Background Human papilloma viruses (HPVs) are a group of viruses with high global distribution. Persistent infection with high-risk HPV (HR-HPV) genotypes had been linked to the progression of different cancers including cervical cancer. Data are insufficient about HPV status in Egypt. Aim This study was held to determine the HR-HPV genotypes among Egyptian women by using single-tube seminested PCR. Patients and methods A total of 203 cervical samples were collected and subjected to pathological examination and HR-HPV DNA detection by seminested PCR using MY09/MY11 and GP6+ primers. Results Of 203 examined samples, 90 (45%) tested positive for HR-HPV detection. HPV DNA was detected in 68.8 and 50% of women with cervical intraepithelial neoplasia I and cervical intraepithelial neoplasia II, respectively. However, it was detected in 41.1% of women with normal cervical pathology.

Background Interleukin-18 (IL-18), known as a member of IL-1 family cytokines, is found to be elevated as a part of the chronic low-grade inflammatory process in obesity, metabolic syndrome, and type 2 diabetes (T2D). Patients with carotid intima-media thickness (CIMT) exhibited a higher level of IL-18 in the serum. Objective To study the relation between serum IL-18 and CIMT in patients with type 2 diabetes mellitus (T2DM). Patients and methods A total of 60 patients diagnosed as having T2D and 30 age-matched and sex-matched patients as a control group were recruited in this study. Diabetic patients were divided into two groups according to the presence or absence of diabetic nephropathy. Clinical examination and laboratory investigations including serum IL-18 (by ELISA) and CIMT of both common carotid arteries were carried out. Results Mean serum IL-18 level was significantly increased in patients with T2DM when compared with the control group. There was a significant increase in the mean serum IL-18 in patients with diabetic nephropathy compared with those patients without nephropathy. Moreover, there was a significant positive correlation between serum IL-18 and CIMT, glycated hemoglobin, serum lipids, creatinine, urea, and urinary protein in patients with T2DM (group I) (P<0.001). Conclusion Serum IL-18 level and CIMT were higher in T2DM than that in controls and in diabetic patients with nephropathy compared with those without nephropathy. Higher serum IL-18 levels correlated with larger CIMT, suggesting a role of IL-18 in atherosclerosis.

Background Hepatitis C virus (HCV) infection is a common cause of chronic hepatitis, which leads to cirrhosis of the liver and hepatocellular carcinoma. Chronic hepatitis can cause iron buildup in the liver and result in liver injury. The major iron metabolism regulator, the hepatic hormone hepcidin, inhibits iron absorption and recycling, and as hepcidin is suppressed by the virus, it contributes to the pathogenesis of the liver. Aim To assess serum iron markers in patients with chronic hepatitis C (CHC) as opposed to people who are healthy and a summary of interactions of HCV and iron overload. Patients and methods This case–control study was performed on 30 hepatitis C-infected Egyptian patients (group I) and 15 apparently healthy control (group II). Routine laboratory investigations, as well as serum hepcidin and iron marker assessments were performed. Results Throughout this study, the serum hepcidin level in patients significantly decreased relative to the control group (P<0.001). The patients showed significantly higher serum iron, transferrin saturation, alanine aminotransferase, and aspartate aminotransferase compared with the control group (P<0.001). Serum albumin in patients’ group was considerably decreased in comparison with the control (P<0.05). There was a highly statistically significant lower platelet count value in patients compared with the control group (P<0.001). The interaction between hepcidin and iron, transferrin, and alanine aminotransferase is significantly negative. Conclusion Hepatic iron deposition is a joint feature in patients with CHC. Chronic HCV infection may reduce serum hepcidin, which may lead to iron overload in these patients. So hepcidin is a surrogate marker for evaluation of iron overload in patients with CHC.

