Dexamethasone versus ondansetron in prevention of postoperative nausea and vomiting after laparoscopic surgery

Background: postoperative nausea and vomiting [PONV] are a common distressing symptoms in patients undergoing laparoscopic surgery and can contribute to anxiety, dehydration, metabolic abnormality, wound disruption, delayed recovery and other issues. The incidence of PONV varies from 20 to 80 % of all surgeries, and it is an economic and social burden

Aim of the Work: was to assess whether dexamethasone is a cost-effective alternative to ondansetron in the prevention of PONV in patients undergoing laparoscopic surgery

Patients and Methods: A study was conducted at Ain Shams University Hospitals between November 2017 and April 2018, after obtaining approval of research ethical committee and patients' informed consents. 80 Patients were included in the study and underwent elective laparoscopic surgery and received general anesthesia

Results: The study showed a statistically significant difference between groups regarding PO nausea and other postoperative complications

Conclusion: Dexamethasone 8 mg was as effective as ondansetron 4 mg. Dexamethasone provided a simple, safe, cheap, and effective postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden

Perceptions of use of a case-based, integrated national electronic public health surveillance system in Jordan

Collection of real-time, standardized data remains a challenge for public health surveillance systems. The use of mobile information technology may facilitate this. A national case-based public health surveillance system was introduced in Jordan in 2015 using mobile tablets and an online framework. After training on the system, users were surveyed about their perceptions of it. Of 596 participants attending the training, 580 [97.3%] completed the survey. The majority of users were nurses [58.5%]. Overall perceptions of the system were highly positive across 5 areas of functionality [standardized case definitions, clinical guidance on signs and symptoms, risk factors and laboratory guidance, SMS and Email alerts for notifiable diseases, one-hour reporting of information via an online framework]. In all areas, over 80% of participants thought the system would help their work and would save time in identifying notifiable diseases and reporting this information centrally. Further work is encouraged to evaluate the system and consider the application of cloud-based models in other settings

Identification and estimation of leucine aminopeptidase activity in the serum and ascitic fluid of patients with schistosomiasis

The activity and electrophoretic mobility or leucine aminopeptidase [LAP] were assessed in the sera of 100 patients with different clinical stages of Schistosoma hacmatobium infestation as well as in 20 sample of ascctic fluids obtained from patients with bilharzial hepatosplenomegaly associated with ascites matched with 20 healthy adult males sample as control. Generally LAP activity was significantly higher in all patients. The activity of serum LAP showed a progressive rise with the advance in the clinical condition. The highest level was encountered in the sera of patients with bladder carcinoma and liver metastasis, leucine aminopeptidase was considerably found in the ascetic fluid. The ratio of the activity or LAP in the ascetic fluid to its activity in the serum of the same patients was 1:4.5 where the enzyme diffuses from the blood to the ascetic fluid. The enzyme detected by electrophoresis, in serum or ascetic fluid LAP migrated as a single component in the alpha1 -globulin faction. The results are discussed and compared with those in the literature

Intensive care unit [ICU] admission and discharge criteria in acute poisoned cases admitted to Menoufiya university hospital over one year [2008] [A prospective study]

