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There are many stages in the medical device management lifecycle to consider, and from the planning stage to commissioning, dismantling and decommissioning, replaceing an equipment is a critical decision. This phase includes several information that help replacement decisions intelligent. Technical, monetary and safety principles are taken into account when replacing medical equipment. One of the most frequently criterion is service life. In recent times, the delivery of a sustainable competitive advantage through the optimization of the management of non-essence activities is considered more relevant. A non-essence example is the Lifespan management of capital goods which are required in supporting the processes involved in healthcare operations ranging from acquiring assets to maximizing the operation, sustaining the performance and conclude the right time to get rid of it properly. The objective: is to identify if Total Cost Ownership (TCO) will give recommendations for decision-making even though it is capable of helping us identify the optimal economic life of the medical device. Overall, 40% of our specimens showed that monitoring TCO is essential to the continuous mapping of the cost of these devices on service.

Summary Objective The aim of this study is to explore the accuracy of two different approaches: transoral versus transnasal office-based laryngeal biopsy. Design Cohort-selection cross-sectional study. Setting Outpatient clinic of Phoniatrics in El Demerdash Hospital, faculty of medicine, Ain Sham University, Cairo, Egypt). Participants The study included all patients aged 18 years or more with suspicious lesions of the larynx or the oropharynx who are eligible for biopsy who came to the outpatient clinic due to different reasons during the period of March 2017 and March 2020. Main outcome measures Patients with suspicious lesions were referred for office-based-based biopsy—either transnasal biopsy or transoral biopsy. All patients were referred for subsequent direct laryngoscopy for definitive diagnosis. Results The overall sample was 60 cases with 30 in each group. The majority of both groups were smokers. The most frequent cause of referral for biopsy was suspicious laryngeal mass. The number of biopsies obtained was significantly higher in the transoral group. Both approaches were tolerated by all patients with few limited aspiration or epistaxis. The sensitivity of the transoral approach was compared with that of direct laryngoscopy and was 95.8% with a specificity of 83.3%. The sensitivity of the transnasal approach was compared with that of direct laryngoscopy and was 26.3%; the specificity was 90.9%. Conclusion The transoral approach to obtaining a biopsy from the upper aero-digestive tract has better diagnostic accuracy than the transnasal approach when combined with transnasal visualization and transcricothyroid anesthesia.

Background: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. In Egypt, CKD approximately affects 13% of the adult population, resulting in significant morbidity, mortality, and health care costs. Patients with advanced CKD (stage 3 or more) experience a high rate of cardiovascular complications compared to earlier stages of CKD. Objective: To evaluate serum YKL-40 levels in patients with CKD to assess its value as a biomarker of inflammation and its correlation with carotid intima-media thickness (CIMT) as a predictor for early atherosclerosis. Patients and Methods: The present study was conducted on fifty subjects divided into 2 groups: group I includes 25 patients with CKD (from stage 1 to stage 5 "pre-dialysis") and group II (control group) includes 25 healthy volunteers. The patients were recruited from Internal Medicine Department and Nephrology Unit, Tanta university hospitals in the period between," August 2020 to September 2021 ". Results: In our study, YKL-40 levels were significantly high in CKD patients(P=0.001). As regards CIMT measurements for the studied cases its median value was 0.90 and1 mm for the right and left carotid respectively. On the other hand, CIMT measurements for the studied volunteers were within the normal range with statistically significant differences between both groups (p=0.001). There is a positive significant correlation between the serum YKL-40 level from the studied cases with each of triglycerides, serum urea, serum creatinine, CRP, ESR, R CIMT, and L CIMT. Systolic blood pressure, triglyceride, cholesterol, LDL, serum urea, serum creatine, e-GFR, ESR, CRP, and YKL-40 were found to be independent predictors for CIMT (P

