non-infectious granulomatous panniculitis, alopecia

…………………………………………………………………………………………………………………………… Cutaneous manifestations in HD patients

Dr.Manal Sharara Dermatology Departement Chronic renal failure, irrespective of its cause, often produces specific skin changes that can develop long before failure manifests clinically. It has been found that 50-100% of patients with end stage renal disease have at least one associated cutaneous change. Hemodialysis is one of the therapeutic modalities that can improve the survival of these patients. Skin changes can precede or follow the initiation of HD treatment, and there are more chances of developing newer skin changes during the course of HD therapy. Although the majority of dermatological disorders in chronic kidney disease are relatively benign, a few rare skin diseases have the potential to cause serious morbidity and mortality. Early recognition of these severe skin disorders and prompt initiation of treatment can markedly alter their course and even save a patient’s life.

…………………………………………………………………………………………………………………………… Osteoporosis- New Challenges to faceProf Hala S Sweed Professor and head of Geriatrics and Gerontology Department Faculty of Medicine- Ain Shams University

Osteoporosis is a disease characterized by low bone mass and brittle bones.With the greying of population phenomena all around the world together with feminization of such population, osteoporosis became a major health problem worldwide. This necessitated the appearance of new modalities in its diagnosis and management that raised the hope of conquering of such threat yet still long path to go. New tools of screening have been developed to facilitate early diagnosis. Researches are being carried out to develop new agents for therapy with more benefits and lesser side effects. ………………………………………………………………………………………………………………………… Machinery Regulating Vesicle Traffic, The principle of cargo cellular transportSahar M. M. Omar professor of histology The 2013 Nobel Prize in cell biology or Medicine is awarded to Dr. James

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E. Rothman, Dr. Randy W. Schekman and Dr. Thomas C. Südhof for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells. This represents a paradigm shift in our understanding of how the eukaryotic cell, with its complex internal compartmentalization, organizes the routing of molecules packaged in vesicles to various intracellular destinations, as well as to the outside of the cell. This specificity is required for the release of neurotransmitters into the presynaptic region of a nerve cell to transmit a signal to a neighboring nerve cell. The precise mechanism by which these vesicles found their correct destination and how they fused with organelles or the plasma membrane to deliver the cargo remained mysterious. The work of the three 2013 Laureates radically altered our understanding of this aspect of cell Histology. Randy W. Schekman used yeast genetics to identify a set of genes critical for vesicular trafficking. James E. Rothman identified proteins that form a functional complex controlling cell fusion. Thomas C. Südhof unraveled the mechanism by which calcium ions trigger release of neurotransmitters, and identified key regulatory components in the vesicle fusion machinery. Together, Rothman, Schekman and Südhof discoveries explain a long-standing enigma in cell biology and also shed new light on how disturbances in this machinery can have deleterious effects and contribute to conditions such as neurological diseases.

………………………………………………………………………………………………………………………… Debate on allergen specific immunotherapy Dr.Asmaa Saber Assistant Professor of Internal Medicine , Allergy and Clinical Immunology Immunotherapy is defined as the treatment of disease by inducing or suppressing an immune response.Allergic diseases result from an unbalanced response of specific immune system, generating allergen-specific IgE antibodies, which mediate various clinical symptoms, such as immediate type hypersensitivity. Allergen-specific immunotherapy is based on the repeated administration of disease - causing allergens with the aim of modifying the allergic-specific immune response in patients so that higher doses of the allergen can be tolerated.Debates on immunotherapy included route of administration, type of allergic disease that may respond to immunotherapy and patient specification.Proper understanding and evaluation of these new modalities are challenging yet promising allowing hope of efficient management of allergic disease. ……………………………………………………………………………………………………………………………

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Immunosuppressive modalitiesDr Osama Abdel Latif Lecturer of allergy & clinical immunology

The modalities of immunosuppression are used widely through most of the medical specialties. Targeting modulation of the immune system is the corner stone of the treatment of allergic diseases, autoimmune diseases and without it the organ transplantation in most of cases is impossible. For that the basic knowledge about immunosuppression should be known by all the specialties of medicine and in some surgical specialties. This lecture will simplify as possible the broad lines of immunosuppressive modalities.

…………………………………………………………………………………………………………………………… Introduction of Tumor Immunology & Immunotherapy: The power withinDr Eman Elsayed Assistant professor of allergy and clinical immunology Tumorigenesis is a dysregulated cell growth and proliferation due to intrinsic genetic factors, extrinsic environmental factors or infections. Tumors express Antigens that are recognized as foreign by the host immune system in a continuous process of Immunosurveillance and immunoediting of tumors. This protective immune response against tumors are both Innate and adaptive immune responses. T cells are the key players of the tumor killing process, they recognize the specific antigens on tumors which are either tumor specific or tumor associated Transplantation antigens. Immune responses frequently fail to prevent the growth of tumors. Tumors can escape in many ways leading to immune evasion.

