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Heba Ahmed Osman,1 Hanaa Nafady-Hego,2 Khalid Ali Nasif,3,4 Heba A Ahmed,5 Ekram Abdel-Rahman Mahmoud,6 Noher Mohamad Abass,7 Amal Rayan,8 Marwa Ahmed Mahmoud,9 Asmaa Nafady10 1Department of Tropical Medicine and Gastroenterology, Qena Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia; 4Department of Biochemistry, Faculty of Medicine, Minia University, Minia, Egypt; 5Department of Clinical and Chemical Pathology Sohag Faculty of Medicine Sohag University, Sohag, Egypt; 6Department of Medical Microbiology & Immunology, Faculty of Medicine, Sohag University, Sohag, Egypt; 7Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt; 8Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt; 9Department of Medical Physiology, Faculty of Medicine, Sohag University, Sohag, Egypt; 10Department of Clinical and Chemical Pathology, Qena Faculty of Medicine, South Valley University, Qena, EgyptCorrespondence: Heba Ahmed Osman, Tropical Medicine and Gastroenterology, Qena Faculty of Medicine, South Valley University, Qena, Egypt, Email drheba.saleh@med.svu.edu.eg; hebaahmed198098@yahoo.comIntroduction: HCC is frequently diagnosed late, when only palliative treatment is available. So, we try to use different immunological markers to identify early HCC in patients with unremarkable raised AFP.Methods: This study was conducted on 112 participants divided into two equal groups: Group I, 56 patients with liver cirrhosis and different stages of HCC; Group II, 56 patients with liver cirrhosis. The diagnosis of HCC was based on AASLD guidelines. TNM and BCLC classification systems are used for staging of HCC.Results: A significant reduction in the median percentage of lymphocyte subset (CD3+, CD4+, CD8+, CD19+) and NK cell percentage (CD56+) has been detected in HCC patients (all P < 0.001). In the HCC group the median monocyte subpopulations CD14+ CD16− Classical, CD14++ CD16+ Intermediate, and CD14−+ CD16++ Non-Classical were 11.7, 4.0, and 3.5, respectively, with marked reduction compared with liver cirrhosis group (all P < 0.001). Patients with advanced stages (BCLC C and D) were more likely to have significantly higher median CD33+ than patients with early stages (BCLC A and B) (P = 0.05); also, the median levels of HLA DR+ lymphocytes % in the HCC case group were 21.8 in patients with advanced disease (BCLC C and D) and 13.1 in patients with early stages of the disease (P = 0.04). Patients with late stage (TNM III) were more likely to have significantly higher median CD14+ CD16− Classical monocyte subset, CD36+ HLA DR+, and CD36+ CD16− than patients with early stages (TNM I and II).Conclusion: Patients with HCC with unremarkable raised AFP showed marked reduction in lymphocytes, natural killer cells, and all monocyte subpopulations. In addition, patients with advanced HCC showed increased CD33+ and HLA DR+ lymphocytes %, CD14+ CD16− Classical monocyte subset, CD36+ HLA DR+, and CD36+ CD16− compared with patients with early stages of HCC.Keywords: monocyte subpopulation, lymphocyte subset, hepatocellular carcinoma, Barcelona clinic liver cancer, tumor (T), nodes (N), metastases (M)

Asmaa M El-Kady,1 Heba A Osman,2 Mohamed Farouk Alemam,3 Dina Marghani,4 Mohammed A Shanawaz,5 Majed H Wakid,6,7 Wafa Abdullah I Al-Megrin,8 Hatem A Elshabrawy,9 Osama H Abdella,1 Khaled S Allemailem,10 Ahmad Almatroudi,10 Mostafa I EL-Amir11 1Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, South Valley University, Qena, Egypt; 3Department of Clinical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt; 4Clinical Laboratory Science Department, Faculty of Applied Medical Science, Taibah University, Medina, Kingdom of Saudi Arabia; 5Department of Public Health, Applied Medical Sciences College, Albaha University, Albaha, Saudi Arabia; 6Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia, Jeddah, 21589, Saudi Arabia; 7Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 9Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX, 77304, USA; 10Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia; 11Department of Medical Microbiology and Immunology, Faculty of Medicine, South Valley University, Qena, EgyptCorrespondence: Asmaa M El-Kady; Hatem A Elshabrawy, Email asmaa.elkady@med.svu.edu.eg; hatem.elshabrawy@shsu.eduIntroduction: In recent decades, the rate of infection with dengue virus (DENV) has risen significantly, now affecting nearly 400 million individuals annually. Dengue fever among humans is caused via specific mosquito vectors bites. Sporadic cases have been reported in Egypt. The goal of this study was to identify the serotype of the DENV outbreak in both human and mosquito vector along the coast of the Red Sea, Upper Egypt, in 2017. Identification of the serotype of the virus may help identify its source and assist in applying epidemiological and control measures.Materials and Methods: The current study was carried out in El Quseir City, Red Sea Governorate, Upper Egypt, on 144 patients complaining of symptoms indicative of dengue fever at the time of the 2017 Egypt outbreak. Human blood samples and the mosquito reservoirs were identified as having dengue virus infection serologically and molecularly.Results: Overall, 97 (67.4%) patients were positive for dengue virus IgM antibodies. Molecular examination of the human samples and pools of mosquitoes revealed that DENV-2 virus was the serotype responsible for the outbreak. Only one pool of female mosquitoes containing Aedes aegypti was infected with dengue fever virus (DENV-2).Conclusion: This was the first serotyping of the DENV responsible for dengue virus outbreak in Egypt in 2017. Determining the serotype of dengue virus can help to avoid and monitor outbreaks. The serotype identified in this study was DENV-2, while DENV-1 was the serotype found in the previous outbreak in 2015 in the province of Assiut. This study thus raises concerns that a new dengue serotype could have been introduced into Egypt. It is necessary for a comprehensive risk assessment to be carried out in the country, including an entomological survey, to assess the presence and potential geographical expansion of mosquito vectors there.Keywords: dengue fever, Upper Egypt, serotyping, human, mosquito, multiplex PCR

