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Background: Melanin production due to phenoloxidase activity is a distinctive property of Cryptococcus neoformans and Cryptococcus gattii species complex yeasts. Therefore, an agar medium containing a precursor of melanin pigment is potentially useful to identify and differentiate cryptococcal colonies from other yeasts. Background: This study aimed to evaluate and compare the ability of Cryptococcus neoformans species complex isolates to produce brown-pigmented colonies when grown on media prepared from various plant leaves or seeds extracts. Material and Methods: Forty-six C. neoformans species complex isolates which were obtained from various environmental and clinical samples were inoculated on different media containing coriander, cumin, soybean, lupine, flax, pumpkin, basil, peppermint, and marjoram, were observed for the rate of growth and pigment production during a five-day period. Results: All isolates were pigmented on all media within 24-48 hours, and brown or dark brown colonies were observed in less than five days, while C. albicans grew but did not produce any pigment. Conclusion: The differential media tested in the present study are simple and inexpensive, and represent alternative valid tools for presumptive identification of C. neoformans species complex from clinical and environmental samples

Inflammatory myofibroblastic tumor is rarely seen in the prostate. Most of prostatic tumors are benign. However, local aggressively invading the adjacent organs and recurrence are frequent. Rarely, the malignant transformation and metastasis occurs, especially in elderly patient. The definitive diagnosis in a small biopsy is challenging. The correct diagnosis preoperatively will help to avoid unnecessary radical prostatectomy. Interval follow up is recommended. Here we reported two cases of prostatic inflammatory myofibroblastic tumor with literature review.

Frequency specific microcurrent (FSM) has been used to treat myofascial pain syndrome [1,2] fibromyalgia associated with spine trauma [3], delayed onset muscle soreness [4], acute and chronic neuropathic pain [5] and chronic scarring in burn patients [6]. In this case, its use was modified to include not only the treatment of neuropathic pain but the treatment of neural adhesions in a patient with a ten year history of pain at rest and painful restricted range of motion following an ulnar nerve anterior transposition surgery in 2001. Eleven standard physical therapy sessions including augmented soft tissue mobilization using plastic tools, and muscle strengthening exercises and stretching failed to resolve symptoms. Three sessions of frequency specific microcurrent produced complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.

Introduction: Desmoplastic Malignant Mesothelioma (DMM) is a rare histological subtype of sarcomatoid malignant mesothelioma arising most frequently in the pleura or peritoneum and less frequently in the lung parenchyma. Patient concerns: A 52-year-old female with no apparent asbestos exposure was referred for consultation in our center after 1 month of cough and no concomitant symptoms of chest. Diagnosis: Chest computed Tomography (CT) revealed a localized mass measuring 4.5 x 3.9 cm in the right lung middle lobe with inhomogeneous enhancement following injection of contrast, and without pleural lesions, considered a primary intrapulmonary desmoplastic mesothelioma. Interventions: Surgical intervention was performed. Outcomes: Following complete tumor resection, the patient declined to receive chemotherapy or radiotherapy. The final diagnosis of intrapulmonary desmoplastic mesothelioma was confirmed by pathological and immunohistochemical examination. In addition, no local tumor recurrence was observed within 10 months of follow-up. Conclusion: Even elderly female patients with localized pulmonary masses without significant pleural lesions should not excluded the possibility of malignant mesothelioma in the lungs.

Objective: To identify the risk factors for marginal cord insertion (MCI). Material and Methods: This case-control study was carried out between 1st February and 30th June 2019. Singletons with and without MCI at delivery were recruited. Main variables analyzed included maternal age, parity, number of previous dilatation and curettage (D&C) or manual vacuum aspiration (MVA), time interval between each procedure and conception, cord insertion. Fisher’s exact test, t-test and logistic regression were used to compare data from both groups. Results: We found 60 cases of MCI (4.1%). The significant (p < 0.05) risk factors for MCI were past-history of D&C (aOR 5.97, 95% CI 1.95-18.25) particularly when conception occurred ˂ 5 months after D&C (OR 10.5, 95% CI 1.36-81.05), fetal female sex (aOR 3.82, 95% CI 1.41-10.32), parity ≥ 4 (aOR 2.63, 95% CI 1.05-12.71) and past-history of MVA (aOR 2.06, 95% CI 1.23-8.76). Conclusion: Women should be advised to conceive at least five months after D&C.

