Background Cirrhosis is the 14th leading cause of mortality globally. Additionally, it is subclassified by clinical stage. Hepatocellular carcinoma (HCC) was reported to account for ~4.7% of patients with chronic liver disease in Egypt. Early detection and treatment are highly beneficial. Growth differentiation factor 15 (GDF-15) proteins are implicated in the infection, fibrosis, and apoptotic processes of the liver. GDF-15 mRNA is mostly found in the heart, kidney, and lungs, as well as in the liver. The adult liver expresses the greatest amounts of GDF-15 following surgical and pharmacological therapies that produce acute liver damage. Aim This study’s objective was to assess serum GDF-15 levels in individuals with cirrhosis of the liver and HCC on top of cirrhosis of the liver. Patients and methods We have recruited 90 people in three groups: group 1 comprised 35 patients with HCC, group 2 comprised 35 individuals having cirrhosis of the liver, and group 3 comprised 20 nonhepatic individuals who acted as controls. Results In the HCC group, alpha-fetoprotein (AFP) was significantly higher than in the cirrhosis group, and the cirrhosis group has significantly higher AFP than in the control group. In comparison with the cirrhosis group, and in comparison with the control group, the HCC group had a significant increase in GDF-15 level. Conclusions GDF-15 levels were substantially greater in individuals with HCC compared with patients with cirrhosis and healthy controls. It is more sensitive, specific, and accurate than AFP. Thus, we may regard GDF-15 as a new marker for the diagnosis of HCC.

Background Liver is a crucial organ for vitamin D metabolism, so vitamin D deficiency is prevalent in liver cirrhosis patients. Hepatitis C is also a global infective disease caused by hepatitis C virus (HCV) and chronic hepatitis leads to liver cirrhosis. Aim To evaluate vitamin D replacement therapy effect through laboratory parameters in HCV cirrhotic patients. Patients and methods Actual enrollment of 25 HCV cirrhotic patients (compensated and decompensated) with a 25(OH)D level of less than 30 ng/ml. All study population are subjected to be investigated at the baseline visit for 25(OH)D, ionized calcium, parathyroid hormone, complete blood count, random blood sugar, glycated hemoglobin (HbA1C), renal function tests, and liver function tests. Study participants received appointments for follow-up visits during the 12 weeks of vitamin D replacement therapy. Results After 3 months of vitamin D replacement therapy, the vitamin D level significantly improved (P=0.001), with significant increase in ionized calcium (P=0.001) and HbA1C (P=0.001). Vitamin D was significantly decreased as the Child score progressed from A to C (P=0.001). There was a significantly negative correlation among vitamin D level, Child score, and prothrombin time. However there was significant positive correlation among vitamin D level, platelet count, albumin, and ionized calcium. These correlations were before and after treatment. Conclusion In HCV cirrhotic patients, supplementation with vitamin D significantly increased 25(OH)D level and ionized calcium. Also, this was associated with improvement of HbA1C, but there was no significant effect on liver function parameters.

Background Stage 4 chronic kidney disease (CKD) in comparison with earlier stages of CKD is associated with higher morbidity, mortality, and costs, and current guidelines recommend greater intensity of care for patients with stage 4 disease. Aim Our study assessed the level of care of patients with diabetic nephropathy (DN) in predialysis stage (CKD stage 4) in Tanta. Patients and methods A total of 257 patients experiencing DN stage 4 from Tanta were subjected to a questionnaire sheet that included age; duration of diabetes; time of diagnosis of DN; treatment of hypertension; patient diet; antidiabetic drugs; level of serum creatinine; estimated glomerular filtration rate; hemoglobin level; serum levels of Ca, Ph, parathyroid hormone, Na, K, and HCO₃; lipid profile; statin therapy; and hemoglobin A1c. The data collected were compared with Kidney Disease: Improving Global Outcomes clinical practice guideline for the evaluation and management of CKD. Results Of the 257 patients, 27.6% were type 1 diabetics and 72.4% were type 2. The mean duration of diabetes was 12.43 years (±6.388). Overall, 29.9% had uncontrolled elevated blood pressure, of whom 27.2% were on no antihypertensive drugs. Renin-angiotensin-aldosterone system blockage agents were used in 52.1% of patients. Overall, 57.2% had good control of diabetes. Dyslipidemia was found in 49.4% patients of them 62.2% patients were on no statin therapy. Hypocalcemia was found in 5.4% patients, hyperphosphatemia was found in 12.4% patients, 4.7% had secondary hyperparathyroidism, 79.8% had bicarbonate level below normal range, 9.7% had mild elevate potassium level, and 20.4% had anemia. Conclusion Our patients reached stage 4 early after few years of diabetes, and parameters that need more level of care include hypertension, diabetes, treatment used for diabetes, dyslipidemia, and acidosis.