The available modalities of tumor therapy include surgery, chemotherapy and radiotherapy (both are non-selective with strong side effects), Gene therapy and Targeted therapy (both are relatively selective) and Immunotherapy (quite selective). The immune system can be activated by external stimuli to effectively kill tumor cells and eradicate tumors but not normal cells. Various strategies in tumor immunotherapy are being developed to enhance the anti-tumor immune responses and enhance Tumor Immunogenicity. Immunotherapy for tumors are either nonspecific therapies that include BCG vaccine, cytokine and cell therapy; or it can be specific modalities of therapy that include Adoptive transfer of

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T-cells or antibodies; or tumor vaccines.

………………………………………………………………………………………………………………………… Ultrasonography Diagnostic Validity In Structural And Functional Laryngeal Disorders

Riad M.A(1)., ,, Omar H.O(2), Fawaz S.(1), Youssef T.A(1)., Askoura A(1)

ENT department Ain Shams University(1), , Radiodiagnosis department Ain Shams University(2)

Background The diagnostic approach for patients with laryngeal lesions differs among otolaryngologists. Indirect laryngoscopy, flexible fibroptic laryngoscopy, CT and MRI are all modalities used for diagnosis. Ultrasonography is noninvasive, nonirradiating, and safe. The availability, affordability, and usability of portable ultrasound units have undergone dramatic improvements. It is well tolerated by patients, dynamic technique that can be performed easily in phonation, quickly performed, and allows for photo-documentation.

Objective To evaluate the validity of sonography as an imaging tool in identifying normal ranges and abnormalities of laryngeal dynamics and anatomic structures.

Methods This prospective study was carried out on individuals in Ain Shams University Hospitals. They were divided into group I (healthy volunteers), group II (unilateral vocal fold paralysis) and group III (patients underwent vertical hemilaryngectomies). After taking full clinical history, thorough head and neck examination, fibroptic nasopharyngolaryngoscopy, patients underwent sonographic examination. The photos were analyzed to identify various laryngeal structures and to measure glottic areas and interarytenoid distances.

Results After identification of laryngeal structures, we found that the percent of change in length and area were much less in group III than group I or II. Another important finding is that glottic area during respiration is related significantly to interarytenoid length during respiration with a statistically significant regression coefficient.

Conclusions Ultrasound proved validity in identifying laryngeal structures and measuring various distances and areas inside the larynx. It is recommended to consider ultrasonography as a reliable imaging modality, and at least a useful adjunct to endoscopy when identification of airway patency, vocal fold mobility or structural alterations are suspected. To our best knowledge, this study may

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contain a hitherto undescribed correlation between interarytenoid length and glottic area.

Keywords: Ultrasonography, cord paralysis, laryngeal imaging

…………………………………………………………………………………………………………………………… Value of vitamin D assessment in patients with head and neck squamous cell cancer before treatmentDr. Heba Mahmoud ,M.D Lecturer of Otorhinolaryngeology

Introduction: The 5-year survival of patients with head and neck squamous cell carcinoma (HNSCC) has not changed dramatically over the last decades despite the use of various therapeutic modalities, including surgery and/or chemoradiation. Thus, new approaches remain necessary to prevent cancer, reduce recurrence and improve treatment with reduction of its side effects. There is recent evidence that vitamin D promotes cell differentiation and decreases cell proliferation, invasion, angiogenesis, and metastasis. Thus, it has been hypothesized that vitamin D may protect against cancer at multiple sites. Objective: The aim of this study was to evaluate vitamin D3 level, plasma calcium and phosphate in patients with HNSCC before treatment as a step in studying its impact on HNSCC development and progression. Type of the study: This prospective study was conducted between March 2013 and October 2014 at Ain Shams University Hospitals, Cairo, Egypt. Patients and methods: The study included 80 participants categorized into 2 groups. Group A included 50 (36 males and 14 females) patients with various HNSCC sites, their median age was 54.8 (±12.7) year. Group B included 30 (20 males and 10 females) healthy volunteers with matched sex and age as control,their mean age was 50.5(±12.0) year. Results: The median VD3 level in group A was 40.35 (31.9-55) and for group B was 118.75(55.0-175) (P value <0.001) indicating a significant decrease of VD3 in group A than group B. VD3 deficiency (<37.5 mmol/ml) in group A was 42% which was significantly more than group B which was 3% only. Conclusion:

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This study showed that vitamin D deficiency is prominent in patients with HNSCC before treatment than that of control subjects. And as it may pose the patients to increased risk of therapy- related morbidity and poor outcome, it may constitute an inexpensive prophylactic and cost-effective option in the therapeutic armamentarium as a synergistic agent to traditional treatment options.