Background The global spread of COVID-19 created an explosion in rapid tests with results in Methods Design: Rapid review and diagnostic test accuracy network meta-analysis (DTA-NMA). Eligibility criteria: Randomized controlled trials (RCTs) and observational studies assessing rapid antigen and/or rapid molecular test(s) to detect SARS-CoV-2 in participants of any age, suspected or not with SARS-CoV-2 infection. Information sources: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials, up to September 12, 2021. Outcome measures: Sensitivity and specificity of rapid antigen and molecular tests suitable for detecting SARS-CoV-2. Data extraction and risk of bias assessment: Screening of literature search results was conducted by one reviewer; data abstraction was completed by one reviewer and independently verified by a second reviewer. Risk of bias was not assessed in the included studies. Data synthesis: Random-effects meta-analysis and DTA-NMA. Results We included 93 studies (reported in 88 articles) relating to 36 rapid antigen tests in 104,961 participants and 23 rapid molecular tests in 10,449 participants. Overall, rapid antigen tests had a sensitivity of 0.75 (95% confidence interval 0.70–0.79) and specificity of 0.99 (0.98–0.99). Rapid antigen test sensitivity was higher when nasal or combined samples (e.g., combinations of nose, throat, mouth, or saliva samples) were used, but lower when nasopharyngeal samples were used, and in those classified as asymptomatic at the time of testing. Rapid molecular tests may result in fewer false negatives than rapid antigen tests (sensitivity: 0.93, 0.88–0.96; specificity: 0.98, 0.97–0.99). The tests with the highest sensitivity and specificity estimates were the Xpert Xpress rapid molecular test by Cepheid (sensitivity: 0.99, 0.83–1.00; specificity: 0.97, 0.69–1.00) among the 23 commercial rapid molecular tests and the COVID-VIRO test by AAZ-LMB (sensitivity: 0.93, 0.48–0.99; specificity: 0.98, 0.44–1.00) among the 36 rapid antigen tests we examined. Conclusions Rapid molecular tests were associated with both high sensitivity and specificity, while rapid antigen tests were mainly associated with high specificity, according to the minimum performance requirements by WHO and Health Canada. Our rapid review was limited to English, peer-reviewed published results of commercial tests, and study risk of bias was not assessed. A full systematic review is required. Review registration PROSPERO CRD42021289712

Background Penetrating abdominal trauma (PAT) poses a significant challenge to trauma surgeons. Laparotomy is still the most popular procedure for managing PAT but has high morbidity and mortality rates. Presently, laparoscopy aims to provide equal or superior visualization compared to open approaches but with less morbidity, postoperative discomfort, and recovery time. The aim of this research is to assess the impact of laparoscopy on the management of PAT. Methods This was a retrospective observational study carried out at the Emergency Hospital of Mansoura University/Egypt and at King Faisal Medical Complex, Taif/KSA from September 2014 to September 2018. All hemodynamically stable patients with PAT who were managed by laparoscopy were included in this study. Data extracted for analysis included demographic information, criteria of abdominal stabs, type of management, and perioperative outcome. Results Forty patients were recruited in this research and the male-to-female ratio was 5.6:1. The mean age of the patients was 31.4 ± 12.318 years. During the laparoscopic procedure, no peritoneal penetration was observed in 4 patients (negative laparoscopy), while peritoneal penetration was observed in the remaining 36 patients. No visceral injuries were noted in 2 patients of the 36 patients with peritoneal penetration, while the remaining 34 patients had intra-abdominal injuries. Conclusion Laparoscopy performed on hemodynamically stable trauma patients was found to be safe and technically feasible. It also reduced negative and non-therapeutic laparotomies and offered paramount therapeutic and diagnostic advantages for traumatic diaphragmatic injuries.

Introduction It is now evident that the loss of smell and/or taste may be consistent accompanying symptoms of the SARS-CoV-2 infection. Objective To estimate the social behavior of recent anosmic non-hospitalized patients in the COVID-19 pandemic and to try to obtain the natural pattern in society in a cross-sectional study. Methods A cross-sectional study conducted on 4,860 patients with anosmia complaints during the COVID-19 pandemic. Patients who needed a consultation for an anosmia complaint confirmed that they had completed the survey regarding age, gender, history of general diseases, history of nasal disease, associated COVID-19 symptoms, smoking, blood group, and risk factors. Results A total of 4,860 patients with a mean age of 34.26 ± 11.91 years completed the study. There was a predominance of female patients: 3,150 (58.9%). Most patients (4,083 patients; 83%) developed sudden anosmia. In 85% (4131 patients) of the patients, a previous history of contact with anosmic patients was present. The most prevalent blood group was O (39%). In total, 67.4% of the patients underwent medical treatment. A history of unusual influenza attacks in December 2020 was reported by by 27% (1312 patients) of the patients. Conclusion Despite large diversity of behaviors among anosmic patients in the COVID-19 pandemic, we can observe a great similarity in the pattern of anosmia in non-hospitalized patients, especially in the way it spreads, the predisposing factors, and the individual recovery.