Poisoning emergency is a common occurrence which constitutes a significant source of aggregate morbidity, mortality, and health care expenditure. The aim of the present study was to clinically evaluate the ICU admitted poisoned cases as regard criteria of ICU admission, approach to treatment and discharge criteria during the period from 1-1-2008 to 31-12-2008. Data were collected from self designed admission clinical sheet which included all needed data. The present study revealed that the total poisoned cases that were admitted to Menoufiya poison control center [MPCC] were, 423 cases from 35550 total menoufiya hospitals admission during the year of the study i.e [1.18%] of which 86 cases have been admitted to ICU i.e. [20.33%] and they represented about [2.79%] of total hospital ICU admission [3073 cases]. Most of admitted poisoned cases throughout the year of the study were due to anticholinesterase poisoning 126 cases [29.78%] from those 34 cases were admitted to ICU i.e. [26.98%] from total ICU admitted poisoned cases. Regarding the admission criteria the present work represents that the patients who were admitted due to both hemodynamic instability and altered mental status were the commonest ones [61.63%], followed by altered mental status [16.3%], hemodynamic instability [13.9%] while those presenting with the three admission criteria were [8.1%]. There is a statistically significant relationship between type of poison and admission criteria where all digitalis poisoned cases were admitted with hemodynamic instability [100%] while a high proportion of anticholinesterase poisoned cases were admitted for both hemodynamic instability and altered mental status were [67.6%]. As regards the poisoning characteristics, the present work shows that suicidal cases who were admitted due to hemodynamic instability were [66.7%], ingestion of solution form of poison, represented in both homodynamic instability and altered mental status were [62.3%] and high percentage of patients that were transported by ambulance were admitted due to both haemodynamic instability and altered mental status [85.7%]. Regarding the discharge criteria from ICU, the present study revealed that the patients who were discharged due to death represented [19.76%] of cases. Discharge of patients as hemodynamic instable [in the form of no need for mechanical ventilation, normal ABG] were [26%], controlled arrhythmia [7.2%], shocked patients discharged with no need for inotropic drugs [5.8%]. The patient who were admitted to ICU due to altered mental status and didn't receive mechanical ventilation were discharge as fully conscious [alert and aware] and represented [76.8%] of ICU discharged cases. This study revealed that an ideal ICU must be available in each PCC [poison control center] and ICU admission and discharge criteria are an important part of clinical evaluation for acutely poisoned patients in emergency room

Epidemiology of rotavirus in greater Cairo

Rotaviruses are a major cause of gastroenteritis in children worldwide. This study was carried out to determine the incidence of rotavirus infection among children and the genotypes circulating in Greater Cairo. During May 2006 to April 2008 one hundred and sixty eight wastewater samples and five hundreds and sixty seven stool specimens from children with acute diarrhea were examined using RT-PCR and multiplex nested PCR for genotyping. Prevalence of rotavirus reached 162/567 [28.6%] and 10/48 [20.8%] in fecal specimens and raw wastewater samples, respectively. A marked occurrence of rotaviruses appeared during autumn and winter [from Sept. to Feb.]. In stool samples, the G-P type combination were G1P[4] 14.8%, G1P[6] 9.9%, G3P[4/ ] 9.9% and G3P[6] 8, 6%, while in wastewater samples G1P[4] 20.6%, and G3P[4] 5.9% were only detected. The efficiency of Zenin wastewater treatment plant [WWTP] to remove infectious rotavirus was higher than El Gabal El Asfar [WWTP] as the former uses a final chlorination step. The time needed for complete removal of the rotavirus infectious units and its genome was 15 and 30 mm, respectively when exposed to UV Lamp[Vilber-Lour mat T-15c] 9W and a virus concentration of 2x 106 CC-RT-PCR units/ml, The chlorine dose 15 mg for 30 mm is sufficient to remove the infectious units of rotavirus at 2x106 CC-RT-PCR units /ml, while the same dose for 45 mm is needed for complete removal of the rotavirus genome. The antiviral activity of a pigenin 7-o-glucoside [extracted from Chrysanthemum coronarium] against rotavirus was 60%

patterns of clinical presentations of cerebellar syndromes among adult Sudanese patients

Cerebellar syndromes are one of the commonest neurological diseases. To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes. This is a prospective hospital based, cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006 -January 2007. The most common age group affected was 18-25 years. Male to female ratio was 1.5: 1; unsteadiness on walking was the most common symptom [83%]. Gait-ataxia was the most common sign [83%]. Cerebrovascular disease was the most common aetiology [25%]. Cerebellar syndromes are not rare in Sudan. However, they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilities for diagnosis. The age of onset, the male predominance, the presentation and clinical findings were not different from reported literature. This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya [Islamic laws] Laws in Sudan

Improving the aqueous solubility of piroxicam and griseofulvin using different surfactants and cosolvents

