Background and objectives. Chemerin is an adipokine associated with inflammation. Musculoskeletal ultrasonography is now widely used for detecting and monitoring RA due to its availability, practicality, and cost-effectiveness. The aim of the study is to determine how accurate serum chemerin levels are as a biomarker of active rheumatoid arthritis (RA) disease and to find a link between these levels and ultrasonographic findings. Materials and methods. This case-control study included 44 RA cases and 44 matched-age and sex-healthy controls. Seven joints in the hand and foot were assessed by the German ultrasound 7 (GUS 7) score through greyscale (GSUS) and power Doppler US (PDUS) in all cases. Disease activity score 28 (DAS28) evaluated RA activity, and serum chemerin levels were measured in cases and controls. Both DAS28-CRP and DAS28-ESR were used in the assessment of the disease. Outcomes. The mean age of patients was 43.48 years versus 39.18 years of controls. 86.4% of patients were females; versus 75% of the control group. 47.7% of the studied patients had moderate disease activity, 31.8% had high disease activity, and 20.5% had low disease activity. There was a statistically significant higher median chemerin serum level among RA cases compared to the control group (898.94 versus 247.81 ng/ml, p <0.001). There was a significant difference in median chemerin between inactive and active patients (352.1 versus 1032.6 ng/ml (p <0.001). The serum chemerin can differentiate between RA patients and controls with a higher sensitivity of 81.8%, a specificity of 88.6%, and an accuracy of 85.2%. There was a statistically significant positive association between chemerin and RA activity (p <0.001). The combination of serum chemerin level and tenosynovitis GSUS score and DAS28-ESR to differentiate between active and inactive RA patients was highly significant with the highest sensitivity of 100%. Conclusions. Chemerin can serve as an advantageous marker for assessing RA activity. The US-7 score is a complementary method used in standard assessment to determine synovial inflammation in RA. The combined use of serum chemerin and the US 7 score could be of high value for detecting disease activity in RA.

Background: Pelvic floor dysfunction caused by multiple factors is a complicated process. As life expectancy rises, so does the prevalence of PFD, which includes pelvic organ prolapse (POP), sexual disorders, and lower urinary tract excretory and defecation abnormalities such as overactive bladder, pelvic organ prolapse, and urine and anal incontinence. This study aimed to evaluate the association between type of delivery and pelvic floor structure changes in Zagazig University Hospitals. Methods: A cohort study conducted at Zagazig University Hospitals in Obstetrics and Gynecology Ultrasonography unit, utilizing a Mindray Dc-70 ultrasound machine. Patients were separated into two groups (24 vaginal deliveries and 24 cesarean deliveries). All women underwent a thorough history taking, general examination, pelvic examination, and transperineal ultrasonography. Results: There were no statistical significance differences between the studied groups in bladder neck rotation. But there was a statistical significance increase in bladder neck descend among NVD group compared to CS group. There was a statistical significance decrease in detrusor muscle thickness among NVD group compared to CS group. There was a statistical significance increase in frequency of pelvic organ prolapse and stress incontinence among NVD group compared to CS group. There was a statistically significant decrease in mean MOS score among NVD group compared to CS group. Also, there was a statistically significant increase in frequency of UPFMC among NVD group compared to CS group. Conclusion: it appears that vaginal delivery is associated with more negative effects on pelvic floor structure and function compared to cesarean section delivery.

Background: A severe maternal complication known as placenta accreta, also known as an abnormally invasive placenta (AIP), carries a significant risk of substantial haemorrhage, peripartum hysterectomy, and potentially difficult surgery. This study aimed to focus on association of incidence of invasive placentation with previous deliveries circumstances. Patients and method: This Cross-sectional prospective the Faculty of Medicine at Zagazig University, Department of Obstetrics and Gynecology, from March 2022 until September 2022. A total of 170 pregnant women of different gravidity and parity with documented ultrasound of abnormally invasive placenta were enrolled. Result: there was a statistically significant positive correlation between numbers the frequency of placenta and the number of prior caesarean sections (more than two prior caesarean sections) accrete. In addition, we reported that the incidence of placenta accrete statistically significant increased among women previously delivered in non-tertiary center. We proved that there was a statistically significant negative correlation between inter-pregnancy interval (less than 1.5 years) and incidence placenta accrete. Bladder damage, which occurred in 5.9% of intraoperative complications in our study, was the most common one. On the other side, wound infection was the most common postoperative complication by a percentage of 2.9%. Conclusion: Cesarean section without medical cause or on maternal request should be avoided as possible as it is proved to be the major risk factor of placenta accrete.