Two millimetere needlescopic instruments induce minimal trauma to the abdominal wall and have excellent cosmetic results. However, these instruments are fragile and expensive with short weak jaws. The aim of this study was to present a novel needlescopic approach for inguinal hernia (IH) repair in girls using 1.6-mm suture grasper device (SGD), modified polypectomy snare (MPS) and a home-made snare (HMS). We refer to this technique as needlescopic inversion and snaring of hernial sac in girls. Over a period of 1 year from March 2018 to March 2019, a prospective study was conducted on girls that presented with IH. Preoperative inguinal ultrasound was performed in all patients to measure the internal inguinal ring (IIR) diameter. All hernias were repaired by our novel technique using two SGDs, MPS or HMS. Follow-up period was at least 12 months. Fifty-three girls with 74 hernias were included in this study, with a mean age of 38 ± 8 months. IIR diameter ranged between 8 and 15 mm with a mean of 11 ± 2 mm. Mean operative time was 15 ± 3 min in bilateral and 11 ± 2 min in unilateral presentations. All procedures were completed successfully with no conversion and without major complications. Follow-up ranged from 12 to 24 (median 16.5) months. Non-visible scars were obtained in all cases and there was no reported recurrence. Needlescopic inversion and snaring of inguinal hernial sac in girls using 1.6-mm instruments, MPS or a HMS is a safe, rapid and feasible method for IH repair. It has the advantage of invisible scars and no recurrence in the short-term outcomes.

Aim: To evaluate effectiveness of multiple rotary file systems on removal of the filling materials during retreatment of oval-shaped root canals. Methods: 40 oval root canals were instrumented with ProTaper Next to size X4. The canals were allocated into two equal groups according to the final rinse, Group I: with Biopure MTAD, and Group II: with 17% EDTA. All the canals were obturated with bioceramic based root canal sealer and gutta-percha using lateral compaction technique. According to the used retreatment rotary system, each group were further subdivided into two equal subgroups including subgroups Ia & IIa using D-Race (DR1) + XP-endo Shaper (XPS) + XP-endo Finisher R (XPFR), and subgroups Ib & IIb using R-Endo retreatment files up to R3 + Revo-S rotary files up to (40/.06). CBCT scans were used to calculate the remaining amount of root filling materials at the pre scan (after obturation), and that of air at the post scan (after retreatment). The dentin volumes were also recorded at both scans to analyze the amount of remaining filling materials. Results: No significant differences were recorded regarding the amount of residual filling material with the tested systems (p > 0.05). Intra subgroups assessments showed more filling material removed when using a larger sized final instrument (p < 0.001). Conclusions: Tested file systems were evenly efficient in removing filling materials from oval-shaped root canals of extracted molars. Types of chelators used and bioceramic based sealer had no significant validity on effectiveness of removal of root canal filling material.

Background: This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine the effectiveness of various palatal surgical techniques in treating OSAS and the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods: The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross-sectional studies as well as NIH tool for quality assessment for case series studies. Results: Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI (Apnea/Hypopnea Index) was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD = −0.848, 95% CI (−1.209 - −0.487), p-value < 0.001) and (SMD = −0.864, 95% CI (−1.234 - −0.494), p-value < 0.001), respectively]. The technique responsible for the best improvement in Epworth Sleepiness Score (ESS) was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD = −0.998, 95% CI (−1.253 - −0.743), p-value < 0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD = 1.011, 95% CI (0.581 - 1.440), p-value < 0.001]. The surgical procedure that results in the best post-operative Visual Analogue Scale (VAS) was Z-Palatoplasty, with a significant mean reduction of [SMD = −1.551, 95% CI (−2.049 - −1.052), p-value < 0.001]. Soft palate length changes with a significant mean reduction of [SMD = −2.219, 95% CI (−2.730 - −1.708), p-value < 0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [event rate = 77%, 95% CI (65.4% - 85.5%), p-value < 0.001]. Conclusion: The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Objective: This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resistance to medical treatment. Patients and Methods: This study was conducted at Ain-Shams University from June-2017 to June-2018 upon 20 patients as the fungal cases are not much in Egypt. All patients were subjected to functional endoscopic sinus surgery and taking specimens. Examination of specimens by scanning electron microscope was made. Results: The prevalence of fungal biofilms was 7 (70%) in cases and 0 (0%) in controls (p-value = 0.001). There is higher risk of fungal biofilms in cases of fungal sinusitis, the odds of biofilms is higher in the study group 2.33 than in the control group 0. The lower is the invasiveness, the higher is the fungal biofilms (OR = 0.94, 95% CI 0.46 - 4.05). Also, the analysis showed that the lower is the recurrence the lower is the fungal biofilms (OR = 2.25, 95% CI 0.15 - 7.93). Conclusion: This study showed the presence of fungal biofilms in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non-invasive. Studies with large sample size are recommended to get a strong evidence.

