Growth arrest-specific gene 6 (GAS6) encodes a vitamin K-dependent protein that regulates inflammation, angiogenesis, and atherosclerotic plaque formation. The level of GAS6 expression is associated with plaque stability and stroke. The role of GAS6 in cardiovascular disease, particularly in acute coronary syndrome (ACS), was explored. The study investigated the role of the single nucleotide polymorphism (c.834 + 7G >A) of GAS6 in ACS. The genotype frequencies for GG, AG, and AA, respectively, in patients with ACS were 57.1% (16/28), 28.6% (8/28), and 14.3% (4/28) and were 20% (4/20), 40% (8/20), and 40% (8/20) in the control group. The AA genotype and A allele were less frequent in patients with ACS than in controls (P < 0.05). Our study indicates that the AA genotype and A allele of the GAS6 gene relate to ACS and may have a protective role against ACS.

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The facial nerve is one of the most commonly injured cranial nerves. Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Here, we review recent developments in the management of facial nerve paralysis and in facial reanimation restoring both form and function. We also discuss tissue engineering and new technologies and their role in the treatment of facial nerve paralysis.

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Objective The objective of this study was to compare the role of phakic foldable angle-supported intraocular lens (IOL) with laser in-situ keratomileusis (LASIK) for correction of moderate and high myopia. Patients and methods Twenty eyes received phakic foldable angle-supported IOL, and 20 eyes received LASIK. Main outcome: slit-lamp microscopy, manifest refraction, uncorrected and best-corrected visual acuity (BCVA), pentacam, IOL calculation (for group 1) with the IOL Master, and specular microscopy were performed before surgery, and 3 and 6 months after surgery. Results At 6 months, the mean spherical equivalent refraction was −0.31 ± 0.44 D (ranging from 0.5 to −1.25 D) in Cachet eyes and −1.04 ± 0.94 D (ranging from 0.25 to −3.5 D) in LASIK eyes. Neither Cachet eyes nor LASIK eyes lost two or more LogMar lines of preoperative BCVA. No Cachet eyes and one LASIK eye lost one LogMar line of preoperative BCVA. The mean percentage of endothelial cell loss in the Cachet group was 8.0% at 6 months, whereas in the LASIK group it was 0.84% at 6 months. Conclusion In this study, Cachet lens implantation and LASIK were found to be effective for the correction of moderate and high myopia. The endothelial cell loss in Cachet eyes was high, which makes it less safe compared with LASIK.

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Aim The present study aimed to evaluate the protective effect and treatment of olive leaves administration on cardiac necrosis markers, some electrolytes, and cardiac tissue antioxidants in myocardial necrosis induced experimentally in rats by subcutaneous injection of isoproterenol (ISO). Results ISO-induced myocardial infarction in male rats resulted in a significant increase in creatine kinase, creatine kinase MB, lactate dehydrogenase, aspartate aminotransferase, glucose, potassium, and phosphorus in serum, in addition to a significant increase in glucose-6-phosphate dehydrogenase in red blood cells. In addition, it resulted in a significant decrease in serum calcium and sodium in serum. Furthermore, this study demonstrated that there was a significant decrease in heart tissue superoxide dismutase and a significant decrease in catalase activity, as well as a significant increase in heart l-malondialdehyde levels, in ISO-injected rats. Conclusion This study shows that that olive leaves administration is effective against myocardial infarction and oxidative damage in heart tissue induced by ISO in rats.

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Background/aims The gold standard for the diagnosis of hepatic steatosis is liver biopsy, which is an invasive method with some limitations. There was an increased need for a noninvasive, cost-effective method for the diagnosis of hepatic steatosis. The aim of this work was to study the controlled attenuation parameters (CAP), a noninvasive tool, for the diagnosis of hepatic steatosis in chronic hepatitis C patients. Patients and methods The study was conducted on 100 Egyptian patients with chronic hepatitis C infection (anti-hepatitis C virus seropositive with detectable hepatitis C virus-RNA) during pretreatment assessment for antiviral therapy; those patients were randomly selected from the Outpatient Clinic in The Specialized Medical Hospital, Mansoura University. All included patients were subjected to full history taking and thorough clinical examination, full laboratory investigations, including complete blood count, liver profile tests, kidney function tests, abdominal ultrasonography, liver biopsy, and transient elastography (FibroScan), including CAP. Results There was a proportional relationship between the degree of steatosis and CAP reading. There was a highly significant difference (the best cutoff value=218 dB/m) for mild steatosis, with a sensitivity of 94.4%, specificity of 82.8%, positive predictive value of 75.6%, and negative predictive value of 96.4%. Furthermore, CAP is valuable in differentiating between moderate degree of steatosis versus no and mild steatosis (cutoff value=241.4 dB/m), with a sensitivity of 100%, specificity of 83.9%, negative predictive value of 100%, and positive predictive value of 31.8 for moderate steatosis. Conclusion CAP can be used in the diagnosis of hepatic steatosis with good diagnostic performance. CAP has the advantages of being a simple, noninvasive, inexpensive, painless, operator and machine independent method, and displays good application prospects.

