Background : Mastalgia, or breast pain (or mastodynia), is globally a com‌mon symptom experienced by women of reproductive age; treatment for these conditions is not yet standardized. Most of the drugs used for mastalgia are expensive and have side effects, so, the aim of this study was to compare different agents for reducing mastalgia in fibrocystic disease of women in outpatient clinics at Zagazig University. Patients and methods: this prospective random comparative study has been carried out in zagazig university out patients clinics specifically in breast clinic subjects in period between may-2019 to mars -2020 on 68 patients enrolled with 3 months period of follow up. Results: In EPO group 30% of patients showed complete resolution and 61% showed partial response. The danazol group received, 58% of patients showed complete resolution and 41% showed partial improvement. In Tamoxifen group 47% of patients showed complete resolution while 52 % showed partial improvement. In the cabergoline group 14% of patient showed complete resolution and 42% showed partial improvement. Conclusion : Evening prime rose oil is effective in reducing the severity of mastalgia with minor tolerable side effects and should be used as first line of management. Danazol is the most effective agent but its side effects make it less favorable agent. Tamoxifen is the second most effective agent among the other agents with reversible tolerable side effects. cabergoline is significantly decrease breast pain especially cyclic mastalgia, with notable side effects.

The postpartum (PP) period is a crucial factor for the resumption of reproductive capacity and the regular cycling of goats. Until now, there is a lack of information on monitoring the PP uterine involution using morphological assessment of uterine echotexture by ultrasonography. This study aimed to use ultrasonography and computer software analysis for morphometrical evaluations of postpartum uterine involution in 30 pleuriparous Egyptian Balady goats from Day zero (kidding day) till Day 21 PP. Uterine echotexture (pixel intensity; PI and integrated density; ID) was assessed by the computer-assisted image analysis software. In addition, the changes in peripheral oxidative stress biomarkers were monitored by measuring superoxide dismutase (SOD; U/mL), glutathione peroxidase (GPx; U/mL) activities, and malondialdehyde (MDA; nmol/mL) levels in the sera during the PP period. Results revealed a significant (P < 0.001) reduction in the transverse uterine diameter from 8.05 +/- 0.58 cm at Day zero to less than 2 cm at Day 16 PP onward. The uterus returned to its apparently normal non-pregnant state with the absence of lochia by Day 16.6 +/- 1.35 PP. There were significant (P < 0.0001) increases in the PI and ID of the endometrium with the progression of the PP days [Day 0: PI: 86.99 +/- 8.61; ID (x1000): 82.09 +/- 1.47 versus Day 12 PP: PI: 186.73 +/- 5.62; ID (x1000): 355.17 +/- 38.63]. Gradual elevations in the levels of SOD (0.33 +/- 0.02 U/mL) and MDA (11.81 +/- 0.21 nmol/mL) were found from Day 0 and reaching the maximum levels (SOD: 0.48 +/- 0.12 U/mL; MDA: 15.31 +/- 0.13 nmol/mL) at Day 6-7 PP. Concentrations of GPx increased gradually from Day 0 (65.23 +/- 2.09 U/mL) till Day 21 PP (145.81 +/- 2.99 U/mL). In conclusion, assessment of the changes in morphometrical and echotextural parameters of the uterus by ultrasonography as well as the oxidative stress biomarkers provided useful information in the progress and completion of the normal physiological PP uterine involution in goats.

Abstract Background: We investigated if staggering sugammadex would reduce postoperative complications(with special regards to cough), compared to single dose of sugammadex or standard neostigmine in patients undergoing thyroidectomy surgery.Methods: A 36 adult patients aged 21-60 years old, ASA I and II undergoing thyroidectomy surgery, were randomized into 3 groups; (S group) that received 2 mg/kg sugammadex as single bolus, (SS group) that received sugammadex 2 mg/kg in a staggered dose of 1 mg/kg prior to extubation and another 1 mg/kg immediately after extubation and (N group) that received 0.05 mg/kg neostigmine combined with 0.02 mg/kg atropine.Results: Cough was absent in (SS) group. The percent of cough was 33% in S group and about 67 % in N group.Patients of (SS) and (S) groups had significant shorter recovery time and extubation time. Patients of (N) group showed significant increase in HR and SBP at 5 min after reversal compared to both (SS) and (S) groups, but no significant difference in DBP between all groups. There was no significant difference between all groups regarding postoperative complications other than cough.Conclusion: Staggered sugammadex reduces significantly risks for cough on emergence when compared to 2mg single bolus sugammadex .In addition, staggered sugammadex-as well as bolus sugammadex-has better recovery and more stable hemodynamics when compared to neostigmine.Keywords: Sugammadex, Staggered, Reversal, Cough, Postoperative

