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Background and Aim: Chronic kidney disease (CKD) is characterized by persistent lowgrade inflammation. Soluble CD14 (sCD14) is involved in many pathological conditions, including inflammation and atherosclerosis. The present study aimed to assess the relationship between sCD14 levels, subclinical atherosclerosis (SCA), inflammation and mortality in Egyptian hemodialysis (HD) patients. Patients and Methods: The present longitudinal study included 62 HD patients. All patients were submitted to careful history taking, thorough clinical examination and laboratory assessment for high-sensitivity C-reactive protein (hsCRP) and sCD14. Carotid intima-media thickness (CIMT) was also assessed. Patients were followed for a maximum of 18 months. The primary outcome is patients’ mortality. Data were statistically analyzed using standard descriptive, comparative, correlative and regression methods. Results: The present study was conducted on 62 HD patients. They comprised 34 males and 28 females with an age of 54.6 ± 9.0 years. At the end of follow-up, 12 patients (19.4 %) died. It was shown that survivors had significantly lower hsCRP levels (104.2 ± 38.2 versus 134.1 ± 15.3 mg/dL, p < 0.001), lower sCD14 levels (32.7 ± 10.3 versus 47.4 ± 18.4 μg/mL, p = 0.02) and lower CIMT (1.32 ± 0.5 versus 1.5 ± 0.2 mm, p = 0.049). sCD14 levels were significantly correlated with hsCRP (r = 0.4, p = 0.001) and CIMT (r = 0.31, p = 0.013). Multivariate analysis identified HD duration [HR (95% CI): 1.02 (1.0-1.04), p = 0.021] and sCD14 levels [HR (95% CI): 1.06 (1.0-1.12), p = 0.026] as significant predictors of patients’ survival. Conclusions: sCD14 levels in this cohort of HD patients are well-correlated with hsCRP levels and CIMT. In addition, they are significant predictors of patients’ mortality.

The genetic parameters, eigenvalues in principal components, correlation, and path coefficient in Egyptian rice (Oryza sativa L.) proceeded to understand the interrelationship among studied traits, which helps develop selection strategies in genetic breeding programs under aerobic conditions. Twelve rice genotypes planted under the aerobic condition in a randomized complete block design included three replications during the 2020 and 2021 seasons. The analysis of variance revealed significant differences among studied genotypes, indicating a broad genetic diversity among its genotypes. Eigenvalues used helped to understand the data structure and trait relations and divided the 21 traits into two components. The highly positive phenotypic and genotypic correlations appeared in 16 characteristics, i.e., leaf area index, total chlorophyll, and antioxidant traits, indicating that any improvement of these traits will improve rice grain yield under aerobic conditions. The path structure showed that panicle weight, the number of panicles hill-1, catalase, superoxide dismutase, root length, and flag leaf area had increased grain yield. The current results indicated that Egyptian hybrid1, GZ9399, and Giza179 could recommend for cultivation under aerobic conditions and serve as donors in breeding programs to improve tolerance to drought under aerobic conditions.

The preparation of adsorbents plays a vital role in the adsorption method. In particular, many adsorbents with high specific surface areas and unique shapes are essential for the adsorption strategy. A Zn–Mg–Al/layer double hydroxide (LDH) was designed in this study using a simple co-precipitation process. Adsorbent based on Zn–Mg–Al/LDH was used to remove crystal violet (CV) from the wastewater. The impacts of the initial dye concentration, pH, and temperature on CV adsorption performance were systematically examined. The adsorbents were analyzed both before and after adsorption using FTIR, XRD, and SEM. The roughness parameters and surface morphologies of the produced LDH were estimated using 3D SEM images. Under the best conditions (dose of adsorbent = 0.07 g and pH = 9), the maximum adsorption capacity has been achieved. Adsorption kinetics studies revealed that the reaction that led to the adsorption of CV dye onto Zn–Mg–Al/LDH was a pseudo-second-order model. Additionally, intraparticle diffusion suggests that Zn–Mg–Al/LDH has a fast diffusion constant for CV molecules (0.251 mg/(g min1/2)). Furthermore, as predicted by the Langmuir model, the maximal Zn–Mg–Al/LDH adsorption capacity of CV was 64.80 mg/g. The CV dimensionless separation factor (RL) onto Zn–Mg–Al/LDH was 0.769, indicating that adsorption was favorable. The effect of temperature was performed at 25, 35, and 45 °C in order to establish the thermodynamic parameters ∆Ho, ∆So, and ∆Go. The computed values indicated exothermic and spontaneous adsorption processes. The study presented here might be used to develop new adsorbents with enhanced adsorption capabilities for the purpose of protecting the water environment.