Background: Premature progesterone rise (PPR) refers to an increase in serum progesterone (P4) levels on or before the human chorionic gonadotropin (hCG) trigger day. This work aimed to evaluate the impact of serum P4 levels on the day of hCG trigger on the outcomes of intracytoplasmic sperm injection (ICSI) cycles using the gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods: The prospective cohort study was conducted at the Cytogenetics and Endoscopy unit, Obstetrics & Gynaecology Department, Zagazig University, including 150 women having ICSI/fresh-embryo transfer (ET). Each patient had one trial of ICSI/fresh ET cycle. In the study, patients were subjected to controlled ovarian stimulation (COS) using a GnRH antagonist protocol. P4 levels were measured on the hCG trigger day (hCG-P4), and the results were correlated to the outcomes of the ICSI cycle. Results: There was a statistically significant negative correlation between hCG-P4 and the top-quality embryo (TQE) rate. No significant association was found between hCG-P4 level and clinical pregnancy, ongoing pregnancy, or miscarriage. The cutoff for hCG-P4 predicting unsuccessful achievement of clinical pregnancy was ≥ 0.925 (p>0.05). Patients with hCG-P4 level ≥0.925 ng/ml had a significantly lower TQE rate than patients with hCG-P4

Background: Endometrial polyps are a main cause of Abnormal Uterine Bleeding (AUB) in premenopausal & postmenopausal women and suggested by screening transvaginal ultrasound. Objectives: The aim of the current study was to determine the effectiveness and acceptability of outpatient hysteroscopic endometrial polypectomy by vaginoscopic approach, and if the technique confers any advantage in term of patient discomfort and reduction in procedure time over the traditional technique. Patients & Methods: This study is prospective randomized clinical trial, it was carried in Endoscopy Unit in the Department of Obstetrics and Gynecology at Zagazig University Hospitals, in period from May 2018 to April 2019. Results: there was a statistical significant difference between traditional and vaginoscopic groups in procedure time where traditional technique needs more time than vaginoscopic one (7.8 VS 6.1 minutes), and all cases had (100.0%) success rate of polypectomy in both groups without complication. but histopathology results discovered one case (2.5%) of all study groups adenocarcinoma and the patient sent to oncology unit for further evaluation and appropriate management. Conclusions: Office vaginoscopic polypectomy for small polyp is feasible and safe minimally invasive procedure.

Background: The treatment decision of patients with moderately severe cases of degenerative lumbar spinal canal stenosis (LSS) whether conservative or surgical is highly dependable on physician evaluation without clear standards. The purpose of this study is to evaluate the effectiveness of conservative treatment of patients complaining of moderately severe degenerative LSS in comparison with surgical intervention throughout one year follow up. The present study was conducted on 60 patients with LSS: 30 patients treated with rehabilitation program and 30 patients treated with decompression surgery. All patients were assessed for pain and physical function before treatment, 3 months, 6 months and 12 months after treatment. Results: Both groups showed significant improvement of Oswestry Disability Index (ODI), ODI walk, and Zurich Claudication Questionnaire (ZCQ) symptoms and function subscales at 3, 6 and 12 months after treatment compared to baseline. However, at 1 year, the most patients of the conservative group did not maintain improvement in ODI and ZCQ subscales scores. The beneficial effect of operative treatment sustained throughout the 1-year follow-up. No serious complications were encountered in conservative group but, there were two patients in surgical group had serious complications. Conclusion: The conservative treatment yielded statistical significant improvement among patients with moderately severe LSS for three, six and twelve months follow up compared to baseline. Nonetheless, at all follow-up end points, the surgical group outperformed the conservative group statistically. Mansoura Medical Journal (Official Journal of Mansoura Faculty of Medicine) pISSN: 1110-211X; eISSN: 2735-3990

