Background: Surgical management of tetralogy of Fallot (TOF) can be either with a total primary repair or staged repair. The superiority of one technique over the other is still debatable, especially in developing countries with late presentation and limited resources. The objective of this study was to compare the outcome of patients with tetralogy of Fallot and borderline pulmonary anatomy defined as McGoon ratio between 1.2 and 1.6 who underwent primary versus staged repair. Results: The patients were divided into two groups: group A included patients who underwent primary repair (n = 120) and group B included patients who underwent repair after previous modified Blalock-Taussig (MBT) shunt operation (n = 100). Patients in group B were significantly older (11 ± 2.6 vs. 7 ± 3.1 months; p < 0.001) and had higher McGoon ratio (1.61 ± 0.07 vs. 1.5 ± 0.08; p < 0.001). In group B, the total operative time (277 ± 21.3 vs. 232 ± 24.6 min; p < 0.001), cardiopulmonary bypass time (81 ± 13.7 vs. 60 ± 11.2 min; p < 0.001), and ischemic time (64 ± 12 vs. 53 ± 7.1 min; p < 0.001) were significantly higher. There was no difference in postoperative complications between both groups. In-hospital mortality was nine patients (7.5%) in group A and 6 (6%) in group B (p = 0.791). Conclusion: Primary repair of tetralogy of Fallot in patients with borderline McGoon ratio is safe with low morbidity and mortality. It has the potential of decreasing hospital stay, cost, and resource utilization of the two-stage repair.

Background: Oncoplastic breast surgery is a safe option in the treatment of early-stage breast cancer that preserves cosmoses without compromising recurrence or survival. Skin sparing mastectomy is oncologically safe based on the absence of breast ductal epithelium at the margin of the native skin flaps. Breast reconstruction with latissimus dorsi (LD) flap produces a high rate of good aesthetic results.Methods: This clinical study included 20 patients who were managed in the general surgery department, Menofiua university hospitals from April 2017 to March 2019. All patients had early breast cancer.Results: Patients with SSM were younger than those with LD flap. In cases of SSM LD flap, average of operative time was 4.95 hours, range 4-6.5 hours, and a median of 4.75 hours with SD ±0.89. While in cases who did delayed LD flap Average time 2.8 hours and range 1.5-3.5 hours and SD ±0.65. The difference was significant. Average blood loss for the patients underwent SSM with LD flap was 975 cc while in those who underwent delayed LD flap reconstruction was 520 cc, and the difference was significant.Conclusions: Skin-sparing mastectomy with immediate LD has become popular; it improves the cosmetic result, reduces cost, and anesthetic risk. It doesn't interfere with radiotherapy or chemotherapy.

Cavendish bananas ʻGrand Nainʼ are commercially important cultivars. It belongs to the Cavendish subgroup of the AAA banana cultivar group. These cultivars face the problem of quick rotting due to infection with different phytopathogens. Gene transformation technique was used to improve the cultivar productivity and resistance to infection. Thionin genes (AT1G12660 and AT1G12663) were isolated from Arabidopsis thaliana. Thionin genes (thio-60 and thio-63) are antimicrobial genes producing antimicrobial proteins which inhibit fungal infection. These two thionin genes were integrated into the pEGAD vector. Then transformed into the tested banana cultivar via chitosan nanoparticles using the shoot tip culture technique. The chitosan nanoparticles are efficient, rapid and safe transformation technique. The resulted transgenic banana lines were partially resistant to infection by two different fungal species: Fusarium solani and Fusarium equiseti. These fungi cause rotting for the non-transgenic lines compared to the transgenic lines which resist the rotting infection due to the expressed inhibitory thionin protein. Transformation of thionin into the transgenic plants were confirmed by conventional PCR.

Background: In spite of the great improvement in the intensive care management of cases of left to right shunt with pulmonary hypertension and understanding a lot about path physiology of pulmonary hypertension and the use of recent medications and methods to prevent and treat its hazards, it still has less satisfactory outcome after closure in comparison to cases with lower pulmonary artery pressure. Our objective was to evaluate the use of selective oral pulmonary vasodilators in the postoperative period in comparison to anti-failure measures alone. Results: A retrospective study included 120 patients below two years who underwent surgical closure for hypertensive ventricular septal defect. Patients were divided into two groups each consists of 60 patients. In group I patients received anti-failure drugs only and in group II patients received selective pulmonary vasodilators in addition to anti-failure drugs. The preoperative patients data and echo pressure measurements where comparable among both groups with non-significant difference. The time of ventilation, ICU stay and hospital stay were significantly shorter in group II (p < 0.05). The rates of hypertensive crisis and 30-days mortality were higher in group I but without significant difference (p > 0.05). Conclusions: Pulmonary antihypertensive drugs have an important role in lowering the pulmonary artery pressure and give better results after surgical closure of ventricular septal defect.