Background: Trauma is a leading cause of morbidity and mortality worldwide. The traumatized patient outcome is multi-factorial through combination of clinical diagnosis and severity of comorbidities. Aim: This study aimed to enhance the outcome of polytrauma patients admitted to intensive care unit through construct a predictive model for mortality on the basis of easily available parameters. Methods: Our cohort prospective study consisted of 60 Egyptian patients from January2020 to January2021 over 16 years old with Glasgow coma scale (GCS) 4-14 followed traumatic brain injury and full clinical evaluation on admission was done including a full history, clinical examination, radiological and laboratory investigations. All patients were evaluated according to GCS, APACHE II and RTS scores. In addition, all patients were followed-up for 2weeks from the day of admission .The primary outcome assessed the mortality with analysis of different clinical and lab parameters for detection of predictors of mortality. Results: Sixty patients were with mean age/year was 40.43 ± 16.9. A mortality rate of 45% as non-survivor was detected with a predominance of road traffic accidents as a mode of injury (51.7%). There is statistically significance of lower scores of GCS and RTS but higher scores of APACHE II in non- survivors than survivors. Multivariate logistic regression detects that diabetes mellitus (DM) is the most significant predictor of non survivors. Conclusion: Multiple significant predictors of mortality were found as: advanced age, low PLT count, high renal function tests and radiological CT brain findings. DM is the most significant mortality predictor.

Background: Chronic empyema thoracis is a debilitating illness with high morbidity and, and is seen among all age groups. Objective: To review all cases of chronic empyema thoracis treated by lung decortication and highlight the outcome In addition to that, residues of the empyema had responsible for general malaise, septicemia. Also, some authors reported critical of oxygen uptake in the atelectatic lung, which resolved critical after re-expansion. Materials and Method: 86 patients with chronic empyema thoracis were admitted and managed in our thoracic surgery unit who underwent surgery of lung decortication through postrolateral thoracotomy . Results: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) , FEV1 and FVC were significantly increased in postoperative than preoperative . There had significant improvement in the pre, post values of the lung volumn on the diseased side and both lungs. .Conclusion: Lung decortication is followed by a significant improvement in Spirometric parameters,CT fiindings.

Background: hyper-thermic intra-peritoneal chemotherapy (HIPEC) is established now as a considerably effective treatment method for peritoneal surface malignancy after optimal cyto-reduction. The obstacle faced by poor places is the high cost of the standard machines and their consumable kit per procedure. This opened the door for the trials of innovating cheaper ones as the one we deigned.Methods: We evaluated the cost of the machine of our design, its expenses per procedure as well as the success of achieving the target temperature and good flow rate, safety aspects, technical failures and the technical support required. The comparison with standard machines was based on the manufacturer information and published reports and not on personal use.Results: Form 2014 to 2017; we performed HIPEC (Coliseum technique) for patients using the machine of our design. Flow rate was 2 L/min and target temperature between 41 and 43 °C could be achieved in all cases. There were no technical failures and there was no safety issue recorded. Chemotherapy costs were not included and independent from the devices used. Cost of consumable kit was 110 USD/procedure, as compared to 1800 to 3500 USD/procedure for commercially available products. The cost for standard machines is between 40,000 and 135,000 USD.Conclusions: Our design in HIPEC machine was efficient, easy to use, with no recorded complications from technical accidents or failure.

Many reaserches have shown associations between inflammatory markers and the risk of cognitive functions decline. Higher serum levels of CRP,IL-6 and TNF-α are associated with deteriorating cognitive function in elderly. The goal of this reaserch was to detect cognitive impairment in elderly individuals with diabetes and their relation to hs-CRP,IL-6 and TNF-α in those individuals. Two hundred fifty-five elderly individuals which were divided into 3 groups according to present or absence of diabetes together with level of diabetes control; Group I: 85 elderly individuals without diabetes, Group II: 85 elderly patients with controlled diabetes. Group III: 85 elderly patients with uncontrolled diabetes. Routine laboratory investigations together with lipid profile , hs- CRP,IL-6 and TNF-α were analyzed in three groups using blood serum sample then correlated to degree of cognitive impairment using mini mental state examination (MMSE). The present study proved that a statistical significant negative correlation between hs-CRP and MMS score examination in total population was found , there is statistical significant negative correlation between hs-CRP ,IL-6 ,TNF-α and MMS score examination in total elderly subjects with diabetes.. As well, there is significant positive correlation between hs-CRP and parameters of diabetic control So, estimation of inflammatory markers in elderly patients with diabetes may be a reliable indicator to identify and anticipate cognitive dysfunction in such individuals.KEYWORDS: hs-CRP,IL-6, TNF-α , cognitive function, elderly diabetics