Management of thyroid disorders depends on accurate clinical assessment, appropriate investigations and radionuclide imaging, which plays an established important role either qualitatively or quantitatively. The aim of this study was to assess the utility of the thyroid/salivary ratio (TSR) as an alternative to technetium-99m (Tc99m) pertechnetate thyroid uptake (TcU) percentage in the evaluation of thyroid function and in the same time to establish reference range for the thyroid uptake of Tc99m-pertechnetate and TSR among Egyptian populations.This retrospective study enrolled 270 patients, out of which 250 with different thyroid disorders and 20 without thyroid diseases, as a control group who all underwent full clinical examination, thyroid function tests and Tc99m pertechnetate thyroid scintigraphy. The TcU percentage and TSR were calculated and then correlated to the thyroid hormonal profile.The normal reference ranges of TcU and TSR were 0.75-3.5% and 1.25-4.8%, respectively. The sensitivity and specificity of TSR to diagnose hyperthyroidism were slightly lower compared with TcU (84.5 and 92.3% vs. 86.2 and 98.3%, respectively) at TSR cutoff value of more than 4.8 and TcU cutoff value of more than 3.5. Meanwhile, they had comparable sensitivity and specificity to diagnose hypothyroidism (86.0 and 93.3% vs. 86.5 and 94.5%) at cutoff values0.75 and1.25, respectively.The current study established a reference range for TcU and TSR in our institution. TSR is comparable to TcU in the evaluation of thyroid function among hyper-and hypothyroid patients and TSR can be used in doubtful cases of mal-thyroid function for confirmation of the diagnosis.

The problem of simultaneously optimizing the information rate and the harvested power in a reconfigurable intelligent surface (RIS)-aided multiple-input single-output downlink wireless network with simultaneous wireless information and power transfer (SWIPT) is addressed. The beamforming vectors, RIS reflection coefficients, and power split ratios are jointly optimized subject to maximum power constraints, minimum harvested power constraints, and realistic constraints on the RIS reflection coefficients. A practical algorithm is developed through an interplay of alternating optimization, sequential optimization, and pricing-based methods. Numerical results show that the deployment of RISs can significantly improve the information rate and the amount of harvested power., Comment: Submitted for publication

The new Fish-bones Completion & Stimulation approach by needles in the pay stack aims at addressing heterogeneous tight carbonate by increasing flow area in the lower permeable streaks, which is efficient as hundreds of tunnels drain connecting the borewell to the body of the reservoir to increase well productivity and oil recovery. The initial plan includes selecting the best ones from Stair step horizontal well, Dual Lateral well, five lateral fish-bone drilling, and horizontal drilling along with hydraulic fracture. Considering the lessons of failure to clean internal tubes, the modified 4-1/2” Liner is installed in the lower two sub-layer by jetting subs combing with production subs for matrix acidizing in the upper one sub-layer as per modified Fish-bones Completion Design. In addition, special acid-releasing float shoes and new fishing baskets are applied to avoid those previous problems with this well technique. The candidate well shows good oil test and production, which improved by three times at 2000bbl/d with respect to the initial plan in the B field. This paper describes the technology background and characteristics, design factors, modified design, execution, well test, and lessons learned during implementation.

While the PROTAC approach to targeted protein degradation greatly benefits from rational design, the discovery of molecular glue degraders currently relies on screening strategies. Here, we describe screening of a library containing 3,630 cereblon binders against a panel of 9 patient-derived cancer cell lines. This led to the discovery of SJ7590, a potent degrader of CK1α, IKZF1 and IKZF3 proteins. Through a structure-guided optimization strategy we developed SJ3149, a uniquely potent and selective CK1α degrader. The crystal structure of the CK1α+CRBN+DDB1+SJ3149 quaternary complex provided a rationale for the improved degradation properties via direct contacts between SJ3149 and CK1α. In a panel of 115 human cancer cell lines SJ3149 displayed broad antiproliferative activity. This activity profile, which showed statistically significant correlation with MDM2 inhibitor Nutlin-3a, suggests potential for the development of treatments for hematological cancers, as well as solid tumors.

