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Background: Defensive medicine has great impact on medical practice and population health. It may provide enhanced quality of services with good explanations to patients resulting in increased satisfaction. On the other hand, it might include unnecessary investigations, prescription of unnecessary treatments which may be expensive or dangerous for patients. Aim of Work: This study aims to evaluate awareness and practice of defensive medicine among junior doctors in Cairo University Hospital. Methods: This cross-sectional study includes 261 junior physicians by interviewing them using a structured questionnaire. Results: Defensive medicine practice is highly affected by sociodemographic characteristics of study population. Almost half the female doctors are always giving extra details about the medication use (56%) P < 0.001. Around 90% of both specialties have not been involved in medical litigation. Conclusions: Defensive medicine is highly prevalent among junior physicians. Following clinical standards and fear of legal actions by patients are considered main causes of practice of defensive medicine.

This study evaluated the impacts of inclusion of Moringa Oleifera leaves extract (MOLE) in semen extender on rams cryopreserved semen quality and fertilization potential. Forty ejaculates were collected from eight fertile Barki rams, pooled and divided into five groups. The semen extender of the control group was without additives. The semen extender of the second and third groups was supplemented with MOLE at doses of 300 and 600 µg/mL, respectively. The semen extender of the fourth and fifth groups was supplemented with a combination of vitamin E and selenium at doses of 2.5 and 5 µg/mL, respectively. One hundred ten multiparous Barki ewes were artificially inseminated with the semen supplemented without or with MOLE or vitamin E and selenium combination. Inclusion of MOLE in semen extender significantly elevated the motility, viability index, membrane integrity and fertilization capacity of the post-thawed spermatozoa, as well as the activities of semen catalase, total antioxidant capacity, superoxide dismutase, glutathione peroxidase, and glutathione reductase. However, it significantly decreased acrosomal defects and DNA fragmentation of spermatozoa, the activities of semen alkaline and acid phosphatase and the concentration of malondialdehyde compared with the other groups. Similarly, vitamin E and selenium significantly improved the above-mentioned parameters compared to those of the control group. This study indicated that inclusion of MOLE to semen extender improved the quality and fertility of the post-thawed rams' semen through enhancing the activities of the antioxidant enzyme system and decreasing the spermatozoa DNA fragmentation and lipid peroxidation. Highlights Moringa Oleifera leaves extract (MOLE) protected spermatozoa against cryopreservation induced oxidative stress. MOLE enhanced cryopreserved semen quality. MOLE enhanced post-thawed spermatozoa fertilization capacity.

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first “International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law”. This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Part 1 of the review “ Back to the Future ” examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section focusing on “ The Past ”, the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on “ The Present ”, the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in “The Future” section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.

Female Genital Mutilation (FGM) is one of those traditional practices whose origin can be traced back to antiquity. The worst types of FGM are practiced in Sudan, Egypt and Nigeria. The international movement against FGM gained momentum in the past two decades, and attempts were made to increase public awareness of the procedure and its complications. In addition, laws were passed in Egypt to criminally charge practitioners who perform FGM. The aim of this study was to describe frequency, prevalence, complications of FGM and awareness of the women at the clinic visit about the latest update (2016) of the Egyptian law that criminalizes it. This was a cross sectional study of women in their childbearing years (18–45) who attended the Gynecology and Obstetrics outpatient clinics at Fayoum University hospitals between January 1st and December 31st, 2018. After giving their consent, one hundred women attending the clinic received a medical examination and structured interview related to their views and plans regarding FGM of female children. Sixty two percent of women participants reported that they had been circumcised. In 88% of cases, the participant's mother was the person who made the decision to have their daughter circumcised. The most common type of circumcision reported was type II, in 86% of cases. Regarding intent to have a female child circumcised, 32% reported that they would have their own daughter circumcised. Despite Egyptian law that criminalizes FGM, the know potential for serious complications of the procedure, including death, and the efforts of governmental, non-governmental, and international organizations to combat the use of FGM, one third of the women interviewed still planned to have their daughter circumcised.

The relationships between the lungs and the kidneys are clinically important; however, the impact of nitric oxide (NO) on respiratory function in renal patients is less known. The aim of this study is to evaluate pulmonary function tests (PFTs), NO level and their correlation in children on treatment with hemodialysis (HD) for the end-stage renal disease. This study was performed among 20 patients on regular HD and 20 controls. Participants were subjected to clinical examination, and pulmonary function evaluation was performed using spirometry. The following parameters were obtained as follows: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Tüffenau index (FEV1/%FVC), (FEF25%–75%), and peak expiratory flow. Spirometry was carried out before and after HD sessions, and at the same time of clinical assessments, blood samples were taken to measure arterial-blood gas (ABG) and NO levels. There was the statistically significant difference between patient and control groups regarding NO and all PFTs except FEV1/FVC. There was no statistically significant correlation between NO and biological parameters in both cases and controls, but there was negative although the statistically not significant correlation between the PFTs, ABG, and duration of dialysis in the case group. There was statistically significant negative correlation between NO and some PFTs in case group; also the effect of dialysis on pulmonary functions tests and NO levels were only on the FVC of patients which significantly improved. Postdialysis blood gases remained normal among children on HD. NO may be involved in the deterioration of pulmonary function, and therefore, we feel that it can be used as a marker of clinical deterioration.

Part 2 of the review “ Back to the Future ” is dedicated to the evolutionary role of the bio-medicolegal sciences, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines that have risen to the role of “ autonomous ” sciences, namely, Genetics and Genomics, Toxicology, Radiology, and Imaging, involved in historic synergy in the “ post-mortem assessment ,” together with the mother discipline Legal Medicine, by way of its primary fundament, universally denominated as Forensic Pathology. The evolution of the scientific research and the increased accuracy of the various disciplines will be oriented towards the elaboration of an “algorithm,” able to weigh the value of “ evidence ” placed at the disposal of the “ justice system ” as real truth and proof.

Little was known about the relationships between the T lymphocytes (CD3+), expression of glucocorticoid receptors (GCR) and the response to GC treatment in children with the idiopathic nephrotic syndrome (INS). Our objective was to determine the relation between steroid responsiveness and GCR expression in T lymphocytes. The present study was carried out on 80 children with new-onset INS admitted in Pediatric Nephrology Units of Zagazig and Tanta University Hospitals and on 40 healthy children of the same age and sex who served as control group. The Subjects were subdivided into three groups as follows: Group 1 with 40 healthy children of comparable age and sex served as control group; Group 2 consisted of 60 patients diagnosed with INS with early response to steroid therapy [early responder (ER)] and Group 3 with 20 patients diagnosed with INS with late response to steroid therapy [late responder (LR)]. They were subjected to history taking, focusing on the pattern of response to steroids (ERs), clinical examination, routine laboratory investigations and the GCR/CD3% relationship. 75% of newly diagnosed INS cases were ER whereas 25% were LR. GCR/CD3% was significantly lower in LR group in comparison with ER and control groups, with a significant negative correlation between time of steroid responsiveness and GCR/CD3%. LR group showed lower GCR expression in T lymphocytes before starting therapy which may mean that GCR expression could be part of a pathophysiological mechanism of steroid responsiveness in these children and can be used as a useful diagnostic marker to predict steroid responsiveness in patients with INS.