Objectives To compare the advantages of conservative breast surgery (CBS) to modified radical mastectomy (MRM) regarding the outcome, prognosis, and survival in management of early breast cancer. Patients and methods This study included 100 patients attending Al Zahraa University Hospital from March 2016 to February 2019 diagnosed as having early breast cancer (stages I and II breast cancer). Their age ranged from 25 to 60 years old. They were classified into two group: group A, which underwent breast-conservative surgery (n=15), and group B, which MRM (n=85). Results The goals of using CBS and radiation therapy to treat patients with early breast cancer (stages I and II) are to provide surgical equivalent to that obtained with MRM. There was only a small risk of recurrence in the treated breast and had satisfactory cosmetic result. The success of CBS depends not only on appropriate patient selection but also on the combination of adequate surgical margins and an acceptable cosmetic result. Conclusion Breast-conservative surgery and mastectomy result in nearly equivalent survival rates for patients with stages 0, I, or II disease. The decision to conserve the breast must be made individually.

Background Chronic suppurative otitis media is an inflammation of middle ear of more than 2 weeks with treatment without improvement. Aim The aim was to evaluate the effect of drill-generated noise after mastoidectomy on hearing status of the nonoperated ear. Patients and methods This is a prospective study of 40 patients with unilateral chronic suppurative otitis media attending ENT Departments of Al-Zahraa University Hospital, Faculty of Medicine (Girls), Al-Azhar University, and El-Maadi Armed Forces Medical Complex during the period from August 2018 till September 2019. Patients were divided into two equal groups: group A included 20 patients who underwent mastoidectomy operations with the usage of mastoid drilling and group B underwent myringoplasty without the usage of drilling. Pure tone audiometry (PTA) and otoacoustic emissions (OAEs) were done for nonoperated ear of all patients preoperatively and at days 1, 2, and 7 postoperatively. Results Result showed that postoperative nonoperated ear hearing was affected in group A. This effect is not significant enough to cause hearing loss as detected by PTA but can be detected by OAE in which their amplitude deteriorated at first day postoperatively and improved after that back to the normal preoperative values within 1 week. However, hearing in nonoperated ear of group B was not affected by observation of PTA or OAE. Conclusion Drill-induced noise during mastoidectomy affects hearing of contralateral nonoperated ear temporarily through some outer hair cells (OHC) damage.

Background Adnexal masses are considered one of the most common disorders in gynecology. Ultrasound remains the most widely used imaging modality to differentiate benign from malignant adnexal masses. Patients and methods This prospective study was conducted upon 50 female patients with 56 adnexal lesions. All patients were evaluated by either transabdominal ultrasonography, transvaginal ultrasonography, or both. All patients were evaluated by gray-scale ultrasound. Color Doppler examination was performed in certain cases with solid components. This study was approved by the Ethics Committee, and all patients gave their informed written consent before inclusion in the study. The radiological and histopathological results were collected then statistically analyzed. Results Our study showed that ultrasound had a sensitivity of 85.7% and a specificity of 90.5% with an overall accuracy of 89.3% in differentiation between benign and malignant lesions. The most significant ultrasound parameters suggesting malignant criteria of adnexal masses in our study were thick wall more than 3 mm, thick papillary projection, and thick septae more than 3 mm on gray-scale ultrasound, resistive index less than 0.5, and central distribution of vessels at color Doppler. Conclusion Ultrasound is recommended to be a very useful highly diagnostic and a reliable modality with good sensitivity and specificity for the diagnosis of adnexal masses.

