Background Persistent pulmonary hypertension of the newborn (PPHN) is a multifactorial syndrome, with 0.43–6.8/1000 live birth incidence and 10–20% mortality rate. Aim To compare the efficacy of tadalafil and sildenafil in controlling PPHN. Patients and methods This prospective study was carried out on 40 neonates with PPHN. Patients were equally divided into two groups: group 1 received tadalafil (Cialis 10 mg), 1 mg/kg as a single dose for 48 h, and group 2 received sildenafil (Silden 25 mg), 1 mg/kg/8 h for 48 h. Echocardiography was done at the time of enrollment and 48 h after starting treatment measuring the change in estimated systolic pulmonary artery pressure (ESPAP), patent ductus arteriosus assessment, assessment of left ventricle functions, changes in oxygen saturation, and oxygen requirements. Results Both drugs were successful in improving oxygen saturation, decreasing oxygen requirements, and decreasing ESPAP. There was a significant difference before and after treatment in both groups, whereas the difference between the two groups was statistically insignificant (P>0.05). Conclusion Tadalafil and sildenafil can similarly reduce ESPAP in neonates with PPHN. No serious short-term adverse effects of tadalafil and sildenafil were observed.

Background Breath-holding spells (BHSs) are paroxysmal nonepileptic attacks that occur in some infants and toddlers. Their pathophysiology and etiology are still incompletely well defined. Aim To measure the serum levels of some antioxidant markers in children with cyanotic BHSs. Patients and methods This cross-sectional study included 50 children with cyanotic breath-holding attacks and 50 healthy control children, recruited from Pediatric Neurology Clinic and General Pediatric Clinic, Pediatric Department, Tanta University Hospital. Serum total antioxidant capacity and catalase activity were measured by the spectrophotometric method. Results Total antioxidant capacity and catalase activity levels were significantly lower in children with cyanotic BHS than in normal control children (P<0.05). The number of breath-holding attacks was significantly negatively correlated with total antioxidant capacity (r=-0.77, P=0.03) and catalase activity levels (r=-0.8, P=0.04). Conclusion Children with cyanotic BHS have significantly lower levels of total antioxidant capacity and catalase activity.

Background Vital stains are very important for evaluation of Marx line (ML) location, regularity, and lid wiper epitheliopathy. ML score can be used to assess Meibomian gland function, whereas lid wiper epitheliopathy is considered an early indicator for tear film instability. Aim To evaluate staining characteristics of the lid margin in different disease conditions, such as dry eye, Meibomian gland dysfunction (MGD), and eyelid malposition using vital stains. Patients and methods A total of 80 patients aged between 40 and 60 years were included in this study. Patients were already diagnosed as having dry eye, MGD, and eyelid malposition (ectropion and entropion). Vital stains (fluorescein, rose Bengal, and Lissamine green) were used to assess the lid wiper area and ML position in these diseases. Results The included 80 participants comprised 44 females and 36 males aged from 40 to 60 years, with mean±SD of 45.10 ± 5.42 years for normal participants, and it was 47.35 ± 6.57 years for dry eye participants. ML was straight in 75% of normal group, but it was irregular in 65% of the dry eye group, 100% of the malposition group, and 70% of MGD group. Lid wiper epitheliopathy was mild degree in one-third of normal participants. In dry eye participants, it was moderate and severe (45% for each). Conclusion ML is irregular and moved gradually anterior to the eyelid margin with different diseases such as dry eye, MGD, and eyelid malposition. Lid wiper epitheliopathy provides information about the location of ML, and it can be easily seen by using the vital staining, and it is useful in the diagnosis of tear film instability.

Background Diabetic macular ischemia (DMI) has not received attention despite its importance. The presence of DMI in the context of diabetic maculopathy affects visual acuity and changes management decisions. Aim This study was done to evaluate optical coherence tomography angiography (OCTA) in the detection of macular ischemia compared with fluorescein angiography (FFA). Patients and methods This prospective study was done on 70 eyes (50 eyes of diabetic patients who were diagnosed of macular ischemia by OCTA and 20 control eyes of healthy subjects matched for age and sex) at the outpatient clinic of the Ophthalmology Department, Tanta University, during the period from November 2017 to October 2018. Results In this study, OCTA and FFA were able to detect macular ischemia in all patients, and in most cases, macular ischemia was more evident on OCTA imaging compared with FFA. The two OCTA parameters that were used in this study to evaluate the degree of macular perfusion and ischemia [FAZ area (mm)² and VDZ% for both superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP)] were found to have a statistically significant difference between patient and control groups. Moreover, we used FAZ area (mm)² to evaluate macular ischemia in FFA images. Conclusion OCTA allows early diagnosis of DMI. Unlike FFA, OCTA allows us to evaluate ischemia in SCP and DCP with high-resolution images and allows detection of retinal and choroidal structures, and its images are not affected by leaking vessels. It is better in the evaluation of FAZ area measurements.