……………………………………………………………………………………………………………………… From diffusion to perfusion imagining in characterization of Laryngeal lesions Mohamed Shehata Taha MD Prof.ORL-HNS Ain Shams University Hospitals

The diagnostic approach used to evaluate patients presenting with laryngeal lesions differs among otolaryngologists, and no consensus has been achieved regarding the appropriate initial workup of these patients. DW MRI is an imaging technique showing molecular diffusion, Cell size, density and integrity influence the signal intensity seen on diffusion-weighted images. This technique is a helpful complementary tool to distinguish tumoral from non- tumoral tissue, and has several interesting applications in the evaluation of head and neck cancer. Perfusion is defined as blood flow through a unit volume of tissue per unit of time. Perfusion imaging may be performed with either CT or MR. Intravoxel incoherent motion (IVIM) DWI, ,utilizes low b values to sensitize DWI to motions of water within the capillary bed. According to the IVIM DWI model, both pure extravascular molecular diffusion and microcirculation of blood within the capillaries (perfusion) can be separated using a biexponential decay function, providing additional parameters for tissue characterization

…………………………………………………………………………………………………………………………… An uncontrollable bleeding from a mass in the maxilla : initial presentation of metastatic hepatocellular carcinoma , A case report Dr. Mohammed Abdelaleem , MD ENT consultant , Lecturer of ORL-HNS , Ain Shams Hospitals Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. It is a highly aggressive tumor with metastases usually occurring in advanced stages. Extrahepatic metastases from HCC have been reported in approximately 50% of cases. Lungs, abdominal lymphatics, adrenal glands or the skeleton could be involved.

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We present a rare case of metastatic HCC to the maxilla, with spontaneous intractable oral bleeding. This case highlights the character of a metastatic HCC to the sinonasal area, its distinctive pathological feature and how to suspect such a rare pathology.

…………………………………………………………………………………………………………………………… Subcutaneous versus Sublingual Immunotherapy for

Allergic Rhinitis therapy: Which Is Superior

Magdy Abdullah Sayedelahl1, Naser Nagib Nasr1, Mahmoud Hamed Akr1, Dina Sayed Sheha2, *,

Tahany Mohamed Rabie3

1Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Zagazig, Egypt 2Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt 3Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt Abstract: Background: A randomized single-blinded study including 50 patients with allergic rhinitis. Objective: To evaluate and compare the efficacy of subcutaneous versus sublingual immunotherapy in treatment of allergic rhinitis. Materials and

methods: Patients divided into Group A: twenty patients received subcutaneous immunotherapy and group B: twenty patients received sublingual immunotherapy for twelve months. We assessed skin prick test, symptom score and medication use, quality of life and nasal smear eosinophilic count before and after treatment. Results: In group A, clinical improvement was achieved in 100% of monosensitised and 62.5% of polysensitised patients, while in group B 100% of monosensitised and 60% of polysensitised patients exhibited clinical improvement. Conclusion: The subcutaneous and sublingual routes of immunotherapy have similar efficacy.

Keywords: Allergen Specific Immunotherapy, SCIT, SLIT, Allergic Rhinitis, Skin Prick Test, Nasal Smear Eosinophilia, Clinical Improvement …………………………………………………………………………………………………………………………… Patiens’ demographic data in different types of fungal sinusitis

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DR. Hesham Abdel Aty Abdel Kader Elsersy Assistant Professor of otorhinolaryngology

Introduction: The first case of fungal sinusitis was reported in 1885. This disease was rarely reported until the past decade, when a worldwide increase in incidence occurred. Fungal sinusitis is well-documented in immunocompromised patient Many reports have indicated an increased prevalence of fungal sinusitis in otherwise healthy individuals.

Aim of the work: To identify risk factors of different types of fungal sinusitis affecting immunocompetent individuals by analyzing their demographic data.

Patients and methods: This is an epidemiological case control study about the risk factors of fungal sinusitis.It was conducted at Ain Shams University hospitals during the period from January 2013 to June 2014. The study was divided into 2 groups (group 1 cases 60- group 2 controls 100).

Recommendations: Because most of the fungal spores detected in a home are derived from outdoors, windows and doors should be kept closed as much as possible. Air conditioners’ filters need to be replaced or cleaned periodically since the filter can be clogged due to dust load and fungal infestation. Since all moist soil can harbor mold, be careful with houseplants. An important aspect of cockroach eradication is the proper use of effective pesticides. ……………………………………………………………………………………………………………………………

Therapeutic Effects of Extracts from Spirulina platensis versus Bevacizumab on Inflammation-Associated Corneal NeovascularizationAhmed2, Yasser Amany Abd El-Fattah El-Shazly1*, Asmaa Ibrahim Abdelmageuid Elzankalony1 and Walid Mohamed Abd El Raouf El-Zawahry1

1Department of Ophthalmology, Ain Shams University, Cairo, Egypt 2Faculty of Medicine, Department of Anatomy, Ain Shams University, Cairo, Egypt

*Corresponding author: Amany Abd El-Fattah El-Shazly, Department of Ophthalmology, Ain Shams University, Cairo, Egypt, Tel: 002 010 1859928; E-mail: amany_elshazly@ymail.com

Received date: Sep 18, 2015; Accepted date: Dec 08, 2015; Published date: Dec 12, 2015

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Copyright: © 2015 El-Fattah El-Shazly AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Aim: The aim of this work was to study histological and immunohistochemical changes resulting from corneal alkali burn and to assess these changes after treatment with either polysaccharide extract from Spirulina platensis (PSP) or Bevacizumab.