This study is an attempt to solubilize a non steroidal anti-inflamatory drug, namely, Piroxicam [PX] and an anti-fungal drug, namely, Griseofulvin [GR], using different surfactant and cosolvent systems. It could be shown that the aqueous solubility of PX is increased by 56, 57, 65, 87 and 138 fold using solution with a concentration of 18% w/v of either Tween 20, sodium lauryl sulphate [SLS], tween 80, Brij 35, or poloxamer 188, respectively. Moreover, the aqueous solubility of PX has been shown to increase by 104, 102, 92 or 34 fold using 60% w/v of either ethanol, polyethylene glycol 400 [PEG 400], propylene glycol [PG], or glycerin, respectively. Propanol, however, gave 140 fold increase in PX aqueous solubility at a cosolvent concentration of only 30% w/v. The solubility of PX has also been shown to increase from 3.6 mg/ml to 10.6 mg/ml by increasing the pH from 6 to 8 respectively. On the other hand, 9, 21, 24, 26 or 219 fold increase in the aqueous solubility of GR could be achieved by using 18% w/v of either poloxamer 188, tween 20, brij 35, tween 80, or SLS, respectively. Moreover, propanol, ethanol, PEG 400, PG, and glycerin gave 104, 99, 26, 14 and 13 and 104 fold increase in GP aqueous solubility at a cosolvent concentration 60% w/v. the addition of cosolvent to the micellar solutions of different surfactants influenced the solubility of either PX or GR in different ways depending on the type of the drug and the cosolvent added. Increasing the temperature at which the equilibration is conducted showed an increase in the aqueous solubility of either PX or GR

Production of protein-fortified biscuits with defatted tomato seed meal

This investigation was carried out in order to produce high protein biscuits of well-balanced, highly nutritive and acceptable foods for young children. In this study, tomato seeds are used as a new source of dietary protein, which is actually considered be as waste products. Tomato seeds meal were added in three gradual levels to be incorporated in the wheat flour dough. Dough characteristics were studied using Farinograph and Extensograph. Biscuits were prepared with supplementation of 5, 10, 15% tomato seeds meal. All samples of biscuits were examined for organoleptic evaluation. Rat feeding trials have shown a good Net Protein Utilization [NPU] was 72.76, Digestibility Coefficient [DC] was 92.62 and Biological Value [BV] was 78.55 percentages gained. As a fact, the obtained results showed that 15% tomato seed meal, the greater addition, gave biscuit having the highest content of protein

Protective effects of caffeic acid phenylethyl ester, a main component of propolis against cyclosporine A-induced nephrotoxicity in rats

The present study was designed to investigate the possible protective effects of Caffeic acid phenylethyl ester [CAPE] against Cyclosporine A [C5A] induced nephrotoxicity in rats. Through antioxidant, free radical scavenger and anti-inflammatory effects of CAPE and CsA. Thirty two male Sprague-Dawley rats were divided into four groups of eight rats in each one; first group served as control [treated with vehicle]. The other groups were treated intraperitoneally with CsA alone [20 mg/kg/24 hours], CAPE alone [10 micro mol/kg/24 hours] and CAPE plus CsA for 21 days. The treatment with CAPE started two days before the first dose of CsA. Estimation of urine volume, serum creatinine and urea concentrations, creatinine clearance, kidney tissue malondialdehyde [MDA] and glutathione [GSH] contents were carried out after the last dose of CsA. Also, the lysosomal enzymes [N-acetyl-beta-glucosaminidase [NAG] and beta-glucuronidase [beta-GLU]] and antioxidant enzymes [glutathione peroxidase [GSH-Px], catalase [CAT] and superoxide dismutase [SOD]] activities were estimated in kidney homogenates. Kidneys were also examined for histological changes. CsA caused a marked nephrotoxicity as evidenced by significant increases in urine volume [295%], serum creatinine [194%] and urea [167%] and a significant decrease in creatinine clearance [Ccr] [24%]. Pre-treatment with CAPE produced amelioration in biochemical indices of nephrotoxicity in serum and urine. Furthermore, CAPE prevented the CsA-induced increase in the renal levels of oxidative stress markers [MDA, NAG and beta-GLU] and prevent the decrease in the antioxidant enzymes [SOD, CAT and GSH-Px] activities. In addition, co-administration of CAPE was found to reduce the degree of kidney tissue damage in histopathological findings. CAPE as a natural antioxidant might have protective effects against CsA-induced nephrotoxicity and oxidative stress in rats. However, clinical studies are warranted to investigate such an effect in human subjects