Background Lacking data about tumor necrosis factor receptor (TNFR)-associated factor (TRAF) molecules in human inflammatory reactions with in-vitro studies which demonstrated the involvement of TRAF molecules in the pathogenesis of inflammatory diseases. Aim The authors aimed to perform a study evaluating expression of TRAF-2, TRAF-5, and interleukin-6 receptor (IL-6R) in psoriasis vulgaris and evaluate their role in IL-6 pathway involved in psoriasis pathogenesis. Patients and methods This is a case–control study, where 40 patients with psoriasis vulgaris and 40 healthy controls underwent taking of 4-mm punch skin biopsy. The diagnosis was confirmed with hematoxylin and eosin, and immunohistochemistry examination was done using IL-6R, TRAF-2, and TRAF-5 polyclonal antibodies for all specimens. The immunohistochemistry results were analyzed and scored either no staining (score 0) or positive staining (either +1, +2, or +3). Results Tissue level expression of IL-6R, TRAF-2, and TRAF-5 showed highly statistically significant difference between patients with psoriasis vulgaris and healthy controls, with no relation to clinical data, except for TRAF-2 in inflammatory lymphocytes, which showed a statistically significant relation with duration of the disease. There was a statistically significant relation between inflammatory expression of IL-6R and both TRAF-2 and TRAF-5 and a statistically significant relation between keratinocyte’s nuclear expression of IL-6R and TRAF-5 only. Conclusion High expressions of TRAF-2 and TRAF-5 in patients with psoriasis vulgaris with IL-6R illustrate their contribution in psoriasis pathogenesis, with no relation to disease severity.

Background Metabolic syndrome (MetSyn) and type 2 diabetes mellitus (T2D) are globally and exponentially increasing. One of the important cytokines that plays a role in metabolic modulation is fibroblast growth factor-21 (FGF-21). Aim The aim was to assess serum FGF-21 in Egyptian women having MetSyn with and without T2D and to study its relation to insulin resistance. Patients and methods This is a case–control study. Blood samples were obtained from 30 women fulfilling the criteria for diagnosis of MetSyn (15 women with and 15 without T2D) and 15 age-matched controls. Serum levels of FGF-21 were quantitatively determined by enzyme-linked immunosorbent assay. Results Patients with MetSyn had significantly elevated FGF-21 values. This was more pronounced in the group having MetSyn including T2D. FGF-21 levels correlated positively with obesity, insulin resistance indices, and low-density lipoprotein cholesterol level and negatively with high-density lipoprotein cholesterol. FGF-21 was significantly related to waist circumference, the main visceral obesity index by linear regression analysis (P<0.007). Logistic regression analysis demonstrated an independent association between MetSyn and FGF-21 value. Conclusion MetSyn was found to be associated with serum FGF-21. This association was stronger than that with homeostasis model assessment-insulin resistance and fasting plasma glucose. This suggests that serum FGF-21 may be used as a potential diagnostic biomarker for MetSyn.

Background Tranexamic acid (TXA) is one of the prominent amino acid lysine synthetic derivatives having its antifibrinolytic effect through the reversible blockade of the lysine-binding sites on plasminogen molecules. It is regularly administered intravenously to treat and avoid bleeding, with good results. Objective This study was carried out to evaluate the effectiveness, safety, and complications of using TXA in elective cesarean section (CS). Patients and methods This was a prospective study that was conducted at Al-Zahraa University Hospital and El Sahel Teaching Hospital on 200 patients planned for elective CS: 100 patients were given 1 g/10 ml TXA (group A) diluted with 20 ml of 5% glucose, whereas another 100 patients received 30 ml of 5% glucose (group B) 10 min before CS. Following the delivery, patients in both groups received a 5 IU intravenous bolus of pre-prepared oxytocin followed by 30 IU oxytocin in 500-ml lactated Ringer’s solution, infused at a rate of 125 ml/h. An antibiotic, 1 g cefazolin, was diluted in normal saline of 20 ml, and it was administered over a duration of 5 min. Estimated blood loss was measured by comparing the hematocrit values before and after the procedure. Results The study revealed a statistically significant decrease in hemoglobin level in group B (placebo group) compared with group A (TXA group), which indicates that there was a significant reduction in the amount of intraoperative and postoperative blood loss in CS in TXA group. Conclusion The use of TXA before CS shows positive effects and can be used as a prophylaxis against postpartum hemorrhage, as revealed by the findings of this study.