Ali A Ghweil,1 Mohammed H Hassan,2 Ashraf Khodeary,3 Ahmed Okasha Mohamed,4 Haggagy Mansour Mohammed,5 Ahmed Alyan Abdelazez,1 Heba Ahmed Osman,1 Shamardan Ezzeldin S Bazeed1 1Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 3Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag 82519, Egypt; 4Department of Radiology, Faculty of Medicine, South Valley University, Qena 83523, Egypt; 5Department of Chest Diseases, Faculty of Medicine, South Valley University, Qena 83523, EgyptCorrespondence: Mohammed H HassanMedical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, EgyptTel +201098473605Email Mohammedhosnyhassaan@yahoo.comBackground: The risk factors, disease characteristics, severity, and mortality of COVID-19 are unclear, particularly in Egypt.Objective: The objective was to analyze the patients’ characteristics, hematological, biochemical, and chest imaging findings among the cohort of patients with COVID-19 in Egypt and also to shed light on the predictors of COVID-19 severity.Patients and Methods: A retrospective study was conducted on 66 patients with COVID-19 in Egypt. Medical history, imaging data (CT chest findings), and measured hematological and biochemical parameters at diagnosis were recorded in the form of complete blood counts and differential counts; CRP, ESR, serum ferritin, creatinine, and liver function tests . Results of real-time reverse transcription-polymerase chain reaction (rRT-PCR) for detection of SARS-CoV-2 RNA at diagnosis and during follow up of these patients were also recorded.Results: The study included 36 patients with mild to moderate COVID-19 and 30 patients with severe/critical infection. There was a significant older age among severe (62.6 years old ± 10.1SD) than mild to moderate infection (55.5 ± 10.1) (p˂0.05). Fever, dry cough, dyspnea, and sore throat malaise were highly frequent among COVID-19 patients, while headache and diarrhea were the least frequently occurring manifestations. All included cases (30 patients, 100%) with severe COVID-19 showed crazy-paving appearance (in the form of reticular and/or interlobular septal thickening) with or without GGO. There were significantly lower mean values of WBCs, lymphocytic count, total protein, and albumin among the severely infected than those who had mild to moderate COVID-19 infection, p˂0.05 for all. Additionally, there were significantly higher mean values of CRP, ESR, ferritin, ALT, and AST among patients with severe/critical COVID-19 when compared with those having mild to moderate COVID-19, p˂0.05 for all.Conclusion: Among the studied demographic, clinical, hematological, biochemical, and imaging data, dyspnea, diabetes mellitus, lymphopenia, raised CRP, ESR, ferritin, ALT, AST, low albumin, and presence of CT chest findings could be considered as predictors for COVID-19 severity using binary logistic regression analysis.Keywords: COVID-19, Egypt, clinical data, hematological parameters, SARS-CoV-2 RNA, biochemical markers, severity

Ali A Ghweil,1 Heba A Osman,1 Mohammed H Hassan,2 Abeer MM Sabry,3 Reem E Mahdy,4 Ahmed RH Ahmed,5 Ahmed Okasha,6 Ashraf Khodeary,7 Hesham H Ameen8 1Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt; 3Internal Medicine and Gastroenterology Department, Faculty of Medicine, Helwan University, Helwan, Egypt; 4Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 5Pathology Department, Faculty of Medicine, Sohag University, Sohag, Egypt; 6Radiology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 7Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag, Egypt; 8Clinical Pathology Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, EgyptCorrespondence: Mohammed H HassanDepartment of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena 83523, EgyptTel +20 109 847 3605Email mohammedhosnyhassaan@med.svu.edu.egBackground and aim: Gastric carcinomais a frequent neoplasm with poor outcome, and its early detection would improve prognosis. This study was designed to evaluate the possible use of new biomarkers, namely SAA and HMGB1, for early diagnosis of gastric cancer.Methods: A total of 100 patients presenting with gastric symptoms were included. All patients underwent upper endoscopic evaluation, histopathological diagnosis and serum CEA, SAA, and HMGB1 measurements.Results: Patients were classed endoscopically with neoplastic, inflammatory, and normal-appearing gastric mucosa: 50, 25, and 25 patients, respectively. Histologically, half the patients had chronic gastritis and the remaining cases gastric carcinoma of diffuse (n=28) or intestinal (n=22) type. SAA at cutoff of 18.5 mg/L had the best validity to differentiate gastritis from gastric carcinoma, with AUC, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 0.99, 98%, 100%, 100%, and 98%, respectively, followed by HMGB1 at cutoff of 14.5 pg/μL, with AUC, sensitivity, specificity, PPV, and NPV of 0.91, 70%, 96%, 94.6%, and 76.2%, respectively. Sensitivity, specificity, PPV, and NPV of serum CEA at cutoff of 2.9 ng/mL to differentiate gastritis from gastric carcinoma were 42%, 72%, 60%, and 55.4%, respectively, with AUC of 0.53. Nonetheless, higher serum levels of both SAA and HMGB1 reflected higher tumor grade (P=0.027 and P=0.016, respectively) and advanced tumor stage (P-OBrk-0.001 for both).Conclusion: Serum levels of both SAA and HMGB1 could be of great value for early diagnosis of gastric carcinoma, comparable to the diagnostic role of serum CEA, which is not valid for early diagnosis of gastric cancer.Keywords: gastric carcinoma, early detection, SAA, HMGB1, CEA

Heba Ahmed Osman,1 Ali A Ghweil,1 Abeer MM Sabry,2 Reem E Mahdy,3 Ashraf Khodeary4 1Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 2Internal Medicine and Gastroenterology Department, Faculty of Medicine, Helwan University, Helwan, Egypt; 3Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag, EgyptCorrespondence: Heba Ahmed OsmanLecturer of Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Qena 83523, EgyptTel +20 96 10 656 4745Email drheba.saleh@med.svu.edu.egBackground and aim: Hepatitis C virus (HCV)–HBV coinfection is a significant health problem with rapid progression of liver disease without precise diagnosis and treatment. We aimed in this study to identify if there were any role of HBV antiviral therapy in patients with HBV reactivation after direct-acting antiviral therapy in HCV–HBV coinfected patients.Methods: A prospective random study was carried out on 140 patients presenting with chronic HCV and chronic HBV coinfection. All patients had pretreatment HBeAg seroconversion, HBV DNA

Mohamed A Mekky,1 Hani I Sayed,2 Mohamed O Abdelmalek,1 Medhat A Saleh,3 Osman A Osman,1 Heba A Osman,4 Khairy H Morsy,5 Helal F Hetta6,7 1Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt; 2Center for Management of Viral Hepatitis, Ministry of Health, Assiut, Egypt; 3Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt; 4Department of Tropical Medicine and Gastroenterology, South Valley University Hospital, Qena, Egypt; 5Department of Tropical Medicine and Gastroenterology, Sohag University Hospital, Sohag, Egypt; 6Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 7Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA Background: Occult hepatitis C virus (HCV) infection (OCI) is characterized by the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA or antibodies in the serum. In this study, we tried to evaluate the prevalence and possible predictors of OCI in patients who achieved sustained virologic response (SVR) post sofosbuvir/daclatasvir (SOF/DCV) therapy.Patients and methods: A cross-sectional multicenter study was designed to enroll 1,280 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks post treatment. They were randomly recruited from three dedicated Egyptian centers for management of HCV. Real-time PCR was performed to detect HCV-RNA in serum and PBMCs and to evaluate the different risk factors pertaining to the existence of OCI.Results: HCV-RNA was detected in PBMCs of 50 (3.9%) of them. All OCI cases exhibited significant fibrosis score and raised pre-treatment alanine aminotransferase (ALT) levels. Logistic regression analysis comparing OCI with non-OCI revealed that high pre-treatment viral load, raised ALT, advanced fibrosis score, prolonged prothrombin time, low albumin, Child B score, antiviral experienced patients, and raised bilirubin are the most significant predictor for the possibility of OCI presence with Odds Ratio as 7.03, 5.13, 4.4, 2.68, 2.52, 1.9, 1.5, and 1.2, respectively.Conclusion: In spite of its remote possibility, OCI post SOF/DCV therapy may be present in some cases, and this may entail a re-auditing for the definition of SVR by dual testing in both serum and PBMCs. Keywords: Occult, hepatitis C, Direct acting, Sofosbuvir