Background: Both diabetes mellitus (DM) and ankle fractures are becoming more common.Patients who have both diabetes and an ankle fracture have a higher risk of complications, some of which can be fatal. Objective:The aim of the current study was to evaluate functional outcomes and complications of internal fixation of Pott's ankle fractures in diabetic patients.Patients and methods: During this prospective study, 30 patients with ankle Pott's fractures were recruited from Orthopedic Out-patient Clinic in Zagazig University Hospital, from January 2022 to January 2023.Operative fixation was done through Open Reduction Internal Fixation (ORIF) by plate and screws or tension band according to AO principles of periarticular fracture fixation.Results: The mean age of participants was 40.09 (SD 13.2) years and 60% were males.The high union rate occurs mainly at week 10 at higher percent (74%) in controlled diabetic patients, while union rate in uncontrolled diabetic patients was delayed till 6 months with higher complication rates. Conclusion:Both open and closed therapy of ankle fractures are associated with greater complication rates in patients with DM.Patients with poorly controlled diabetes who have high HBA1C levels experience more complications than patients with well-controlled diabetes.The best method of treating unstable ankle fractures in diabetes patients under control is open reduction and internal fixation.

The present study aimed to determine the cryoprotective effect of melatonin supplements on the extender on the quality of canine epididymal spermatozoa. Epididymis from 20 castrated dogs were minced and incubated in Tris buffer. Spermatozoa were diluted in tris-citric acid-fructose (TCF) extender with two doses of melatonin (0.002 and 0.0035 mol) as well as a control (0.0 mol). The samples were packed in 0.25 ml straws after 2 hr of equilibration at 5°C and kept in liquid nitrogen (−196°C). Sperm parameters such as viability, motility, integrity of acrosome, sperm membrane functioning, and DNA integrity were assessed after thawing (37°C for 30 s). In addition, lipid peroxidation was assessed using the determination of malondialdehyde (MDA) levels. Results revealed that adding 0.0035 mol melatonin to the cryopreservation medium enhanced ( P < 0.05) the measured parameters of spermatozoa compared to the control and 0.002 mol melatonin. Levels of MDA were obviously ( P < 0.05) lower when 0.0035 mol melatonin was added in comparison to 0.002 mol melatonin and the control. Eventually, adding 0.0035 mol melatonin to the TCF extender significantly improved the percentage of motility, viability, and integrity of both plasma membrane and acrosome integrity of dog epididymal spermatozoa. In addition, melatonin supplementation improved DNA integrity and reduced membrane lipid peroxidation.

Diclofenac sodium is normally used as anti-inflammatory and pain killer drug.The current study was performed to examine the possible protective roles of the date palm pollen and silymarin against diclofenac sodium (DS)-induced histopathological changes in the spleen of rats.Rats were divided into nine groups.Group1 (control), group2 (DS group) was administrated 15 mg/kg b.wt. of DS, group 3 (Date Palm Pollen ,DPP group; 100 mg/kg b.wt),group 4 (silymarin, Sil.group; 100 mg/kg b.wt), group 5 (DPP+DS group), group 6 (DS+DPP group),group 7 (Sil.+DS group), group 8 (DS+ Sil.group) and group 9 (DPP combined with SIL +DS group).DS resulted in a significant alterations in the splenic architecture indicated by cell necrosis at the white pulp, lymphocytic cell necrosis at the red pulp and depletion of lymphocytes at the white and red pulps.Each date palm pollen and silymarin restored the normal histological structure of the spleen.Also, the administration of the combined date palm pollen and silymarin before diclofenac sodium protected the spleen structure against the toxicity of diclofenac sodium.So, the data from this study suggested that date palm pollen and silymarin (as antioxidants) prevented DS-induced spleen structure toxicity and may be beneficial in protecting the therapeutic index of DS.