Myringosclerosis incidence among children with acute otitis media in relation to the isolated pathogens

Patients with acute otitis media [AOM] or otitis media with effusion [OME] and treated with tympanostomy tube insertion can develop myringosclerosis. The aim of this study was to investigate and compare the incidence of myringosclerosis among children with acute otitis media in relation to the isolated aerobic and anaerobic pathogens in their ear discharge. This study as conducted on two groups of patients. Group [1] included 23 subjects of OME had been treated with tympanostomy tubes and some of them had the complication of otorrhea, and group [2] included 48 subjects with AOM with or without otorrhea. Otorrhea of discharging ears of both groups was cultured and the status of their tympanic membranes was followed regularly by otoscopic examination during follow-up duration in scheduled visits to detect the incidence rate, time of appearance and severity of myringosclerosis in relation to the type of isolated pathogens. [GI] had 6 cases [10 ears] of myringosclerosis detected at 2-3 months average duration, and [G II] had 11 cases [20 ears] of myringosclerosis detected at 1-2 months average duration. The highest number of isolated pathogens was Streptococcus pneumoniae [S.P] and Haemophilus influenzae [H.I], and they were the only pathogens accompanied the incidence of myringosclerosis with more incidence and severity in [S.P] infected ears. These findings support the inflammatory theory of development of myringosclerosis. Our study considered myringosclerosis an inflammatory condition rather than to be traumatic reaction from tympanostomy tubes insertion, where Streptococcus pneumoniae is the most liable organism can induce myringosclerosis in improper treated cases of AOM .Anaerobic organisms cannot afford the hyperoxic environment which is suggested by some researchers to be a necessary factor in the development of myringosclerosis and proper treatment of cases of AOM diminishes the chance of incidence of myringosclerosis

Natural inhibitors of coagulation and markers of coagulation activation: the hypercoagulable state in sickle cell disease

This study was designed to clarify abnormalities of the natural coagulation inhibitors and of the markers of thrombin generation in patients with homozygous sickle cell disease [HbSS] in the steady-state, and to evaluate their role in the contribution of the increased thrombotic risk in these patients that could result in new therapeutic interventions. This study was carried out on 50 subjects. They were divided into two groups. Group [A] included 30 patients with homozygous sickle cell disease [HbSS]. Group [B] included 20 apparently healthy age- and sex-matched control subjects; with normal baseline hematologic parameters and haemoglobin electrophoresis as well as no apparent increased thrombotic risk. All patients were tested during steady-state phase with no symptoms or signs of crises or infection for at least 8 weeks and had not had any blood transfusion during the preceding two weeks. They were not on medications other than folic acid 5mg tablets. HbSS was diagnosed by family studies and haemoglobin electrophoresis on cellulose-acetate at pH 8.6. Both patients and control groups were subjected to initial laboratory investigations including complete blood count [CBC], bleeding time [BT], prothrombin time [PT] and INR, activated partial thromboplastin time [aPTT] and haemoglobin electrophoresis. Then, both groups were tested for: [1] Natural coagulation inhibitors including Protein C [antigen and activity], Protein S [total and free levels], Antithrombin-III activity, Heparin cofactor II level, and Tissue factor pathway inhibitor [TFPI] and [2] Markers of coagulation activation; Prothrombin fragments 12 [Fl.2] and Thrombin-antithrombin complex [TAT]. HbSS patients had significantly higher leukocytic count [x 10 [3]/cmm] than control subjects [10.4 +/- 2.8 compared to 6.2 +/- 2.4, p < 0.01]. There was no significant difference between both groups regarding platelet count, bleeding time, prothrombin time [and INR] and activated partial prothrombin time. HbSS patients had significantly lower values than the control group regarding the level of protein C antigen, protein C activity, protein S total and protein S free as well as heparin cofactor TI [p < 0.001, each]. Although FIbSS had lower antithrombin-III activity and tissue factor pathway inhibitor than the control group, the difference was not significant. On the other hand, markers of coagulation activation [namely prothrombin fragments 1.2 and thrombin-antithrombin complex] were significantly higher in HbSS patients compared to the control group [p < 0.001, each]. Comparative studies showed no significant correlation between the level of haemoglobin SS and any of the studied coagulation inhibitors or markers of activation. These data shows that steady state SCD is associated with significant reduced level and/or function of the majority of naturally occurring anticoagulants as well as increased markers of thrombin generation denoting a state of chronic hypercoagulability with increased thrombotic and vasoocclusive tendency. Such changes might justify the prophylactic use of low dose coumadin and/or antiplatelet drugs in HbSS