Amro M Hassan,1 Heba A Osman,2 Hasan S Mahmoud,2 Mohammed H Hassan,3 Abdel-Kader A Hashim,4 Hesham H Ameen5 1Tropical Medicine Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 2Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 3Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt; 4Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt; 5Clinical Pathology Department, Faculty of Medicine Al-Azhar University (Assiut Branch), Assiut, Egypt Background and aims: Hepatitis C virus (HCV) infection is associated with extrahepatic manifestations such as cryoglobulinemia and accounts for up to 90% of all cases of mixed cryoglobulinemia (MC). The present study aimed to evaluate the effect of sofosbuvir–­daclatasvir therapy on symptomatic HCV-related MC and sustained virologic response (SVR) achievement. Patients and methods: This prospective cohort study was carried out on 120 patients with chronic HCV infection, clinically suspected to have MC, but only 63 of whom were positive for cryoglobulins. HCV-MC patients were treated with sofosbuvir 400 mg and daclatasvir 60 mg once daily for 3 months. The serum cryoglobulins levels, complement 3 (C3), complement 4 (C4) (using ELISA assay kits) and rheumatoid factor (RF) (using immunoturbidimetric assay kit), were measured in the included HCV infected patients (to confirm HCV-MC diagnosis), in addition to quantitave HCV-RNA assays, using real time PCR. All these measurements have been done before stating therapy and 12, 24 weeks post-therapy for assessments of immunological recovery, viral load and SVR. Results: Significant increase in the serum cryoglobulin levels and RF with significant decrease in C3 and C4 serum levels were detected in only 63 out of 120 included HCV infected patients, upon whom the study has been completed. They showed significant decrease in their mean cryoglobulin levels from 41.47 µg/mL ±12.32 SD to 5.12 µg/mL ±3.59 SD then to 5.09 µg/mL ±3.02 SD, 12 to 24 weeks post-therapy respectively (p

Hassan AM, Osman HA, Mahmoud HS, et al. Infect Drug Resist. 2018;11:895–901.On page 896, “Investigatory workup” section, first bullet point, second sentence should read from “Four milliliters of blood was taken in a plain glass tube, and after clotting, the tube was centrifuged at 3,000 rpm for 5 min. Then, the serum was separated for use in estimating liver function (including liver enzymes, albumin, bilirubin-total and direct, prothrombin time, prothrombin concentration, and INR), serum creatinine, protein:creatinine ratio, and RF . . . ” to “Two milliliters of blood was taken in citrated tubes and after centrifugation, the separated citrated plasma has been used for estimation of prothrombin time, prothrombin concentration, and INR, while the remaining two milliliters of blood was taken in a plain glass tube, and after clotting, the tube was centrifuged at 3,000 rpm for 5 min. Then, the serum was separated for use in estimating liver function (including liver enzymes, albumin, bilirubin-total and direct), serum creatinine, RF and in addition to urinary protein:creatinine ratio, all were measured . . . ” Following a review of our paper post-publication, we found the incorrect information for these sentences. This correction of sentences has no impact to the findings of the study. The authors apologize for this error.Read the original article

Abstract Purpose Juvenile systemic lupus erythematosus (J-SLE) is a complex, heterogeneous disease affecting multiple organs. However, the classification of its subgroups is still debated. Therefore, we investigated the aggregated clinical features in patients with J-SLE using cluster analysis. Methods: Patients (≤ 16 years) diagnosed using the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were identified from the clinical database of the Egyptian College of Rheumatology (ECR) SLE study group. Demographic data, clinical characteristics, laboratory features, and current therapies were selected. A cluster analysis was performed to identify different clinical phenotypes. Results: Overall, 404 patients, of whom 355 (87.9%) were female, had a mean age at diagnosis of 11.2 years and a mean disease duration of 2.3 years. We identified four distinct subsets of patients. Patients in cluster 1 (n = 103, 25.5%) were characterized predominantly by mucocutaneous and neurologic manifestations. Patients in cluster 2 (n = 101, 25%) were more likely to have arthritis and pulmonary manifestations. Cluster 3 (n = 71, 17.6%) had the lowest prevalence of arthritis and lupus nephritis (LN), indicative of mild disease intensity. Patients in cluster 4 (n = 129, 31.9%) have the highest frequency of arthritis, vasculitis, and LN. Cluster 1 and 4 patients had the highest disease activity index score and were less likely to use low-dose aspirin (LDA). The SLE damage index was comparable across clusters. Conclusions: Four identified J-SLE clusters express distinct clinical phenotypes. Attention should be paid to including LDA in the therapeutic regimen for J-SLE. Further work is needed to replicate and clarify the phenotype patterns in J-SLE.

The presence of the stomach in the thorax is called gastrothorax. If excessive dilatation occurs due to a valve mechanism in the stomach which then is herniated into the thorax, it is called tension gastrothorax and the situation can be life-threatening. In late presentation, congenital diaphragmatic hernias or traumatic diaphragmatic hernias, if the stomach located in the thorax is severely distended, it can be confused with tension pneumothorax or pleural effusion/empyema. We presented tension gastrothorax in two patients with distended stomach in the thorax, in which tension pneumothorax and pleural effusion/empyema-like images were created, based on plain X-rays taken at the first admission in the emergency department, which may cause diagnostic confusion. The tension gastrothorax can cause mediastinal shift, which can lead to respiratory distress and eventually cardiac arrest secondary to obstructive shock. In case of mediastinal shift, it should reduce the tension of the stomach located in the thorax by inserting a nasogastric catheter, and if this fails, by aspiration with a needle.

The integration of artificial intelligence (AI) in sports medicine is opening new frontiers for athlete health and performance, aligning with the spirit of the Paris 2024 Olympic Games slogan, “Games Wide Open.”

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes’ health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete’s performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement’s purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE’s effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete’s needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete’s health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

The fruit of Saba senegalensis is respectively known among local folks in Ghana, Senegal, and Burkina Faso as εsononantin, maad and weda. The plant has been used traditionally, ethnobotanically, and medicinally in most West African countries. The phytochemicals that have been discovered in various extracts of S. senegalensis parts include alkaloids, coumarins, anthracene glycosides, anthocyanosides, anthocyanins, coumarins, flavonoids, saponins, saponin glycosides, sterols, condensed tannins, tannins, triterpenes, and triterpenoids. Presently, isolation and characterisation of phytochemicals from various parts of S. senegalensis has not been fully explored since scientists have isolated only two steroidal alkaloids from the stem of the plant namely Irehine and Homoandrost-9-ene-17β,17aβ-diol-3β-(methylamino)-17aα-methyl-12-one. The phytochemicals have shown biological properties such as anti-oxidant, anti-inflammatory, anthelmintic, anti-microbial, analgesic, larvicidal, ovicidal, myostimulant, hypotensive, anti-diabetic, anti-lipid peroxidation and anti-mycobacterial effects. Additionally, isolation and characterisation of medicinally beneficial phytochemicals from various parts of the plant, namely latex, leaf, stem, flower, root, fruit, and bark should be comprehensively investigated. Thus, this current review summarises the traditional uses, phytochemicals, and biological properties of various parts of the plant.