Background The relationship between sleep disorders and stroke has been well-documented through multiple direct or indirect mechanisms. Participants and methods This was a cross-sectional (comparative case–control study) study. A total of 75 poststroke patients attending the neurology and internal medicine outpatient clinics at Al Zahraa University Hospital were selected, along with 75 matching individuals as a control group. All poststroke patients had a modified Ranken Scale less than or equal to 3 and interval was 8–12 weeks after stroke. All participants were subjected to complete neuropsychiatric history and medical history, the Pittsburg sleep quality index, insomnia severity index, and Epworth sleepiness scale. Strokes were divided into right and left cerebral hemispheres and the localization of stroke to cortical, subcortical, basal ganglion, or brain stem. Results Comparison between poststroke patients and the control group regarding Pittsburg sleep quality index shows statistically significant difference regarding all components of the scale except the use of sleep medication. Regarding insomnia severity index, poststroke patients scored more than the control group, denoting more insomnia ranging from subthreshold insomnia (30.67%) to moderately severe (32%) and severe (30.6%) insomnia. Epworth sleepiness scale shows a statistically significant difference between both groups, denoting more daytime sleepiness. It was more in right-sided hemispheric lesions and subcortical infarctions. Conclusion Increasing awareness about poststroke sleep disorders is mandatory among physicians to improve the prognosis and quality of life of these patients.

Background Conventional hemorrhoidectomy for grades III and IV hemorrhoids is a tedious procedure associated with significant morbidity and a prolonged convalescence. We compared LigaSure hemorrhoidectomy with conventional (Milligan-Morgan) hemorrhoidectomy for the treatment of grades III and IV hemorrhoids. Patients and methods A total of 80 consecutive patients of grades III and IV hemorrhoids were randomized to either the LigaSure hemorrhoidectomy (40 patients) or Milligan-Morgan hemorrhoidectomy (40 patients). The hemorrhoidal pedicle was coagulated with LigaSure in the LigaSure group and transfixed with 2/0 vicryl in Milligan-Morgan method. Results In comparison with Milligan-Morgan method, LigaSure hemorrhoidectomy had a shorter operating time (P<0.001 and was highly statistically significant), less blood loss (P<0.01 and was highly statistically significant), less postoperative pain (highly significant test P<0.01), postoperative complications including hemorrhage (15 vs. 0.0% at 5 days), urinary retention (P=0.169), and faster wound healing at 7 weeks. Conclusion Because of its ease of use and less postoperative pain and complication, LigaSure hemorrhoidectomy can be performed as a day-care procedure with less incidence of postoperative complications than Milligan-Morgan method.

Background C-reactive protein (CRP) is an acute-phase reactant and a commonly employed indicator of low-grade systemic inflammation. Elevated CRP levels are accompanied by higher risk of popular diseases. This study aimed to study the correlations of maternal CRP level with fetal growing and the risk of neonatal complications. Participants and methods This prospective observational randomized study was conducted in Al Zahraa University and El Sheikh Zayed hospital throughout the interval from April 2018 to March 2020. It included 150 pregnant women attending for antenatal care in the outpatient clinic. CRP was done twice. The first measure was done at second trimester (13–20 weeks), and the second measure was done after 26 weeks. Positive results were obtained at a CRP concentration above 10 mg/l. The pregnant women were subdivided into two groups: group A, with positive (high) CRP, and group B, with negative (ordinary CRP). Follow-up was done by ultrasound during pregnancy [to detect Intrauterine Growth Restriction (IUGR), low birth weight, and congenital anomalies]. Follow-up during labor was done to detect mode of delivery, IUGR, respiratory distress, and NICU admission. Results Median CRP level at 13–20 weeks was higher than median CRP level at 26–30 weeks. Regarding CRP finding, it was found that ∼60 (40%) women had positive CRP and 90 (60%) women had negative CRP. IUGR was statistically significantly higher among positive CRP group than negative CRP group (5 and 0%, respectively; P=0.031). Respiratory distress was statistically significantly higher among positive CRP group than negative CRP group (6.7 and 0%, respectively) (P=0.01). Admission at neonatal ICU was statistically significantly higher among positive CRP group than negative CRP group (6.7 and 0%, respectively; P=0.031). Conclusion Maternal-grade inflammation in pregnancy, as estimated by CRP counts, was accompanied with fetal growing restriction and higher risks of neonatal complications.