In this research article, a modified algorithm for the generation of a fractal pattern resulting from the iteration of an algebraic function using the numerical iteration method is presented. This fractal pattern shows the dynamical behavior of the numerical iterations. A nonstandard convergence test of the displayable fractal pattern was applied.

AIMS:Cardiac affection is common in diabetic patients. Although insulin exerts a cardioprotective role, it may not be enough to totally prevent this affection. The current study aimed to compare the cardioprotective effect of insulin alone or combined with sitagliptin in a rat model of type 1 diabetes mellitus. MATERIALS AND METHODS:Diabetes was induced by a single intraperitoneal injection of streptozotocin (STZ; 60 mg/kg). Diabetic rats were treated with insulin (3 IU), insulin (6 IU), or insulin (3 IU) + sitagliptin (10 mg/kg) for 42 days. KEY FINDINGS:Diabetic rats exhibited significant systolic and diastolic cardiac affection with significant elevation of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) and brain natriuretic peptide (BNP) levels. Treatment with insulin prevented the deterioration of diabetes-induced cardiac condition, an effect that was significantly potentiated by the combined use of sitagliptin. SIGNIFICANCE:The combined use of sitagliptin and insulin significantly improved the cardioprotective effect of insulin and prevented the early cardiac dysfunction in STZ diabetic rats.

In this study, a new concept of generalized intuitionistic fuzzy topological space, called intuitionistic fuzzy b(similar to)-door space, is introduced and several characterizations of intuitionistic fuzzy b(similar to)-door spaces are analyzed. Many examples were introduced to prove the validity of these concepts. Moreover, certain properties and relationships between intuitionistic fuzzy b(similar to)-door spaces and other intuitionistic fuzzy topological spaces were investigated.

Background: Controlling intrathecal opioid induced pruritis is considered a significant challenge to anesthetists. The aim of this study was to compare the effects of Nalbuphine, Propofol, and Ondansteron in controlling intrathecal morphine induced pruritis to find out the best one with least side effects.Methods: 248 parturients with moderate to severe pruritus after spinal anesthesia with 2 mg morphine added to 10 mg bupivacaine for cesarean section were included. According to the used drugs, they were randomized into four equal groups: Control group (Group C) received 10 ml of normal saline (as Placebo) IV, Nalbuphine group (Group N) received 4mg (0.2 ml) of 2% Nalbuphine diluted up to 10 ml with normal saline IV, Propofol group (Group P) received 20 mg (2 ml) of 1% Propofol diluted up to 10 ml with normal saline IV, and Ondansetron group (Group O) received 8 mg (4ml) of 0.2% Ondansetron diluted up to 10 ml with normal saline IV. The effects of interventional drugs in controlling pruritus and associated side effects were evaluated in each group.Results: Statistically, parturients' characteristics and pre-treatment pruritus scores distribution were comparable. The post-treatment pruritus scores distribution was highly significant decreased in Nalbuphine group and post-treatment success rate was highly significant in Nalbuphine group (93.6%) than in Propofol (71%) and Ondansetron groups (53.2%). No statistical significant difference was noticed regarding the adverse events in the studied groups.Conclusion: Nalbuphine (4mg) was superior to both Propofol (20mg) and Ondansteron (8mg) for treatment of intrathecal morphine-induced pruritus after cesarean section.

: This study evaluated the protective and ameliorative role of date palm pollen and vitamin C against bisphenol- A (BPA) induced gastric structure toxicity in rats. Control rats received only food and water. Second group administrated BPA ( 30 mg/kg b.wt. ). Third group was given DPP (100 mg/kg b.wt.).Fourth group was given Vit. C (160 mg/kg b.wt.). Fifth group was given DPP 12 hrs before administration of DPP, while the sixth group was given BPA 12 hrs before administration of BPA. The seventh group was given Vit. C 12 hrs before administration of BPA, whereas the eighth group was given BPA 12 hrs before administration of vit. C. The ninth group was given DPP combined with Vit. C 12 hrs before administration of BPA.BPA induced histopathological changes in the stomach indicated by congestion at the vasculatureand edema of the submucosal layer of the non-glandular part, and congestion of the blood vessels at the muscular layer of the glandular part. However, administration of each DPP and vitamin C before and after BPA, or combined with each other before BPA, restored the normal histological structure of the stomach. So, this study revealed that DPP and Vit. C protected and ameliorated gastric structure against BPA toxicity via their antioxidant activities.