Background The gallbladder wall thickness (GBWT) is affected by portal hypertension, so GBWT can predict portal hemodynamic changes. Aim To determine whether noninflammatory GBWT correlates with portal hemodynamic changes and esophageal varices (EV) in cirrhotic patients. Patients and methods A total of 80 patients were enrolled in this cross-sectional study. Patients consisted of 30 cirrhotic patients with EV, 30 cirrhotic patients without EV, and 20 noncirrhotic individuals as a control group. Complete blood count, liver function tests, hepatitis C virus antibody, and HBsAg were assessed. Child–Pugh score was calculated in cirrhotic patients. Moreover, abdominal ultrasonography was performed for measuring wall thickness of the gallbladder, spleen length, and portal vein diameter. Moreover, portal vein Doppler was done for portal blood mean flow velocity measurement. Upper gastrointestinal tract endoscopy was done. Results GBWT was significantly increased in cirrhotic patients with EV compared with cirrhotic patients with without EV and noncirrhotic individuals (P<0.001). Moreover, GBWT was significantly correlated with spleen length, portal vein diameter, and portal velocity in cirrhotic patients with EV (P<0.001). Conclusion The GBWT could be one of the simple noninvasive predictors of portal hypertension and EV as it was positively correlated with portal hemodynamic changes that accompany cirrhotic portal hypertension.

Background Liver cirrhosis is a major source of morbidity and mortality. Esophageal varices and ascites are common complications of portal hypertension. In newly diagnosed cirrhotic patients, endoscopic screening for varices is suggested. This increases the costs and overloads endoscopy units. Aim To study the relationship between serum ascites albumin gradient (SAAG) and presence and severity of esophageal varices in patients with chronic liver disease to validate the use of SAAG as an indirect indication of varices existence. Patients and methods The study was done on 50 adult cirrhotic patients presenting with ascites. Patients were evaluated for laboratory investigations and abdominal ultrasonography. Esophagogastroduodenoscopy was done to find out if varices are present and their severity. Diagnostic paracentesis was done for ascitic fluid examination, and SAAG value was calculated. Based on SAAG value, patients were divided into three groups. Results There was a significant difference in the distribution of varices between SAAG groups. At cutoff value of SAAG of greater than equal to 1.5, the occurrence of varices can be predicted with 76% accuracy, sensitivity of 77%, and specificity of 75%. Conclusions There is a directly proportional significant relation between SAAG value and the presence of esophageal varices, as well as their severity. A cutoff value of SAAG of greater than equal to 1.5 can be used for prediction of varices existence. Accordingly, SAAG could be used to predict the development of varices among other noninvasive predictors.

Background Transcranial Doppler is a noninvasive approach with high temporal resolution, permitting continuous cerebral blood flow velocity recording through major cerebral arteries. Aim To determine cerebral blood flow (CBF) changes in neonatal sepsis (NS) by ultrasound (US) Doppler examination. Patients and methods This prospective case–control trial was conducted on 60 neonates who were divided into two groups: group I (sepsis): 32 neonates with NS diagnosed by clinical and laboratory data and group II (control): 28 healthy neonates with gestational age and sex matched. All cases underwent detailed antenatal and natal history, clinical and laboratory investigations and transcranial Doppler examination with assessment of CBF. Results As regards anterior cerebral artery (ACA) and middle cerebral artery (MCA), peak systolic velocity (PSV) (cm/s) and end-diastolic velocity (EDV) (cm/s) were significantly increased in the sepsis group than in the control group (P<0.001), but both resistive index and pulsatility index were significantly decreased, in the sepsis group than in the control group (P<0.001). Validity of MCA PSV with a cut-off point of 55.4 detects a sensitivity of 94% and specificity of 86%; validity of MCA EDV with a cutoff point of 18 detects a sensitivity of 94% and specificity of 89%; validity of ACA PSV with a cutoff point of 49.3 detects a sensitivity of 88% and specificity of 93%; validity of ACA EDV with a cutoff point of 21 detects a sensitivity of 91% and specificity of 93%. Conclusion NS was found to elevate both PSV, EDV, decrease resistivity, and pulsatility indices causing an elevated CBF and a decreased resistance.