Background The importance of the angiosome concept in critical limb ischemia remains controversial. The peroneal artery is relatively spared from the terminal stages of atherosclerosis and is often the last tibial vessel to become occluded in diabetes or end-stage vascular disease. The main prejudice, on the contrary, against its use in distal revascularizations is that the perfusion of the foot is indirect, via collaterals from its anterior and posterior branches, despite an extensive collateral arterial bed, so the target vessel may be inadequate for treating a septic or gangrenous foot. The value of peroneal artery revascularization has always been debatable, especially in patients with tissue loss. As one of the most important factors of wound healing is the establishment of in-line flow to the foot, the role of peroneal angioplasty has to be defined. The aim of this retrospective study was to assess the outcomes of single peroneal indirect revascularization (IR) (nonangiosome-targeted tibial angioplasty) versus other tibial direct revascularization (DR) (angiosome-targeted), in infra-popliteal arterial disease. Patients and methods Thirty patients were included and presented to the Vascular Surgery Department of Al-Azhar University Hospitals and El araby Specialized Hospital, Menoufia with infra-popliteal arterial lesions, distributed into two equal groups: 15 patients were treated with single peroneal IR, while 15 patients were treated with other tibial DR during the period from June 2019 to June 2019. Results Fifteen patients reached the endpoint of adequate healing (nine patients with ‘DR’ technique and six patients with ‘ID’ technique) and nine patients underwent major amputations. The limb salvage after 1 year was 70%. Conclusion DR of tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality, or reintervention rates.

Aim To assess the outcome of living-related-donor liver transplantation for chronic hepatitis C infection in Egyptian patients including hepatitis C recurrence, fibrosis progression, and improved survival. Patients and methods This retrospective study included 104 adult Egyptian patients with chronic liver disease due to chronic hepatitis C, who underwent living-donor liver transplantation at Wadi El-Neel Hospital, Cairo, Egypt, during the period from January 2005 to January 2014. All data regarding comprehensive history taking, clinical examination, laboratory evaluation, model for end-stage liver disease score, fibrosis-4 score, liver biopsy, histopathology examination, and radiological evaluation before and after transplant were collected and analyzed. Moreover, the data of regimen of immunosuppression and regimen of antiviral therapy after transplant were collected and analyzed. Results There were 75 males and 29 females. Their ages ranged from 30 to 74 years, with an average of 51.62 years old. Of 104 cases, 90 were of class C, whereas 13 cases of class B, and only one case was class A Pugh–Child classification. Of 104 cases, 31 missed follow-up owing to follow-up in another hospital within their city. Recurrence of hepatitis C virus infection after liver transplantation occurred in 73 (70.19%) cases. Sustained virological response was observed in 40 (54.79%) cases, and relapse was observed in 33 (31.73%) cases after antiviral treatment. Second relapse after treatment occurred in 33 (31.73%) of 73 cases and received antiviral therapy course again, with sustained virological response in 15 (45.45%) cases out of 33, relapse again was seen in seven (21.21%) of 33 cases, and 11 (42.4%) of 33 cases were nonresponders. According to clinical outcomes in the studied cases, eight (7.7%) died, five (4.8%) cases had decompensated liver disease, five (4.8%) cases underwent retransplantation, two (19%) cases had liver fibrosis, and one case (0.96%) had hepatocellular carcinoma.