Background: Primary lymphedema occurs as a result of genetic abnormalities of the lymph system. Currently, complex decongestive therapy is accepted as the standard treatment of the lymphedema. In this case presentation, we described the management of bilateral primary lower extremity lymphedema and the use of complex decongestive therapy. Case Report: A 62 years old female patient had stage III primary lymphedema on her left lower extremity and stage II primary lymphedema on her right lower extremity. The patient, who had morbid obesity, also had untreatable sleep apnea, urinary incontinence, umbilical hernia and hypertension controlled by drugs. She had stage 4 gonarthrosis according to Kellgren – Lawrence classification in her both knees. The patient received complex decongestive therapy as an outpatient. After 27 sessions of complex decongestive therapy, edema reduced in both lower extremities. Before the treatment started, the patient couldn’t go up and down stairs, get out and had difficulty mobility in the home. But after the treatment, the patient could go up and down 16 stairs by holding the railing, get out by two walking sticks and had less difficulty mobility in the home. However, due to gonarthrosis in her knees, her pain did not diminish. Conclusion: Complex decongestive therapy is effective in the management of bilateral primary lower extremity lymphedema, which progressed with multiple health conditions.

Chagas disease is a public health problem in Latin America and its treatment is based on the use of benznidazole or nifurtimox compounds. Both present problems such as resistance, inefficiency in chronic infection and cytotoxic effects. New compounds such as posaconazole and amiodarone have been tested against T. cruzii and shown to be effective. In addition, new molecules have been synthesized and tested against T. cruzii. Because this protozoan is highly pathogenic, even with a number of cases of accidental laboratory infections, few laboratories located outside Latin America are authorized to work with its infective developmental stages. On the other hand, Trypanosoma dionisii is a non-pathogenic protozoan phylogenetically related to T. cruzii and that shares similar strategies to complete its life cycle in mammalian cells in vitro. Here, we describe a comparative analysis of the sensitivity of both parasites to benznidazole, posoconazole and amiodarone. We also analyzed the morphological effects of these compounds on both Trypanosoma species using electron microscopy. Our results show that T. dionisii is more sensitive to the compounds tested than T. cruzii. They also support a previous suggestion that it may constitute an excellent model for large scale screening of compounds against T. cruzii.

Purpose: To investigate the suture-tourniquet technique for haemostasis in patients with acute thrombosis of native arteriovenous fistula (AVF) whom underwent manual aspiration thrombectomy using large-bore venous sheaths and high dose heparin. Methods: Between January 2016 and May 2018, patients with acute AVF thrombosis performed successful manual aspiration thrombectomy by using large bore venous sheaths and high dose heparin were included in this retrospective study. Success rate for haemostasis, procedural complications clinical and imaging follow up was reported descriptively. Results: A total of 52 patients with 64 procedures met the inclusion criteria. In 60(94%) of 64 procedures, successful haemostasis was achieved with suture-tourniquet technique. In 2(3.1%) of the 64 procedures, the suture broke while turning the tourniquet and haematoma occurred in another 3 procedures (4.7%) although suture-tourniquet technique was applied appropriately. Manual compression was performed in these patients. There were 3 major complications unrelated the suture-tourniquet technique. Conclusion: The suture tourniquet technique can achieve haemostasis rapidly and can be safely used with low complication rates without fistulae thrombosis after large-bore venous sheath removal following treatment of AVF thrombosis.

