Background and Aim Some healing promoting factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), hyaluronic acid (HA), and platelet-rich plasma (PRP), have been in use nowadays to assist healing eardrum perforations. Several trials have been conducted to assess their effectiveness. This meta-analysis was conducted to find out the prognostic effects of these factors. Materials and methods The search methods consist of electronic databases and literature references for published and unpublished studies, besides the reference lists of all relevant studies. Selection criteria All types of studies (randomized controlled trials, prospective, retrospective, or case–control). Data collection and analysis Eighteen articles were included after screening by titles and/or abstracts and full-text assessment. They were categorized according to the used healing promoting factor. Data were extracted and analyzed via Cochrane Collaboration’s Review Manager Software. Results EGF and FGFs significantly improved the rate of closure, healing duration, and increased hearing gain. On the contrary, the overall effects of HA and PRP were nonsignificant in this respect. Conclusion EGF and FGF can increase the rate of closure of tympanic membrane perforations, shorten healing duration, and improve hearing gain. PRP and HA do not have a significant effect. This can be attributed to heterogeneity of the studies included to assess the role of each of these two factors.

Background Caudal septal deviation is a major cause of nasal obstruction. This problem affects normal nasal breathing by narrowing the external valve area and the nasal valve angle, in addition to aesthetic deformity of the nose. Treatment of midseptal and posterior deviations is rather straightforward, but treatment of the caudal septal deviation can be a more challenging problem. Aim To assess the aesthetic and functional satisfaction for patients with tongue in groove technique vs cartilage resection technique in managing caudal septal dislocation. Patients and methods This is a prospective, cohort controlled study of 25 patients divided into two groups: group A consisted of 13 patients who underwent tongue in groove technique and group B consisted of 12 patients who underwent cartilage resection technique. Results In managing caudal end septal dislocations, both tongue in groove and cartilage resection techniques have valuable aesthetic and functional outcomes. Conclusion The tongue in groove technique has a better outcome as there is no residual postoperative caudal dislocation or sublaxation. Also, it is usually used in combination with other septoplasty maneuvers to achieve the desired functional and cosmetic result. The cartilage resection technique does not add any other incision or scar except for the same ones used for septoplasty.

Background Eustachian tube (ET) function and middle ear ventilation is affected by severe chronic nasal obstruction. Aim To study the effect of severe nasal obstruction due to nasal septal deviation and hypertrophic inferior turbinate and their correction on ET functions and middle ear ventilation. Patients and methods This prospective study involved 50 patients with severe nasal obstruction along with complaints of ear fullness. The nasal pathologies were surgically managed. Preoperative and postoperative impedance audiometric evaluation and nasal endoscopy were done to assess ET function. Results Patients included 28 (56%) males and 22 (44%) females. The age of patients ranged between 15 and 41 years, each group was divided into subtypes according to middle ear affection: group 1: severe nasal obstruction with type C: 18 ears, type B: four ears, and type A: 18 ears. Group 2: severe nasal obstruction with type C: eight ears, type B: nine ears, and type A: 17 ears. Group 3: severe nasal obstruction with type C: 17 ears, type B: five ears, and type A on tympanogram: four ears. Tympanogram was done preoperatively, and postoperatively the results were a significant improvement in ET dysfunction (P<0.05). Conclusions ET function and middle ear ventilation are affected by severe chronic nasal obstruction caused by deviated nasal septum and hypertrophic inferior turbinate. After septoplasty and inferior turbinate reconstruction, there was a signification improvement in nasal airway and ET function but insignificant improvement in cases with OME (Otitis Media with Effusion).

Background Hepatocellular carcinoma (HCC) is the tumor of hepatocytes and occurs mainly in patients with liver inflammation, liver fibrosis, and cirrhotic livers. Recent studies hypothesize that neuropilin-1 (NRP-1) can be a specific indicator for HCC as it shows high levels in cases of HCC only. Aims To study serum NRP-1 in chronic liver diseases and HCC. Patients and methods Our research included 80 Egyptian subjects who were divided into three groups; Group I(20 healthy controls), Group II(30 patients with HCC and hepatitis C) and Group III (30 patients with liver cirrhosis and hepatitis C). Results Albumin, blood alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase enzymes, and urea showed a significant decrease in HCC and cirrhotic groups in comparison with controls. There was an increase in the mean values of NRP-1 in HCC and cirrhotic patient groups in comparison with controls, and there was also a significant increase in the HCC patient group in comparison with the cirrhotic patient group. In cirrhotic patients, there was a significant positive correlation between NRP-1 and each of alpha-fetoprotein (AFP), AST, ALT, and prothrombin time. In patients with HCC, there was a significant positive correlation between NRP-1 and each of AFP, AST, and ALT. There was an increase in serum AFP in the HCC group in comparison with both control and cirrhotic patient groups and a significant increase in the cirrhotic patient group in comparison with the control group. Conclusion Serum NRP-1 levels in cirrhotic patients with hepatitis C virus may guide us about progression to HCC. In these patients, if NRP-1 levels were found to be high, follow-up with radiological studies could be done.