Background and aim: Uremic pruritus (UP) is one of the most distressing symptoms in hemodialysis (HD) patients. Subclinical hypothyroidism (SCH) is a biochemical condition with high prevalence in HD patients. The present multicentric study aimed to assess the relationship between UP and SCH in HD patients. Methods: The present cross-sectional study included 328 HD patients. All patients were submitted to careful history through clinical examination and standard laboratory assessment. Pruritis was evaluated using the pruritis visual analog scale (VAS). Patients were diagnosed with SCH if they had TSH levels above the upper limit of the normal reference range in association with normal free thyroxine (FT4) levels. Results: Among the studied patients, there were 196 patients (59.8 %) with UP. Comparison between patients with UP and patients without revealed that patients in the former group had significantly longer HD duration (median (IQR): 47.5 (27.0-72.5) versus 36.0 (23.0-50.5) months, p0.001) and lower Kt/v (median (IQR): 1.4 (1.09-1.7) versus 1.54 (1.12-1.91), p=0.009). Moreover, they had significantly higher ferritin (median (IQR): 653.0 (526.0-800.0) versus 628.0 (470.8-716.0) ng/mL), hsCRP (median (IQR): 12.0 (8.0-14.0) versus 8.0 (6.0-9.0) mg/dL,p0.001) and TSH levels (median (IQR): 4.34 (1.98-5.2) versus 3.34 (1.9-4.85) µIU/ml) with a significantly higher frequency of SCH (45.9 % versus 28.8 %, p=0.002). Logistic regression analysis identified hemodialysis duration (OR (95%) CI): 1.02 (1.009-1.028), p0.001), ferritin levels (OR (95% CI): 1.002 (1.001-1.003), p0.001), and SCH (OR (95% CI): 0.54 (0.32-0.89), p=0.016) as significant predictors of UP. Conclusion: The present study suggested a possible link between SCH and the development of UP in HD patients.

Introduction: \ud A UPJO is a blockage of the ureter that affects urine flow. UPJO is mainly treated by an open approach, however, in recent years minimally invasive techniques are taking place. These techniques include robotic and laparoscopic pyeloplasty. Some patients require a redo after a primary intervention. A systematic review was conducted through the examinations of the efficacy and safety of a robotic redo pyeloplasty in adult patients from previous literature reviews.\ud \ud Methods: \ud A literature search was made through PubMed. A selection process was done based on our eligibility criteria. The data were represented numerically, listed on tables and analyzed cumulatively using Microsoft Excel.\ud \ud Results: \ud Twenty studies were included in this review, of which nine were studies on robotic outcomes () (157 patients), 10 on laparoscopic (210 patients), and one review by Zhang et al., focused on both types of surgeries. Two papers (24 patients) from the robotic studies and one paper (21 patients) from the laparoscopic studies were excluded from the intra and post-operative characteristics because not enough data were available and were only included for the success and complication rates. The success rate for the robotic studies was 88.5% while the laparoscopic studies had a success rate of 91%. However, the robotic studies had a complication rate of (11.8%) while the laparoscopic studies had a complication rate of (15.9%). Conversion surgery was required in one patient undergoing laparoscopic surgery.\ud \ud Conclusion: \ud The minimally invasive methods are becoming more viable in adult patients with rUPJO, considering its effectiveness and fast recovery. This can lead to a new era of robotic assisted surgeries to becoming the gold standard.

Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma (HCC), comprising 1%-9% of all HCCs. FLC is a poorly understood malignancy, which seems to be more prevalent in young patients with no underlying liver diseases. The term "fibrolamellar" is derived from thick fibrous collagen bands surrounding the tumor cells. Unlike HCC, cirrhosis and viral hepatitis infection are not predisposing to FLC, and it is not associated with elevations in serum alpha-fetoprotein. FLC patients often present with vague abdominal pain, nausea, malaise, and weight loss. Most cases present are at an advanced stage at the time of initial diagnosis. However, curative treatment options can still be offered to up to 70% of patients. Surgery (resection/liver transplantation) is the mainstay of treatment and the only potentially curative option. FLCs have been less chemo-responsive than the conventional HCC, however, in advanced cases, multimodality treatments can be effective. Recent advances in molecular studies of FLC have found a unique DNAJB1-PRKACA fusion transcript in most of the cases studied. The review aims to describe clinical characteristics, diagnostic methods, and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.

Enteric septicemia of catfish, which is caused by Edwardsiella ictaluri, is detrimental to farmed Channel Catfish Ictalurus punctatus. The hemin receptor HemR is involved in binding and uptake of heme into bacteria. Here, we explored pathological and ultrastructural changes in catfish fry that were immunized with a triple hemR mutant of E. ictaluri and challenged with wild-type E. ictaluri (EiWT) 28 d after immunization. Following immunization, pathological changes in the triple hemR-immunized fry were less severe compared to the EiWT-exposed control fry. Widely disseminated bacteria and severe necrosis in most organs, especially the kidney and spleen, were detected in both groups at days 4, 5, and 6. Multifocal granulomatous encephalitis with bacteria was seen in hemR-immunized fry at days 21 and 28 and in EiWT-exposed control fry at day 14. Phagocytic cells in the kidney and spleen of EiWT-exposed control fry contained more replicating bacteria compared to hemR-immunized fry. During the EiWT challenge of immunized fry, a robust immune response was observed in the triple hemR-immunized fry compared to the sham-vaccinated group. Many activated phagocytic cells were detected in the kidney and spleen with fragmented or no bacteria in the triple hemR-immunized fry. Our data suggested that virulence of triple hemR was lower and the onset of the lesions was delayed compared to EiWT. Additionally, triple hemR-immunized fry could mount an immune response and had milder lesions compared to the sham control after EiWT exposure.