Rosai-Dorfman disease (RDD) is an idiopathic, benign proliferation of histiocytes that can be present in multiple organs such as lymph node, skin, soft tissue, orbit, central nerve system and bone; however, it rarely occurs in the breast. In general, RDD is a painless, firm and poorly defined lesion, which can radiologically mimic a breast cancer and is therefore an important differential consideration. The diagnosis of breast RDD is challenging, especially on a small biopsy specimen. We report a unique case of breast RDD with a literature review including common presentation, differential diagnosis, and recommended management. A high index of suspicion for this rare entity is essential to render a correct diagnosis, thereby avoiding unnecessary diagnostic tests and treatment.

Uterine torsion is a rare life-threatening event that happens at any age or any gestational age. By definition, it consists of a rotation of more than 45 degrees around the long axis of the uterus. The reported cases have variable presentations. The uterine torsion can happen without any sequelae either for the fetus or the mother. However, fetal and maternal mortalities were also reported in such a case. We hereby, report the case of a 29-year-old female patient, with previous four Normal Vaginal Deliveries, pregnant with twins, presenting at 36 weeks gestation with an irreducible uterine torsion at the third trimester of her pregnancy complicated by maternal and fetal deaths. We concluded that the prognosis is improved as long as the management is done rapidly. More data is needed to know about the genetic predilection and the characteristics of imaging workup for a rapid preoperative diagnosis of this condition. 

The shapes and sizes of human cardiomyocytes are accessible to systematic observation under most circumstances only at autopsy. This constraint has seriously curbed the study of these topics, thereby leaving a crippling gap in our understanding of heart failure. In recent years the only published ongoing findings have come from this laboratory. This article is a condensation of these reports, using those sources to develop fresh analyses designed to construct a set of organizing principles. The data are entirely retrospective thereby forbidding hypothesis testing and permitting only hypothesis formation. The hypotheses generated in this way are novel and surprising. In spite of the severe limitations in this methodology is seems possible that some useful new directions of inquiry might evolve from pursuing these original observations.

Bleeding diatheses due to platelet-related disorders can present challenges to treating clinicians especially in the context of peri- and post-partum patients in the obstetric setting. TARS is an inherited disorder characterised by reduced bone marrow platelet production, skeletal deformities affecting radii and other limbs; cardiac, renal, and other heterogeneous anomalies may occur. It is caused by co-inheritance of a microdeletion and a nucleotide polymorphism in the RBM8A gene on chromosome 1. Bleeding phenotype is more severe than platelet numbers might predict especially in infants but improves with age. There is minimal literature regarding impact in pregnancy and puerperium. We describe management of three pregnancies in the haematology-obstetrics clinic. As platelet counts normally decrease through pregnancy, close monitoring is required in TAR syndrome. No major bleeding was seen antenatally but two required platelet transfusion during labour. No other treatment definitely improves bleeding, although case reports of steroids claim variable success. Tranexamic acid may be helpful, and thrombopoietin agonists represent a potential future option. 

Vitamin D has immunomodulatory and antifibrotic properties, and therefore used for treatment of many of chronic liver disease [1]. Although there are many reports on the relationship between serum 25-hydroxyvitamin D3 levels and chronic liver diseases, but the relationship between hepatitis B virus e antigen (HBeAg) and vitamin D level is still unclear. The modification and prevention of vitamin D deficiency needs an accurate illustration of the current position in each region. Vitamin D level in patients with HBV is relatively an important issue, which has been studied in many researches. As different papers published in national and international journals.

Endometriosis is a common benign disease in women of reproductive age, it has been associated with an increased risk of various malignancies that is defined by certain histological criteria mainly 80% in ovary and 20% in extragonadal sites such as intestine, rectovaginal septum, abdominal wall, pleura and others; the greatest risk for colorectal cancer is women with adenomyosis or endometriosis; Several genetic alterations have been found in the risk of endometriosis associated with cancer; The symptomatology, imaging and endoscopic characteristics simulate other inflammatory and malignant lesions that make the preoperative diagnosis of extragonadal endometriosis difficult. This is a review of the knowledge about endometriosis and its potential risk of malignancy, particularly with colorectal cancer 