Methods: Alkali burn was induced in corneas by direct application of a filter paper ring (2.5 mm diameter)

saturated with 1 N NaOH and applied to the center of the rat corneas for 30 seconds. PSP (extracted from dry powder of Spirulina platensis) and avastin were administered topically on the corneas 4 times daily for 7 days starting 7 days after induction of corneal alkali burn. The therapeutic effects of PSP and avastin were evaluated daily using slit-lamp. At the end of the therapy, corneas were harvested for H and E staining, Masson trichrome staining, immunohistochemical study for assessment of inflammation and corneal neovascularization (CorNV).

Results: Topical application of either PSP extract or Avastin had significant therapeutic effects on corneal injuries induced by alkali burn. This was demonstrated by decreasing the CorNV, total and differential corneal thickness and inflammatory cellular responses. They increased the epithelial thickness. PSP showed better results than Avastin in this regards.

Conclusion: The naturally occurring Spirulina platensis (PSP) is more cost effective in treatment of corneal neovascularization and decrease inflammation and fibroblast activity in a rat model of corneal neovascularization induced by alkali burn as compared to Avastin.

Keywords: Spirulina platensis ; Bevacizumab; Avastin; Corneal Neovascularization; Inflammation; Immunohistochemical changes

…………………………………………………………………………………………………………………………… Stem Cell Potential in Ophthalmology Dr.Sheriff Elwan , MD Professor of Ophthalmology

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POTENTIAL FOR STEM CELL THERAPY IN OPHTHALMOLOGY. 1- Provides for localised stem cell deficiency, Prevents recurrence 2- Amniotic membrane: enhances wound healing, antimicrobial potential 3- Potential for retinal ganglion cell regeneration in: a- Glaucoma b- Leber’s optic atrophy C- Retinitis pigmentosa. PERSONAL EXPERIENCE WITH LIMBAL STEM CELL DEFICIENCY. ……………………………………………………………………………………………………………………ELECTRON MICROSCOPE UNITS OF FACULTY OF MEDICINE AIN SHAMS UNIVERSITY : PAST, PRESENT AND FUTUREDr.ELHAM I. SEIF EMERITUS PROFESSOR OF PATHOLOGY and First Director of ASUSH-EM Diagnostic Pathology Laboratory.AIN SHAMS UNIVERSITY

Abstract

Electron microscopes both transmission TEM (revealing sectioned material) or scanning SEM (showing surfaces) were first introduced to the market in Germany (1938-1939). The first TEM unit in faculty of medicine was established in Internal Medicine Department in the sixties due to the efforts of late Professor Mohamad Sadek Sabbour .This unit confronted maintenance problems due to the absence of local service engineers dealing with the expensive sophisticated apparatus, few years later this specific problem caused the unit termination. In 1977, after finishing her PhD in England on the applications of Electron Microscopy, professor Alia Mahmoud Nassar established an electron microscope unit in Anatomy Department .She equipped it with a Philips 201 TEM. She made a service contract with Philips company which hired experienced Egyptian service engineers. She made a team work from nearly all departments utilizing microscopes in their work; anatomy, histology, pathology, parasitology, microbiology, dermatology, medicine and ophthalmology .The work continued in this unit mainly in research with limited contributions in diagnostic fields of renal pathology till the year 1984. In 1982 , she added a new TEM in Ain Shams University Specialized Hospital . This was the nucleus for the first Diagnostic TEM laboratory which was initiated and maintained by Professor Elham Ibrahim Seif who trained a generation of pathologists working successfully till now. Diagnostic fields included ; renal diseases ,skeletal muscles, peripheral nerves ,skin ,liver ,tumor pathology and

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semen morphology as well as research work that includes; master and PhD degrees and scientific papers in all fields of medicine and biology . In the year 2011 , after 29 years of continuous work ,the service company could no more maintain the TEM in ASUSH ,because the mother company stopped manufacturing this model so there was lack of spare parts . Despite the need for a new Electron microscope yet a replacement did not take place because of administration problems. However, the diagnostic work in the unit continued by using other available microscopes either in the Faculty of Science or in the Military Academy. Professor Nassar added a new TEM, Philips CM100 and a SEM in 1999 to the unit in Anatomy Department. Unfortunately, obstacles hindered the work such as absence of experienced personnel (travelling to Arab countries), selection of inadequate directors , moreover financial support was no more provided for the equipment service. Currently the two microscopes in anatomy department unit stopped working . As for the future of EM units, It is important to emphasis that success does not only depend on having a recent expensive electron microscope and other equipment but also in the necessity of having a competent team of doctors and technicians as well as a continuous service of all equipment and above all , a director with both experience and vision. …………………………………………………………………………………………………………………………… Selective screening in neonates suspected to have inborn errors of metabolismRabah M. Shawky *, Heba Salah Abd-Elkhalek Elabd, Samah Elyamani Elakhdar Pediatrics Department , Faculty of Medicine

Background: Inborn errors of metabolism (IEM) have a high morbidity and mortality in neonates. Unfortunately, there is no nationwide neonatal screen in Egypt, so several cases may be missed.