Background The growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations. Methods This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol. Discussion This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD. Systematic review registration PROSPERO CRD42020175016.

Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up.To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care.We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations.Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital.Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD).We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence).There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.

Background Sometimes it becomes a dilemma to repair a failed circumcised distal penile hypospadias with partial or complete wound dehiscence. In many of these cases, redo operations need a graft or a flap. The aim of this study is to evaluate the double-folded meatal-based flap in redo circumcised hypospadias with shallow urethral plate and a small glans penis. Results From September 2015 to August 2018, we prospectively studied the double-folded meatal-based flap in 56 failed circumcised distal hypospadias without penile curvature with shallow urethral plate and a small glans penis. Distally folded Mathieu flap was done. Forty-seven cases only had completed the study. We had 19 patients with distal penile hypospadias, 19 with sub-coronal hypospadias, and 9 with coronal hypospadias. Median operative time was 50 (range 40–80 min). The median length of the double-folded flap was 14 (range 10–18 mm). The median follow-up was 12 (range 1–33 months). The success of the operation means that there is an absence of any complications. Our success rate was 73%. We had 8 patients with meatal retraction, one fistula, and one patient with wound disruption. Only 3 patients (6.4%) needed re-operation: one case with meatal retraction, another with fistula, and a third with complete wound disruption. Conclusion Distally folded meatal-based flap is an additional option in redo circumcised hypospadias with shallow urethral plate, small glans penis, and pliable anterior penile skin with a considerable high percent of meatal recession.

KEY POINTS TRESK background K+ channel is expressed in sensory neurons and acts as a brake to reduce neuronal activation. Deletion of the channel enhances the excitability of nociceptors. Skin nociceptive C-fibres show an enhanced activation by cold and mechanical stimulation in TRESK knockout animals. Channel deletion selectively enhances mechanical and cold sensitivity in mice, without altering sensitivity to heat. These results indicate that the channel regulates the excitability of specific neuronal subpopulations involved in mechanosensitivity and cold-sensing. ABSTRACT Background potassium-permeable ion channels play a critical role in tuning the excitability of nociceptors, yet the precise role played by different subsets of channels is not fully understood. Decreases in TRESK (TWIK-related spinal cord K+ channel) expression/function enhance excitability of sensory neurons, but its role in somatosensory perception and nociception is poorly understood. Here, we used a TRESK knockout (KO) mouse to address these questions. We show that TRESK regulates the sensitivity of sensory neurons in a modality-specific manner, contributing to mechanical and cold sensitivity but without any effect on heat sensitivity. Nociceptive neurons isolated from TRESK KO mice show a decreased threshold for activation and skin nociceptive C-fibres show an enhanced activation by cold and mechanical stimulation that was also observed in behavioural tests in vivo. TRESK is also involved in osmotic pain and in early phases of formalin-induced inflammatory pain, but not in the development of mechanical and heat hyperalgesia during chronic pain. In contrast, mice lacking TRESK present cold allodynia that is not further enhanced by oxaliplatin. In summary, genetic removal of TRESK uncovers enhanced mechanical and cold sensitivity, indicating that the channel regulates the excitability of specific neuronal subpopulations involved in mechanosensitivity and cold-sensing, acting as a brake to prevent activation by innocuous stimuli.