Introduction: COVID-19 may put pregnant women at greater risk of serious conditions and poor outcomes for new-borns. Aim: The study aimed to evaluate the effect of an educational intervention based on health beliefs model adoption on pregnant women's knowledge and preventive health behaviours in relation to COVID-19. Subjects & Method: A quasi-experimental design was performed on 100 pregnant women in the antenatal clinic of Zagazig University Hospital using purposive sampling. Data were collected using three tools: a structured interview questionnaire, the health beliefs model and preventive health behaviours of pregnant women in relation to COVID-19. Results : Mean and standard division of knowledge and preventive behaviours about covid-19 were greatly improved from 21.1±5.67 and 26.88±2.49 before applying the Health Belief Model to 27.84±1.67 and 31.92±3.61 after applying the health belief model. Conclusion : The study concluded that an educational intervention based on the adoption of the health belief model enhanced pregnant women's knowledge and preventive health behaviors in relation to COVID-19. Recommendations : The study suggests that health education interventions should specifically target pregnant women at different antenatal clinics at Zagazig city.

The present study investigated whether or not passive immunization against inhibin modulates testicular blood flow in goats. Male Shiba goats were injected with either 10 ml of inhibin antiserum (INH group; n = 5) or 10 ml of normal castrated goat serum (NGS group; n = 4). Concentrations of FSH, LH, testosterone (T), and estradiol (E2) in the plasma were measured by radioimmunoassay. Blood flow within the supratesticular (STA) and marginal testicular arteries (MTA) were measured by color pulsed-Doppler ultrasonography, and Doppler indices (resistive index; RI and pulsatility index; PI) were recorded. Results revealed significant increases in concentrations of FSH and E2 in the INH group compared to those in the NGS group (P < 0.05). Animals in the INH group had greater (P < 0.05) FSH concentrations than those in the NGS group in the period between 60 h and 144 h after treatment than at any other time. Estradiol concentrations were greater (P < 0.05) in the INH group than in the NGS group at 6 h (12.15 ± 2.09 pg/ml vs 5.49 ± 1.17 pg/mL), 12 h (8.27 ± 1.29 pg/mL vs 3.05 ± 0.38 pg/mL), and 36 h (9.35 ± 1.31 pg/mL vs 5.09 ± 0.46 pg/mL) after treatment than at any other time. Concentrations of LH and T did not significantly change between the two groups. Goats in the INH group had lesser (P < 0.05) RI of the STA than those in the NGS group and RI values were lesser at 24 h (0.37 ± 0.031 vs 0.49 ± 0.004) and 120 h (0.38 ± 0.028 vs 0.55 ± 0.048) after treatment than at any other time. Furthermore, values of RI and PI of the MTA were significantly lesser (P < 0.05) in the INH group compared to those in the control group at 48 h (RI of MTA: 0.21 ± 0.014 vs 0.37 ± 0.039; PI of MTA: 0.24 ± 0.016 vs 0.46 ± 0.058) after treatment than at any other time. In conclusion, passive immunization against inhibin has a stimulatory effect on testicular blood flow in goats by inducing decreases in the RI values of the STA and MTA.

Introduction Local bupivacaine provides safe, effective, and low-cost anesthesia with good postoperative analgesia. Our aim was to confirm the postoperative analgesic efficacy and safety of bupivacaine for local infiltration in pain relief in laparoscopic sleeve gastrectomy. Patient and methods This prospective, double-blind study was conducted on 70 patients of age 18–50 years, posted for laparoscopic sleeve gastrectomy and randomly allocated into two groups of 35 patients each. Control group (group C) received an injection of 40 ml saline 0.9%: 30 ml intraperitoneal plus 10 ml normal saline injection local infiltration in the three port sites. Group P received 40 ml of bupivacaine: 30 ml intraperitoneal plus 10 ml local infiltration at the port site. Assessment of pain scores visual analog scale in the 24 h after surgery, first need for rescue analgesia, and incidence of various complications were recorded. Results The timing of the first analgesic request in the control group was 102.5±10.3 min, and in group D was 328.8±32.4 min, which is statistically significant (P<0.000), with no adverse effects. Conclusion Bupivacaine (intraperitoneal and local infiltration) leads to prolonged postoperative analgesia after sleeve gastrectomy without adverse effects.