Background Osteoprotegerin (OPG) acts as an important regulatory molecule in vascular disease. The presence of diabetes mellitus greatly increases the risk of peripheral artery disease (PAD), and also both subclinical and overt hypothyroidism have been clearly linked with dyslipidemia, which is a known risk factor for peripheral arterial disease. Aim We aimed to evaluate the relation between serum OPG and PAD among type 2 diabetic patients with subclinical hypothyroidism (SCH). Patients and methods A total of 60 participants were enrolled in the study who were divided into three groups: group 1 included 20 type 2 diabetic patients with normal thyroid function, group 2 included 20 type 2 diabetic patients with SCH, and group 3 included 20 healthy participants. They were subjected to complete history taking, complete clinical examination, routine laboratory investigations, serum OPG level, neck ultrasound, and Doppler study for ankle-brachial index (ABI). Results We found that OPG levels were statistically elevated in type 2 diabetic patients with SCH group compared with type 2 diabetic patients with euthyroidism (P=0.040). Also there was lower ABI in type 2 diabetic patients with SCH compared with those with euthyroidism, showing an increased incidence of PAD in group 2 than group 1 and nondiabetic patients, with statistically significant results in between groups. Conclusions Our results found that diabetic patients with SCH revealed an independent association between thyroid-stimulating hormone and serum level of OPG. Likewise, we found a statistically significant difference between OPG level and ABI among type 2 diabetic patients. Therefore, OPG can act as a marker of PAD among diabetic patients with SCH.

Background Ulcerative colitis is a huge health problem, and its occurrence is increasing around the world. It is manifested with abdominal pain, diarrhea, bloody stool, and body weight loss. Aim This work aimed to evaluate the possible effects of quercetin on a rat model of ulcerative colitis that was induced by acetic acid. Materials and methods A total of 40 adult male albino rats were used in this study. Rats were divided into controls, that is, group I, which included 10 rats that received intrarectal injection of a single dose of 2 ml of physiological saline, and experimental cases, that is, group II. The experimental group contained 30 rats and were divided into three equal subgroups. Subgroup IIA received 50 mg/kg/day of quercetin orally for three consecutive days, subgroup IIB received intrarectal injection of a single dose of 2 ml of 4% acetic acid solution for ulcerative colitis induction, and subgroup IIC received 50 mg/kg/day of quercetin orally for 3 consecutive days before induction of ulcerative colitis by a single dose of acetic acid that was received by intrarectal injection on the fourth day. Colonic specimens were subjected to histological and immunohistochemical examinations. The data were analyzed statistically. Results The current study of subgroup IIB showed disturbed normal histological architecture of colonic structure, but in subgroup IIC, quercetin resulted in preservation of normal histological architecture of the colon. Conclusion There is a correlation between quercetin and reduction of the severity of acute attacks of ulcerative colitis induced by acetic acid in adult male albino rats. Quercetin leads to protection of colon.

Background Lung fibrosis is a severe form of idiopathic interstitial pneumonia. Targeting cells is a good approach in drug delivery. Pirfenidone is an antifibrotic drug ‘used’ for the treatment of idiopathic pulmonary fibrosis. Aim The aim of the present work was to study the effect of nanoparticles (niosomes) loaded with pirfenidone on bleomycin-induced lung fibrosis in adult male albino rats with different histological techniques. Material and methods A total of 40 rats were divided into six groups: group I, control (five rats); group II pirfenidone treated (five rats); group III, encapsulated-pirfenidone treated (five rats); group IV, bleomycin treated (five rats); group V, bleomycin-pirfenidone treated (10 rats), which was then subdivided into two subgroups, that is, subgroup Va (five rats) and subgroup Vb (five rats); and group VI, bleomycin-encapsulated-pirfenidone treated (10 rats), which was then subdivided into two subgroups, that is, subgroup VI a (five rats) and subgroup VIb (five rats). Lung specimens were stained using hematoxylin and eosin-stained, Masson’s trichrome, anti-transforming growth factor beta 1 (TGF-β₁), and toluidine blue for light microscopic examination and transmission electron microscopy. Assessments of mean area % of the stained collagen fibers and intensity of TGF-β₁ and the mean thickness of blood–air barrier of ultrathin sections were performed and then subjected to statistical analysis. Results Encapsulated pirfenidone-treated subgroups showed more patent alveoli, sacs, and ducts; patent bronchioles; blood vessels; and more type I pneumocytes and less type II. The blood–air barrier had thin basal lamina. There were better results in collagen deposition and TGF-β₁ in lung tissues with encapsulated pirfenidone treatment. Conclusion Encapsulated pirfenidone resulted in better improvement than using pirfenidone only.