Objective To report the outcomes of surgical correction of post-circumcision webbed penis using two previously described techniques: the Heineke-Mikulicz (HM) scrotoplasty and the multiple Z-plasty. Patients and methods A prospective study of children with post-circumcision webbed penis was conducted. The patients were classified into two groups according to the degree of web and the remaining ventral penile skin as to whether adequate or short after circumcision. Group I was repaired by HM scrotoplasty and in Group II the multiple Z-plasty technique was used. Results This study included 86 patients of whom 71 maintained follow-up; 44 (62%) in Group I and 27 (38%) in Group II. The median (range) operative time was 45 (30–55) min in Group I and 75 (60–90) min in Group II. Wound infection occurred in two (4.5%) patients in Group I. In Group II postoperative mild self-limited penile oedema was present in three patients (11.1%). A self-limited scrotal haematoma developed in two (7.4%) patients. Conclusion Correction of post-circumcision webbed penis in children can be done by one of two techniques: HM scrotoplasty in Grade 1 and multiple Z-plasty in Grade 2 and Grade 3, with favourable outcomes. Abbreviations HM: Heineke-Mikulicz; IQR: interquartile range

The conservation of water is, justifiably, a huge concern to water companies, regulatory bodies, environmentalist and more but, unfortunately, water loss through leakage can remain undetected for long periods of time without effective leakage detection. Leakage detection in water distribution networks has taken many forms through investigating varying properties of leakage. Understanding the characteristic leakage types and properties introduces the different emerging technologies. Even though some methodologies have gained popularity in the past decade, the need to establish a complete, economical leakage detection solution that effectively identifies background leakage as well as burst events persists. The benefits and limitations of the aforementioned technologies has often confused water utilities on adapting the most suitable method. Therefore, there is an arising need to classify and benchmark leakage detection practices. This paper reviews technologies in leakage detection contrasting hardware & software, intrusive & non-intrusive, steady state & transient, single & hybrid methods. A particular focus will be placed on scoping the projected direction of leakage detection and localisation. As anticipated, the various techniques refined over the last two decades introduce different capabilities, conditions, and constraints[1]. Assessing and comparing those methods will provide a deeper novel understanding of the research area thus paving the way for novel solutions.

Background The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932. Objectives This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies. Results Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value Conclusion The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Background: Alar rim collapse is an agonizing problem that has both cosmetic and functional sequalae. It has been usually addressed with batten grafts. In this study, we are describing a simple technique for insertion of alar rim grafts to fix external nasal valve collapse.Patients and Methods: Between January 2018 and October 2020, eighteen patients with alar rim collapse or deformities were addressed using alar rim septal cartilage grafting.Results: All patients who underwent alar rim grafting for external nasal valve collapse were evaluated functionally and aesthetically with post-operative follow up ranging from 12 to 24 month. During which, they showed marked improvement in their nasal airway patency with complete satisfaction for the aesthetic outcome. No complications were encountered.Conclusion: Alar rim grafting is a simple and effective approach to provide support for the external nasal valve and alar contour. In cases of malpositioned lower lateral cartilage, alar flaring, nasal tip deformities, mild retraction, or contour asymmetries, these cartilage grafts showed good outcomes in primary or revision cases.

Objective To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes. Design Systematic review and network meta-analysis (NMA). Methods Data sources—Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction—All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis—We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach. Results A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD –0.92, 95% confidence interval −1.55, −0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes. Conclusion and implications Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.

Introduction Achieving a hermetic apical seal is mandatory to prevent ingress of any microorganisms or periapical fluids into the root canal system. Therefore it is essential to develop new materials having favorable physical, chemical and biological properties. Aim the purpose of this study was to use scanning electron microscopy to compare the marginal adaptation of new formulation of MTA (Harvard MTA), MTA flow and glass ionomer as root end filling materials using ultrasonic root-end preparation. Methodology Thirty-nine extracted single rooted human teeth were prepared using Protaper Next file system (Dentsply/Sirona) and filled with gutta-percha and MTA fillapex sealer (MTA Fillapex; Angelus, Londrina, Brazil) and obturated using cold lateral compaction technique. The apical 3 mm of the roots were sectioned perpendicular to the long axis of the roots. A 3-mm depth root-end cavity was prepared with ultrasonic tips powered by an Enac ultrasonic device. The teeth were randomly allocated into three groups of 13 teeth each according to filling materials tested. Group I the samples were filled with Harvard MTA (Universal, Handmix, Germany, Harvard), Group II filled with MTA Flow (Ultradent Products Inc., South Jordan,UT, USA), group III filled with glass ionomer (Fuji II, GC gold label 2, GC International, Japan). Using SEM the distance between the tested materials and the surrounding dentin was measured at different points.Results According to the results of Kruskal-Wallis, there was significant difference between the three experimental groups at P value 0.01. The Man Whitney test was used for two-by-two comparison of the groups which revealed no statistical significant difference between MTA flow and MTA Harvard group however; there was statistically significant difference in Glass Ionomer group. Conclusion SEM results showed the presence of gaps in the root-end filling materials in all groups. MTA flow has the best marginal adaptation followed by MTA Harvard while the Glass Ionomer showed the least marginal adaptation.