INTRODUCTION: We aimed to assess clinical (type, grade, symptom, quality of life), demographical, and psychological (social support, anxiety, and depression) risk factors of suicidality among newly diagnosed cancer patients in Turkey. METHODS: 122 cancer patients within their first month of diagnosis were enrolled in the study. Sociodemographic Form, Suicide Probability Scale (SPS), Multidimensional Scale of Perceived Social Support (MSPSS), European Organization for Research and Treatment (EORTC) quality of life questionnaire (QLQ-C30), Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS) were given to the patients. RESULTS: There were no relationships between SPS scores and age, gender, having metastatic cancer, being religious, marital status, having health insurance or employment. The EORTC QLQ-C30 cognitive function (p= 0.003, r= -0.267) and emotional function (p= 0.006, r= -0.249) and social function (p= 0.019, r= -0.212) were found to be negatively and weakly correlated with SPS. Among ESAS variables, only severe insomnia was significantly correlated with high SPS scores (p= 0.012). There were no statistical significance between SPS scores and having anxiety (p=0.110) or depression (p=0.591). There was no statistically significant relationship between SPS and MSPSS scores. DISCUSSION AND CONCLUSION: There have been no study published in the literature that assesses the correlation between suicide risk and a variety of clinical and sociodemographic characteristics among Turkish cancer patients who have just received a diagnosis. According to our results, special attention must be given to cancer patients with severe insomnia and poorer cognitive, emotional, and social functioning.

Objective: To determine whether dynamic renal scans – DTPA or MAG3 – routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. Patients and methods: In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative “triple test”. The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. Results: The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Conclusions: Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

Using an easy mechanical agitation process at room temperature, a metal–organic framework (MOF) based on metallic Zn(ii), organic linker benzene-1,3,5-tricarboxylic acid (Zn-BTC), Fe3O4 nanoparticles, and nanocellulose are combined to create a novel composite material called Fe3O4/NC/MOF. Various tools were used to characterize the created composite. Congo red, Basic Blue 54 (BB 54), Basic Violet 14 (BV 14), and Acid red 88 (AR 88) dyes were effectively eliminated from water using Fe3O4/NC/MOF. A number of variables were investigated, including pH, temperature, contact time, initial dye concentration, and adsorbent dosage. To understand the specific adsorption process, a number of kinetic models were used, including the intra-particle diffusion model, Elovich’s kinetic model, pseudo-first-order, and pseudo-second-order kinetic models. The most accurate description of dye sorption kinetics comes from the pseudo-second-order kinetic model. Also, the Langmuir model is more accurate to describe isotherms than Freundlich and Temkin models. Furthermore, thermodynamic parameters were obtained and examined, including enthalpy (ΔH), Gibbs free energy (ΔG), and entropy (ΔS). After four cycles, the Fe3O4/NC/MOF demonstrated good recyclability. According to experimental research, this adsorbent is promising to enhance the quality of environmental water that has been tainted with organic dyes.

The dominance of dual-setting directional overcurrent relays (DS-DOCRs) based protection schemes and associated high-reliability requirements require rigorous verification of these schemes before deployment. Traditionally, numerical and simulation-based methods are used to analyze the performance of these schemes. However, they are incomplete and, thus, cannot provide complete and accurate analysis results due to their inherent limitations, like round-off errors and sampling-based deductions. Analyzing the impact of each replacement level (replacement of conventional DOCRs by DS-DOCRs) on the protection performance/efficacy of individual network lines is challenging as each deployment level leads to different primary and backup relay protection pairs, which may lead to miscoordination. Also, the random and uncertain nature of faults leads to numerous possible scenarios, which need to be rigorously considered during the analysis. As a more complete and accurate analysis approach, we propose to utilize probabilistic model checking, which is a formal verification technique, for the performance verification of DS-DOCRs-based protection schemes. A formal analysis methodology to determine the optimal deployment of DS-DOCRs. The proposed analysis requires formal models of the behavior of fault, C-DOCRs, and DS-DOCRs-based protection systems, and these models are developed as part of our work. Moreover, we also formalize the quantitative properties to determine the impact of various relay deployment scenarios on the performance of the protection system. For illustration purposes, we use formal models for the quantitative verification of a state-of-the-art DS-DOCRs-based protection scheme for power distribution networks using the probabilistic model checker. This helps us identify the most optimal protection solution for different scenarios.

The base connection is flexible, not fully pinned/fixed, implying a nonlinear moment–rotation relationship. This deviates from a linear response, where rotation is not directly proportional to the applied moment. Numerical investigations using the commercial software ABAQUS were conducted to analyze the steel base plate connections. The finite element (FE) models were verified against previous experimental results. Moreover, numerical findings of a comprehensive parametric investigation were conducted. The studied connections were examined with different configurations, including variations in the diameter, spacing, and number of the anchor bolts; the thickness of the base plate; and the applied axial force. The current study aims to use numerical results combined with the whale optimization algorithm (WOA) and classical genetic algorithm (GA) to derive a formulation for the moment–rotation (M-θr) relationship. The distinctive aspect of this formulation is that it aims to simulate the nonlinear rotational behavior exhibited by flexible base connections under combined moment and tension loads, while also considering various parameters such as bolt number/diameter and plate thickness. The findings indicate that the WOA is capable of obtaining an optimal equation for accurately simulating the M-Ɵr relationship. This underscores the ability of the WOA to effectively address the complexity of the problem and provide a reliable equation for predicting the rotational behavior of such connections. Consequently, the WOA method can be utilized to calculate the rotational stiffness at H/150, offering valuable support for engineering design processes.

