Clinical trials

Chronic Rhinosinusitis with Nasal Polyps (CRSWNP) is a complex and persistent inflammatory disease of the paranasal sinus mucosa. It is clinically characterized by long-standing sinonasal mucosal inflammation, severe nasal congestion, continuous anterior and posterior rhinorrhea, facial pressure or fullness, and partial or complete loss of olfactory function. Functional Endoscopic Sinus Surgery (FESS) remains the primary surgical procedure of choice for CRSWNP cases that are refractory to conventional medical management. The ultimate goal of FESS is to restore surgical drainage pathways, improve sinus clearance, and re-establish proper sinus ventilation. This surgical intervention creates an anatomical environment optimal for post-operative topical medical therapies. Nevertheless, persistent mucosal inflammation, recalcitrant tissue edema, and post-operative recurrence of polypoid tissue represent major challenges during long-term follow-up. Despite initial surgical success, recurrent nasal polyposis remains a significant clinical challenge following Functional Endoscopic Sinus Surgery (FESS). In cases of recurrence, medical management plays a pivotal role in controlling mucosal inflammation and delaying or preventing re-operation. Diverse pharmacological interventions have been explored to control post-operative recurrence, including standard anti-inflammatory regimens as well as alternative systemic therapies such as some antibiotics, long-term macrolides, and novel biologics targeting specific inflammatory pathways. Macrolides, particularly 15-membered azalides such as Azithromycin, possess significant immunomodulatory and anti-inflammatory properties distinct from their classic antibacterial actions. When administered in low doses over extended periods, Azithromycin actively downregulates pro-inflammatory cytokines, inhibits tissue neutrophil infiltration, decreases goblet cell hypersecretion, and fosters mucosal healing and epithelial restoration.

Migraine is a common chronic neurovascular disorder ranked among the leading causes of disability worldwide, and its global burden has continued to rise over the past three decades, with prevalence increasing substantially between 1990 and 2021the global number of prevalent cases, incident cases, and DALYs for migraine increased by 58%, 42%, and 58% respectively from 1990 to 2021 (1). In 2021, migraine affected an estimated 1.2 billion people globally, and although tension-type headache was more prevalent, migraine caused greater disability (2). Chronic migraine, defined as headache occurring on 15 or more days per month for more than three months, with migrainous features on at least 8 days, represents a particularly disabling subtype that is frequently refractory to standard pharmacological prophylaxis (3). Pharmacologic treatment of chronic migraine often has limited efficacy, prompting growing interest in interventional and peripheral neuromodulatory approaches (4). OnabotulinumtoxinA is currently the only FDA-approved interventional prophylactic therapy for chronic migraine, with efficacy established by class-one evidence from the PREEMPT clinical program (5). Although onabotulinumtoxinA is traditionally known for inhibiting muscle contraction, its efficacy in chronic migraine is now attributed to inhibition of SNARE-mediated vesicle trafficking in sensory as well as motor nerve terminals (6). However, treatment with onabotulinumtoxinA, while effective, must be repeated every three months for sustained relief and can impose a significant financial burden on patients (7), which has driven exploration of alternative peripheral procedures targeting the same pericranial sensory nerve distribution. Greater occipital nerve block and PRF have shown efficacy in reducing migraine frequency, intensity, and duration, with pulsed radiofrequency treatment thought to reduce conduction in nociceptive fibers through a neuromodulatory, non-neurodestructive mechanism (8). Randomized data comparing GON block with GON-PRF found that VAS pain scores were significantly lower in the PRF group than the GON block group at six months follow-up (9), and longer-term cohort data have shown durable benefit of GON-targeted radiofrequency techniques over twelve months of follow-up (10). Beyond the occipital nerve, radiofrequency ablation of pericranial nerves including the supratrochlear and supraorbital nerves has emerged as a promising option for headache conditions refractory to pharmacologic treatment, with a favorable and largely self-limited side-effect profile (7). Case reports have further demonstrated good therapeutic response to PRF in patients whose chronic migraine remained refractory even after botulinum toxin injection (10). Despite this growing evidence base, direct head-to-head comparisons between combined GON-supratrochlear nerve PRF and onabotulinumtoxinA injection, the two leading peripheral interventional strategies covering the trigeminal and occipital sensory distribution, remain scarce. Given the cost, repeated dosing requirement, and resource burden associated with botulinum toxin therapy, and the emerging durability data for PRF, a direct comparative study is warranted to determine which modality offers superior and more sustained efficacy, better safety, and greater cost-effectiveness for patients with chronic migraine.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality among children globally, with an estimated incidence ranging from 47 to 280 cases per 100,000 children (1). The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is characterized, because most pTBI occurs in LMICs (2). TBIs can have both short- and long-term effects including impairment of physical, cognitive, or emotional functions (3). Advances in acute trauma care have decreased mortality rates (4). Elevated intracranial pressure (ICP) following TBI or stroke has been recognized as an important second insult that is strongly correlated with increased mortality. Therefore, an increase in ICP can cause a decrease in brain perfusion and may result in brain ischemia (5). Early detection of raised intracranial pressure (RICP) is considered a better strategy to prevent secondary brain insult (6). The gold standard for ICP measurement is invasive techniques (i.e., ventriculostomy and intraparenchymal microtransducers), associated with risks, such as infection and haemorrhage (7). Several methods for noninvasive measuring of elevated ICP have been proposed: radiologic methods including computed tomography and ophthalmological techniques (8). Some brain computed tomography (CT) findings, such as brain parenchymal swelling, midline shifting, and compressed basal cisterns, are traditionally used for the indirect measurement of raised ICP (9). Among non-invasive methods, the measurement of optic nerve sheath diameter (ONSD) has gained particular interest (7). The optic nerve sheath is continuous with the meninges of the central nervous system and is encased with the subarachnoid membrane. Cerebrospinal fluid (CSF), located in the subarachnoid space, accumulates in the optic nerve sheath, thereby widening its diameter in the setting of increased ICP and limited intracranial compliance (10). Ultrasound assessments of ONSD could be a better option because of the low cost and rapid bedside operation without the need for radiation exposure, especially for cases that are unstable and require real-time monitoring of ICP in an intensive care unit (11). Despite existing research, there remains a gap in evaluating the diagnostic accuracy of the ONSD measured via ultrasound for the prediction of increased ICP in pediatric patients (12). This study aims to assess the diagnostic accuracy of bedside optic nerve sheath diameter ultrasonography for detecting raised intracranial pressure in pediatric traumatic brain injury using brain CT findings as the reference standard.