The aim of this study is to evaluate the bond strength of AH Plus sealer after irrigation of the root canals using of Nano-Silver and Sodium hypochlorite. Sixty, freshly extracted, sound maxillary anterior teeth with completely formed apices and straight roots were used in this study. Each tooth was decoronated to provide approximately 16 mm± 1 of root, root canals with initial apical file size #20 were selected to approximately standardize the canal diameter. The samples were divided into two groups 30 root each according to the irrigation protocol used through instrumentation: Group A: root canal preparation was performed using the Protaper Next system during instrumentation the root canals were irrigated using Nano-Silver irrigant 0.02mol/L = 2000ppm. Group B: root canal preparation was also performed using the Protaper Next system but during instrumentation the root canals were irrigated using Sodium Hypochlorite (NaOCl) irrigant 5.25%. Root canals of each group were then obturated using master cones of #40/06 and AH Plus sealer in lateral condensation technique. 2mm thick slices of apical, middle and coronal root portion for all samples were prepared for assessment of push out bond strength for the two groups.Results showed that AH plus sealer had a lower value of push out bond strength ( 1.223± 0.533) in the group irrigated using nano silver than the second group irrigated with sodium hypochlorite (2.321 ± 0.650) at the coronal third with statistically significant difference( P= 0.004), also at the middle third it showed a lower value (1.732 ± 0.899) than the sodium hypochlorite but with no statistically significant difference, and finally at the apical third it also a lower value of push out bond strength (2.103 ± 1.319) than the other group irrigated with NaOCl (5.045 ± 1.397) with statistically significant difference (0.001)

This study aimed to compare the antimicrobial effect of Nano-Silver Irrigant, Sodium Hypochlorite and Chlorohexidine against Enterococcus Faecalis bifilm. 60 Sixty, recently extracted, sound maxillary anterior teeth with completely formed apices and straight roots were selected in this study. Canals were instrumented using the Protaper Next system (Dentsply Sirona) 1 mm shorter from the apical foramen up to size X5 ( size# 50/06). Sterility of the teeth after complete root canal cleaning and shaping were achieved by autoclaving for 15 min at 121oC with the teeth immersed in distilled water. Enterococcus Faecalis Biofilm was prepared by mixing 5 mL of the bacterial inoculum with sterilized BHI, then inoculated in teeth samples for 60 days. Teeth were then divided after the incubation period into three groups; 20 teeth each, and were treated by delivering the each of the tested irrigating solution using sterile plastic syringes. The first group was treated with Nano-Silver 0.02mol/L (2000ppm) while the second was treated using with Sodium Hypochlorite (NaOCl) 5.25% and the third was treated usinwith Chlorohexidine (CHX) 2.0%. Serial rinses ensured 5 minutes contact period between the aseptic solution and the bacteria. Sterile paper points size 50 were introduced into the canals and maintained for 3 min for sample collection, after which the paper points were placed in test tubes containing 2ml of sterile saline and several dilutions were prepared. 100 µL of each dilution was applied to the blood agar culture plates and incubated at 37oC for 24 hours. A classical bacterial counting technique was used for each group after the treatment application for the recovery of viable E. faecalis on agar plates The results showed that the NaOCl had the highest antibacterial activity with high statistically significant difference with the other groups followed by the chlorhexidine group which also show statistically significant difference than the other two groups, then came the nano silver irrigant group which showed the lowest antibacterial activity among all the groups with statistically significant difference with them.