Amaç: Beyazlatıcı içerikli deneysel diş macununun, minedeki renk değişimine ve yüzey pürüzlülüğüne olan etkisini değerlendirmektir. Gereç ve Yöntemler: Çalışmada 30-adet sağlam, çürüksüz, boyutları birbirine yakın daimi dişler kullanıldı. Dişler rastgele olarak 6 deneysel gruba ayrıldı (n=5); Grup 1: Beyazlatıcı ajan içeren deneysel diş macunu (Zubio Test-1, Dar Kozmetik, İstanbul, Türkiye); Grup 2: Beyazlatıcı ajan içeren deneysel diş macunu (Zubio Test-2); Grup 3: Beyazlatıcı ajan içeren diş macunu (İpana 3D White luxe, İpana P&G, ABD); Grup 4: Bitkisel içerikli bir diş macunu (Gumgumix, Beka ilaç, İstanbul, Türkiye); Grup 5: Kahvede bekletilen; Grup 6: Suda bekletilen. Tüm örneklerden 3 farklı zaman aralığında (T1-T2-T3) renk ve yüzey pürüzlülüğü ölçümleri yapıldı. T1: Tüm örnekler 24-saat kahvede bekletildikten ve renklenmeleri sağlandıktan sonra; T2: Her gün 15 dakika (3 kez-5’er dakika) kahvede bekleme ve 10 saniye (2 kez-10’ar saniye) fırçalama işlemi yaptıktan 7 gün sonra; T3: Her gün 15 dakika (3 kez-5’er dakika) kahvede bekleme ve 10 saniye (2 kez-10’ar saniye) fırçalama işlemi yaptıktan 14 gün sonrayı göstermektedir. Veriler Kruskal-Wallis ve Friedman istatistik testleri ile değerlendirildi (P=0.05). Bulgular: Tüm test gruplarında renk değişimi görüldü ancak test gruplarının aralarında farklılıklar oluşmadı (P>0.05). Grup 2, sayısal olarak olumlu yönde en büyük değişimi oluştururken, diğer gruplarla arasında istatistiksel bir farklılık ortaya çıkarmadı. Zubio Test-2 diş macununun beyazlatıcı etkisi İpana 3D White luxe ve Gumgumix diş macunları ile benzer bulundu. 14 günlük araştırmanın sonucunda Zubio Test-2, Test-1’e göre daha yüksek yüzey pürüzlülük değerleri sergiledi. Sonuç: Zubio Test-2’nin, kahvenin neden olacağı renklenmeye karşı geleneksel beyazlatıcı diş macununa benzer koruyucu etki göstererek, renklenmeyi önleyici yönde etkili olabileceği söylenebilir.

Currently, Model-Driven Engineering (MDE) plays a key role in the software development process as it aims to handle their increasing complexity and focuses on the automatic generation of code and/or specifications from system models. This paper presents a very useful tool for the automatic generation of Maude specifications from both Petri net PNML (Petri Net Markup Language) descriptions or incidence matrices. At the end of this paper, a simple but complete Petri net example will be presented to demonstrate the usefulness of the developed tool.

Objective: The aim of this study was to examine the relationship between risky alcohol use, burnout, and suicide in physicians. Methods: An online questionnaire (SurveyMonkey®) including the Sociodemographic Data Form, Maslach Burnout Inventory, Addiction Profile Index Risk Screening (APIRS), and Suicide Probability Scale (SPS) was created. Results: Two hundred eighty-five physicians took the survey. It was determined that 49 of the physicians (17.2%) were high-risk alcohol users. SPS scores of residents (p=0.014), physicians without children (p=0.019), physicians with a history of suicide attempt (p=0.034) and psychiatric treatment (p=0.001) were found to be significantly higher. Suicide probability scores were weakly correlated with APIRSalcohol scores (rho: 0.138, p=0.02) and highly correlated with burnout scores (r=0.718, p=0.001). Conclusion: Structural and organizational measures should be taken to decrease burnout in physicians, and preventive public health services should be increased to reduce alcohol use in physicians.

This study concentrated to investigate the influences of white-Portland cement (W-PC) containing silica fume (SF: micro-silica (µSi) and nano-silica (nSi)) as replacement (2–4 wt%) on mechanical (strength and durability), physical and microstructural behaviors of self-compacting mortars (SCMs) fabricated at 0.48–0.63 w/b ratios. In keeping with these purposes, besides of carrying out the workability (mini-slump flow: M−SF and V-funnel: V-F) experiments of SCMs, the mechanical and microstructural tests implemented were: unconfined compressive strength (UCS), flexural strength (FS), freeze–thaw (F-T) and scanning electron microscope (SEM) analysis. The outcomes displayed that, in comparison with the control, replacing W-PC by SF (particularly nSi) enhanced the UCS and FS, resisted against F-T durability by lowering the strength losses in UCS and FS. The ameliorated microstructure resulting in a reduction in the number and/or a narrowing in the size of micro-cracks and pores contributed to generate a more compact and consolidated SCM structure for the improving of strength and durability due of pore-filling effect and superior pozzolanic characteristics of µSi and especially nSi, this in turn reduced the permeability of SCM, which has a significant effect on the strength and durability behaviors of the SCM.

IntroductionAs useful tools for clinical decision-making, diagnostic tests require careful interpretation in order to prevent underdiagnosis, overdiagnosis or misdiagnosis. The aim of this study was to explore primary care practitioners’ understanding and interpretation of the probability of disease before and after test results for six common clinical scenarios.MethodsThis cross-sectional study was conducted with 414 family physicians who were working at primary care in Istanbul via face-to-face interviews held between November 2021 and March 2022. The participants were asked to estimate the probability of diagnosis in six clinical scenarios provided to them. Clinical scenarios were about three cancer screening cases (breast, cervical and colorectal), and three infectious disease cases (pneumonia, urinary tract infection, and COVID-19). For each scenario participants estimated the probability of the diagnosis before application of a diagnostic test, after a positive test result, and after a negative test result. Their estimates were compared with the true answers derived from relevant guidelines.ResultsFor all scenarios, physicians’ estimates were significantly higher than the scientific evidence range. The minimum overestimation was positive test result for COVID-19 and maximum was pre-test case for cervical cancer. In the hypothetical control question for prevalence and test accuracy, physicians estimated disease probability as 95.0% for a positive test result and 5.0% for a negative test result while the correct answers were 2.0 and 0%, respectively (p

Objective: To determine the frequency of cigarette use and the sociodemographic and psychological factors that may be related to alcohol and substance use and in all public high schools in Karabağlar district of İzmir province of Turkey. Method: Sociodemographic variables, the self-confidence scale (SCS) and Multidimensional Scale of Perceived Social Support (MSPSS) were applied to 1,697 high school students online and their results were analyzed. Results: Of the students, 159 (9.4%) were using cigarettes. The mean score of SCS was found to be 3.85+-0.63. The mean score of MSPSS was found to be 64.51+-16.71. The total MSPSS score of the students who smoke (61.51+-17.30) was found to be significantly lower than non-smokers (64.82+-16.62). Absenteeism rate and disciplinary punishment were found to be higher in smoking students. There was no significant relationship between students' SCS scores and smoking. The MSPSS scores of students who had friends who use alcohol or substances were lower than those who did not. Conclusion: We have found that presence of any type of whether alcohol, substance or cigarette user in family incresed the risk of cigarrette use in students. MSPSS scores of cigarette users and who had alcohol or substance user friend was found lower in our study. These findings shows us strong relationship with addictive behaviours and social support. It is important to know factors associated with alcohol-substance use disorder and related factors in order to prevent this psychosocial problem.

We report the case of a patient with lymphedema who experienced an osteoporotic vertebral fracture following lumbar sympathetic ganglion block (LSGB). A 66-year-old woman with intractable lymphedema of the right leg went through surgery for cervix cancer. Because she was resistant to conventional treatments, we planned to commence LSGB treatment. Thus, she received two sessions of LSGB administered with a steroid and local anesthetic mixture. After the second session, the patient underwent severe lumbar pain. After thorough anamnesis and physical examination, we decided to use magnetic resonance imaging to rule out the possibility of metastasis. Contrast-enhanced magnetic resonance imaging, which was assessed by an expert spine radiologist, revealed an osteoporotic fracture of the L4 vertebra. The patient’s severe pain considerably diminished in the third month after beginning antiosteoporotic and analgesic medications, orthosis, and exercises. We speculate that the use of steroids in LSGB may lead to osteoporotic vertebral fracture.