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Background Investigations suggest that adipokines may play an important role in pathogenesis and cartilage damage in osteoarthritis (OA). Whether adiponectin (ADN) has proinflammatory or anti-inflammatory actions in OA remain controversial. Aim The aim of this study was to measure the serum level of ADN in patients with knee osteoarthritis (KOA) and to evaluate the relationship between its level and clinical and radiological picture of OA. Patients and methods The study included 56 patients with primary symptomatic KOA and 30 matched controls. Parameters of obesity and serum ADN, leptin (LEP), and matrix metalloproteinase (MMP)-3 were measured in all participants. Clinical features of KOA severity and activity were evaluated in the patients. Extent of knee joint damage due to OA was evaluated by means of plain radiograph and MRI. The volume of the infrapatellar fat pad was measured using MRI. Results KOA patients had high serum ADN, LEP, and MMP-3 compared with controls and they were higher in female KOA patients than in male KOA patients. Serum ADN, LEP, and MMP-3 were significantly correlated with parameters of obesity and with each other. The serum ADN level was significantly correlated with tenderness, visual analogue scale pain, OA activity, OA severity, and also with Western Ontario and McMaster Universities Osteoarthritis Index score. Serum LEP level was significantly correlated with OA severity. Serum level of MMP-3 was significantly correlated with the tenderness score. Higher ADN serum levels were associated with increased Kellgren–Lawrence grade, increased Noyes MRI grade, increased OA severity MRI grade, and increased meniscal degeneration MRI grade. Serum levels of ADN, LEP, and MMP-3 were significantly correlated with the Hoffa fat pad volume. Conclusion ADN serum level was associated with radiological evidence of OA severity and was correlated with serum LEP and MMP-3 levels. These findings strongly suggest that ADN is involved in the pathogenesis of joint inflammation and cartilage destruction in OA and may be a target for disease-modifying drug development.

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Background Perinatal asphyxia is a common cause of neonatal morbidity and mortality. Inflammatory cascades are involved in the pathogenesis of ischemic brain injury during asphyxia, which is mediated by cytokines such as interleukin-1β (IL-1β). Objective We determined IL-1β in cases with perinatal hypoxia to evaluate its role in the pathogenesis of this condition and its relation to the development of complications, which may be reflected on its management. Design This is a case–control study. Patients and methods The patient group included 31 full-term newborn infants diagnosed as having perinatal asphyxia who were selected from the Neonatal Intensive Care Unit in Benha Teaching Hospital. The control group included 16 full-term newborns with no natal or postnatal complications who were selected from the well baby care unit. IL-1β and C-reactive protein (CRP) were measured by the ELISA technique (highly sensitive CRP). Erythrocyte sedimentation rate (ESR) was performed by the Wintrobe method. Statistical analysis Results were analyzed and compared with 16 controls using SPSS 20. Results IL-1β was significantly higher in asphyxia cases compared with controls. In addition, it was significantly higher in cases with seizure, systemic organ failure, and in cases who developed cerebral palsy (CP) compared with those without seizure, organ failure, and CP. IL-1β correlated positively with encephalopathy stages. It showed no relation to gestational age, sex, weight, hematological data, or CRP. Conclusion We conclude that the level of IL-1β is high in cases with perinatal asphyxia. Cases with seizure, organ failure, and neurological sequelae had higher levels. It correlates positively with encephalopathy stages without relation to hematological parameters or CRP.