Objective: The aim of this work was to detect the prevalence of IEM among neonates with suspected IEM, and to diagnose IEM as early as possible in order to minimize morbidity and mortality in high risk neonates.

Subjects and methods: This prospective study included 40 neonates admitted to the Elmahalla General Governmental Hospital Neonatal Intensive Care Unit (NICU) with sepsis like symptoms (lethargy, hypoactivity, poor suckling, and poor crying), convulsions, persistent metabolic acidosis, persistent vomiting, or previous sib death of unidentified cause (neonates with suspected IEM). All included patients were subjected to detailed full history, through clinical examination, laboratory investigations, and metabolic screening by tandem mass

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spectrometry (MS/MS). Other investigations for IEM including lactate, ammonia, and galactose 1 phosphate levels in the blood, as well as organic acids in urine were done according to each case.

Results: 13 patients (32.5%) were diagnosed as having IEM, 7 of them (53.8%) had urea cycle defect, 2 (15.4%) had maple syrup urine disease, while methylmalonic acidemia, fatty acid oxidation defect, mitochondrial disease, and galactosemia were diagnosed in one patient each (7.7%). Out of these patients, 12 patients (30%) were discharged from NICU after therapy, and one patient (2.5%) died (the one who had mitochondrial disease). Two patients were diagnosed as diseases other than IEM, one had hyperinsulinism and another one had congenital myopathy, while 2 patients were proved to be normal. Five patients (12.5%) were suspected to have IEM (tyrosinemia, mitochondrial disease, organic acidemia) 4 of them died before final diagnosis, and one transferred to another NICU. There was a significant difference between diagnosed and undiagnosed patients as regards history of sibling death (p= 0.012), plasma ammonia level (p= 0.002), and discharge from NICU (p= 0.000).

Conclusion: IEM represent a high percent (32.5%) of neonates who had sepsis like symptoms, and when diagnosed, patients showed marked improvement after therapy. IEM should be considered in differential diagnosis of the sick neonates, and investigations, and management should be started rapidly to decrease morbidity, and mortality till nationwide screen for IEM is applied in Egypt.

…………………………………………………………………………………………………………………………… Update on management of type 1 diabetesDr. Randa Matter Professor of Pediatrics, Ain Shams University

Type 1 diabetes mellitus (T1D) is a heterogeneous disorder characterized by destruction of pancreatic beta cells, culminating in absolute insulin deficiency. Treatment of type 1 diabetes mellitus involves the administration of exogenous insulin to avoid diabetic ketoacidosis, maintain glycemic control and prevent the long-term complications associated with diabetes. Insulin preparations with differing pharmacokinetic profiles have provided greater flexibility in the management of type 1 diabetes. In addition, technological advances in continuous glucose monitoring and continuous subcutaneous insulin infusion via insulin pumps show promise in helping to achieve treatment goals for the individual with type 1 diabetes. Unfortunately, conventional medications only partially protect against the development and progression of diabetic complications. Thus, agents targeting alternative pathogenic mechanisms have been intensively investigated. Islet cell transplantation is an experimental treatment for type 1 diabetes mellitus. Researchers hope that islet

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cell transplantation will help people with type 1 diabetes live without daily injections.

The presentation will highlight the most novel and innovative studies in new management of type 1 diabetes in pediatrics.

Dietary Fructose Intake and Procollagen type III N-terminal peptide (P3NP) and Ultrasonic Grading of Non Alcoholic Fatty Liver Disease in Obese Children and Adolescents Authors: Rasha Tarif Hamza1, Alaa Youssef Ahmed1, Doaa Gamal Rezk1, Amira Ibrahim Hamed2

Departments of Pediatrics1 and Clinical Pathology2, Faculty of Medicine, Ain Shams University

Background: The excessive use of high fructose corn syrup was incriminated as one of the risk factors responsible for the current obesity epidemic in children. It has been shown to be hepatotoxic to the liver as the intake of fructose favors the development of hepatic steatosis. Procollagen type III N-terminal peptide (P3NP) was recently validated in adults as a sensitive and specific marker for steatosis and steatohepatitis.

Aim: Assessment of dietary fructose intake from different sources; artificial and natural and linking that to the ultrasound grading of non-alcoholic fatty liver disease (NAFLD) and to the level of P3NP as a marker of steatohepatitis.