Metabolic syndrome is a major global health burden characterized by a clustering of metabolic abnormalities including central obesity, hypertension, dyslipidaemia, and impaired glucose metabolism. Recent modelling data indicated that the worldwide prevalence of metabolic syndrome doubled between 2000 and 2023, reaching approximately 31% among women and 26% among men, with an estimated 1.54 billion adults affected globally \[1\]. In the Middle East and North Africa region, the prevalence of metabolic syndrome-associated liver disease has been reported to reach nearly 40% in the general population \[2\]. Hepatic steatosis, now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD) following the 2023 multi-society Delphi consensus statement, encompasses a spectrum of conditions ranging from simple steatosis to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma \[3\]. The global prevalence of NAFLD/MASLD has been estimated at approximately 32.4%, with a steadily increasing trend over the past two decades \[4\]. Given that early identification of hepatic steatosis may prevent progression to advanced liver disease, there is a clinical need for simple, inexpensive, and readily available screening biomarkers \[5\]. Serum creatinine is traditionally used as a marker of renal function; however, because creatinine is generated as a metabolic end-product of skeletal muscle, its circulating concentration also reflects total body muscle mass. Adjusting serum creatinine for body weight yields the creatinine-to-body weight (Cr/BW) ratio, which has been proposed as a simple surrogate marker of relative muscle mass and sarcopenic obesity \[6\]. In a landmark longitudinal cohort of 13,728 participants, participants in the lowest Cr/BW quartile demonstrated a significantly higher cumulative incidence of NAFLD compared with the highest quartile, confirming Cr/BW as an independent predictor of fatty liver disease \[7\]. Reduced skeletal muscle mass and sarcopenia are increasingly recognized as contributors to insulin resistance and metabolic dysfunction, both of which are central to the pathogenesis of MASLD \[8\]. A bidirectional relationship between the Cr/BW ratio and NAFLD has been demonstrated in a longitudinal study of 9,662 participants followed for four years, suggesting that low muscle mass and hepatic steatosis may reinforce one another \[9\]. Furthermore, a recent cross-sectional study of 1,492 participants found that the Cr/BW ratio independently predicted the severity of hepatic steatosis as measured by controlled attenuation parameter, with a threshold of 1.01 identifying high-risk individuals \[10\]. Despite this emerging evidence, published data on the predictive value of the Cr/BW ratio for hepaticsteatosis specifically in patients with metabolic syndrome remain limited. Most existing studies were conducted in East Asian populations and focused on NAFLD without selecting for the metabolic syndrome phenotype. Therefore, this study aims to evaluate the predictive value of the Cr/BW ratio for hepatic steatosis in patients with metabolic syndrome attending Assiut University Hospital.