Background Aplastic anemia (AA) is a severe bone marrow failure condition with a high mortality rate in its severe form if left untreated. Interleukin (IL)-6 is a pleiotropic cytokine with various biological activities, including B-cell terminal differentiation, T cell, and macrophage stimulation. Moreover, they are critical for tissue damage in acute inflammation and have also been shown to be potent inhibitors of myelopoiesis. Aim Our purpose was to assess IL-6 level in AA patients and to correlate it with AA severity. Patients and methods The study was conducted on 40 individuals divided into 20 patients with AA and in-patient clinic of Hematology Department, Faulty of Medicine, Tanta University Hospitals, and 20 apparently healthy participants used as a reference-control group. Results Pallor, weakness, and bleeding were present among 95% of the studied AA cases, while fever and infection were found among 90% of the studied AA cases. High levels of IL-6 were observed in AA. A correlation of increased levels with disease severity has been demonstrated. Conclusion High levels of IL-6 were observed in AA. Increased levels showed a correlation with disease severity, and therefore appear to play an essential role in AA.

Background Cirrhosis and hepatocellular cancer are the most common complications of chronic hepatitis B and therefore it is necessary to avoid these complications in high-risk patients with high replicative capability. Conventional serum indicators are insufficient for detecting hepatocellular carcinoma in these patients early. Aim The goal of this study was to see if hepatitis B core-related antigen (HBcrAg) could be used as a marker for hepatocellular cancer in people who had hepatitis B. Patients and methods This research was conducted on 90 people who attended the Hepatitis Outpatient Clinics at the Department of Tropical Medicine and Tanta University Educational Hospital between January 2019 and August 2020. Results In comparison to the control group, hepatocellular carcinoma (HCC), and chronic hepatitis B (CHB) patients had a marked decline in hemoglobin, serum albumin, white blood cells count, and platelet count. Aspartate transaminase (AST), Alanine aminotansferase (ALT), bilirubin, and international normalization ratio (INR) levels all increased considerably. Hepatocellular carcinoma and CHB patients had relatively high levels of alkaline phosphatase (ALP) and Alpha-feto protien (AFP) than the control group. In both patient groups, there was a strong whereas ALT. Levels was within normal values. In the HCC group, HBcrAg levels were closely linked with ALP, AFP, and DNA levels. In both patient groups, the AST to Platelet Ratio Index (APRI) score indicated a strong association. Conclusion As an excellent biomarker of intrahepatic cccDNA, HBcrAg demonstrated encouraging results as a potential biomarker of HCC incidence in CHB patients.

Background Urolithiasis represents one of the most common urogenital disorders. Extracorporeal shock-wave lithotripsy (ESWL) has changed the management of urolithiasis. ESWL has many complications, including cardiac dysrhythmia, bacteriuria, bleeding, steinstrasse, renal colic, and urosepsis. Multidetector computed tomography (MDCT) allows reliable detection and quantification of post-ESWL complications. Aims The aim of this work was to evaluate post-ESWL sequel by CT and to rule out complications. Patients and methods In total, 30 patients with renal stones received treatment with ESWL. Patients came after undergoing ESWL procedure and suffering from clinical complaints to the Department of Diagnostic Radiology in Tanta University Hospital examination center. Results All patients included in our study were evaluated by MDCT to detect complications after ESWL. We found that 10 cases had multiple stone fragments along the course of the ureter that was called steinstrasse. Urinary-tract infections in six (20%) cases. Two cases had signs of inflammation with steinstrasse. Six cases had renal hematoma. We found a significant value. No significant value between the incidence of complications and systolic blood pressure and also diastolic blood pressure. We found significant differences between the incidence of complications and high fasting blood sugar, especially urinary-tract infection. MDCT-diagnosed pyelonephritis has high white blood cell count in urine more than 100. Red blood cell significantly increased in urine analysis of cases with renal hematoma and pyelonephritis. Conclusion MDCT is considered the most accurate noninvasive imaging tool not only for diagnosis of urinary-tract stone but also detection of complications after ESWL.

