Background: Solitary thyroid nodules are a common clinical problem. None of sonographic features is sufficient to discard or detect malignancy efficiently. Midkine is a novel heparin-binding growth factor, plays critical roles in carcinogenesis. In this study, we aimed to evaluate serum midkine levels in patients with solitary thyroid nodules to predict malignancy. Methods: A total of 100 patients who had solitary thyroid nodules were enrolled in the study. Serum midkine levels were measured. Fine needle aspiration cytology was done to all nodules (25 suspicious/ malignant and 75 benign). Results: Serum midkine levels were significantly higher in patients who had nodules with the following sonographic features; hypoechoic nodules compared to isoechoic and hyperechoic nodules (P=0.024), nodules with microcalcification compared to nodules with macrocalcification or without calcification (P = 0.011), nodules with irregular borders compared to nodules with regular borders (P = 0.014) and nodules more than 2 cm in length than shorter ones (P = 0.011). Serum midkine levels were also higher in nodules with absent halo compared to those with clear halo but with no significant difference (P = 0.660). Also, levels of serum medikine were significantly higher in suspicious/ malignant nodules than in benign nodules (P < 0.001). Conclusion: Serum midkine can predict malignancy in solitary thyroid nodule and also well correlated with sonographic features of thyroid nodules. We suggest that midkine levels may serve as a novel biochemarker in association with sonographic features in evaluation of solitary thyroid nodules.

Background: The Egyptian National Committee of Viral Hepatitis program is the leading national hepatitis C virus (HCV) management program globally. However, limited data is available about the effect of the new directly acting antiviral agents on the cardiovascular system. Objectives: Our study aimed to assess the safety of the relatively new directly acting antiviral agents approved by the National Health Committee in Egypt to treat patients infected with hepatitis C virus who have midrange left ventricular ejection fraction. Methods: This multicenter study included 400 successive patients with an ejection fraction (40–49%) from May 2017 to December 2019. We classified them into two groups: Group I (Child A), who received Sofosbuvir and Daclatasvir for twelve weeks, and Group II (Child B), who received Sofosbuvir, Daclatasvir, and Ribavirin for twelve weeks. Patients were evaluated for their symptoms, ejection fraction, brain natriuretic peptide, lipid profile, fasting blood glucose, fasting insulin, Homeostatic Model Assessment of Insulin Resistance levels, and Holter monitoring (just before the start of treatment and within three days after completing therapy). Results: We found New York Heart Association Class, ejection fraction, brain natriuretic peptide, premature ventricular contractions burden, as well as highest and lowest heart rate did not show a statistically significant difference in both groups after treatment. The treatment did not cause bradycardia or non-sustained ventricular tachycardia. Fasting blood glucose and fasting insulin levels declined, with improved insulin resistance after treatment in both groups. Both low and high-density lipoprotein cholesterol increased after treatment in Group II. Conclusions: Both regimens of directly acting antiviral agents used in Egypt to treat chronic hepatitis C virus infection are safe in patients with New York Heart Association Class I and II with midrange left ventricular ejection fraction (40–49%). There are beneficial metabolic changes following HCV clearance as an improvement of insulin resistance.

Background Heart failure with preserved ejection fraction (HFpEF)is challenging. Patients usually have normal LV size and ejection fraction. This clinical syndrome develops from a complex interaction of several risk factors that cause organ dysfunction and clinical symptoms. There’s evidence that testosterone deficiency is associated with a worse cardiometabolic profile and increased inflammatory markers. We thought that these changes might have an impact on heart failure pathogenesis. We aimed to study the relationship between testosterone level and symptoms in HFpEF. Methods We studied 120 male patients with HFpEF. According to New York Heart Association (NYHA), patients were classified into I, II and III classes; class IV patients were excluded. All patients were subjected to clinical and echocardiographic examinations. In addition, we measured serum testosterone, cardio-metabolic profile, intracellular adhesive molecule-1(ICAM-1), P-selectin and nitric oxide (NO) levels. Results Patients with testosterone deficiency had worse NYHA class and higher BNP P = (0.001). Additionally, they had a significantly worse metabolic profile; higher total cholesterol, triglycerides, LDL cholesterol, fasting insulin and HOMA-IR P = (0.005, 0.001, 0.001, 0.001), respectively. Also, they had higher inflammatory markers and worse endothelial functional parameters; (ICAM-1, NO and P- selectin) P = (0.001). Age, BNP and testosterone deficiency can be used as independent predictors of NYHA class III symptoms with a Testosterone cutoff value of 2.7 ng/ml. Conclusion Testosterone deficiency could be used as an independent predictor of symptom severity in HFpEF, and it aggravates systemic inflammation and endothelial dysfunction in these patients.

