Background Acromioclavicular joint has an important role in suspensory mechanism of shoulder joint to the axial skeleton. Acromio-Clavicular Joint (ACJ) dislocation is not a common injury, yet it may cause limitations. In this study, a modified novel loop technique is evaluated. Aim The aim of the study is to assess the outcome of double-loop Ethibond sutures in ACJ dislocations of grades IV, V, and VI and some cases of grade III. Patients and methods This prospective randomized study was conducted on 21 patients with acute dislocations of ACJ. All the patients were treated by loop suture technique using Ethibond sutures. Results All patients presented with acute ACJ. The final results were analyzed, and it was found that the grade of dislocation is inversely proportional with end results. Earlier operated patients got better results. Time of pins removal, compliance to physical therapy, and postoperative exercises affect the final results. Conclusion The results show high incidence of good outcome. It could not be proven that the good results are owing to CC ligament healing or Ethibond sutures.

Background Red cell distribution width (RDW) is a marker of red blood cell size heterogeneity. Increased RDW is associated with liver diseases, but it has not been studied in patients with hepatitis C virus (HCV). Aim To determine if RDW is a potential prognostic index for liver diseases due to chronic HCV infection. Patients and methods A total of 95 patients with liver diseases due to chronic HCV infection and 20 healthy controls were enrolled in this cross-sectional study. Patients comprised 20 patients with chronic HCV, 52 patients with HCV-related cirrhosis, and 23 patients with HCV-related hepatocellular carcinoma (HCC). HCV antibody, PCR of HCV, HBsAg, complete blood count, liver function tests, and RDW were assessed. Child–Pugh score were calculated in patients with cirrhosis and those with HCC. Results RDW was significantly increased in patients with HCV-related liver cirrhosis and patients with HCV-related HCC compared with patients with chronic HCV infection and healthy controls (P≤0.05). Moreover, RDW was higher in patients with chronic HCV infection than in healthy controls, but it did not achieve statistical significance (P>0.05). In patients with cirrhosis and patients with HCC, RDW was positively correlated with total bilirubin and Child–Pugh score and negatively correlated with hemoglobin concentration, platelet counts, and serum albumin. Conclusion RDW was increased in patients with HCV-related liver cirrhosis and patients with HCV-related HCC and was correlated with higher Child–Pugh score. RDW could be a valuable prognostic index for chronic liver diseases due to HCV infection.

Background Retina is the best structural model for histological study of the nervous system. Aging is a biological phenomenon that involves gradual degradation of the structure and subsequent deterioration of the retina. Aim This study aimed to clarify the postnatal changes in the albino rat retina as well as the effect of aging on its structure. Materials and methods Twenty albino rats were divided into four groups (five rats each) according to their ages into 1, 3, 18, and 24 months. The retinae of all groups were prepared for light microscopic examination (histological and immunohistochemical), electron microscopic examination, and quantitative study including statistical analysis of the number of retinal ganglion cells. Results All layers of the retina were highly organized at 1 and 3 months with strong positive immunoreactivity of the ganglion cells to tubulin β III stain at 3 months. Ultrastructurally, oval light cones, irregular dark rods, and bipolar cells were noticed and the nuclei of ganglion cells layer exhibited finely dispersed chromatin at 1 month and at 3 months these cells were arranged in several layers of variable sizes and shapes. Aging caused degenerative changes to all layers of the retina at the age of 18 months which became marked with complete loss of the outer layers at 24 months. Ganglion cells showed weak immunoreactivity to tubulin β III stain and statistically, their number showed a highly significant increase from 1 to 3 months and then showed a highly significant reduction with aging. Conclusion Retina became highly organized postnatally and aging caused its deterioration with significant reduction in the number of ganglion cells.

Background Radiofrequency (RF) denervation is a commonly used therapeutic option for chronic low back pain, with high-quality evidence for its effectiveness being proved. Aim To evaluate the effectiveness of RF denervation in patients with chronic low back pain. Patients and methods This study was conducted in Department of Neurosurgery at Tanta University from October 2016 to December 2017. It included 32 patients with chronic low back pain with mal-response to medical treatment. These patients were categorized into two groups according to origin of pain: group 1 included 20 patients with facet joint pain, and group 2 included 12 patients with sacroiliac joint pain. All patients were subjected to history taking, complete physical, neurological examination, radiological investigations, and special RF neurotomy maneuver according to the origin of back pain. Outcome assessment was done by visual analog score and daily living activity measured before intervention, immediately after intervention, after 1 month, and after 3 months of the intervention. Results Of 32 patients, 23 (71%) had satisfactory pain score more than or equal to 5 at the end of the study. There was a highly significant increase in daily living activity (P<0.001) immediately, after 1 month, and after 3 months from intervention as compared with before RF in the two studied groups. In addition, 75% of patients attained normal daily activity at the end of the study. There were significantly decreases in analgesic use after intervention. Conclusions RF is considered as an alternative safe minimally invasive maneuver in relieving chronic low back pain and improving patient’s daily activity, whatever the diagnosis facet or sacroiliac types.