Background The aim was to understand the etiology of vitiligo, many hypotheses have been proposed. Melanocyte survival and skin pigmentation abnormalities may be linked to autophagy deficiencies. Microtubule-associated protein 1 light chain 3 (LC3) is one of the most important indicators of this process. Aim The current study seeks to determine the level of LC3 in patients with nonsegmental vitiligo with lesional and nonlesional skin in comparison with normal skin to indicate the level of autophagy in a trial to elucidate a possible relation with the pathogenesis of vitiligo. Patients and methods The study included 20 patients with nonsegmental vitiligo from whom 20 lesional skin biopsies and 14 biopsies of nonlesional skin were obtained. Moreover, 14 normal skin specimens were taken from healthy individuals as controls. LC3 level was measured in the skin biopsies using enzyme-linked immunosorbent assay. Results The level of LC3 in the lesional and nonlesional skin biopsies of the patients was significantly lower than the control group. Female participants showed lower levels of LC3 than male with a significant difference. The ability of the level of LC3 in lesional and nonlesional skin was also investigated using a receiver operating characteristic curve analysis for diagnosis of the vitiligo, and the results were of predictive ability with a cutoff value of 128.4 ng/ml. Conclusion Lesional and nonlesional skin had lower LC3 levels than normal control skin. So, autophagy deficiency may play a role in vitiligo development.

Background Many low-income to middle-income countries are facing the dual burden of undernutrition combined with overnutrition. The legacy of malnutrition, especially among preschool children, is a huge obstacle to overall national development, so the ultimate aim for all children is to be free of malnutrition in all forms. Aim To assess the prevalence of concurrent stunting and overweight/obesity (OW/OB) among preschool children in Itay Albarud City, El Beheira Governorate, Egypt, and to reveal risk factors associated with the condition. Patients and methods A cross-sectional study was conducted on 445 children aged less than 6 years in Itay Albarud, El Beheira, Egypt, during the academic year 2019/2020. Tools of the study were as follows: (a) a predesigned questionnaire containing sociodemographic data, feeding pattern, and health conditions of the child during infancy and childhood, and (b) weight and height measurement to calculate BMI for the child and parents. Results The prevalence of concurrent stunting and OW/OB was 2%. Concurrent stunting and OW/OB was more common in girls and children living in rural settlements (66.6%) than boys and urban ones (33.4%). Maternal age at child birth and nutritional status of mothers were also important factors contributing toward the condition. Conclusion This study showed a relatively high prevalence of concurrent stunting and OW/OB among preschool children (2%). Different factors seem to be predisposing to this problem, for example, sociodemographic factors, some acute and chronic diseases that affected the child, feeding pattern during infancy, and maternal nutritional status.

Background Safe and gross total resection (GTR) of intra-axial brain-tumor surgery is associated with improving functional outcomes, reducing symptoms, and decreasing the incidence of postoperative complications. Intraoperative imaging helps in achieving the maximum extent of resection. Intraoperative evaluation of the neurological function provides safe tumor resection in eloquent areas. Aim This study aimed to assess the achievement of GTR of intra-axial brain tumors guided by neuronavigation and intraoperative ultrasound and to evaluate the safety of tumor resection in eloquent areas with the use of intraoperative neurophysiological monitoring or awake craniotomy. Patients and methods This study included 30 patients with intra-axial brain tumors in the period from September 2019 to February 2021. Neuronavigation and intraoperative ultrasound were used for all cases, while intraoperative neurophysiological monitoring or awake craniotomy was used for intra-axial brain tumor in eloquent area. Operative details, outcomes, and final results had been recorded and analyzed. Results The mean age was 42 years (4–75 years). GTR was achieved in 18/30 (60%) of all cases. GTR was achieved in 4/10 (40%) of tumors located in the eloquent area, while GTR increased to 14/20 (70%) in noneloquent areas. The mean Karnofsky performance status for all cases has improved from 80 preoperatively to 86.67 postoperatively. Conclusion Neuronavigation and intraoperative ultrasound provides maximization of the extent of resection of intra-axial brain tumors. Intraoperative neurophysiological monitoring or awake craniotomy provides safe tumor resection in eloquent areas.