Background The thickness of the cornea is a sensitive and important indicator for the health of the cornea. It is beneficial for evaluating endothelial pump function and corneal barrier, monitoring the disorders of the cornea such as keratoconus and corneal edema, and choosing patients for refractive surgery. Aim The aim of this work was to compare central corneal thickness (CCT) using orbscan, ultrasound pachymetry (USP), and anterior segment optical coherence tomography (AS-OCT). Patients and methods This prospective study was carried out on 60 eyes of 30 individuals aged from 18 to 40 years old and with clinically normal cornea who attended the outpatient clinic of Tanta University Hospital and Nour El Ein Hospital from April 2018 till March 2019. Results There was no statistically significant difference in mean minimal measurement of the thickness of the central cornea as measured by the three devices. There was a statistically significant difference in the mean maximal measurement of the CCT as detected by the three devices. The average CCT was statistically significantly different across the three devices. Conclusions OCT, USP, and orbscan were reliable for CCT measurement. Orbscan and USP were more reproducible, but OCT and ultrasound were more technically dependent. The average CCT was the highest by orbscan.

Background Diabetic retinopathy is a complication of the microvessels related to diabetes that most commonly leads to blindness. Optical coherence tomography angiography (OCTA) is an innovative noninvasive procedure that allows depth-resolved imaging of the microvessels of the retina and choroid. Aim The aim of this work was to study OCTA of macular area in diabetic patients having no diabetic macular edema and in healthy persons. Patients and methods This cross-sectional, prospective research included 55 participants who were divided into two groups: group I included 30 eyes of 30 cases with type 2 diabetes mellitus [having no diabetic macular edema on fluorescein angiography (FA), clinical assessment, and optical coherence tomography (OCT) macular B-scan], and group II included 25 eyes of 25 healthy persons not having any ocular or systemic diseases. Both groups underwent FA, OCTA, and OCT. Two metrics from OCTA images were quantified: foveal avascular zone area and vessel area density at two levels, that is, superficial capillary plexus and deep capillary plexus. Moreover, diabetic changes such as microaneurysms, capillary nonperfusion, and vessel tortuosity were estimated in the two groups. Results Between cases and controls, a statistically significant variance in vessel area density values and foveal avascular zone area was observed in superficial capillary plexus and deep capillary plexus utilizing OCTA. No significant differences were detected between diabetic cases and normal participants regarding central foveal thickness. Conclusions OCTA was capable of detecting microvascular alterations in diabetic eyes before visualization through clinical evaluation or FA. OCTA may be able to rapidly and noninvasively test for diabetic maculopathy.

Background The peripheral cornea has unique features, which make it more vulnerable to inflammatory reactions and necrosis. Peripheral corneal ulcer is caused by various infectious and noninfectious ocular and systemic diseases. It may impair vision by inducing astigmatism and ulcer progression to the center or threaten the eyeball integrity by spontaneous perforation. So, early diagnosis and proper treatment prevent blindness. Aim To evaluate different modalities for management of peripheral corneal ulcer. Patients and methods In this prospective study, 30 eyes of 29 patients having peripheral corneal ulcer were evaluated and treated with medical treatment and surgical intervention as adjunctive therapy in resistant cases. The duration of the study was 6 months with a follow-up period of 3 months. Results Of 30 eyes, 14 responded to medical treatment, with complete epithelial healing ranging from 2 to 6 weeks, with a mean of 3.36 ± 1.34 weeks. On the contrary, 16 of 30 eyes were resistant within 2 weeks and underwent surgical interference. A total of seven eyes were managed by amniotic membrane transplantation, and nine eyes were treated with tectonic keratoplasty. Time of healing ranged from 4 to 14 weeks, with a mean of 9.38 ± 3.91. All eyes showed anatomically successful outcomes. Conclusion Mild infectious peripheral keratitis heals on medical treatment. Cases of moderate infectious peripheral keratitis with history of diabetes mellitus or exposure keratitis need amniotic membrane transplantation as adjunctive therapy. Severe noninfectious cases with history of rheumatoid arthritis or Mooren’s ulcer need systemic treatment and tectonic keratoplasty.