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Objective The study aimed primarily to evaluate urethral patency and continence following anastomotic urethroplasty, as well as the quality of life of the patient as the secondary outcome. Materials and methods A retrospective study was conducted that included 104 adult male patients in whom perineal anastomotic urethroplasty had been performed for post-traumatic urethral stricture with postoperative follow-up for at least 6 months. Ninety-five (91.4%) patients presented with an in-dwelling suprapubic catheter. Thirty-eight (36.6%) patients had heavy pyuria that was adequately treated before the procedure. Escherichia coli was the most frequently isolated organism (36.6%). Results The mean age of the patients was 30.85 years (range = 18–71 ± 12 years). Sixty-eight patients had strictures 10–20 mm in length (65.4%) and only four (3.9%) patients had a stricture that was larger than 40 mm. All procedures had been carried out through perineal incision. Fifty-eight (67.4%) patients had normal urethral flow on retrograde urethrogram after the procedure, and the global success rate rose to 93% after a secondary procedure (urethroscopic dilatation under anesthesia or direct visual internal urethrotomy). The stricture with a mean length of 24.7 ± 15.2 mm was the only statistically significant predictor of failure of the procedure (P < 0.001). Only two (2.5%) patients suffered stress urinary incontinence with patent urethra and kept using condoms or pads following the procedure. These patients were managed with a bulbourethral sling and finally were continent. Conclusion Stricture length is the only statistically significant predictor of success or failure of anastomotic urethroplasty. Stress urinary incontinence has low incidence following this procedure, whereas bulbourethral sling appears to be a reasonable treatment option. Successful repair of the urethral stricture has a positive impact on the quality of life of the patients following urethroplasty.

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Objective The aim of the present study was to examine the changes in knowledge, attitude, and practice of evidence-based medicine (EBM) among physicians. Patients and methods The present interventional study was conducted from December 2012 to December 2013 at Benha University Hospitals in the Qualibia governorate, Egypt. Data were collected in three stages: first, by determining the physicians’ knowledge, attitude, and practice toward EBM; second, by conducting an educational program to increase awareness and improve attitude and practice of physicians toward EBM; and, third, by determining their knowledge, attitude, and practice toward EBM after the program. A total of 220 self-administrated questionnaires were distributed to physicians in different specialties. Findings The response rate was 70.5% across different specialties. Overall, 73.2% of the physicians had poor knowledge of EBM before the program, which decreased to 40.2% after the program. This change was statistically significant. Most of the physicians had a high attitude score (92.3 and 97.3%) toward EBM before and after the program, respectively. Poor percentage of physicians (before and after the program) reported attending any courses in EBM (18.2 and 24.5%). More than 60% physicians (before and after the program) used the Internet to inform their practice. The most prevalent barrier against the use of EBM among physicians was the attitude of colleagues (94.6% before and 89% after the program). Conclusion After the educational program, knowledge on evidence-based practice improved markedly. Physicians’ attitude towards EBM was positive before and after the program. Changes in practice were small, and were based on the frequency of searching and appraisal activities.

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This prospective study was designed to evaluate the role of intra-abdominal pressure (IAP) measurement during the early postoperative period as a criterion of the need for re-exploration. The study comprised 90 patients; 60 (66.7%) males and 30 (33.3%) females, with mean age of 45.15 ± 11.9. All patients were assigned to undergo exploratory laparotomy for acute abdomen for various indications. Each patient underwent single preoperative and 8-h postoperative serial IAP measurements for a period of 72 h through two-ways indwelling Foley's catheter. Twelve patients underwent relaparatomy, 10 had a significant increase in IAP during first 48 h postoperatively followed by slow or even no decline during the next 24 h. This rise preceded the day of operative confirmation by 3 ± 1.5 days, whereas the other two patients showed slow decline over first 72 h postoperatively. Seventy-eight patients had uneventful course, 18 patients had mild increase in IAP levels during first day followed by decline over next 2 days, whereas 60 patients had a decline in IAP levels during the first 72 h postoperatively. The specificity of the method was 76.9%, sensitivity 83.3%, negative predictive value 96.8%, positive predictive value 35.7%, with overall accuracy of 77.8%. This study supports the role of IAP as a relevant marker for deciding the need for relaparotomy, as a part of the on-demand approach.

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Congenital double lip is rare and usually involves the upper lip. Apart from a deformity that interferes with speech and mastication, operation may also be indicated for cosmetic reasons. The purpose of this study was to evaluate the results of the operative treatment of congenital maxillary double lip during the period from July 2008 to October 2010. All patients were treated surgically in our hospital. We used an elliptical excision of the mucosal excess. The results were esthetically satisfactory.

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