Subjects and methods: The study was cross sectional including 55 obese children and adolescents who had exogenous obesity randomly collected from the Pediatric Obesity Clinic, Pediatrics Hospital, Ain Shams University with 30 age and sex matched healthy children and adolescents as controls. All were subjected to detailed anthropometric assessment, laboratory assessment of fasting blood sugar, fasting insulin, calculation of HOMA-IR, fasting lipid profile, serum uric acid and alanine aminotransferase, measurement of P3NP and abdominal ultrasound.

Results: Obese children and adolescents had higher fructose intake than their lean counterparts (p=0.005). Fructose intake from artificial sources as well as the total fructose intake correlated positively with the HOMA-IR r=0.258, p=0.04 and r=0.287, p=0.034 respectively. Fructose intake from different categories as well as the total fructose intake and total caloric intake showed significant differences in the various degrees of NAFLD with a similar finding regarding P3NP.

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Conclusion: P3NP may serve as a marker of NAFLD in obese children and adolescents with NAFLD that is associated with high fructose intake.

…………………………………………………………………………………………………………………………… Acute Metabolic Decompensation Dr. Nada Hammad Abdelfattah Pediatrics Departement Congenital metabolic disorders result from the absence or abnormality of an enzyme or its cofactor, leading to either accumulation or deficiency of a specific metabolite. Encephalopathy is by far the most common clinical manifestation of inborn errors of metabolism, and may be acute, intermittent, chronic (progressive), or even non-progressive. The management of metabolic emergencies in the pediatric population is challenging for the emergency clinician because it requires in-depth knowledge of a broad range of conditions. Adequate and rapid sampling represents the most important step during emergency as it helps interpretation of the data that could be masked later on after initial management. Basic investigations should include:

• Arterial blood gases

• Random blood sugar.

• serum ammonia and lactate

• Extended metabolic screening .

• Organic acids in urine.

Initial management should be directed to adequate stabilization of vital organs function as airway and circulation , besides specific management to inborn errors of metabolism, including:

• High caloric intake

• Low protein supplementation

• Correction of acidosis if present

• Treatment of metabolites abnormalities based on withdrawn lab.

……………………………………………………………………………………………………………………………Postoperative control of Cushing disease

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Dr.Randa Khalaf, M.D Lecturer, Department of Pediatrics Background: Cushing disease is a cause of Cushing syndrome characterized by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary. Pituitary adenomas are responsible for 80% of such cases.The postoperative management of those patients is quite difficult because of the need for optimum glucocorticoid replacement dose, the possibility of tumor recurrence and the recovery of the hypothalamic-pituitary-adrenal axis (HPA).Case History: A 16-year-old female patient presented to the endocrinology clinic with short stature, rapid weight gain and skin striae all over her body. Her height was at <-4 SD (135 cm), and her weight was 63 Kg (BMI 34.6). Tanner staging was A3 – B5 – P4. Morning ACTH was 15.9 SI units (<26) and cortisol was 590.3 SI units (140-690) with no circadian rhythm where the pm ACTH was 17.29 SI units and Cortisol was 880 SI units, so Cushing disease was suspected. MRI brain revealed a pituitary adenoma that was successfully removed. On following up the HPA axis on the morning after surgery, cortisol was 22 SI units. Hydrocortisone (HC) was immediately started at a dose of 7.5mg/m2/day. Morning cortisol level after one month was 201.3 SI units and ACTH was 4.79 SI units so it was decided to gradually taper HC and reevaluate after one month. Morning ACTH was 9.24 SI units and cortisol was 300.7 SI units. One month later, ACTH levels rose up to 13.2 SI units with cortisol to 325.5 SI units. Another MRI brain was requested which showed no evidence of recurrence of the pituitary adenoma.Discussion: The patient presented with straightforward Cushing disease yet the recovery of her HPA axis postoperatively was faster than expected. This has raised the possibility of pituitary adenoma recurrence, which was not detected by MRI.………………………………………………………………………… Role of Nerve conduction studies in detecting subclinical peripheral neuropathy in hyperlipidemiaMona Abd Allah Elsebaay, Nadia Hamed Elarousi, Enas Abd Allah ElAttar and Sarah Saeed Ahmed Sarhan Departement of Physical Medicine , Rheumatology and Rehabilitation

Background and Aim : Hyperlipidemia is a common metabolic disease with a controversy whether to consider it as a cause of peripheral neuropathy or not. we conducted this study to detect subclinical peripheral neuropathy and its electrophysiologically