Background: Pseudomonas aeruginosa is one of the top five pathogens causing healthcare-associated infections. Biofilm formation is nowadays a major problem. Aim: The aim of this study was to examine the prevalence of virulence genes in clinical isolates of Pseudomonas aeruginosa at Suez Canal University Hospitals with respect to the site of infection and microbial resistance of the strains. Materials and methods: A cross-sectional descriptive study was carried out on 47 Pseudomonas aeruginosa strains collected from hospitalized patients from December 2015 to August 2017. To detect biofilm formation, we used Tissue Culture Plate Method. The virulence genes (toxA, algD, nan1, pslA and pelA) were amplified using PCR technique. Results: The highest sensitivity was to Imipenem and Ciprofloxacin (85.1% and 68.1% respectively).With respect to the virulence genes, toxA gene was detected in 45 isolates (95.7%), algD gene in 42 isolates (89.4%), pslA in 42 isolates (89.4%) %), pelA cted in 41 isolates (87.2%) and nan1gene was detected in 19 isolates (40.45%). Conclusions and Recommendations: We conclude that there is relationship between virulence genes and biofilm formation in Pseudomonas aeruginosa. We recommend the expansion of work on a larger sample size in a longer period of time.

The incidence of HBV infections among the pregnant in Europe falls within the range of 1% - 7%, whereas it is 1.7% - 4.3% for HCV. The aim was to assess the course of pregnancy among women infected with HBV or HCV, and the condition of neonates in the fifth minute after the birth. The study included 157 pregnant individuals infected with HBV, 53 infected with HCV, and 330 healthy pregnant women. None of the women infected with HBV and HCV as well as from the control group were infected with HIV, and none of them took intoxicants. Weight of neonates delivered by healthy women was higher as compared with children born by women infected with HBV or HCV (3,517 vs. 3,347 and 3,366). The Apgar score of neonates delivered by women with HBV and HCV infections was lower as compared with the children born by healthy women (9.4 vs. 9.3 vs. 9.7; p < 0.05). Premature births occurred more often in HBV and HCV-infected women than in the control group (14.6% and 24.5% vs. 6.96%; p < 0.05). Miscarriages were significantly more common among the pregnant with HCV infections as compared with the pregnant who were healthy (9.4% vs. 1.8%; p < 0.05). In comparison with the healthy individuals, this group of patients experienced pruritus (10.5% vs. 4.2%; p < 0.05), oedemas (9.4% vs. 2.4%; p < 0.05), and hypertension (9.4% vs. 1.5%; p < 0.05) more often. An increase in HBV loads was observed between the 6th and 28th – 32nd week of pregnancy among the infected with HBV, and then, a decrease was observed in the 6th months after the delivery. The pregnant infected with HBV without HBsAg (-) and the infected with HCV are subject to common incidence of premature births. Women infected with HCV often experience oedemas, hypertension, and pruritus.

Antithrombin deficiency, although the rarest thrombophilia, carries the highest risk of thromboembolism. This risk is increased especially for pregnant women due to physiological coagulation changes in pregnancy. Therefore, in cases of positive personal and/or family history of thromboembolic events as well as recurrent pregnancy loss women should be tested for antithrombin deficiency. Antithrombin deficiency is caused by numerous mutations of serpin peptidase inhibitor clade C 1 gene (SERPINC) and is classified according to antithrombin plasma activity and antigen levels into Type I (quantitative defect) and Type II (qualitative defect). Complications during pregnancy can be divided into those regarding the mother and those concerning the fetus. The main clinical manifestation of antithrombin deficiency regarding the mother is thromboembolism occurring spontaneously or recurrently during pregnancy. Numerous major gestational complications such as miscarriage, intrauterine growth restriction or fetal death, placental abruption, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome can be linked to antithrombin deficiency. Close monitoring with early and adequate prophylaxis and treatment nowadays can mostly assure the positive pregnancy outcome for both mother and child. Prophylaxis/therapy with both low molecular weight heparin and antithrombin concentrate should start as soon as pregnancy is planned or at least as early as possible in pregnancy and continue until the end of the puerperium.

