Background/aims Hepatitis B virus (HBV) infection in hemodialysis (HD) patients represents a serious problem due to the immunosuppressive effect of renal failure and the susceptibility for de-novo HBV infection during HD with high morbidity and mortality. Occult hepatitis B virus infection (OBI) is defined as the presence of HBV-DNA in the serum and/or the liver in the absence of hepatitis B surface antigen (HBsAg). The strategy of combined screening for HBsAg and hepatitis B core antibody (anti-HBc) can virtually eradicate blood-transmitted HBV. The aim of this study was to evaluate the presence of anti-HBc among Egyptian regular HD adult patients and to determine the presence or absence of HBV-DNA in the serum samples from HBsAg-negative, anti-HBc-positive regular HD adult patients using the polymerase chain reaction (PCR) method to assess the magnitude of OBI in these patients. Patients and methods This cross-sectional study included 90 regular HD patients negative for HBsAg and anti-hepatitis C virus. Patients were investigated for anti-HBc, and samples of anti-HBc-positive patients were tested for HBV-DNA using real-time PCR. Results Among the 90 HBsAg-negative sera, anti-HBc was detected in 17 sera (18.9%). Eleven anti-HBc-positive patients were anti-HBs-positive. HBV-DNA was detected in seven of those 17 anti-HBc-positive patients (41.2%) (7.8% of all patients). Conclusion The overall prevalence of OBI in adult Egyptian regular HD patients is 7.8% in Al-Gharbia Governorate.

Aim The purpose of this study was to discuss the role of different imaging modalities in the diagnosis and evaluation of adnexal masses. Patients and methods A total of 50 female patients with 60 adnexal lesions were included in his study. After clinical evaluation, ultrasound examination was carried out for all cases. After observing all gray scale features, color Doppler was superimposed on the gray images to assess the site of blood flow and measure the Doppler indexes. Computed tomography was performed in seven suspicious cases, and MRI was performed in eight suspicious cases. The results were correlated with operative and histopathological findings. Results Nine malignant cases had Alcázar score greater than 6, whereas the benign cases (41 cases) had a score less than 6. There were two cases (4%) of hydrosalpinx, five cases (10%) of ectopic pregnancy, three cases (6%) of tuboovarian abscess, four cases (8%) of polycystic ovaries, and four cases of solid masses (8%) (one case of ovarian fibroma, one case of subserous uterine fibroid, one case of broad ligament fibroid, and one case of Krukenberg tumor). There were 24 cases of cystic masses (48%) either unilocular or multilocular within thin septae (seven cases of follicular ovarian cysts, eight cases of hemorrhagic cysts, one case of corpus luteal cyst, two cases of endometrioma, three cases of dermoid cysts, two cases of serous cystadenoma, and one case of paraovarian cyst). There were eight complex masses (16%) (one case of granulosa cell tumor, one case of dysgerminoma, one case of papillary carcinoma, one case of metastasis, two cases of serous cystadenocarcinoma, and two cases of mucinous cystadenocarcinoma). Conclusion Using ultrasound and color Doppler studies with scoring system was found to be useful in differentiating a benign from a malignant adnexal mass. Computed tomography scan has shown to be beneficial in assessing the disease extent and planning for treatment. MRI was beneficial in characterizing adnexal masses in problematic cases.

Background Deep vein thrombosis (DVT) is a serious disease resulting from the interaction of environmental and inherited risk factors. One of the causes may be thrombosis resulting from the inherited resistance to activated protein C caused by factor V Leiden (FV Leiden) mutation. Objective The aim of this study was to investigate the presence of FV Leiden mutation among Egyptian patients with DVT in comparison with a normal population of controls, and to evaluate its relevance in thrombotic tendency. Patients and methods This cross-sectional, case-controlled study included 50 patients with DVT, with a mean age of 38.70 ± 7.96 years and a male to female ratio of 0.72. These patients were recruited among the patients admitted to the Department of Vascular Surgery in Tanta University Hospitals. For association and risk analysis, these patients were compared with 10 healthy unrelated control participants of matched age and sex. FV Leiden gene mutation (G1691A) was detected using real-time PCR. Results There was a statistically significant difference between the patients and the controls regarding FV Leiden polymorphism (P = 0.043). Ten patients (20%) were found to be heterozygous for the gene. None of the patients was homozygous for this polymorphism. Risk factor for DVT was 1.3 (95% confidence interval). FV Leiden mutation was found to be significantly prevalent among patients with a positive family history of DVT (P = 0.001). There were no statistical significant difference between the control participants and the DVT patients as regards age, sex, and history of previous exposure. In addition, there was no association between FV Leiden and the site of DVT. Conclusion FV Leiden mutation has a high prevalence (20%) and positive association with DVT among Egyptian patients.