Erythro-thrombocytopoiesis in hemodialysis patients: possible interaction between thrombopoietin and erythropoietin? is there a role for arterio-venous fistula?

This study was carried out to evaluate the thrombopoietic status of patients with ESRD, to postulate possible causes of altered thrombopoiesis [if any], to verify the clinical significance of endogenous thrombopoietin on both erythropoiesis and thrombopoiesis as well as to assess the contribution of arteriovenous fistula on TPO activity. It included 60 subjects divided into two groups. Group [A] included 40 patients with ESRD on regular hemodialysis three times a week. All included patients had no history of thrombosis [local or systemic, arterial or venous] or a hemorrhagic event within the previous 6 months and they were negative for hepatitis B antigen [HBsAg] and for hepatitis C virus RNA [HCV-RNA] and have normal aminotransferases for the previous 6 months. Patients with a history of malignancy, autoimmune disease, or a documented infection were not included in this study. None of the patients received medication known to interfere with haemostasis [i.e. oral contraceptives, anticoagulants] except for heparin administered during hemodialysis as well as antihypertensives [but not angiotensin-converting enzyme inhibitor or angiotensin II-receptor antagonist] when indicated. Group [A] patients were further subdivided into two subgroups according to their need to rHu-Epo therapy; group [AI] included 19 hemodialysis patients treated with recombinant erythropoietin at a dose of 170 +/- 30 U/kg/sc per week, and group [AII] included 21 patients treated only with oral iron supplementation. Group [B] included 20 age-and sex-matched healthy as the control group. Both patients and control groups were subjected to the following tests: Complete blood count [including blood smear], BUN, serum creatinine, ALT, AST, serum iron, total iron binding capacity [TIBC], serum ferritin, serum erythropoietin [EPO], serum thrombopoietin [TPO] and absolute reticulated platelets count. Furthermore, serum TPO was measured from both the venous return of the AVF and the contra-lateral peripheral vein in each patient with ESRD. Serum erythropoietin was significantly lower [p < 0.01] in HD patients [7.6 +/- 0.8] than in the control group [10.1 +/- 1.3]. Also, serum thrombopoietin was significantly lower [p < 0.001] in the HD patients [60.6 +/- 6.9] than in the control group [120.7 +/- 50.9]. Furthermore, the absolute count of reticulated platelets [x10 [3]/cmm] was significantly lower [p < 0.01] in the HD patients [9.4 +/- 3.7] than in the control group [2 1.7 +/- 4.3]. Hemoglobin and hematocrit were slightly higher in Group AII [10.2 +/- 0.8, 32.7 +/- 5.2, respectively] than in group AI [10.1 +/- 0.9, 32.5 +/- 4.3, respectively]. Such difference was not significant. Platelet count [x10 [3]/cmm] was significantly higher [p < 0.01] in group AI [190 +/- 24.6] than in group AII [150 +/- 30.8]. On the other hand, the absolute count of reticulated platelets [x10 [3]/cmm] was lower in group AI [8.8 +/- 1.5] than group AII [9.3 +/- 1.1], and such difference was not significant. Furthermore, serum TPO was significantly higher [p < 0.05] in group AII [64.7 +/- 5.9] than group AI [55.6 +/- 6.8]. The serum EPO level was significantly higher [p < 0.01] in group AI [8.3 +/- 1.1] than in group AII [6.3 +/- 0.7]. In hemodialysis patients, comparative studies showed significant positive correlation between s. TPO and hematocrit and reticulated platelet count particularly group AII [p < 0.02 and p < 0.01 respectively]. But there was insignificant inverse correlation between s. TPO and platelet count in HD patients. On the other hand, there was significant inverse correlation between s. TPO and endogenous s. EPO in dialysis patients [p < 0.01]. In ND patients, s. TPO concentrations in AVF samples were significantly lower than in the peripheral veins [60.6 +/- 6.9 vs 40.4 +/- 3.9, p < 0.01]. These data confirm the presence of impaired erythro-thrombocytopoiesis in HD patients. This could be partly due to impaired thrombopoietin production and/or increased thrombopoietin destruction and partly due to impaired bone marrow response to the endogenous thrombopoietin. Thrombopoietin appears to induce marrow erythropoiesis either directly or indirectly by augmenting the action of endogenous erythropoietin. Also, it suggests possible involvement of the arteriovenous fistula in the production and/or catabolism of this growth factor. These findings serve as a starting point for further studies to determine the regulatory mechanisms of TPO levels and its precise erythrothrombocytopoietic role in end-stage renal disease