Background The frequency of early stroke occurrence after transient ischemic attacks (TIAs) has been poorly studied. Aim This work aimed to determine the possible predictors of early ischemic stroke within 90 days of the first attack of TIA among Egyptians. Patients and methods A total of 80 patients presented with acute ischemic stroke or TIAs were recruited and were divided into group A, which included 40 patients presented with ischemic stroke preceded by TIAs within the last 3 months, and group B, which included 40 patients who had one or more TIAs and were asymptomatic for more than 3 months. All patients were subjected to the following: neurological assessment, laboratory investigations, cardiologic assessment, and brain imaging. Results Older patients were more liable to stroke occurrence after TIAs. Hospital admission during TIAs significantly reduced the risk of early stroke occurrence. Receiving medical treatment during TIAs significantly reduced the risk of early stroke occurrence. Hypertension was the only significant modifiable risk factor for early stroke occurrence. Multiple TIAs were significant predictors of early stroke recurrence. The rate of stroke occurrence was higher during the short-term follow-up, especially during the first week. Magnetic resonance diffusion changes were significant predictors of early stroke occurrence. Conclusions The main prognostic factors for early stroke occurrence after TIAs were age, hypertension, hospital admission, early medical treatment after TIAs, duration and frequency of TIAs symptoms, ABCD2 score, and positive findings in brain imaging.

Background Drugs are an important cause of liver injury. Chrysin is a flavonoid and the main constituent of Oroxylum indicum. Many pharmacological and biological benefits have been attributed to it. These include anti-apoptotic, anti-inflammatory, and antioxidant effects. Aim We intended investigating the anti-apoptotic, anti-inflammatory, in addition antioxidant influence of chrysin on lithium-induced hepatotoxicity in rats. Materials and methods The present research was conducted at the Medical Biochemistry Department, Faculty of Medicine, Tanta University, Egypt. A total of 40 albino male rats weighing between 150 and 200 g were included in this experiment and were split randomly into 4 equal groups (each group involved 10 rats): group I (control), group II (lithium treated), group III (lithium+chrysin), and group IV (chrysin treated). All rats that were acquired originated in the laboratory’s animal colony at Tanta University. Liver function tests, total and direct bilirubin, malondialdehyde, superoxide dismutase, reduced glutathione, caspase-3, and nuclear factor-kappa B levels were measured. Results Chrysin treatment resulted in significant decrease in liver functions, total and direct bilirubin, caspase-3, nuclear factor-kappa B, and malondialdehyde levels and significant increase in superoxide dismutase activity, with reduced glutathione intensity. Conclusion Based on these correlating findings, it is possible to conclude that chrysin has protective potential on lithium-induced hepatotoxicity; therefore, it represents a promising therapeutic strategy in its management.

Background Fomites can serve as a vehicle in transmission of health care-associated pathogens especially in intensive care units (ICUs) and operating rooms (ORs) where the patients are immunocompromised and at high risk of acquiring multidrug-resistant bacteria. Aim To assess bacterial contamination on inanimate surfaces and equipment in ICUs and ORs at Tanta University Educational Hospital to detect the potential reservoirs of hospital-acquired infections (HAIs) and to give appropriate recommendations for corrective actions. Materials and methods The samples were collected in sterile nutrient broth and incubated for 24 h. The isolation and identification of pathogenic bacteria were done through standard microbiological methods. Antibiotic susceptibility tests of the isolates were assessed by disc diffusion method. Results The contamination levels from group I (hospital samples) and group II (control samples) were 88.3% and 84%, respectively. In group I, Gram-negative bacilli were the most frequent isolates followed by Gram-positive cocci then Gram-positive bacilli, fungi, and lastly Gram-negative cocci that represented 35.7%, 34.4%, 25.9%, 3.2%, and 0.8%, respectively. In group II, all bacterial isolates were Gram-positive bacilli that represented 100%. Conclusion The presence of potential pathogenic-resistant bacteria on inanimate surfaces in hospital is of great health concern and these surfaces can serve as sources of HAIs.