IntroductionLesser narcotics use during laparoscopic bariatric surgery is needed to decrease the impact on respiratory parameters and reduce analgesic requirements after surgery. Using dexmedetomidine has a role in perioperative pain control in obese patients' recovery in postanesthetic care unit (PACU) and hospital stay. In this study, we hypothesized that dexmedetomidine would delay and decrease opioid requirements during surgery, promoting less time in the PACU and faster, safer recovery.Patients and methodsAfter obtaining ethics committee approval, informed consent to participate in this study was obtained from 56 patients who were scheduled for planned laparoscopic bariatric surgery. Patients were randomly divided into two groups − group D (n=28) received dexmedetomidine 1 µg/kg loading for 10 min and 0.4 µg/kg/h maintenance until extubation, and group N (n=28) received normal saline (placebo) at the same volume and rate. PACU stay time, the total amount of intraoperative fentanyl used, recovery profile, pain score, and the total amount of pethidine used postoperatively were measured.ResultsThe dexmedetomidine group showed significant decrease in intraoperative and postoperative hemodynamics, shorter recovery time, and shorter stay in PACU. Perioperative narcotic use, intraoperative fentanyl use, visual analog scale scores, PACU pethidine dose in the first hour, and total pethidine dose on the first day were significantly less in the dexmedetomidine group. Patient satisfaction at discharge regarding pain management was less in the control group.ConclusionIntraoperative dexmedetomidine infusion with its opioid-sparing effect enhanced recovery in this study population of morbidly obese patients undergoing laparoscopic bariatric surgery with minimal side-effects.

Background: Adequate pain management has a great importance for smooth postoperative recovery, early hospital discharge and early rehabilitation. In this study is we compare between the analgesic effect and possible side effects of different routs of magnesium sulphate administration in cases of spinal anesthesia for knee arthroscopy. Methods: 120 patients scheduled for knee arthroscopy 4 groups (30 patients each): group C received only Bupivacaine intrathecally. group Mg-Sp received 50 mg Mg sulphate with Bupivacaine intrathecally, group Mg-Iv 10 min after intrathecal injection, received intravenous injection of 30 mg/kg Mg sulphate in 100 ml saline over 10 min followed by 10 mg/kg intravenous infusion over one hour and group Mg-Art received intra-articular injection of 800 mg Mg sulphate diluted in 12 ml normal saline (0.9% NaCl) 10 min before the end of surgery. Operative time in minutes, VAS at rest and at passive movement, time to be able to perform knee flexion, time from end of surgery until first requirement of analgesics, analgesic consumption, hemodynamic changes and any possible side effects were recorded. Results: Regarding Time to be able to perform knee flexion, time taken from end of surgery until first analgesic dose and amount of pethidine consumption in first postoperative 24 h, group Mg-Art is significantly better than other groups (P = 0.000) (P = 0.000) (P = 0.000) respectivly. Group Mg-Iv is significantly better than group Mg-Sp and group C as regards time taken from end of surgery until first analgesic dose (P = 0.000) and as regards amount of pethidine consumption in first postoperative 24 h (P = 0.000). VAS at rest and with passive movement in group Mg-Art is significantly lower other groups (P = 0.000). Conclusion: Intraarticular administration of magnesium sulphate is found to be better than Intravenous magnesium and intrathecal in postoperative analgesia.