Background Keratoconus is mainly a noninflammatory, bilateral corneal disease, which changes stability and refractive intensity. Aim Studying the visual acuity, refraction, and keratometric data of keratoconic patients who underwent either standard or accelerated cross-linking at 6-month duration. Patients and methods A randomized, comparative study with 60 eyes of 30 keratoconus patients. The study participants were categorized into two groups: A and B. Patients in group A underwent epi off conventional corneal crosslinking according to The Dresden’s protocol (3 mW/cm² for 30 min), while patients in group B underwent epi off accelerated corneal crosslinking (30 mW/cm² for only 3 min). Preoperative and postoperative outcomes were evaluated and then compared. Results The conventional corneal crosslinking group showed more improvement than the accelerated corneal crosslinking group in postoperative uncorrected distant visual acuity and corrected distant visual acuity at 6 months of follow-up. The two groups were similar in terms of spherical equivalent and manifest refraction. No significant change in K1 and K2 in the both groups from preoperative at 6 months. The same results were found for 6 months of f/up of corneal topography as well as central corneal thickness (CCT) and thinnest location of cornea thickness. Conclusions The study has increased the proof on the power of conventional corneal crosslinking in comparison with accelerated corneal crosslinking at 6 months of follow up.

Background Primary immune thrombocytopenic purpura (ITP) is an autoimmune illness characterized by increased platelet breakdown in the peripheral blood as well as impaired platelet production and it is also characterized by platelet counts less than 100 × 10⁹/L. T-follicular helper (TFH) cells have been linked to the pathogenesis of autoimmune conditions. Aim The study’s aim was to study the role of TFH cells and their function in ITP children. Patients and methods This research involved 25 ITP patients and 20 age-matched and sex-matched controls, with the frequency of circulating TFH cells measured by BD FACS Calibur Flowcytometer in both ITP patients and healthy controls. Results The results showed that the ratio of circulating CD4+ CXCR5+ PD1+ (TFH) in ITP (+) patients, that is, (ITP patients with antiplatelet antibody-positive results) was dramatically higher than those of ITP (−) patients, that is, (ITP patients with antiplatelet antibody-negative results) and it was discovered that the ratios of circulating CD4+ CXCR5+ PD1+ (TFH) were dramatically higher in ITP (+) patients than the control group. However, the ratio of circulating CD4+ CXCR5 +PD1+ (TFH) was not dramatically different between ITP (−) patients and the control group. Conclusion Patients with ITP have an increased number of TFH cells, which prove its critical role in B-cell proliferation, resulting in the development of autoantibodies that contribute to the pathophysiology of ITP.

Background Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in the bone marrow producing excessive amounts of monoclonal immunoglobulins (Ig) and suppression of other normal polyclonal Igs, leading to bone destruction and marrow failure. B-cell maturation antigen (BCMA) is known to bind to B-cell-activating factor (BAFF) or a proliferation-inducing ligand (APRIL), leading to the activation of cell proliferation pathways and upregulation of antiapoptotic proteins, which is considered the main step in the pathogenesis of MM. Aim This study was planned to evaluate serum BCMA levels in MM patients and its clinical significance. Patients and methods This study was carried out on 40 newly diagnosed MM patients and 40 apparently healthy individuals served as the control. The two studied groups were compared as regards serum BCMA levels using the enzyme-linked immunosorbent assay technique. Results Results showed that there was a statistically significant increase in MM patients when compared with the control group, and there was a significant positive correlation between BCMA level and plasma cells in bone marrow, M protein, number of bone lesions, and beta-2 microglobulin. However there was no correlation between BCMA level and age, creatinine, and hemoglobin. Conclusion Serum BCMA level was significantly elevated in MM patients compared with healthy controls that may suggest the role of BCMA in the pathogenesis of MM. The high sensitivity of BCMA suggests that it may be a novel diagnostic marker, and its level was positively correlated with other prognostic markers. It may be used as a prognostic marker in MM patients.

Background Internet addiction is a serious and growing problem. There is an emerging public health concern over the increase in Internet usage, particularly among adolescents. Aim The purpose of this study was to assess the pattern of Internet use among university students and to evaluate the personality and the associated psychiatric disorders with students of Internet addiction. Participants and methods A total of 300 medical students were subjected to the Internet Addiction Test (IAT) developed by Young in 1998. Personality evaluation by Eysenck Personality Questionnaire and psychiatric interview by Arabic version of Mini-International Neuropsychiatric Interview were done for Internet addicts to assess any associated personality or psychiatric disorders. Results Students were divided into four Internet user groups according to their IAT total scores: normal Internet users (n=117, 39.0%), mild Internet addicts (n=116, 38.7%), moderate Internet addicts (n=64, 21.3%), and severe Internet addicts (n=3, 1.0%). Males were more prone than females to develop severe forms of Internet addiction. Family environment had a major effect on developing Internet addiction. Neurotics and introverts were more susceptible to develop Internet addiction than others. Depression and anxiety were significantly associated with Internet addiction. Conclusions This study suggests that students who use the Internet excessively exhibit significantly more psychiatric symptoms than students who use the Internet less frequently. In addition, pathological Internet addicts appear to have a distinctive personality and social profile when compared with nonpathological users.