Background Colistin is used currently as a last-line antibiotic for the treatment of infections caused by carbapenem-resistant Enterobacteriaceae (CRE). For colistin-susceptibility testing, the conventional methods are not reliable, and the standard broth microdilution (BMD) method is both laborious and time consuming. Therefore, there is an urgent need for a rapid diagnostic technique for identification of colistin resistance. Aim The aim was to report the prevalence of CRE among hospitalized patients, to evaluate the performance of the rapid polymyxin Nordmann/Poirel (NP) test for detection of polymyxin resistance among CRE, and to detect the mcr-1 gene among these isolates. Patients and methods A total of 300 samples were included. CRE isolates were isolated and subjected to BMD test, disk diffusion test, E-test, and rapid polymyxin NP test to detect colistin resistance. In addition, PCR assay was done to detect mcr-1 gene. Results Out of 300 different clinical samples, 132 Enterobacteriaceae isolates were obtained. The prevalence of CRE was 41.7% (55/132). The prevalence of colistin resistance among CRE isolates was 7.3% (4/55). Of the four colistin resistant isolates detected by the standard BMD, disk diffusion test and E-test detected 2 and 3 isolates as colistin resistant, respectively, giving low sensitivity (50 and 75%, respectively) and unacceptably high rates of very major errors (3.6 and 1.8%, respectively), whereas all four isolates were recorded as colistin-unsusceptible by the rapid polymyxin NP test, giving 100% sensitivity and specificity, with no very major errors. Only one isolate was detected as mcr-1 positive by PCR assay. Conclusion There is a high prevalence of CRE. Rapid polymyxin NP test is an accurate and rapid method for detection of colistin resistance. This research confirms the alarming spread of the plasmid-mediated mcr-1 gene among CRE.

Background Plane wart is a common disease that is caused by human papillomavirus. Many modalities of treatments are introduced in practice, but none of them proved to be effective. Potassium hydroxide (KOH) solution is a keratolytic agent with many dermatological uses. Objective To compare between topical KOH solution and cryotherapy in the treatment of plane warts. Patients and methods Lesions in each patient were divided into two groups: group A was treated with topical 5% KOH solution once at night, whereas group B was treated with cotton bud method of cryotherapy once every 2 weeks. In group A, the lesions were evaluated at second and fourth week to assess the cure rates and adverse effects. In group B, the lesions were evaluated every 2 weeks for 6–12 weeks or until warts completely disappeared. Patients were followed up for 3 months after complete cure to detect any recurrence. Results Regarding the response between lesions of plane warts treated with KOH 5% (group A) and cryotherapy (group B), lesions in group A showed a complete response in 17 (56.7%) patients, partial response in seven (23.3%) patients, and no response in six (20.0%) patients, whereas lesions in group B showed a complete response in 16 (53.3%) patients, partial response in nine (30%) patients, and no response in five (16.7%) patients. There was a statistically significant difference between the two groups regarding the response rate. Adverse effects included itching, erythema, crust, scar formation, hypopigmentation, and hyperpigmentation. No statistically significant differences were reported regarding adverse effect, except for crust and scar formation. Regarding crust, a statistically significant difference was found (P<0.05), with a higher percentage in group B. Regarding scar formation, a statistically significant difference was found (P<0.05), with a higher percentage in group B.

Background Bone marrow edema (BME) has not been recognized as a significant pain generator or as a primary contributor to disease until recently. BME is characterized by a nonspecific pattern of ill-defined high signal intensity on short-tau inversion recovery and T2-weighted MRI and low signal intensity on T1-weighted images. Objective To assess the value of diffusion-weighted MRI in the diagnosis and evaluation of BME at the knee region. Patients and methods This study was conducted on 130 patients referred with clinical suspicion of knee edema with or without history of trauma. They were divided into group ‘A,’ with lesions less than 15 mm, and group ‘B,’ with lesions greater than 15 mm. Their ages ranged between 9 and 75 years, with a mean age of 42 years. There were 43 females and 87 males. Results Between groups A and B, we found that bone marrow lesions (BMLs) were approximately two times larger on apparent diffusion coefficient (ADC) maps than on fat-saturated (FS) proton density (PD)-weighted turbo spin echo images. The most important value of adding the ADC-derived maps in routine MRI examination of the knee is to show additional BMLs that only can be detected at the ADC maps but could not be detected at the FS PD. Approximately 27 more lesions in 27 patients and one patient with two more lesions were detected. These nonconcordant lesions accounted totally for 29 more BMLs. Conclusion MRI is the mainstay of diagnosis, staging, and management plan of knee traumatic and nontraumatic disorders. ADC maps are more sensitive than corresponding FS PD-weighted turbo spin echo images allowing for detection of significantly more and larger BMLs. In addition, they represent a valuable add-on in knee imaging protocols.