This prospective observational study aims to evaluate the prognostic utility of the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) as novel inflammatory biomarkers for monitoring disease activity and predicting renal progression, flares, and outcomes in patients with lupus nephritis.

To compare the radiological, clinical and functional outcomes of short-segment versus long-segment transpediclular screw fixation in patients with thoracolumbar fractures AO-type B.

the goal of this observational study is to apply different scores 1. To assess Fatigue, Frailty, Liver Transplant Comorbidity Index and MELD 3.0 in patients with liver cirrhosis awaiting liver transplantation. 2\. To evaluate the predictive accuracy of these Scores for the short-term outcomes (early complications, recurrent hospitalization and 3-month mortality). 3. To determine whether using these Scores in the pre-transplant evaluation improves risk stratification compared to MELD score alone.

To estimate the prevalence of tension-type headache among adults attending the outpatient clinics at Assiut University Hospitals, and to assess its association with smartphone use, sleep quality, and quality of life.

Ligamentous injuries of the ankle are common among athletes. Inversion injuries of the ankle account for 40% of all athletic injuries. The anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are sequentially the most commonly injured ligaments when a plantar-flexed foot is forcefully inverted. The posterior talofibular ligament (PTFL) is rarely injured, except in association with a complete dislocation of the talus. Eighty percent of patients with lateral ankle injuries make a full recovery following conservative rehabilitation. Up to 20% of patients with an acute inversion injury develop chronic functional instability. Electromyography (EMG) has demonstrated prolonged reaction times of the peroneal muscle in this group of patients. Strengthening and proprioception exercises can lead to improvement. Patients whose injury does not respond and who have continued mechanical laxity and functional instability may be candidates for lateral ligament reconstruction Chronic pain of the lower extremity remains challenging to manage.Non-Surgical Treatments include * Physical therapy: Do strength, flexibility, and balance exercises to build support around the joint. * Bracing and support: Wear an ankle brace or use custom shoe inserts (orthotics) to stabilize your foot. * Activity changes: Swap high-impact sports like running for low-impact options like swimming or cycling. * Medications: Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to manage swelling and pain. * Injections: Get targeted corticosteroid or regenerative injections if recommended by a doctor. * Neuromodulaion : RFA, Cryneurolysis, botulinum injection Hydrodissection with botulinum toxin Hydrodissection is a minimally-invasive procedure that involves injecting fluid into anatomic spaces to facilitate dissection and adhesiolysis during surgery as proposed by Graesser et al. in 2022. In the past decade, it has been applied to the management of nerve entrapments by injecting fluid around the nerve to create space and separate them from surrounding structures. Injectates used are either saline, corticosteroids, anesthetic,dextrose water, platelet-rich plasma,Botulinum or combinations of these injectates Radiofrequency ablation in chronic ankle pain The use of both PRF and CRF has been reported to be used for chronic ankle and foot pain.CRF works by applying an active electrode to heat-targeted neural tissue to temperatures of 60-80 °C. These high temperatures cause coagulative necrosis, collagen destruction, and axonal degeneration, thereby resulting in third- and fourth-degree peripheral nerve injury . Pain relief is limited however by progressive axonal regeneration . In contrast to CRF, PRF delivers high-frequency current in a pulsed manner, allowing time between pulses for the dissipation of produced heat. As such, the electrode tip is kept at a maximum of 42 °C, which is below the temperature that produces nerve damage. Instead, though it is not yet clarified, it is thought that PRF employs a strong electromagnetic field to functionally change neuronal cells in small unmyelinated and lightly myelinated nerve fibers selectively. This in effect causes disruption of neuronal membranes, modulation of neuronal gene expression, and modulation of neuronal local cytokine release . Following treatment, immediate changes of endoneurial edema can be seen histologically and clinical pain relief may last several years Cryoneurolysis Cryoneurolysis, also known as cryoablation or cryoneuroablation, is the application of cold temperatures to targeted nerves to "freeze" them in an attempt to block pain signals . This technique was introduced to treat acute pain initially but has significantly gained interest as an intervention for those struggling with chronic pain conditions, primarily due to the failure of traditional interventions that resulted in temporary results and further complications. Evidence has shown that cryoneurolysis may offer long-term pain relief without the need for constant pharmaceutical interventions . It is for this reason that it represents a desirable therapeutic opportunity to consider for patients suffering from chronic knee pain, neuropathic pain, and post-surgery-related pain Owing to its minimally invasive/non-invasive nature and lasting pain relief over months, cryoneurolysis offers significant advantages over traditional pain management methods . Furthermore, cryoneurolysis does not have systemic effects or addiction risks, as seen in long-term opioid use, making it a better pain management option today in the context of the increasing opioid crisis Aim of study: To evaluate and compare the efficacy of three ultrasound-guided neuromodulation techniques-hydrodissection with botulinum toxin, conventional radiofrequency ablation (RFA), and cryoneurolysis-targeting the superficial fibular nerve (SFN) in athletes with chronic ankle pain after anterior talofibular ligament (ATFL) injuries.