Introduction Obstructive sleep apnea (OSA) is a common comorbidity in morbid obese patients scheduled for gastroplasty. The objective of our study was to determine the relationship between postoperative pulmonary complications and the severity of OSA in patients undergoing gastroplasty, who were evaluated preoperatively by using polysomnography. Methods All patients with BMI greater than or equal to 50 kg∕m² were selected and referred to the sleep lab to detect OSA. Patients with apnea hypopnea index (AHI) less than 16 were excluded. Patients with AHI greater than or equal to 16 were divided into two groups according to the severity of AHI: patients with AHI in the range 16–30 were classified as having moderate OSA (group I) and patients with AHI greater than 30 were classified as having severe OSA (group II). In total, 40 patients were divided into two equal groups. Pulmonary complications in the first 24 h were analyzed according to the AHI. Results Overall, 15% patients of group I and 25% of group II received preoperative continuous positive airway pressure therapy, and postoperatively, all patients were closely monitored either in the Postanesthetic Care Unit or in the ICU. The rate of incidence of the postoperative pulmonary complications was not increased with increased the severity of OSA. Conclusion In obese patients with OSA, the severity of which was assessed by using the AHI, the incidence of postoperative pulmonary complications did not increase with increased severity of OSA. Appropriate preoperative evaluation and preparation with meticulous perioperative monitoring lead to a decrease in pulmonary complications, despite the severity of OSA.

Background and aim MRI can detect intramedullary infiltration in a highly advanced manner. It is also useful for the detection of tumor extension, associated soft tissue masses, and neurological compromise. MRI can increase the rate of successful bone marrow biopsies as it can assess a large volume of bone marrow noninvasively and relatively quickly. The aim of this study was to assess the role of MRI in the evaluation of bone marrow infiltrative lesions. Patients and methods This study included 30 patients with bone marrow infiltrative lesions: 14 male and 16 female patients. The ages of the patients ranged from 8 to 75 years (mean 41.5 years). Pain was the most common symptom in the studied cases, followed by swelling. The patients in our study were examined by means of plain radiography (15 cases), computed tomography (five cases), isotopic bone scan (one case), and MRI (all cases). Results According to the pathological and radiological results, the lesions in our study were classified as follows: metastasis (12 cases); plasma cell dyscrasias (eight cases), including multiple myeloma (six cases) and plasmacytoma (two cases); lymphoma (seven cases), including non-Hodgkin’s lymphoma (five cases) and Hodgkin’s lymphoma (two cases); Ewing’s sarcoma (two cases); and leukemia (chronic lymphatic leukemia) (one case). Conclusion MRI is a sensitive method for detection of areas of marrow infiltration. The value of MRI lies in its ability to document the presence and extent of disease and to determine an appropriate radiation field.

Background Helicobacter pylori is a pathogenic bacterium that has been linked to many disorders such as cardiovascular diseases, diabetes mellitus, and dyslipidemia. However, whether it is associated with insulin resistance still needs to be evaluated. In this work we aimed to delineate the possible relation of H. pylori infection with insulin resistance in nonobese nondiabetic patients. Patients and methods The study was carried out on 80 individuals who were divided into two groups. Forty patients were diagnosed to have H. pylori and 40 healthy volunteers formed the control group. All were subjected to history taking, clinical examination, routine laboratory investigations, evaluation of H. pylori immunoglobulin G level, and assessment of fasting blood glucose and fasting insulin level to calculate homeostasis model assessment of insulin resistance. Results There was a significant increase in C-reactive protein in H. pylori-positive patients when compared with H. pylori-negative controls. Also a significant positive correlation was found between homeostasis model assessment of insulin resistance and each of fasting blood glucose, fasting insulin, and C-reactive protein in both groups. Conclusion H. pylori infection was strongly associated with insulin resistance in nonobese, nondiabetic patients.

Background and aim Distal embolization during primary percutaneous coronary intervention of the proximal right coronary artery (RCA) leads to impairment of flow of right ventricular (RV) branches and RV dysfunction. Glycoprotein IIb/IIIa receptor antagonists improve microcirculation and decrease the incidence of distal embolization. In the present study we aimed to assess RV function in patients with acute inferior ST-segment elevation myocardial infarction who received intracoronary (i.c.) bolus eptifibatide, and to compare them with patients who received a standard intravenous (i.v.) dose. Patients and methods Sixty-six patients with acute inferior myocardial infarction who underwent primary percutaneous coronary intervention and whose culprit lesion was RCA proximal to major RV branch were included in the present study. Patients were divided into two groups. In the first group, 36 patients received double bolus intracoronary eptifibatide followed by i.v. infusion. In the second group, 30 patients received standard i.v. dose. Forty-eight hours after the index procedure, all the patients underwent standard echocardiography assessment of RV function using conventional two-dimensional and tissue Doppler imaging. Results There were no significant differences regarding baseline characteristics, final Thrombolysis In Myocardial Infarction (TIMI) flow, and left ventricular systolic function between the two groups. RV function indices, including tricuspid annular plane systolic excursion, myocardial performance index-tissue Doppler imaging, and RV fractional area change, were significantly better in patients who received i.c. bolus eptifibatide (P<0.001). Conclusion I.c. double bolus eptifibatide followed by i.v. infusion was found to be superior to the standard i.v. dose with respect to RV function in patients with acute inferior ST-segment elevation myocardial infarction due to proximal RCA occlusion.