role of bronchoscopy versus fluoroscopy in diagnosing persistent stridor in infants and children

Stridor is a high pitched respiratory sound usually inspiratory, but may be expiratory or biphasic produced by turbulent airflow due to partial airway obstruction at the level of the pharynx, larynx and/or trachea. Stridor can be classified into two types: acute stridor and persistent or chronic stridor. Evaluation of child with persistent stridor includes radiological assessment mainly plain X-ray and fluoroscopy. Direct visualization of the airway is often necessary to confirm the diagnosis and is essential in children with persistent stridor. The aim of this study was to determine the role of flexible fiberoptic and rigid bronchoscopy in comparison with fluoroscopy in diagnosing the site of partial upper airway obstruction in infants and children with persistent stridor. The study was conducted on 35 infants and children presented by persistent stridor. Fluroscopy and bronchoscopy [Flexible or rigid] were done for all the cases. The results obtained from fluoroscopy were compared to those obtained from bronchoscopy. The most common type of stridor was inspiratory in 80% of cases followed by biphasic stridor [11.4%], and lastly, the expiratory stridor [8.6%]. The most common cause of stridor in the studied group was Laryngomalacia in 17 cases [48.6%]. Flexible and rigid endoscopy were able to diagnose the site as well as the pathology in 35/35 of studied cases [100%]. Fluoroscopy delineated the site of obstruction in 4/35 cases [11.4%], two cases had external compression by vascular ring, one case of subglottic stenosis and one case with congenital tracheal stenosis. This study demonstrated the usefulness and safety of bronchoscope either flexible or rigid, in infants and children with persistent stridor. It usually provides rapid and precise diagnosis without significant complications. Diagnostic radiological modality as fluoroscopy needs more improvement. It may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway

Genetic and anthropometric studies of Prader-Willi syndrome

This study included 26 Prader-Willi syndrome [PWS] cases. Full clinical examination, pedigree analysis and intelligent quotient [IQ]were carried out. Fifteen anthropometric parameters, including longitudinal and transverse body and head measurements as well as two derived indices, were taken. Cytogenetic studies using G-banding and high resolution techniques were performed. According to chromosomal profile, the cases were divided into three groups: Cases with 15q deletions, cases with normal chromosomes and cases with chromosome 15 rearrangements. The study showed that the most characteristic anthropometric finding of PWS was truncal obesity and the variability in chromosomal pattern had no marked influence on the anthropometric findings. The cytogenetic results suggested that PWS is due to chromosome 15 imbalance