Background: Superior labrum anterior to posterior (SLAP) lesions are labral tears that extend anteriorly from the posterior superior labrum, involving the long head of the biceps tendon originating from the glenoid labrum, and stopping before the anterior glenoid notch. Accurate diagnosis of suspected SLAP tears is confirmed by arthroscopy. Progress in arthroscopic techniques had made it possible to achieve accurate and safe repair in selected patterns of injury. Recent outcomes studies have shown good functional results and an acceptable rate of return to activity with treatment of SLAP tears by arthroscopy.Aim of the work: The aim of this work is to evaluate the diagnosis, clinical outcome and management of superior labrum anterior to posterior (SLAP) lesions using arthroscopy.Patients and Methods: This is prospective study consisted of twenty denovo patients who had done arthroscopy for the treatment of isolated SLAP lesions between (2011) to (2014). Inclusion Criteria: Adult denovo patients aged from (20-55) years old. All patients provided written informed consent to share in the study. Patients diagnosed by: thorough clinical examination (history, clinical presentation and examination), radiological diagnosis (plain x-ray & MRI), SLAP lesions that did not respond to non surgical treatment, and lastly SLAP lesions either isolated or associated with other lesions (Bankart lesion & rotator cuff lesions). Exclusion Criteria: Patients’ refusal to share in the study, Frozen shoulder, Failed previous surgery to patient with SLAP lesion.Results: In our study there was significant difference regarding UCLA score between pre and post operative as in preoperative 100% UCLA score was <27 Fair/Poor not satisfied, while in postoperative 90% UCLA score was > 27 Good/Excellent was satisfied, and only 10% UCLA was < 27 Fair/Poor not satisfied.Conclusion: Treatment of SLAP lesions by arthroscopy is challenging and provides good functional outcome.

Photocatalytic degradation of polychlorinated biphenyls (PCBs) in seawater was successfully achieved at laboratory level with UV light and at pilot-plant scale under natural solar radiation using carbon-modified titanium oxide (CM-n-TiO2) nanoparticles. The photocatalytic performance of CM-n-TiO2 was comparatively evaluated with reference n-TiO2 under identical conditions. As a result of carbon incorporation, significant enhancement of photodegradation efficiency using CM-n-TiO2 was clearly observed. To optimize the operating parameters, the effects of catalyst loading and pH of the solution on the photodegradation rate of PCBs were investigated. The best degradation rate was obtained at pH 5 and CM-n-TiO2 loading of 0.5 g L−1. The photodegradation results fitted the Langmuir-Hinshelwood model and obeyed pseudo-first-order reaction kinetics.

Introduction: Sugammadex is an efficient reversal agent at any time, after neuromuscular blockade. It provides complete reversal for light or deep block facilitating rapid airway control and decreases anesthesia recovery period in outpatient surgeries in children. Patient and methods: After ethical committee approval, informed consent and sample size calculation, 70 patients planned for outpatient total bilateral tonsillectomy were divided randomly into 2 groups. Group S (n = 35) received 2 mg/kg sugammadex to reversing NMB achieved by rocuronium. Group N (n = 35) received 0.05 mg/kg neostigmine and atropine sulfate 0.01 mg/kg, and extubation time (time from administration of reversal agent to time of extubation), train-of-four ratio, time to reach train-of-four >0.9, and side effects were recorded. Results: There was no significant difference in demographic variables. TOF ratio after reversing was a statistically less in group S than in group N (p < 0.05). The time when TOF rate exceeded 0.9 and extubation time were less in group S than in group N with significant difference (p < 0.05). No adverse effect was recorded in both groups. Conclusions: Sugammadex has created a novel rapid, effective and reliable retrieval from NMB with rocuronium in children undergoing tonsillectomy with no side effects.

In this work, the sonicated sol-gel method was used for synthesizing carbon-modified titanium oxide nanoparticles. Carbon incorporation was achieved by using titanium (IV) isopropoxide as a titanium and carbon-containing precursor. The photocatalytic efficiency of the synthesized photocatalyst was assessed by examining the photocatalytic removal of polychlorinated biphenyls (PCBs) from aqueous solution. For comparison, unmodified (regular) titanium dioxide (n-TiO2) was used as a reference catalyst. To confirm the carbon incorporation in CM-n-TiO2 nanoparticles, energy dispersive spectroscopy (EDS) analysis was used. Significantly, the bandgap energy was found to be reduced from 2.99 eV for n-TiO2 to 1.8 eV for CM-n-TiO2, which in turn improved the performance of CM-n-TiO2 toward the photocatalytic removal of PCBs. The effects of CM-n-TiO2 loading, PCBs concentration, and pH of the solution on the photodegradation rate of PCBs were investigated. The highest removal rate was found to be at pH 5 and CM-n-TiO2 loading of 0.5 g L-1. According to Langmuir-Hinshelwood model, the photodegradation of PCBs using CM-n-TiO2 followed a pseudo-first order reaction kinetics. (C) 2016 Elsevier B.V. All rights reserved.