IntroductionEndometrial scratching (or injury) is defined as intentional damage to the endometrium. The objective of this study was to investigate the effect of the method of endometrial scratching by hysteroscope or pipelle curette on the outcome of assisted reproduction. Scratching had done in the follicular phase of the preceding cycle to embryo transfer in infertile women aged 20-40 years.MethodsIn this study, 225 ICSI cycles were studied and divided into three groups: - hysteroscope group (75) scratching by scissor, pipelle group (75) scratching by pipelle curette, control group (75) no scratching had done. For each woman in hysteroscope and pipelle groups an appointment was scheduled on day7–14 of the cycle before the planned start of COS to perform endometrial scratching.ResultsThere were statistical significant differences between women in the pipelle group, hysteroscope group and control group as regard positive pregnancy test P value = 0.046, clinical pregnancy P value = 0.042, ongoing pregnancy P value = 0.039 and implantation rate P value = 0.044. With further analysis to each intervention group separately with control group, there were statistical significant differences between women in the pipelle group and control group. There was improvement in pregnancy rates in hysteroscope group than control group but with no statistical significant differences. ConclusionEndometrial scratching performed in the follicular phase of the preceding cycle to ovarian stimulation by pipelle curette or hysteroscope is associated with improved clinical and ongoing pregnancy rates in infertile women undergoing ICSI

OHSS) is an iatrogenic state, potentially lethal, and still one of the major complications encountered during controlled ovarian stimulation (COS) in IVF. It occurs in approximately 1

Green, rapid and modified surface-active ionic liquid assisted cloud point extraction method (SAIL-CPE) was developed to preconcentrate trace levels of nickel Ni(II) ions in environmental samples perior to its detection by FAAS. The proposed method based on utilizing a mixture of a nonionic surfactant (Triton X-114) and a surface-active ionic liquid, 1-hexadecyl-3-methylimidazolium chloride (C16MeImCl), as an extracting phase for Ni(II) ions after the complexation with sunset yellow FCF at pH 6.5. The impact of different analytical parameters on improving the extraction efficiency was invistigated. In the range of 2.0-600 µg L−1, the calibration graph was linear with correlation coefficient of 0.9998. Limit of detection and preconcentration factor were 0.6 and 100. The reliability and precision of the proposed SAIL-CPE system as the relative standard deviation (RSD %) in the presence and absence of SAIL were examined by applying ten replicate determinations of 300 µg L-1 of Ni(II), and RSD % of the recoveries were found to be 1.40 and 2.9%, respectively. The validation of the proposed procedure was verified by test of certified reference materials (TMDA-51.3 fortified water, TMDA-53.3 fortified water and SRM spinach leaves 1570A) applying the standard addition method. Finally, the proposed SAIL-CPE method was developed and applied to preconcentrate and determine of trace levels of Ni(II) ions in real water, food and tobacco samples with satisfactory results.

Background:: Cadmium (Cd2+) is considered to be one of the most important hazardous heavy metals due to its toxicity for living organisms at low concentration levels. Therefore, the estimation of trace Cd2+ in different types of various samples is a very important objective for chemists using effective methods. In the present work, a novel, green, easy and fast ultrasoundassisted ionic liquid-dispersive liquid phase microextraction technique (UA-IL-DLPME) was developed to preconcentrate and determine trace quantities of cadmium (Cd2+) ions from real samples, prior to detection by FAAS. Methods: The proposed technique is based on utilization of ionic liquid (IL) (1-hexyl-3- methylimidazolium tris(pentafluoroethyl)trifluorophosphate [HMIM][FAP]) as an extraction solvent for Cd2+ ions after complexation with 2-(6-methylbenzothiazolylazo)-6-nitrophenol (MBTANP) at pH 7.0. The impact of different analytical parameters on the microextraction efficiency was investigated. The validation of the proposed procedure was verified by the test of two certified reference materials (TMDA-51.3 fortified water, SRM spinach leaves 1570A) applying the standard addition method. Results: In the range of 2.0-200 μg L−1, the calibration graph was linear. Limit of detection, preconcentration factor and the relative standard deviation (RSD %, 100 μg L-1, n=5) as precision was 0.1 μg L-1, 100 and 3.1%, respectively. Conclusion: Green UA-IL-DLPME method was developed and applied to preconcentrate and determine trace quantities of Cd2+ in real water, vegetables and hair samples with satisfactory results.