Smoking remains one of the leading preventable causes of morbidity and mortality worldwide and is strongly associated with chronic respiratory diseases, cardiovascular disease, cancer, and premature death. Physicians play a central role in tobacco control through the delivery of smoking cessation counseling, and even brief physician advice has been shown to significantly increase smoking quit rates. The evidence-based 5A's model (Ask, Advise, Assess, Assist, and Arrange) is widely recommended as the standard framework for smoking cessation counseling.

This prospective cohort study aims to evaluate whether blood levels of soluble receptor for advanced glycation end products (sRAGE), Club Cell Protein-16 (CC16), and Syndecan-1 measured early after severe chest trauma can predict the development of acute respiratory distress syndrome (ARDS) and in-hospital mortality. Adult patients aged 18 years or older admitted with severe blunt or penetrating chest trauma will be enrolled. Clinical data, injury severity, laboratory findings, imaging results, and clinical outcomes will be recorded. Patients will be followed daily during the first 7 days after admission for the development of ARDS, and in-hospital mortality will be recorded until discharge or death. The findings may help identify patients at high risk of respiratory complications and poor outcomes after severe chest trauma.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease primarily affecting the peripheral joints, yet its extra-articular burden particularly on the cardiovascular (CV) system has emerged as its most consequential long-term complication . Cardiovascular disease (CVD) accounts for 40% of all deaths in RA patients, making it the leading cause of mortality .This excess CV risk is estimated to be 1.5 to 2 times higher than in the general population .The overall CV risk conferred by RA has been linked in magnitude to that of diabetes mellitus, underscoring RA as an independent cardiovascular risk factor formally recognised in the 2021 European Society of Cardiology Guidelines on CVD prevention . In this context, the non-invasive detection of preclinical atherosclerosis before the onset of clinical CV events has become clinical priority. Carotid intima-media thickness (CIMT), measured by high-resolution B-mode ultrasonography, is a well-validated surrogate marker of early structural arterial wall changes that independently predicts future myocardial infarction and stroke .Multiple studies have documented significantly elevated CIMT in RA patients compared with age- and sex-matched controls; studies found higher CIMT values across all age groups in RA, with values increasing in proportion to disease severity as assessed by the Disease Activity Score in 28 joints . The atherogenic index of plasma (AIP) defined as the base-10 logarithm of the triglyceride-to-HDL-cholesterol ratio has emerged as a calculated composite biomarker reflecting lipoprotein particle atherogenicity, particularly the preponderance of small, dense LDL particles .A high AIP (\>0.21) has been independently associated with major adverse cardiovascular events beyond the predictive capacity of conventional lipid panels .

This prospective observational study aims to evaluate the diagnostic utility of vascular ultrasound for internal jugular vein (IJV) assessment in adult patients undergoing clinically indicated IJV cannulation. Traditionally, bedside clinical assessment of jugular venous pressure (JVP) is challenging and frequently imprecise in critically ill or obese individuals. This study investigates whether non-invasive ultrasound parameters, specifically IJV diameter, collapsibility index, and Doppler flow patterns, can reliably estimate central venous pressure (CVP) and identify elevated JVP. Participants admitted to the Intensive Care Unit, Emergency Department, or Operating Theatres who require right IJV catheterization will receive a standardized pre-procedural vascular ultrasound evaluation in a supine position (0-30° head elevation) prior to routine, ultrasound-guided cannulation. Ultrasound measurements will then be compared to direct central venous pressure readings to assess diagnostic accuracy and correlation.