Les outils cliniques employes dans les etablissements de soins peuvent fournir des informations pronostiques importantes aux professionnels de la sante. Dans cette etude observationnelle prospective d'un an, nous avons examine l'association entre les scores au Short Performance Physical Battery (SPPB), d'une part, et les consultations a l'urgence et les hospitalisations au cours de l'etude, d'autre part. Au total, 191 patients ayant ete nouvellement referes a une clinique geriatrique externe de Hamilton (Ontario) ont ete contactes, et parmi eux, 120 pris part a l'etude. Le SPPB et d'autres evaluations ont ete realises dans le cadre de consultations de routine. Les dossiers medicaux electroniques ont ete examines pour determiner le nombre de consultations a l'urgence et d'hospitalisations dans l'annee qui a suivi l'evaluation de base. Des analyses de regression logistique ont ete utilisees pour identifier des predicteurs des consultations a l'urgence et des hospitalisations. Le score moyen au SPPB dans la cohorte etudiee (moyenne d'âge = 80,6 ans, ecart-type = 6,3 ans ; 53 % de femmes) etait de 6,3 (ecart-type = 3,2). Au cours de cette periode d'un an, le score au SPPB etait associe au nombre de consultations a l'urgence [RR = 0,90 (0,78-1,03)] et d'hospitalisations [RR = 0,84 (0,72-0,97)], apres ajustement pour l'âge, le sexe et les comorbidites. Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78–1.03]) and hospitalization (OR = 0.84 [0.72–0.97]) after adjusting for age, sex, and co-morbidities.

Background Technological advances have allowed a variety of computerized cognitive training tools to be engineered in ways that are fun and entertaining yet challenging at a level that can maintain motivation and engagement. This revolution has created an opportunity for gerontological scientists to evaluate brain gaming approaches to improve cognitive and everyday function. The purpose of this scoping review is to provide a critical overview of the existing literature on nonimmersive, electronic brain gaming interventions in older adults with mild cognitive impairment or dementia. Research Design and Methods Systematic search was conducted using 7 electronic databases from inception through July 2017. A comprehensive 2-level eligibility process was used to identify studies for inclusion based on PRISMA guidelines. Results Seventeen studies met eligibility criteria. Majority of the studies were randomized controlled trials (n = 13) and incorporated an active control (n = 9). Intervention doses ranged from 4 to 24 weeks in duration with an average of 8.4 (±5.1 standard deviation [SD]) weeks. Session durations ranged from 30 to 100 min with an average of 54 (±25 SD) minutes. Nearly half of studies included a follow-up, ranging from 3 months to 5 years (n = 8). For most studies, brain gaming improved at least one cognitive outcome (n = 12); only one study reported improvement in activities of daily living. Discussion and Implications This scoping review conveys the breadth of an emerging research field, which will help guide future research to develop standards and recommendations for brain gaming interventions which are currently lacking.

Background: In mitral valve prolapse is associated with severe mitral regurgitation, mitral valve repairor surgical replacement may be necessary. In Mitral valve replacement, some surgeon use continuoussuture, others use interrupted suture technique.Aim of the work: to compare efficacy of semi-continuous technique & interrupted suture of prosthesticvalve replacement in mitral valve replacement.Patients and Methods: it was a prospective randomized comparative study done at the CardiothoracicSurgery Department, Qena University Hospitals, South Valley University, Egypt between April 2016 toApril 2018. It included 31 patients with rheumatic mitral valve disease whatever the cause. They weredivided into group1: patients underwent semi-continuous technique for MVR (18 cases) and group2:patients underwent interrupted technique (13 cases).All of patients were subjected to preoperative data:complete history, general examination including general condition of the patient and vital signs,investigations including routine laboratory investigations, especially complete blood count, chest X ray(CXR), 12 lead Electrocardiography (ECG), echocardiography and coronary angiography if patientmore than 40 years old, operative data including total bypass time, aortic CCT, number of sutures, andpostoperative outcome including ICU stage and inotrope use, postoperative complications, pulmonaryhypertension and echo findings as immediate postoperative and echo after 1 and 3 monthspostoperative.Results: We found that the mean total bypass time was significantly higher among interrupted group compared to semicontinuous one.Conclusion: Semicontinuous sutures showed significantly better results than interrupted ones,especially regarding the total bypass time

Aim: This study compared the efficacy of gutta percha and sealer removal during retreatment using Protaper universal retreatment rotary files, D-Race rotary files and hand files with Gates Glidden. Methods: Thirty six extracted single rooted teeth were selected for the current study. The canals were prepared using a modified crown-down technique then filled using the lateral compaction technique. Specimens were randomly divided into 3 equal groups each consisted of twelve specimens. Group one used manual files, group 2 used D-Race system while group 3 used Protaper retreatment system. Samples were split longitudinally and examined under the stereomicroscope. Results: No significant differences among the Protaper and the D-RaCe groups in the mean values of root canal filling remnants, whereas the hand files and Gates Glidden group differed significantly. Conclusion: D-Race and Protaper retreatment files removed gutta percha and sealer more efficiently than hand files and Gates Glidden. Keywords: D-race, Protaper, Gutta percha, Steriomicroscope, Hand files

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.