Background and aim Postoperative pain severity depends on patient factors, anesthesia-related factors, and type of surgery. Pain after orthopedic surgery has been found to be immediate and severe, which necessitates more attention for its management. The aim of this study was assessment of the effectiveness of intravenous ketamine to provide postoperative analgesia after orthopedic surgery. This randomized double-blind study had been performed in Al-Zahraa University Hospital from December 2019 to October 2020. Patients and methods A total of 75 patients subjected to major orthopedic surgery were registered in the study. The patients had been randomly assigned into three equal groups (control, bolus, and bolus with infusion groups) to receive intravenous ketamine bolus dose alone (0.3 mg/kg) (bolus group); ketamine bolus (0.3 mg/kg) plus infusion (5 µg/kg/min), which terminated at the end of operation (bolus with infusion group); or placebo in the form of normal saline (control group). Visual analog pain scale score, postoperative 24 h morphine requirements, time to first analgesic requirement, and postoperative adverse effects were recorded and compared. Results Postoperative visual analog pain scale score and total morphine requirements were significantly less in bolus with infusion group, followed by bolus group, whereas the highest score and requirements were in control group. Regarding the time to first analgesic requirement, there was a statistically significant increased time to first analgesic in bolus with infusion group, followed by bolus group, whereas the shortest time was in control group, and there were nonsignificant differences among groups regarding postoperative complications. Conclusion Ketamine bolus dose alone before skin incision or followed by infusion had the capability of decreasing postoperative pain and total analgesic requirement and increasing the time to first analgesic requirement after orthopedic surgery, with superiority of ketamine bolus dose plus infusion without increasing the incidence of adverse effects.

Objective Doppler ultrasound changes in the common carotid artery intima-media thickness (CCA IMT) and estimation of serum thiobarbituric acid reactive substances (TBARS) as predictors to the atherosclerotic complications of long use of antiepileptic drugs (AEDs). Patients and methods The study was done on 45 epileptic patients and 15 healthy individuals as a control group. All patients have been selected from the outpatient clinic of Neurology Department of Al-Zahraa University Hospital from period July 2018 to July 2020. They have been treated by monotherapy AEDs for at least 2 years. No other risk factors for atherosclerosis had been considered in these patients. They have been investigated for serum level of TBARS and Doppler ultrasound for assessment of CCA IMT. The patient group was also subdivided into three groups according to their type of treatment. Results The risk of carotid atherosclerosis in patients with epilepsy is linked with long use of older generation AEDs, namely carbamazepine and valproic acid, rather than levetiracetam which have no effect in vascular risk or CCA IMT changes. Conclusion The choice of AED therapy for long-term use should be guided with serum level of TBARS and CCA IMT as their mechanism of action as enzyme inducer might be a leading cause of vascular changes in epileptic patients.

Background The most common demyelinating disease of the central nervous system is multiple sclerosis (MS), which is considered an acquired chronic progressive inflammatory process. Overall, 25% of the patients have an optic neuritis (ON) as a first neurological presentation. Aim To evaluate optic nerve head microcirculation in patients with MS without ON by using an optical coherence tomography angiography (OCTA). Patients and methods Our prospective study included 50 patients divided into two groups: patient group, which included 25 patients with relapsing-remitting MS without ON, and control group, which included 25 healthy participants matched with patient group regarding age and sex. Results The mean for average ganglion cell complex, average retinal nerve fiber layer thickness, and whole image retinal peripapillary capillary density % was 84.56±15.60, 80.64±21.89, and 46.42±5.48, respectively, for the patients group, whereas it was 95.84±5.13, 105.56±4.27, and 50.72±2.93, respectively, for the control group, and the differences between the two groups were highly statistically significant. Conclusion Significant decreases in vessel density and perfusion of optic nerve vasculature are evidenced in OCTA in patients with MS without ON in comparison with the normal control. So, OCTA is considered a promising paraclinical technology that can aid in early diagnosis of ON in MS for better management.