Aluminum (III) has high toxic impacts in some human pathologies like renal osteodystrophy, Parkinson's and Alzheimer's disease. So, it is very important to assess and determine the trace concentrations of Aluminum (III) in various water and acid digested food samples. The present work proposed a new green supramolecular solvent liquid-phase microextraction procedure has been sophisticated to preconcentrate and determine Aluminum (III) in various samples. The proposed method was based on the application of Undecanol/THF supramolecular solvent system and thymol blue as a chelating agent. Aluminum (III)-thymol blue complex was formed at pH 6.0, extracted into (Undecanol/THF) supramolecular solvent phase, centrifuged and spectrophotometrically measured at 550 nm. The influence of different analytical parameters was studied and optimized. The validation of the suggested preconcentration method was checked using certified reference materials. The calibration curve was linear in the range of 5.0-200 mu g L-1. The developed method has preconcentration factor of 50 and detection limit was 1.20 mu g L-1. The method precision was confirmed with relative standard deviation <= 1.80%. The accuracy of the new preconcentration procedure was checked by the analysis of the certified reference materials (SRM 1643e trace element in water and NIST SRM 1515 Apple Leaves), and successfully applied to determine Aluminum (III) in real samples with relative recovery values in the range of 95.0%-100% for the spiked samples. This study explores the effectiveness of thymol blue for the first time together with supramolecular solvent to develop green supramolecular solvent liquid-phase microextraction method to preconcentrate and separate of trace amount of Aluminum (III) in real samples.

Three simple, sensitive spectrophotometric methods were proposed for the quantification of two phosphodiesterase type 5-inhibitors; vardenafil HCl (VARD) and tadalafil (TDF) in pure forms as well as in tablets dosage forms.The methods use N-bromosuccinimide (NBS) as an analytical reagent and three dyes, amaranth methylene blue, and indigocarmine or orange G, as auxiliary reagents.The three methods are based on oxidation reaction of VARD or TDF with a known excess of N-bromosuccinimide (NBS) in acid medium, followed by determination of unreacted NBS by the reaction with a fixed amount of three dyes, amaranth, methylene blue and indigocarmineor orange G followed by the measurement of the absorbance at 520, 664 and 610 or 478 nm, respectively.Under the optimum conditions, the three methods are applicable over the concentration ranges of 1.0-16, 1.0-12 and 1.0-10 µgmL -1 for VARD using amaranth methylene blue and indigocarmine methods, respectively and 2.0-12, 2.0-15 and 1.0-10 µgmL -1 for TDF using amaranth methylene blue and orange G, respectively.The molar absorptivities, Sandell's sensitivity values, correlation coefficients, limits of detection and quantification are reported.Intra-day and inter-day accuracy and precision of the methods have been evaluated.No interference was observed from the common tablet excipients.The methods were successfully applied to the assay of VARD and TDF in tablets preparations and the results were statistically compared with those of the reference methods by applying Student's t-test and F-test.The reliability of the methods was further ascertained by performing recovery studies using the standard addition method.