Background There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Patients and methods Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. Results A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. Conclusions Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

BackgroundThe increase rate seen in Total Hip Arthroplasty (THA) for younger patients has implications for future rehabilitation demands for primary and revision THA surgery. This study aims to determine the impact of a 6-week post-operative rehabilitation program designed for THA patients ≤ 60 years on physical activity (PA) and function compared to age- and a sex-matched control group received usual postoperative care at 12-week post-THA. MethodsIn this quasi-experimental study, a cohort of THA candidates was recruited during their 6-week postoperative visit to their surgeons. The out-patient rehabilitation program consisted of 12 structured exercise classes (2 hrs/class) over 6 weeks. Physical activity was assessed using Sense Wear Pro ArmbandTM [SWA]. Participants completed the Hip Osteoarthritis Outcome Score (HOOS), and THA satisfaction questionnaire before and immediately after the intervention. ResultsThe intervention group took significantly more steps/day at the follow-up compared to baseline. The intervention group had a higher mean change in the number of weekly PA bouts than the control group. Within the intervention groups, all HOOS subscales were significantly higher at the follow-up compared to baseline. ConclusionThe augmented rehabilitation program may have immediate effects on pain relief and symptom reduction for patients (≤60 years) following THA.

Financial inclusion is currently a very important event that had drawn many international organizations to talk about and try to spread all over the world. It had shown its importance for individuals and organizations. Financial stability is now so important in the economy of any country in which it refer to the capability of the economy and financial institution to resist internal and external economic shocks to achieve its primary functions. In this research we tried to find the relationship and the effect of the financial inclusion on the financial stability in the SME’s as the SME’s is the drivers for the country growth. The research will be applied on the Egyptian economy and our expectation that there is a positive relationship between the two variables. In this study, the focus was on analyzing the different stakeholders (CBE, FRA, and the Ministry of Finance) in promoting financial inclusion for different targeted beneficiaries mainly SMEs. The study tested the relationship between the Financial Inclusion & the financial stability. The importance of the study comes from the claim that financial inclusion can have over Egypt’s economic growth on different potential beneficiaries. The thesis general framework tried to find the link between FI & FS in Egypt SME’s through an exploratory study to identify the relationship and the recent progress achieved towards increasing the inclusive financial system for Egypt. Data was collected through questionnaire in which a questionnaire was distributed among a different participants that reached almost 200 participants and respondents reached 103 respondents and results were collected and analyzed through SPSS.

We sought to identify the predictors of not achieving remission or low disease activity (LDA) among axial spondyloarthritis (SpA) patients in four Middle Eastern countries.In this multicenter prospective real-world study, adult patients with axial SpA diagnosed clinically during January-June 2019, and who met the Assessment of SpondyloArthritis International Society classification criteria for axial SpA, were enrolled from the participating centers of four countries-Lebanon, Oman, Qatar, and the UAE. Patient demographics, disease history, comorbidities, treatment, and compliance data were obtained at baseline. The primary outcome was to determine the percentage of patients who did not achieve the clinical target of remission or LDA as indicated by Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP)2.1 after a three-month follow-up period. Secondary outcomes were assessing the demographic and clinical characteristics of 'achievers' and 'non-achievers' and to study the predictors of ASDAS-CRP ≥ 2.1 in different clinical subsets.The participants were 309 patients of both sexes, with a median age of 43 years. Women had a slight majority (53.7%). At the end of the study, 72.2% of patients achieved the clinical target of ASDAS-CRP2.1. Non-achievers were significantly more likely to have enthesitis, positive human leukocyte antigen B 27 status, psoriasis, peripheral involvement, fibromyalgia, and a lower score on Compliance Questionnaire for Rheumatology (CQR). Multiple regression analysis showed that low CQR score, enthesitis, psoriasis, and family history of SpA were independent predictors of ASDAS-CRP ≥ 2.1.This real-world study suggests that low compliance, positive human leukocyte antigen B 27 status, peripheral involvement, and presence of enthesitis, psoriasis, and fibromyalgia are predictors of not achieving remission or LDA in axial SpA patients.