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pattern in a cohort of hyperlipidemic patients .Patients and Methods: twenty hyperlipidemic neurologically asymptomatic patients (with exclusion of pregnancy ,other metabolic diseases, other chronic medical illness and malignancy) , and 10 healthy matched age and sex controls, subjected to full history taking, clinical examination including (BMI), cervical & lumbar Xray , laboratory investigations [lipid profile including total plasma cholesterol (TC), High density lipoproteins (HDL), low density lipoproteins (LDL), and Triglycrides (TG) levels] , complete blood count (CBC), Fasting blood sugar, kidney & liver functions , Thyroid stimulating hormone (TSH) as well as nerve conduction studies (distal Motor latency, amplitude of CMAP and motor conduction velocity) for both median, ulnar, tibial and peroneal nerves as well as(distal sensory latency, amplitude of SAP and sensory conduction velocity) for both median and sural nerves, F wave study for both median ,ulnar and tibial nerves.Results: there was a significant difference between patients and controls as regards: distal latencies of median (motor & sensory), ulnar, tibial and sural nerves, as well as the amplitude of tibial, peroneal and sural nerves and conduction velocities of all the studied nerves, with a significant negative correlations between level of triglycerides &LDL and median sensory conduction velocity and the same with the sensory cv for sural nerve with TG and LDL only and a significant negative correlation of HDL with tibial motor latency & a positive significant correlation with tibial motor amplitude and sural sensory amplitude.With a significant negative correlations between total cholesterol and Median sensory amplitudes, median& tibial motor conduction velocities. With a conclusion that mononeuropathy was found in five patients (25%), and polyneuropathy was found in seven patients (35%) .…………………………………………………………………………………………………………………………… Doubt on the role of vitamin D Prof. Naglaa Ali Gadallah Professor of Physical Medicine, Rheumatology& Rehabilitation, Faculty of Medicine, Ain Shams UniversityThe registration of all available drugs for osteoporosis, including vitamin D, was obtained from the results of large randomized clinical trials demonstrating their ability to reduce fracture risk. On the contrary, new results from extensive analyses of observational and randomized clinical trials suggest that vitamin D given alone, or combined with calcium, does not appear to increase bone-mineral density or reduce the risk for fractures or falls in older people.

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New results also signify that a clear role for vitamin-D supplementation for any other indication remains to be established — no significant effect on mortality overall in randomized clinical trials was seen for any indication. It is suggested that Low concentrations of 25-hydroxyvitamin D (25[OH]D) are most likely an effect of health disorders and not a cause of illness. The discrepancy between observational and interventional studies suggests that low 25(OH)D is only a marker of ill health.Further insights on the role of vitamin D are still needed.…………………………………………………………………………………………………………………………… Neuropsychiatric Presentations among Recipients after Adult-to-Adult Living Donor Liver Transplantation: A pilot study in an Egyptian population.Hend Mubarak Mohammed, Mohamed Khairy Mostafa El-Naggar **, Mohamed Amin Sakr **, Mahmoud El-Meteini ***, Azza Abd El-Nasser Abd El-Aziz ****, Mohammed Omar Khalifa ***** * Assistant Lecturer of Tropical Medicine, Faculty of Medicine-Ain Shams University ** Professor of Tropical Medicine, Faculty of Medicine-Ain Shams University *** Professor of liver transplant surgery, Faculty of Medicine-Ain Shams University **** Professor of Neuropsychiatry, Faculty of Medicine-Ain Shams University ***** Assistant Professor of Tropical Medicine, Faculty of Medicine-Ain Shams UniversityCorresponder author: Hend Mubarak MohammedABSTRACTBackground: Neuropsychiatric complications that develop after Living donor liver transplantation are frequently encountered however not adequately estimated among Egyptian recipients. Objectives: To estimate the incidence of neuropsychiatric manifestations post living donor liver transplantation. Also, the neurocognitive function development after transplantation.Patients and methods: A prospective observational cohort study was conducted to evaluate 30 adult patients with end stage liver disease pre-operatively in a single Egyptian Transplant Center from November 2012 till January 2014. Relevant pre, intra, post-operative data were collected and at 3 and 6 months’ follow-up. The assessment included neurologic evaluation, etiology of end stage liver disease, clinical stage of pre-operative hepatic encephalopathy, pre-operative comorbidities, intra and post-operative events and conditions