Abstract Background Eye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD. Methods Patients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors. Results A total of 1094 BD patients [71.5% were men, mean ± SD age 36.1 ± 10 years] were included. 549 (50.2%) individuals had VTBD. Extreme Gradient Boosting was the best-performing ML model (AUROC 0.85, 95% CI 0.81, 0.90) compared with logistic regression (AUROC 0.64, 95%CI 0.58, 0.71). Higher disease activity, thrombocytosis, ever smoking, and daily steroid dose were the top factors associated with VTBD. Conclusions Using information obtained in the clinical settings, the Extreme Gradient Boosting identified patients at higher risk of VTBD better than the conventional statistical method. Further longitudinal studies to evaluate the clinical utility of the proposed prediction model are needed.

Sign language recognition (SLR) enables the deaf and speech-impaired community to integrate and communicate effectively with the rest of society. Word level or isolated SLR is a fundamental yet complex task with the main objective of using models to correctly recognize signed words. Sign language consists of very fast and complex hand, body, face movements, and mouthing cues that make the task very challenging. Several input modalities; RGB, optical Flow, RGB-D, and pose/skeleton have been proposed for SLR. However, the complexity of these modalities and the state-of-the-art (SOTA) methodologies tend to be exceedingly sophisticated and over-parametrized. In this paper, our focus is to use the hands and body poses as an input modality. One major problem in pose-based SLR is extracting the most valuable and distinctive features for all skeleton joints. In this regard, we propose an accurate, efficient, and lightweight pose-based pipeline leveraging a graph convolution network (GCN) along with residual connections and a bottleneck structure. The proposed architecture not only facilitates efficient learning during model training providing significantly improved accuracy scores but also alleviates computational complexity. With the proposed architecture in place, we are able to achieve improved accuracies on three different subsets of the WLASL dataset and the LSA-64 dataset. Our proposed model outperforms previous SOTA pose-based methods by providing a relative improvement of 8.91%, 27.62%, and 26.97% for WLASL-100, WLASL-300, and WLASL-1000 subsets. Moreover, our proposed model also outperforms previous SOTA appearance-based methods by providing a relative improvement of 2.65% and 5.15% for WLASL-300 and WLASL-1000 subsets. For the LSA-64 dataset, our model is able to achieve 100% test recognition accuracy. We are able to achieve this improved performance with far less computational cost as compared to existing appearance-based methods.

Abstract Two-dimensional (2D) image processing systems are concerned with the processing of the images represented as 2D arrays and are widely used in medicine, transportation and many other autonomous systems. The dynamics of these systems are generally modeled using 2D difference equations, which are mathematically analyzed using the 2D z-transform. It mainly involves a transformation of the difference equations-based models of these systems to their corresponding algebraic equations, mapping the 2D arrays (2D discrete-time signals) over the ( $$z_1$$ z 1 , $$z_2$$ z 2 )-domain. Finally, these ( $$z_1$$ z 1 , $$z_2$$ z 2 )-domain representations are used to analyze various properties of these systems, such as transfer function and stability. Conventional techniques, such as paper-and-pencil proof methods, and computer-based simulation techniques for analyzing these filters cannot assert the accuracy of the analysis due to their inherent limitations like human error proneness, limited computational resources and approximations of the mathematical expressions and results. In this paper, as a complimentary technique, we propose to use formal methods, higher-order logic (HOL) theorem proving, for formally analyzing the image processing filters. These methods can overcome the limitations of the conventional techniques and thus ascertain the accuracy of the analysis. In particular, we formalize the 2D z-transform based on the multivariate theories of calculus using the HOL Light theorem prover. Moreover, we formally analyze a generic ( $$L_1,L_2$$ L 1 , L 2 )-order 2D infinite impulse response image processing filter. We illustrate the practical effectiveness of our proposed approach by formally analyzing a second-order image processing filter.

This study presents an experiment for investigating the residual strength and toughness of reinforced concrete, RC, and slab reinforced by a geogrid as shrinkage reinforcement along with lower tensile steel reinforcement. Three different parameters were considered, slab thickness, number of geogrid layers, and thickness of the upper concrete cover. Fifteen slab samples with sizes of 50 × 50 cm exposed to the impact load on its center before being re-load by the static load and six slab samples exposed to the static load only. The load and deflection relation were recorded through the static loading process for all specimens, where loading capacity, toughness, and toughness index were measured. The results show an enhancement in the slabs residual strength as the slab thickness and concrete cover increased. On the other hand, the residual strength of slabs has a remarkable decrease with the increase in geogrid layers. Moreover, the toughness has a positive relationship with the concrete cover and has an inverse relation with the slab thickness and the number of layers. A geogrid reduced the number and distribution of cracks and mitigated their severity, especially for double layers with the same concrete cover.

Aim: The aim of this study is to test the validity and reliability of the individual workload perception scale adapted to Turkish so that nursing home and elderly care rehabilitation centers can use it as a measurement tool to evaluate the workload perception levels of health workers. Method: This methodological study is carried out with the participation of 777 healthcare professionals employed in 47 Nursing Homes and Elderly Care and Rehabilitation Centers located in 10 districts of Istanbul determined by judgmental sampling method over the period January 1, 2020 - March 31, 2020. Study data were collected using the Turkish version of “Personal Information Form” and “Individual Workload Perception Scale” adapted into the Turkish language in determining the reliability of the scale, confirmatory factor analysis is performed to test the validity of Cronbach’s alpha coefficient. Results: Cronbach’s alpha reliability coefficient of the Individual Workload Perception Scale is calculated as 0.894. As a result of confirmatory factor analysis, the factor structure consisting of 31 items and 5 factors is confirmed and the fit criterion is determined to be within an acceptable level of 0.069. Conclusion: In this study, it is concluded that the scale is a valid and reliable measurement tool that can be utilized in investigating the individual workload perceptions of healthcare professionals employed in nursing homes and rehabilitation centers.

Hydatid cyst is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Hydatid cyst of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We present an 8-yr-old girl with complaints of swelling of lower abdomen, pollakiuria and bilateral flank pain was brought to Emergency Department of Harran University, Turkey, in Jun 2019. The patient had simultaneous hydatid cysts of the liver, mesentery and uterus. We performed abdominal exploration and completely removed the inner germinal layer of cyst through an incision made in the anterior of the uterine fundus. Then, we applied total excision to the two cysts in the right and left colon mesentery. Finally, we performed partial cystectomy to the cyst in the liver, and we removed the cyst membrane totally. In endemic regions, hydatid cysts should be considered for the diagnosis of children with cystic mass lesions. Uterine-sparing approach should be kept in mind as an option, especially in young women. Early surgical treatment of large pelvic cysts that cause obstructive uropathy may prevent the progression of renal damage.