Background Reintervention is typically difficult owing to perinephric anatomical changes in individuals with a history of open stone surgery. Aim The aim of the current study was to see what effect open renal surgery may have on the effectiveness and morbidity of later percutaneous nephrolithotomy (PCNL). Patients and methods PCNL was performed on 100 patients between March 2017 and March 2018. Overall, 20 of these patients were eliminated (tubeless or bilateral simultaneous PCNL). The remaining 80 patients were divided into two groups: 40 primary patients and the rest (history of open nephrolithotomy). Before intervention, a standard preoperative assessment was conducted. Statistical analysis was performed using SPSS v. 20 with the χ² test and the independent samples t-test. P value <0.05 was considered statistically significant. Results In terms of demographics and stone load, both groups were comparable. Group 1 had fewer attempts to access the pelvicalyceal system than group 2 (1.2 ± 0.5 vs. 2.7 ± 0.9, respectively), which was statistically significant (P=0.001*). Moreover, there was a statistically significant difference in the mean operational time between the two groups (85.24 ± 19.47 vs. 128.39 ± 17.45 min, respectively), with a statistically significant difference (P=0.001*). The rate of blood transfusion was similar in both groups (P=0.396). The remaining problems in both groups were similar. Conclusion Patients with renal stone surgery might require additional attempts to reach the pelvicalyceal system and may have difficulties with tract dilatation owing to retroperitoneal fibrosis. However, the overall morbidity and efficacy are the same in both groups.

Background Cancer cells are characterized by high cellular stress that is considered crucial for cancer cell survival and metastasis. Aim In this study, we assessed cellular stress in Ehrlich ascites carcinoma (EAC) cells before and after treatment with intraperitoneal zinc oxide nanoparticles. Materials and methods This experiment was performed on six groups of mice: 90 female albino mice were included in this study and were divided into six groups (n=15 per group): C [saline treated mice (20 ml/Kg intraperitoneal (i.p.)], CZn20/2d [ZnO NP-treated mice (20 mg/kg i.p. every other day], EC [untreated EAC-bearing mice], EZn 10/d [EAC-bearing mice administered with ZnO NPs 10 mg/kg everyday], EZn 10/2d [EAC-bearing mice administered with ZnO NPs 10 mg/kg every other day], EZn20/2d [EACs-bearing mice administered with ZnO NPs 20 mg/kg every other day]. After 2 weeks, the ascitic fluid and mammary gland were collected to measure the level of nitric oxide (NO) and peroxynitrite. Results Based on this results, there was a significantly high level of NO and peroxynitrite in the EAC groups compared with the control group. Zinc oxide nanoparticles significantly decreased the level of NO and peroxynitrite in the EAC groups compared with the control group. Conclusion This study implied that cancer cells have higher cellular stress, and it was efficiently decreased by treatment with zinc oxide nanoparticles indicating its efficacy against cancer cells.

Background Adenoid hypertrophy has a major effect on development of middle ear effusion not due to the large volume but through combination of factors including local immune regulation, biofilm, and immunoglobulin E allergic reaction. Aim To assess the correlation between adenoid tissue volume and development of middle ear effusion. Patients and methods This was a sequential analysis study including a sample size of 195 patients from 4 to 12 years. They were diagnosed with adenoid hypertrophy, confirmed by flexible nasopharyngeal endoscopy (FNE) and lateral neck radiographs. They were evaluated by tympanometry to assess otitis media with effusion. Results We found that 59 (29.2%) patients had FNE grade 1, 68 (35.4%) patients had FNE grade 2, 68 (35.4%) patients had FNE grade 3, and no patients had grade 4. A total of 101 (52.6%) patients had a tympanogram type A and 94 (47.4%) patients had a tympanogram type B. There was no statistically significant correlation between tympanogram groups in relation to the FNE (P=0.762). Conclusion We suggested that there was no valuable correlation between change in size or volume of adenoid tissue and development of middle ear effusion.