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including immunosuppressive drug treatment. Results: HCV was the main etiology for liver disease in 27 patients (90%). As for Overt HE 26.6% were symptomatic while 43.3% had covert HE. Post-operatively 76.7% demonstrated neuropsychiatric manifestations with 50% of the patients showing mainly early major events; namely encephalopathy. Late minor manifestations rates were 50%. Prolonged intr-operative cold ischemia time and early cyclosporine administration are associated with higher risk of developing early neuropsychiatric eventsConclusion: patients of living donor liver transplantation are at increased risk for developing early post-operative major neurologic which become of less clinical significance later on. Keywords: Liver Transplant, Neuropsychiatric, encephalopathy, calcineurin inhibitors, cyclosporine, tacrolimus. …………………………………………………………………………………………………………………………… BACTERIAL INFECTIONS AND THEIR EMERGING RESISTANT PATTERNS IN HCV PATIENTS FOLLOWING LIVER TRANSPLANTATION IN EGYPT. “A single center study” Dr. Yasmine Mahmoud Aly Massoud Tropical Medicine , Internal Medicine Department Background: More than two-thirds of liver transplant recipients have infection in the first year after transplantation. Aim of the work: To study the incidence, types and risk factors of bacterial infections in HCV patients following LDLT in Egypt and identify the emerging resistant strains and their proper antimicrobial therapy. Patients and methods: 35 Patients with end stage liver disease who were hepatitis C virus positive and age between 18-60 years were recruited in the study from January 2013 till May 2014 and each one was followed up during a period of 3months following transplantation. Patients were checked for the possible risk factors suggestive of acquiring infection pre, intra and post-operative. Patients were identified and classified based on clinical assessment, laboratory work up with stress on; CBC, CRP, liver profile abnormalities and Pan cultures. Infections were defined using criteria proposed by the Center for Disease Control.

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Results: Bile was found to be the most common site of infection. Acinetobacter was found to be the most common organism isolated. Klebsiella turned out to be the most resistant organism (PDR). Levofloxacin proved to be of significant statistical significance regarding its sensitivity in the treatment of repeated episodes of infection. HCC and the duration of drain insertion (in days) by multivariate analysis were independent risk factors for occurrence of repeated episodes of infection. Conclusion: Most patients in the early post-transplant period acquire at least 1 episode of infection; some develop recurrent episodes, with development of MDR strains. All infections took place in the first month post-operative. Key words: Infections, post-transplantation. …………………………………………………………………………………………………………………………… Liver Transplantation Dr. Manar Mohamed Salah Tropical Medicine , Internal Medicine department The mortality on the waiting list for LDLT is high. Facing this situation, transplant centers have developed alternatives to increase the number of accepted grafts, which were previously considered to be inadequate.Currently, some marginal donors are being routinely used: elderly donors, steatotic grafts,hepatitis B core antibody-positive donors.These so-called marginal or extended-criteria donors.Shall we hit our fear and expand our donor selection ?! ……………………………………………………………………………………………………………………………EFFICACY AND SAFETY OF Qurevo (Ombitasvir/Paritaprevir/r )+ RBV IN HCV GT4-INFECTED PATIENTS WITH OR WITHOUT COMPENSATED CIRRHOSIS is a new hope for cure Prof Amal Shawky Bakir Internal Medicine Department A large number of new therapies are in development for chronic hepatitis C including direct-acting antiviral drugs (DAA), which target specific hepatitis C virus enzymes.Most direct-acting antivirals (DAAs) being developed against the hepatitis C virus target the NS3/4A protease, the NS5A protein and the NS5B

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polymerase.Food and Drug Administration (FDA) has approved ZEPATIER™ (elbasvir and grazoprevir) for the treatment of adult patients with chronic hepatitis C virus (HCV) genotype (GT) 1 or GT4 infection, with or without ribavirin (RBV), following priority review by the FDA. ZEPATIER (pronounced ZEP-ah-teer) is a once-daily, fixed-dose combination tablet containing the NS5A inhibitor elbasvir (50 mg) and the NS3/4A protease inhibitor grazoprevir (100 mg).HHARVONI is a prescription medicine used to treat chronic (lasting a long time) hepatitis C genotype 1, 4, 5 or 6 infection. It is not known if HARVONI is safe and effective in children under 18 years of age. The cost and side effects of the DAA will be important considerations for treating physicians .……………………………………………………………………………………………………………………………

State-of-the-Art Interpretation and Management of Pancreatic CystsProfessor Dr/ Abdel Ghany El ShamyCurrently Pancreatic Cystic Lesions are being discovered with increasing frequency. The most common Cystic Pancreatic Lesions reported in literature are Pseudocysts, which usually arise as sequelae of Pancreatitis or trauma. The most common Cystic Pancreatic Neoplasms reported are Intraductal Papillary Mucinus Neoplsasms (IPMNs), Mucinous Cystic Neoplasms (MCNs), and Serous Cystadenomas (SCAs). Although SCAs and Pseudocysts are considered benign, IPMNs and MCNs have malignant potential. Other Cystic Pancreatic Lesions account for fewer than 10% of cases and include uncommon pathologic findings such as Solid Pseudopapillary Neoplasms, Cystic Pancreatic Neuroendocrine, Neoplasms, Cystic Degeneration in other Solid Pancreatic Neoplasms, Lymphoepithelial Cysts, and Cystic Adenocarcinoma of the Pancreas. Pancreatic Cystic Lesions necessitate a multidisciplinary team for accurate interpretation and management.The aim of this presentation is to highlight the multidisciplinary interpretation, diagnosis and treatment of Pancreatic Cystic Lesions to offer patients with Pancreatic diseases in general and Pancreatic Cysts in particular the best treatment and the best standard of care in the era of subspeciality.

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