Background : Laryngoscopy and the endotracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. Aim of work: The aim of the current study was to compare the effect of magnesium sulphate and two doses of dexmedetomidine on hemodynamic response to laryngeoscopy and tracheal intubation. Patients and methods: This comparative prospective randomized controlled (single-blind) clinical study was carried out in Zagazig University hospitals on 80 patients during the period from May 2019 to February 2020. Patients were divided randomly into four groups each is 20 patients: Group Da: 20 Patients received dexmedetomidine 0.5mcg/kg in 20 ml normal saline intravenous infusion over 10 min. Group Db: 20 Patients received dexmedetomidine 1mcg/kg in 20 ml normal saline intravenous infusion. Group M: 20 Patients received magnesium sulphate 30mg/kg in 20 ml normal saline intravenous infusion over 10 min. Group C: 20 Patients received 20ml 0.9% in 20 ml normal saline intravenous infusion over 10 min. Results: Heart rate in Db group were statistically lower than other groups, Heart rate in Da group were statistically significant lower compared to group M and group C. Systolic blood pressure were statistically significant lower in group Db compared to other group. Conclusion : Through this study, we can conclude that Dexmedetomidine 1mcg/kg is more effective than dexmedetomidine 0.5mcg/kg and magnesium sulphate 30mg/kg in decrease the hemodynamic response to laryngeoscopy and tracheal intubation.

Background: Childhood-onset systemic lupus erythematosus is a multisystem, autoimmune disease, beginning before the age of 18 that may affect any organ system. The aim of the study was to assess the role of spirometery in detection of pulmonary involvement in children with lupus nephritis and to correlate spirometric parameters with degree of renal affection. Patient and Methods: This cross-sectional study was conducted in Nephrology unite at Zagazig University Hospital on 24 cases that diagnosed SLE patients during the period from Oct 2019- Mar 2020. Patients in the study had subjected to complete history taking, Laboratory investigations included hematological and examination of urine, kidney function test, Chest X-ray, ultrasonography of chest and Renal Biobsy, pulmonary function test, SLED score. Results: Restrictive lung disease was prevalent in 54.2% of patients, mean value of FEV1 was (86.208 ± 23.268), forced vital capacity was (79.321± 23.79), FEV1/FVC was (108.14±11.731), MEF75 was (88.404±19.703). MEF50 was (93.358±25.616). MEF25 was (107.808±47.54), PEF was (84.4± 18.865) there was statistically significant negative correlation between systemic lupus erythematous Disease score and Forced expiratory Volume in 1 sec, forced vital capacity and forced expiratory flow at 25% FVC There is statistically significant negative correlation between grades of nephropathy by renal biopsy and forced expiratory flow at 25% FVC. Conclusion: Present study showed that pulmonary diseases occur frequently in childhood onset Systemic lupus erythematosus. Serial PFT studies may be useful in assessing the presence of lung involvement in childhood onset SLE and monitoring of course and activity of the disease

Background: Slow coronary flow (SCF) phenomenon is an angiographic finding which is defined as slow contrast passage through coronary arteries which may predispose patients to serious cardiac complications such as fatal arrhythmias. The work aimed to investigate the correlation of QT interval and p wave dispersions with coronary slow flow. Methods: This case control study was conducted on 60 patients whom undergoing coronary angiography (CAG) in Cardiology Department at Zagazig University Hospitals during the period from October 2019 to March 2020. The study population was divided into two groups: CSF Group: included 30 patients with normal coronary arteries (obstructive lesion