Background: As the treatment approaches of Graves' disease (GD) and thyroiditis are different, the differential diagnosis is essential. Aim: To assess the diagnostic value of free triiodothyronine (FT3) to free thyroxine (FT4) ratio for differentiation between GD and destructive thyroiditis. Subjects and Methods: The present study was conducted on 100 newly diagnosed thyrotoxicosis patients; 61 with thyroiditis (group 1) and 39 with GD (group 2) and 20 healthy, age-matched subjects representing a control group (Group 3). All participants underwent medical history taking and clinical examination, serum levels of thyroid-stimulating hormone (TSH), FT3, and FT4 were measured, Technetium 99m thyroid Scan was done to all recruited patients. Results: The present results recorded significant increases in FT3, FT4, and decreases in TSH levels in Graves' disease group than in the thyroiditis group. There was a statistically significant difference between the study groups regarding FT3/FT4 ratio, which was lower in thyroiditis group than in Graves' disease group (0.21± 0.03 in group 1 vs 0.35±0.18 in group 2, p-value <0.01), while there was no significant difference between thyroiditis group and the control group. The FT3/FT4 ratio showed a predictive value, with an area under the ROC curve (AUC) of 0.936 (95%CI, 0.876-0.995) for Graves' disease vs. thyroiditis (p < 0.001). Based on the cutoff value of this ratio of more than 0.269 offered a sensitivity of 89.7% and specificity of 91.8%. Conclusion: The results of the present study demonstrated that free thyroid hormones and the FT3/FT4 ratio are useful to differentiate Graves' disease from destructive thyroiditis.

Мета роботи: поліпшити результати лікування хворих на жовчнокам’яну хворобу, ускладнену синдромом Міріззі, шляхом покращення якості його передопераційної діагностики та удосконалення хірургічного лікування через відновлення фізіологічного пасажу жовчі у дванадцятипалу кишку. Матеріали і методи. Проведено ретроспективний аналіз 898 хворих на гострий холецистит, синдром Міріззі діагностували у 117 хворих, перший тип – у 74, другий тип – у 43 пацієнтів. Комплекс обстеження складався з даних аналізів, клініко-лабораторних методів, променевих методів (ультразвукова діагностика, комп’ютерна томографія), інструментальних методів (фіброгастродуоденоскопія, ендоскопічна ретроградна холангіопанкреатографія). Отримані результати дослідження зіставляли з результатами оперативного лікування. Результати досліджень та їх обговорення. Аналіз 898 історій хвороби пацієнтів із гострим холециститом показав, що синдром Міріззі було виявлено у 117 (13 %) хворих, зокрема перший тип був у 74 (8,3 %), а другий – у 43 (4,7 %). З 74 хворих із першим типом ЛХЕ виконана в 43 (58 %) випадках, а у пацієнтів із другим типом синдрому Міріззі лапароскопічна холецистохоледохолітотомія виконана у 3 (6,9 %) хворих. Зі 117 пацієнтів з обома типами синдрому Міріззі у 46 (39,3 %) були виконані лапароскопічні втручання. У всіх 117 (100 %) хворих було відновлено фізіологічний пасаж жовчі у дванадцятипалу кишку шляхом використання оригінальної техніки оперативних втручань, пріоритетність яких захищена патентами України. Удосконалення діагностичних прийомів для виявлення синдрому Міріззі та визначення його типу, а також використання нових способів виконання оперативних втручань дало змогу уникнути конверсій та ятрогенних ушкоджень жовчних проток.