Diabetic kidney disease (DKD) is a frequent microvascular complication in individuals with type 2 diabetes mellitus (T2DM) and a major cause of chronic kidney failure worldwide. Chronic low-grade inflammation and platelet activation contribute significantly to renal microvascular damage. The purpose of this observational study is to evaluate whether routine blood test markers, specifically the Systemic Immune-Inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet indices (such as mean platelet volume \[MPV\] and platelet distribution width \[PDW\]), can serve as simple, accessible, and cost-effective biomarkers for identifying the presence and progression of diabetic kidney disease. Participants will include adult patients with type 2 diabetes categorized according to their urinary albumin-to-creatinine ratio (normoalbuminuria, microalbuminuria, and macroalbuminuria) as well as healthy control subjects. Complete blood counts, derived inflammatory indices, and renal parameters will be measured to assess their diagnostic accuracy for DKD.

The goal of this clinical trial is to determine whether a structured oral hydration regimen reduces the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The main questions it aims to answer are: Does a structured oral hydration regimen reduce the incidence of CI-AKI compared with standard care without a prescribed hydration regimen? Does oral hydration improve renal outcomes without increasing the risk of adverse events, such as heart failure or fluid overload, in patients undergoing PPCI? Researchers will compare patients receiving a structured oral hydration regimen with patients receiving standard care without a prescribed hydration regimen to determine whether oral hydration decreases the incidence of CI-AKI and improves clinical outcomes. Participants will: Be randomly assigned to either the oral hydration group or the standard care group. Undergo primary percutaneous coronary intervention according to institutional practice. Receive the assigned hydration strategy after the procedure. Have serum creatinine measured at baseline and after contrast exposure to assess for CI-AKI. Be monitored for adverse events, including fluid overload, heart failure, need for renal replacement therapy, length of hospital stay, and other relevant clinical outcomes.

This observational study aims to determine how common fibromyalgia syndrome and central sensitization are in adults with plaque psoriasis compared to healthy individuals. Plaque psoriasis is a chronic inflammatory skin disease that can affect the entire body, which may increase the risk of developing chronic pain conditions. Fibromyalgia causes widespread musculoskeletal pain, fatigue, and sleep disturbances, while central sensitization involves the central nervous system becoming highly sensitive to pain. Researchers will evaluate 55 adult patients diagnosed with plaque psoriasis and 55 age- and sex-matched healthy volunteers at the Dermatology Outpatient Clinic at Assiut University Hospital. Participants will undergo a clinical examination to assess their psoriasis severity and will complete standardized questionnaires to evaluate pain intensity, fibromyalgia symptoms, central sensitization, and overall quality of life. The findings of this study may help doctors better understand these overlapping conditions to improve the early identification and management of pain in patients with psoriasis.

Puberty is a critical transition from childhood to adulthood. Over the past two decades, studies worldwide have shown a trend toward earlier pubertal onset, which is thought to be influenced by factors such as lifestyle changes, improved nutrition, and environmental exposures. However, there is currently a lack of local data regarding the timing of puberty in Upper Egypt. The main purpose of this observational study is to determine the average age at which puberty begins among girls living in the Asyut governorate, Egypt. The study specifically focuses on thelarche (breast development), which is the earliest clinical sign of pubertal onset. Additionally, the study aims to identify possible genetic, demographic, physical, and environmental factors that might influence the timing of this developmental milestone. The study will include approximately 600 girls aged 6 to 13 years from both urban and rural areas of Asyut. Researchers will collect data during a single visit using a structured questionnaire administered through personal interviews with the participants and their parents or caregivers. The questionnaire will gather information on early life history, family history, dietary habits, physical activity, sleep patterns, screen time, stress, environmental exposures, and pubertal history. Researchers will also take basic physical measurements, including height, weight, and waist circumference to calculate Body Mass Index (BMI). Participants will not be exposed to any invasive procedures or additional clinical risks beyond their routine care. The findings will help establish local reference values for pubertal development and support evidence-based adolescent health strategies in Egypt.

Evaluation of fetal cardiac functions in cases complicated with growth restriction

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that may cause joint stiffness, pain, reduced mobility, and impaired functional ability. Self-care education may help patients improve their knowledge and practices related to disease management, joint protection, physical activity, exercise, energy conservation, and symptom management. This study aims to evaluate the effectiveness of a self-care educational program on joint stiffness and functional ability among patients with rheumatoid arthritis. Participants will be assigned to either a study group or a control group. The study group will receive the self-care educational program in addition to routine care, while the control group will receive routine care only. Joint stiffness and functional ability will be assessed before and after implementation of the educational program.