The aim is to evaluate the clinical and biochemical response of treatment with anti-tumor necrosis factorα (anti-TNFα) therapy used for induction and maintenance of remission in Egyptian inflammatory bowel disease (IBD) patients who attended an IBD Clinic of the Internal Medicine Department, Zagazig University over a one year. Methods A prospective cohort study included seventy-seven IBD patients; 40 ulcerative colitis (UC) and 37 Crohn’s disease (CD) indicated for biological therapy. Patients were randomly assigned into either two treatment subgroups: (a) received Infliximab, or (b) received Adalimumab. Results 51.95% (n=40/77) showed an initial significant improvement following induction of remission dose and completed the study. Clinical remission was maintained to week 52 in 37 patients. The reduction rate of fecal calprotectin from the baseline was higher for CD compared to UC patients (82.4% and 51.7%, respectively, p < 0.001 for both). 14.29% of all patients were non-responders; 10.39% were referred for surgery, 15.59% discontinued treatment due to adverse effects, mostly infusion reactions as an anaphylactic reaction or late serum sickness-like symptoms. Conclusion anti-TNFα therapy seems to deliver a beneficial clinical and laboratory response in severe, steroid-dependent, or refractory patients. The effect was more noticed CD than UC patients; however, longer follow-up periods and mucosal healing assessment are needed in further studies for our populations.

Background: Folic acid can protect tissues against the side effects of cytotoxic drugs by removing free radicals and prevention of oxidative damage. Material and Methods: 28 adult pregnant female albino rats were divided into groups as follows: Group I: (control group) 12 rats were further subdivided into two equal subgroups: Subgroup Ia: (negative control group) received saline. Subgroup Ib: (positive control group) received folic acid (2.4mg/kg/day). Group II: (experimental group) 10 rats received Cyclophosphamide (CP) (15 mg/kg) single intraperitoneal injection on the 9th day of gestation. Group III: (protected group) 6 rats received folic acid (2.4 mg/kg/day) and Cyclophosphamide (15mg/kg). The treatments except CP were given by orogastric tube from 1st to 19th GD. The skeletons were double stained by Alizarin red and Alcian blue stains and examined by Olympus SZ dissecting stereomicroscope.Results: Various eye, ear, tongue, and fusion defects were recorded. Skeletal anomalies were in the form of incomplete and un-ossified skull bones, open arch of atlas, incomplete ossification of sacral vertebrae, supernumerary sacral vertebra, rib, and incomplete ossification and wavy ribs, incomplete ossification of sternum, and metacarpus, metatarsus and phalanges. Their incidence increased significantly in the experimental group compared to the control group while it decreased significantly in the protected group for all reported anomalies except for incomplete ossification of skull bones and vertebrae and supernumerary sacral vertebrae and ribs.Conclusion: Cyclophosphamide is a teratogenic drug and folic acid has a protective role against its teratogenicity.

Background: Cognitive impairments are common finding with aging particularly in postmenopausal women. Dentate gyrus is the most specialized region in the hippocampus being involved in formation of new memories and neurogenesis. Panax Ginseng is a promising natural compound having many beneficial effects, including anti-inflammatory, antioxidant, antiaging activities. The aim of the current study was to explore the effect of ovariectomy on structure of dentate gyrus and the possible protective role of Panax Ginseng. Materials and methods: 25 adult female Albino rats were divided into three groups control group subdivided into 3 subgroups, ovariectomized (OVX) group and OVX plus Ginseng treated group. Hippocampal sections were subjected to biochemical, histological morphometric and immunohistochemical studies.Results: ovariectomized rats showed significant increase in their weight and decrease in serum estradiol level. Significant increase in malondialdehyde (MDA) with significant decrease in reduced glutathione (GSH) and catalase. Dentate gyrus of ovariectomized rats showed degeneration of granular layer with significant decrease in its thickness. Significant increase in expression of caspase-3, inducible nitric oxide synthase( iNOS), Glial fibrillary acidic protein (GFAP), and significant decrease in , Microtubule-Associated Protein (MAP2),synaptophysin and Ki 67 immunoreactivity were detected. Treatment of ovariectomized rats with Panax Ginseng induced significant reduction in weight and MDA with significant increase in estradiol level, GSH and catalase. Significant decrease in expression of caspase-3, (iNOS), (GFAP) and increase (MAP2), synaptophysin and Ki 67 expression with improvement of the histopathological changes. In conclusion, Panax Ginseng may serve as a promising therapeutic substitute in amelioration of menopausal related cognitive affection.