Oro-dental abnormalities in patients with mental retardation

The present study included 132 cases with mental subnormality. The aim of the present work was to investigate the prevalence of the oral and dental abnormalities in patients with mental retardation and to delineate the most common patterns of presentation associated with oro-dental abnormalities. All patients were subjected to full history taking, thorough oro-dental examination and IQ assessment. Chromosomal studies and metabolic screening were done when needed. It was concluded that oro-dental abnormalities are more frequent in patients with severe or profound mental retardation. The oral region abnormalities represent a major problem in the oral health of patients with mental retardation. Medical dental services and care were recommended for the affected cases, since there is no national oral disease prevalence data for patients with mental retardation and developmental disability

Structural abnormalities of the Y chromosome: Genotype-phenotype correlation

The aim of this study was to correlate the structural abnormalities of the Y chromosome to its presenting clinical features to evaluate the phenotype-genotype correlation. The study was performed on 30 patients who had structural Y chromosome abnormalities. The cytogenetic methods included conventional G-banding, diamidino-2-phenylindole [DAPI] and fluorescent in situ hybridization [FISH] techniques. The structural abnormalities of the Y chromosome were a deletion of the long arm [Yq-] in 13 cases, a partial deletion of the short arm [Yp-] in 6 cases, large heterochromatin of Y [Yq+] in 6 cases, pericentric inversion in 4 cases and one case with ring Y. Their phenotypic presentations varied from complete normal male, ambiguous genitalia to complete female phenotype. The clinical presentations and cause of referral of the patients were variable including male infertility and azoospermia, primary amenorrhea, mental retardation, multiple congenital anomalies and/or dysmorphism, short stature, ambiguous genitalia, routine premarital counseling and repeated abortions

Total hip arthroplasty after renal transplantation

This study was performed on 31 cemented total hip arthroplasty in 25 renal transplant recipients. The average follow up was 48 months [range 6-66 months]. Total hip arthroplasty relieved pain and improved function in all patients. The average preoperative Harris hip score was 34 +/- 9.46 points which improved to 94 +/- 4.32 points after surgery. At the end of follow up, there were 64.52% excellent and 35.48% good results, there were no fair or poor results in this study. One case had dislocation, one case with grade II myositis ossificans and two cases with suspected cup loosening. The overall complications rate of this group were parallel to those in young patients who had hip arthroplasty for osteoarthritis. There were no reported complications with the renal allograft either intra or postoperatively

Staged management of commiunted intra-articular pilon fracture

Seventeen patients with 18 intra-articular pilon fractures associated with severe soft tissue swelling were managed by two-staged protocol of treatment. The first step composed of the reduction and stabilization of the fibular fracture, immediate calcaneal pin traction to maintain length and axial alignment, ice packing and elevation of the affected limb, blisters were left intact, nonsteroidal anti- inflammatory drugs and I.V. antibiotics. The second step was done 10-15 days post-trauma, which composed of open reduction, anatomical restoration of articular surface and stable internal fixation using low-profile plate screws. On the quantitative assessment by three scoring systems [clinical, anatomical and arthritis scores], there were 78% satisfactory results. The fractures healed at an average of 17.9 weeks. No patients had nonunion. There was a statistical significant effect of the type of fracture on the duration of healing and on the final results. All unsatisfactory results were among C3 and C2 fractures and non among the less comminuted fractures [AO classification]. The degree of soft tissue swelling significantly affected the final results. No unsatisfactory results among grade I soft tissue swelling was detected. The average follow up period was 25.5 months [14-42 months]. Delayed open reduction and internal fixation after the period of traction and soft tissue care gave satisfactory results for such severe intra-articular fractures