This observational study aims to compare how quickly and smoothly younger children (ages 3 to 6 years) recover from general anesthesia compared to older children (ages 6 to 12 years). While inhalational anesthesia (breathing in anesthetic gases) has traditionally been the standard for pediatric surgeries, total intravenous anesthesia (TIVA) using a short-acting medication called propofol is increasingly being used. Propofol TIVA offers several benefits, including reduced postoperative nausea and vomiting, less airway irritation, a smoother waking process, and an earlier readiness to go home. However, because children's bodies and metabolisms change rapidly as they grow, the way propofol is processed by and clears from the body varies significantly by age. Currently, there is limited evidence detailing exactly how these age-related differences affect recovery times. To investigate this, researchers will monitor 64 children undergoing elective surgeries (lasting between 30 and 120 minutes) who receive propofol TIVA as their primary anesthetic. After the procedure, the study will measure the exact time it takes for participants in both age groups to meet specific, standardized safe-discharge criteria (known as Phase II recovery readiness). Researchers will also track several other important recovery factors, including the time it takes for children to open their eyes, pain levels, the occurrence of emergence delirium (agitation or confusion upon waking), and any breathing-related complications. By comparing the recovery trajectories of toddlers and older children, this research seeks to improve postoperative care planning and provide clearer expectations for pediatric intravenous anesthesia.

This protocol proposes a prospective observational study to develop and validate such a model, directly addressing a critical evidence gap identified by recent systematic reviews.

Migraine is one of the most prevalent neurological disorders worldwide and remains a leading cause of disability, particularly among individuals of working age. Chronic migraine affects approximately 1-2% of the global population and is associated with substantial impairment in quality of life, reduced work productivity, and increased healthcare utilization . Despite recent advances in migraine management, including calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies and gepants, many patients continue to experience inadequate symptom control, treatment intolerance, or limited access to these therapies . Consequently, peripheral nerve blocks have emerged as effective non-pharmacological treatment options for patients with refractory migraine and other primary headache disorders . Among the available interventional techniques, the greater occipital nerve block (GONB) is one of the most widely used procedures for both acute and preventive treatment of migraine. The therapeutic effect of GONB is believed to result from modulation of nociceptive transmission within the trigeminocervical complex, thereby reducing central sensitization and interrupting convergence between cervical and trigeminal afferents. Several randomized clinical trials and systematic reviews have demonstrated that GONB significantly reduces headache intensity, headache frequency, analgesic consumption, and migraine-related disability while maintaining an excellent safety profile . Migraine pain often involves overlapping sensory territories supplied by interconnected peripheral nerves. The greater auricular nerve (GAN), a superficial sensory branch of the cervical plexus arising from the C2 and C3 spinal nerves, supplies the skin over the parotid region, mastoid process, lower auricle, and angle of the mandible . Because cervical sensory afferents converge with trigeminal nociceptive pathways within the trigeminocervical complex, the GAN may contribute to peripheral nociceptive transmission involved in migraine pathophysiology . Combined blockade of multiple cervical sensory nerves may therefore provide broader interruption of peripheral nociceptive input, potentially enhancing analgesic efficacy and reducing central sensitization . Ultrasound-guided GONB has been shown to produce greater procedural accuracy and consistent clinical outcomes than landmark-guided techniques . Despite the increasing use of peripheral nerve blocks in headache medicine, evidence regarding the additional benefit of combining a greater auricular nerve block with the standard greater occipital nerve block remains limited. To the best of our knowledge, no prospective randomized double-blind clinical trial has directly compared ultrasound-guided combined GONB and GAN block with GONB alone in patients with chronic migraine.

Post-tonsillectomy hemorrhage (PTH) is one of the most common and potentially life-threatening complications of tonsillectomy. * Secondary PTH (Bleeding occurring \>24 hours post-operatively) is of particular clinical significance. * Tonsillectomy is a frequently performed procedure at Assiut University Hospital (AUH). * However, no local prospective data exists comparing secondary PTH rates across techniques, or systematically characterizing its causes. * This study addresses this gap by comparing rates, and analysis of causes.

The primary objective of this study is to evaluate the biochemical efficacy of Magnesium Sulfate (MgSO₄) as an anti-inflammatory therapeutic agent in patients suffering from moderate traumatic brain injury (TBI) at Assiut University Hospitals by measuring Nucleotide-binding oligomerization domain-Like Receptor Pyrin domain-containing 3 (NLRP3) inflammasome-a multiprotein complex.

Evaluation of Uromodulin as a biomarker of renal histological activity/ Chronicity indices in lupus nephritis