Three sensitive, accurate and validated spectrophotometric methods has been developed for estimation of ezetimibe (EZT)in pure and dosage forms. The proposed methods is based on oxidation reaction of EZT with a known excess potassium permanganate (KMnO4) as an oxidimetric reagent in acid medium followed by determination of unreacted oxidant by adding a fixed amount of amaranth (AM), orange G (OG) andmethylene blue (MB) dyes followed by measuring the absorbance at 520, 480and664 nm, respectively.The experimental conditions affecting the reaction were studied and optimized. The beer’s law was obeyed in the concentration ranges of 2.0-15, 2.0-10, and 2.0-12 μg mL-1 using AM, OG and MB dye, respectively with a correlation coefficient ≥ 0.9992. The calculated molar absorptivity values are 1.7012 × 104, 3.0117 × 104and 1.5321 × 104L mol-1 cm-1 using AM, MB and OG dyes, respectively. The limits of detection and quantification were reported. Intra-day and inter-day accuracy and precision of the methods have been evaluated. No interference was observed from the additives and the applicability of the method was tested by analyzing the pharmaceutical preparations containing the investigated drug. The proposed methods were successfully applied to the assay of EZT in tablet preparations and the results were statistically compared with those of the reported method by applying Student’s t-test and F-test. The reliability of the methods was further ascertained by performing recovery studies using the standard addition method.

A simple, sensitive and accurate spectrophotometric methods have been developed for the determination of two phosphodiesterase type 5-inhibitors; vardenafil HCl (VARD) and tadalafil (TDF) in bulk drugs and pharmaceutical preparations. The methods are based on the oxidation of the studied drugs by a known excess of ceric(IV) ammonium sulphate (CAS) in acid medium followed by determination of unreacted oxidant by adding a fixed amount of orange G (OG), rhodamine B (RB), methylene blue (MB) and methyle orange (MO) dyes followed by measuring the absorbance at 478, 550, 664 and 510 nm, respectively. The experimental conditions affecting the reaction were studied and optimized. The beer’s law was obeyed in the concentration ranges of 1.0-8.0, 1.0-10, 1.0- 12 and 1.0-12 μg mL-1 for VARD using OG, RB, MB and MO methods, respectively and 2.0-12, 1.0-12 and 1.0-15 μg mL-1 for TDF using OG, RB and MB methods, respectively with a correlation coefficient ≥ 0.9990. The calculated molar absorptivity values are 4.5874 × 104, 3.4207 × 104, 2.1705 × 104 and 4.3091 × 104 L mol-1 cm-1 for VARD using OG, RB, MB and MO methods, respectively and 3.3086 × 104, 5.2058 × 104 and 3.3342 × 104 L mol-1 cm-1 for TDF, using OG, RB and MB methods, respectively. The limits of detection and quantification were reported. Intraday and inter-day accuracy and precision of the methods have been evaluated. No interference was observed from the additives and the applicability of the method was tested by analyzing the pharmaceutical preparations containing the investigated drugs. The methods were successfully applied to the assay of VARD and TDF in tablet preparations and the results were statistically compared with those of the reported methods by applying Student’s ttest and F-test. The reliability of the methods was further ascertained by performing recovery studies using the standard addition method.

Rapid, simple and sensitive and validated spectrophotometric methods have been developed for the assay of two phosphodiesterase type 5-inhibitors; vardenafil HCl (VARD) and tadalafil (TDF) in pure and dosage forms. The proposed methods were based on the oxidation of both drugs by a known excess of potassium permanganate (KMnO4) in acidic medium and estimating the unreacted permanganate by the reaction with a fixed amount of three dyes, amaranth, indigo carmine and methylene blue, in the same acid medium followed by measuring the absorbance at λmax=520, 610 and 664 nm, respectively. Different variables affecting the reaction were studied and optimized. The beer’s law is obeyed in the concentration ranges of 2.0-12, 2.0-15 and 2.0-12 μg mL for VARD and 2.0-15, 2.0-20 and 2.0-12 μg mL for TDF using amaranth, indigo carmine and methylene blue methods, respectively with a correlation coefficient ≥ 0.9992. The apparent molar absorptivity values are in the range 2.0956×10, 1.2138×10 and 1.7502×10 L mol cm for VARD and 1.0769×10, 0.7922×10 and 1.0918×10L mol cm for TDF, using amaranth, indigo carmine and methylene blue methods, respectively. The limits of detection and quantification are reported. Intra-day and inter-day accuracy and precision of the methods have been evaluated. No interference was observed from the common tablet excipients. The methods were successfully applied to the assay of VARD and TDF in tablet preparations and the results were statistically compared with those of the reported methods by applying Student’s t-test and F-test. The reliability of the methods was further ascertained by performing recovery studies using the standard addition method.