Background: Egypt has the highest prevalence of HCV in the world as more than 10% of population suffers from HCV infection. High prevalence of HCV in Egypt represents a great risk to the whole population that requires aggressive mass awareness regarding routes of infection and means of prevention. Aim: To determine the knowledge and practices of university students in 5 different faculties in Suez Canal University regarding HCV infection and means of prevention. Materials and method: A cross sectional study was conducted in five university faculties in Suez Canal University. Results: The study included 698 students from the faculties of Medicine, Pharmacy, Dentistry, Nursing and Education in Suez Canal University in Ismailia city in Egypt. There was a statistically significant difference regarding the knowledge about the diagnosis, complications and routes of transmission total knowledge score for HCV among the different faculties. Conclusion and Recommendations: Knowledge and practices of university students in Suez Canal University is partial to weak especially in students of non-biological sciences who have less close contact with patients

Objective: Pregnancy after age 40 remains a concern as it exposes to particular obstetrical complications. Our study aims to determine the risks of complications related to pregnancy and childbirth of women aged 40 and over. Study design: We carried out a cross-sectional analytical study of a historical cohort comparing the progress and the outcome of pregnancy in women 40 years of age and over to those aged 20 and 35 who gave birth at the University Hospital of Obstetrics and Gynecology in Befelatanana, from 1st January 2010 to 31 December 2013. Results: The prevalence of childbirth among 40 years old and over was 0.61%. They were multiparous and large multiparous in 88% of the cases. The analysis showed that parturients aged 40 years and older were at significant risk for caesarean section, with three times the risk of emergency caesarean section. The frequency of this emergency caesarean section increased with parity ((RR = 3.04 [2.15-4.30], p = 10-10). Among their neonates, 23.42% were hypotrophic, 22.86% premature, 12% asphyxiated at birth, 13.14% admitted to neonatal resuscitation and 5.71% died in utero, but without significant difference with the group unexposed. Perinatal death was 7.43% in women aged 40 and over vs. 4% in 20 to 35 year olds ((RR = 1.85 [0,89-3,86]; p 0.052). Conclusion: We found that pregnancies after 40 years were not exposed to pregnancy-related pathologies or specific fetal complications. The use of an emergency cesarean is, however, frequent.

Objectives: Type-2 diabetes mellitus, caused by impaired secretion of insulin, is becoming one of the health hazardous threats to human lives across the world. Its prevalence is rising with time. In this study, 2750 phytochemicals, that are considered to have great ability to eliminate diseases caused by different viruses and bacteria, are obtained from different medicinal plants and discovery of inhibitors through in silico method was performed against Dipeptidyl peptidase-4 (DPP4). Method: The pharmacological assessment and pharmacokinetics of phytochemicals, molecular docking and density functional theory (DFT) analysis helped to explore the inhibitory action of phytochemicals against DPP4. Total forty-nine phytochemicals were screened initially to reduce the number of compounds to be analyzed further based on a threshold of binding affinity ≥ -5.5 kcal/mol and were considered for further computational studies to analyze their inhibitory effects for DPP4. For comparison and validation of the results of present study, various previously reported and experimentally validated compounds were docked with the DPP4. For these dockings, binding affinity was predicted and compared with those of phytochemicals to check if these phytochemicals are competent enough to be used as an inhibitor in the treatment of diabetes mellitus in the future. Results: Only four phytochemicals showed binding affinity greater than those of experimentally validated compounds. These included two phytochemicals from Silybum marianum, i.e. Diprenyleriodictyol and Taxifolin and while other two phytochemicals from Santolina insularis and Erythrina Varigatae i.e. Papraline and Osajin respectively. The reactivity levels for these four phytochemicals with the binding site residues of DPP4 were obtained by DFT based analysis, in which ELUMO, EHOMO and band energy gap were computed. Conclusion: Based on these results, it is concluded that these four phytochemicals, after passing through in vitro and in vivo validation, can be utilized as potential DPP4 inhibitors as they have strong properties as compared to those of various experimentally validated inhibitors.