Background Multiple myeloma (MM) is a malignant disorder characterized by the proliferation of monoclonal plasma cells. Apelin seems to play a role in MM pathogenesis and could be used as a diagnostic and prognostic biomarker. Aim The aim of this study was to evaluate the serum apelin level in patients with MM and its clinical significance. Patients and methods This prospective study was conducted on 60 participants who were divided into 2 groups: 30 patients newly diagnosed as having MM and 30 as a healthy control group. All patients were subjected to clinical evaluation, routine laboratory tests, and serum apelin level evaluation, which was estimated by enzyme-linked immunosorbent assay. Results There was a significant decrease in hemoglobin level and platelet count and a significant increase in serum creatinine, blood urea, serum calcium, lactate dehydrogenase, serum β2-microglobulin, and apelin level among patients with MM than control group. There was a statistically significant increase in serum γ globulin level in patients with +ve M band compared with patients with −ve M band group. There was a positive significant correlation between apelin level and serum creatinine, blood urea, serum calcium, plasma cell percentage in bone marrow aspiration, β2 microglobulin, and γ globulin, with no significant correlation with hemoglobin, platelet, and lactate dehydrogenase. Receiver operating characteristic curve analysis showed that the area under curve for apelin in MM was 0.83 ng/l (95% confidence interval: 0.745–0.955, P<0.0001). Conclusion Serum apelin level can be used as a diagnostic marker for MM.

Background Hepatitis C virus (HCV)-positive patients may exhibit a wide range of extrahepatic manifestations, including peripheral neuropathy (PN). Aim The aim of this work was to study the incidence and patterns of PN among patients with HCV infection, with a special emphasis on the Egyptian HCV treatment protocol of direct-acting antiviral agents (DAAs). Patients and methods This was a case–control study carried out at the outpatient clinic of Neuropsychiatry and Tropical Medicine Departments in Tanta University Hospitals from August 2017 to April 2018. This study was applied on 60 patients with HCV infection targeting assessment of PN, clinically and neurophysiologically, before starting the Egyptian HCV treatment protocol of DAAs (visit 0) and 3 months later at the end of treatment with compliant drug therapy (visit 1), with follow-up of affected patients for 3 months after stoppage of treatment (visit 2). Results Clinical assessment of patients before treatment showed clinical diagnosis of neuropathy in 10% (6/60) of our patients, with sensory predominance, and by electrophysiology assessment, we found 15% (9/60) of our patients had PN, with sensory axonal type. After treatment, 30% (18/60) of our patients had a clinical evidence of PN with sensory predominance. By electrophysiology, 33.33% (20/60) of our patients were found with sensory axonal type. Follow-up showed partial regression of neuropathy at clinical and electrophysiological level. Conclusion DAAs induced PN in patients after receiving it at the end of treatment, with partial regression on follow-up.

Background Bleeding and surgical wound infections after open heart surgery are associated with increased morbidity and mortality. These complications have devastating effects on patients’ recovery and a substantial economic effect on health care providers. There remains an incentive to reduce the risks further. Platelet-rich plasma (PRP) is a source of growth factors and cytokines, which can promote tissue healing and regeneration. Aim The aim of this study is to determine the effect of PRP on bleeding and surgical wound infection after cardiac surgery. Patients and methods A total of 34 patients were randomized into two groups: PRP group and control group. Overall, 30 ml of the patient’s autologous blood was centrifuged for 5 min to separate the red blood cells from the plasma. The plasma was then centrifuged for 10 min; the precipitate is the PRP. Activation of PRP was done by adding 1 ml of calcium gluconate to the syringe just before spraying the PRP in the operative field. After weaning the patient from cardiopulmonary bypass and before the insertion of sternal wires, the mediastinal cavity was irrigated with the PRP (30 ml of warm saline mixed with an equal amount of PRP) in group ‘A’ and saline only in group ‘B.’ Study end points were bleeding and blood transfusion. Results Wound discoloration occurred in 11.8% (two cases) in the control group; however, no wound discoloration was recorded in the PRP group, with P value of 0.145. Drainage (with mean drainage in control group was 473.53 ml and mean drainage in PRP group was 193.75 ml) and transfusion requirements (with mean transfusion requirements in control group was 1.5 pack and mean transfusion requirements in PRP group was 0.63 pack) showed a statistically significant difference between the two groups, in favor of the PRP group (P<0.001). PRP depends on the enrichment of thrombocytes that release the growth factors platelet-derived growth factor, transforming growth factor-ß1/ß2, epidermal growth factor, and insulin-like growth factor-I from their granules, and this results in the formation of a blood clot. Conclusion Our results suggest that bleeding tendency, coagulation profile, and the incidence of blood transfusion are better with the application of PRP. Wound discoloration was better with the application of PRP.