Abstract Background Chronic Kidney Disease (CKD), i.e., gradual decrease in the renal function spanning over a duration of several months to years without any major symptoms, is a life-threatening disease. It progresses in six stages according to the severity level. It is categorized into various stages based on the Glomerular Filtration Rate (GFR), which in turn utilizes several attributes, like age, sex, race and Serum Creatinine. Among multiple available models for estimating GFR value, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), which is a linear model, has been found to be quite efficient because it allows detecting all CKD stages. Methods Early detection and cure of CKD is extremely desirable as it can lead to the prevention of unwanted consequences. Machine learning methods are being extensively advocated for early detection of symptoms and diagnosis of several diseases recently. With the same motivation, the aim of this study is to predict the various stages of CKD using machine learning classification algorithms on the dataset obtained from the medical records of affected people. Specifically, we have used the Random Forest and J48 algorithms to obtain a sustainable and practicable model to detect various stages of CKD with comprehensive medical accuracy. Results Comparative analysis of the results revealed that J48 predicted CKD in all stages better than random forest with an accuracy of 85.5%. The study also showed that J48 shows improved performance over Random Forest. Conclusions The study concluded that it may be used to build an automated system for the detection of severity of CKD.

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Objectives: The aim of this experimental animal study is to investigate the effect of bone graft and topical ellagic acid application on bone regeneration in rats with critical-sized calvarial bone defects. Material and Methods: A total of 24 male Wistar rats were divided into three groups, and 7 mm critical-sized calvarial bone defects were created surgically in them. In the first group, the created defect was left empty, and this acted as a control group. In the second group, only a bone graft was placed in the created defect. In the third group, in addition to placing a bone graft in the created defect, 0.325 mg/kg ellagic acid (EA) was applied topically to the defect. Results: As a result of semiquantitative scoring, osteoblast counts were 2 (SD 0.82) in the control group, 2.71 (SD 0.76) in the graft group, and 1.14 (SD 0.69) in the EA + graft group. The number of osteocytes was 2.29 (SD 0.76) in the control group, 2.71 (SD 1.11) in the graft group, and 1.43 (SD 0.54) in the EA + graft group. When inflammations were evaluated, values of 1.71 (SD 0.75), 1.14 (SD 0.69), and 3 (SD 0.82) were obtained in the control, graft, and EA + graft groups, respectively. Conclusions: Topical ellagic and graft applications show different effects at different doses under topical and systemic conditions. The dose amount of ellagic acid applied, especially in topical applications, has critical importance in bone healing.

Objective: The aim of this study is to evaluate the attitudes, behaviors, and beliefs of medical faculty students about the covid-19 pandemic. Methods: Between 29/03/2020 and 04/13/2020 a total of 1,332 students had been questioned in three Turkish speaking countries (Turkey, Azerbaijan, Turkish Republic of Northern Cyprus). Results: The average age of the students were 20.1 +- 1.6. Among all 895 (67.7%) of them were female and 427 (32.3%) were male. 1020 (77.2%) of the studens were in Turkey, 195 (14.8%) were in Azerbaijan and 107 (8.1%) were in the TRNC. 104 of the students (7.9%) had a chronic disease. It was found that number of alcohol and cigarette users decreased significantly during the pandemic. (p

Objective: Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion.Methods: Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side.Results: Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0±10.2 months. The average interval between facial denervation and nerve repair was 14.0±4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5±20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5±17.4% to postoperative 93.4±6.9%. Vertical excursion changed from preoperative 38.4±24.6% to postoperative 89.3±11.8%. Overall excursion changed from preoperative 68.4±19.6% to postoperative 92.9±10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p

The current empirical literature ignores the possible influence of oil prices on environmental degradation through fiscal policy instruments. Contributing to the literature, this study explores the influence of oil price on the environmental degradation in Turkey through fiscal policy instruments, using a novel methodology of the bootstrap ARDL approach. The FMOLS, CCR, DOLS, and ARDL models are used to examine the long-run linkage among the tested variables. The findings from estimating models demonstrated that government expenditures positively affected environmental degradation in Turkey. In contrast, the taxation revenues negatively affected the environmental degradation. Furthermore, the empirical outcomes affirm that oil prices have a powerful effect on the levels of Turkey’s environmental pollution through taxation revenues, energy, and GDP factors. Therefore, the study suggests that the Turkish policymakers should design policies to avoid any undesirable impacts of the spillover effects of the oil price on the environment using fiscal policy channels. In this sense, the government in Turkey should design a framework that includes financial incentives such as low taxation rates on green energy investment. In addition, the policy markets in Turkey should start to use the carbon tax policy, which is one of the most efficient tools to reduce environmental pollution.

The first part gives an overview of the basic trends of comparative study of literature in the last century on European and American areas, with particular emphasis on changes in epistemological assumptions and methodological approaches influenced by gnoseological and dialectical horizons that have brought new literary theoretical paradigms in the last decades 20. century. It brings a diachronic sketch of the history of the South Slavic literatures and the reading of the South Slavic literatures, which, by varying intensity and volume of academic work, intensely or affectively, reflected the continuity of the comparative approach to the literatures of the South Slavs. In the climate of socio-political changesbrought about by the inevitable dissolution of the Yugoslav state community, inertial differentiation and the alienation and mutilation of South Slavic cultures, since the early 1980s, we have been followingattempts to find new patterns and a platform for comparative study of South Slavic literatures. Although welcome pluralism is present today in the South Slavic intercultural space in understanding the conceptsof national, comparative and world literature, their ontological-empirical relationship, the concept of interliterary community and the theory of the interliterary process by Dionýz Ďurišin seems, in the urrent transitional-globalization context, as the most perspective a platform for future South Slavic comparative literature and the inter-literary/intercultural history of South Slavic literatures. The paper concludes with texts and books that demonstrate a kind of consensus on this issue, visible over the past two decades in almost all key academic centers of the former Yugoslav republics.

INTRODUCTION[|]Distress tolerance and Discomfort tolerance are well-established psychological constructs that are related but distinct. Distress tolerance is defined as an individual's perceived capacity to withstand negative emotional states or the capacity to continue goal-directed behavior in the context of negative affect. As for discomfort tolerance, it mainly is about the capacity to withstand negative bodily sensations. Premenstrual dysphoric disorder (PMDD) which consists of bodily and psychological symptoms is a DSM-5 diagnosed disease determined under the category of depressive disorders.In this research article, we investigated the possible effects of premenstrual dysphoric disorder on distress and discomfort tolerance levels as well as dysfunctional attitudes on individuals with this disorder. [¤]METHODS[|]In our study, 218 people were interviewed in total. People who could possibly have PMDD according to Premenstrual Symptoms Screening Tool (PSST) were monitored for 8 weeks and 31 people were diagnosed with PMDD. People without PMDD and having under threshold symptoms for PMDD according to PSST who have matching age and BMI were also included in the study. Distress Tolerance Scale (DTS), Discomfort Intolerance Scale (DIS), Dysfunctional Attitude Scale-short forms (DAS-sf) were filled for each sample. [¤]RESULTS[|]DTS self-efficacy scores were found to be higher in group without PMDD than the groups with PMDD and having under threshold symptoms. DAS-total score was found to be higher in group with PMDD than the groups without PMDD group and having under threshold symptoms group. Discomfort avoidance subscale score of distress tolerance scale was found to be higher compared to participants without PMDD and participants having below threshold symptoms. [¤]DISCUSSION AND CONCLUSION[|]Women with PMDD may benefit from preventive treatment modalities that minimize discomfort and avoidance behaviours and facilitate their coping with negative bodily sensations of premenstrual syndrome and prevent the development of dysfunctional attitudes toward these bodily and mental disturbing sensations. [¤]

Abstract Background Stunting is a major public health issue in most of developing countries. Although, its worldwide prevalence is decreasing slowly but the number of stunted children is still rising in Pakistan. Stunting is highly associated with several long-term consequences, including higher rate of mortality and morbidity, deficient cognitive growth, school performance, learning capacity, work capacity and work productivity. To prevent stunting, we proposed Stunting Diagnostic and Education app. This app includes detailed knowledge of stunting and it’s all forms, symptoms, causes, video tutorials and guidelines by the Pediatricians and Nutritionists. Methods A cross-sectional study has been conducted in schools of Multan District, Pakistan for the period of January 2019 to June 2019. Sample data of 1420 children, aged 4 to 18 years using three age groups, were analyzed by using SPSS version 21.0 to assess the prevalence of stunting and to analyze the risk factors associated with it in children under and over 5 age. Chi square test was applied in comparison with rural and urban participants and p-value

Abstract This study was conducted to evaluate the potential of pineapple peel (PP) and pineapple crown leaves (PCL) as the substrate for vanillic acid and vanillin production. About 202 ± 18 mg L−1 and 120 ± 11 mg L−1 of ferulic acid was produced from the PP and PCL respectively. By applied response surface methodology, the ferulic acid yield was increased to 1055 ± 160 mg L−1 by treating 19.3% of PP for 76 min, and 328 ± 23 mg L−1 by treating 9.9% of PCL for 36 min in aqueous sodium hydroxide solution at 120 °C. The results revealed that PP extract was better than PCL extract for vanillic acid and vanillin production. Furthermore, the experiment also proved that large volume feeding was more efficient than small volume feeding for high vanillic acid and vanillin yield. Through large volume feeding, about 7 ± 2 mg L−1 of vanillic acid and 5 ± 1 mg L−1 of vanillin was successfully produced from PP extract via Aspergillus niger fermentation.

Next-generation transportation will be integrated, interconnected and highly autonomous. One key challenge in traffic management is ensuring safety while maintaining the required level of service quality. In such future mobility systems, rigorous formalization and validation will thus become critical to ensure that the transportation network operates as intended, traffic properties are reliably maintained, and services resume in a timely manner after potential disruptions. Formal methods have recently gained considerable attention as a modeling and verification paradigm capable of addressing many challenges associated with next-generation transportation systems. In this regard, we propose to use higher-order-logic theorem proving for formally analyzing transportation systems. As a first step towards this direction, we present a logical framework for the formal analysis of macroscopic models of traffic flow. Leveraging upon the high expressiveness of the underlying logic, we formally model the continuous components of macroscopic models while capturing their real behavior. In particular, we present a formalization of some foundation concepts of macroscopic models, namely density, flow rate, mean speed, relative occupancy, and shockwave using the higher-order-logic theorem prover HOL Light. This choice is primarily motivated by the fact that the macroscopic models deal with the traffic flow dynamics and thus play a vital role in planning strategies in allocating resources for implementing optimized and balanced transportation systems. For illustration, we perform the formal input-output and shockwave analysis of a German freeway. The case study demonstrated the practicability of this formal approach due to the high expressiveness of the underlying logic. The proposed research is first step towards formalizing the foundational mathematical theories and core concepts of traffic flow theory. This accomplishment will open new ways to plan and model various components of the transportation systems such as highway links, ramp metering, merging behavior and eventually address the problem of routing vehicles in a network of automated vehicles.

Ixodid ticks are one of the major health constraints on small ruminant productivity and contribute to significant economic losses in Somalia. An across-sectional study was conducted from November 2019 through December 2020 to identify hard tick species and determine the prevalence of tick infestation in small ruminants in the Benadir region, Somalia. Ticks were identified at the genera and species level by using morphological identification keys under a stereomicroscope. During the study period, a total of 384 small ruminants were examined for the presence of ticks through purposive sampling. All visible individual adult ticks were collected from the bodies of 230 goats and 154 sheep. A total of 651 Ixodid adult ticks were collected, of which 393 were male and 258 were female. The overall prevalence of tick infestation in the study area was 66.15% (254/384). The prevalence of tick infestation in goats and sheep was found to be 76.1% (175/230) and 51.3% (79/154), respectively. In the present study, nine species of hard ticks, which were grouped into three genera, were identified. The most abundant species found in this study were Rhipichephalus pulchellus (64.97%), Rhipichephalus everstieversti (8.45%), Rhipichephalus pravus (5.53%), Rhipichephalus lunulatus (5.38%), Amblyomma lepidum (5.22%), Amblyomma gemma (3.38%), and Hyalomma truncatum (2.62%) according to predominance. Rhipichephalus bursa (2.46%) and Rhipichephalus turanicus (1.99%) were the minor species observed in both species in the study area. The difference in the prevalence of tick infestation was found to be a statistically significant variation (p

BackgroundSerostudies are important resources when following pandemics and predicting their further spread, as well as determining the length of protection against reinfection and vaccine development. The aim of this study was to update data on the prevalence of seropositive individuals in Canton Sarajevo, Bosnia and Herzegovina (B&H) from September 2020 to May 2021.MethodsAnti-SARS-CoV-2 antibodies were quantified using an electrochemiluminescence immunoassay.ResultsCompared to the period April-July 2020, when anti-SARS-CoV-2 antibodies were detected in 3.77% of samples, one year later (May 2021) the estimated percentage within the same population of the urban Canton Sarajevo was 29.9% (5,406/18,066). Of all anti-SARS-CoV-2 Ig-positive individuals, 53.27% were men, and 69.00% were of 50 years of age or younger. Also, the current update found the individuals 50 years of age or younger to be more frequently anti-SARS-CoV-2 Ig positive compared to older individuals. On the other hand, higher median anti-SARS-CoV-2 Ig levels were found in individuals > 50 years old than in younger individuals, as well as in men compared to women. Seropositivity gradually increased from September 2020 to May 2021, with the lowest frequency of positive cases (3.5%) observed in September 2020, and the highest frequency (77.7%) in January 2021.ConclusionOur results provided important seroprevalence data that could help in planning restrictive local public health measures to protect the population of Sarajevo Canton, especially considering that at the time of the study the vaccines were virtually inaccessible to the general population not belonging to any of the high-priority groups for vaccination.