Aim: The aim of this work was to evaluate the analgesic efficacy of ultrasound guided femoral nerve block compared with intravenous (IV) fentanyl in fractures of the femur in patients presented to Emergency Department (ED). Methods: This prospective, comparative, (blinded, randomized controlled clinical trial) was conducted on fifty patients with femur fracture. Patients were divided into two equal groups: group A underwent ultrasonography-guided femoral nerve block and group B given IV fentanyl 2 µg/kg). All patients underwent initial resuscitation. Intra-venous (IV) access with wide bore cannula and baseline investigation were obtained. Patients underwent X-ray imaging for diagnosis of femur fracture and FAST (Focused Assessment with Sonography for Trauma) scan on presentation at ED by ED trained physicians. Results: There is significant difference in group B as regard to peripheral oxygen saturation (SpO2) and Systolic blood pressure (P

Marwa Khalaf,1 Mohamed Alboraie,2 Muhammad Abdel-Gawad,3 Mohamed Abdelmalek,4 Ahmed Abu-Elfatth,4 Walaa Abdelhamed,5 Mariam Zaghloul,6 Rabab ElDeeb,7 Doaa Abdeltwab,4 Mohamed Abdelghani,4 Fathiya El-Raey,8 Hani Aboalam,1 Azza Badry,9 Mina Tharwat,10 Shima Afify,11 Doaa Elwazzan,7 Ahmed Shawkat Abdelmohsen,4 Hayam Fathy,12 Shaker Wagih Shaltout,13 Helal F Hetta,14 Shamardan E Bazeed15 1Assiut Liver Center, Ministry of Health, Assiut, 71515, Egypt; 2Department of Internal Medicine, Al-Azhar University, Cairo, Egypt; 3Hepatology, Gastroenterology and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt; 4Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt; 5Tropical Medicine and Gastroenterology Department, Sohag University Hospital, Sohag, Egypt; 6Hepatology, Gastroenterology and Infectious Diseases Department, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt; 7Tropical Medicine Department, Alexandria University, Alexandria, Egypt; 8Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Damietta, Egypt; 9Epidemiologist, Infectious Disease Control Department Preventive Medicine Assiut Health Affairs Directorate, Assiut, Egypt; 10Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt; 11Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 12Internal Medicine, Hepatogastroenterology Unit, Assiut University, Assiut, Egypt; 13Tropical Medicine Department, Port Said University, Port Said, Egypt; 14Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt; 15Tropical Medicine and Gastroenterology Department, South Valley University, Qena, EgyptCorrespondence: Marwa Khalaf, Assiut liver center, Ministry of health, Assiut, 71515, Egypt, Email Marwa.Kh@med.aun.edu.eg Helal F Hetta, Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt, Email helalhetta@aun.edu.egBackground and Aim: Little is known about the persistence of symptoms after clearance of SARS-CoV-2 infection. Our study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection.Methodology: A multi-center survey was conducted on first wave COVID-19 patients with confirmed SARS-CoV-2 infection. Sociodemographic and clinical characteristics, including presenting symptoms and persistent symptoms after viral clearance and possible factors contributing to persistence of such symptoms, were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to their persistence.Results: Overall, 538 patients were enrolled. Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported co-morbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to the intensive care unit. Our study identified 49 types of persisting symptoms. Fatigue (59.1%), sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8) and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR = 8.03, 8.89 and 10.12, respectively).Conclusion: Our study revealed that in COVID-19 recovered patients, many patients reported persistence of at least one symptom, particularly fatigue and sense of fever. Follow-up of patients after discharge from hospital is recommended until complete resolution of symptoms.Keywords: coronavirus, COVID-19, SARS-CoV-2, fatigue, dyspnea

Background: Mobile health projects have been implemented all over the world, using mobile phones for record keeping, data collection, or patient communication. Further, mobile health tools have been used to promote behavior change in health workers and/or patients. For example, text message reminders have been shown to increase health care seeking behavior or medication adherence in some patients, and mobile data collection and communication tools for health workers have improved follow-up of patients and data reporting. Methods: This literature review was conducted through a keyword search of the following databases to identify relevant peer-reviewed articles: Google Scholar, PubMed, Embase, and EKB. Keywords used in these searches included mHealth, mobile health, mobile phone, coverage, usage, delivery, vaccination, immunization and COVID-19. Results: Eleven studies satisfied the inclusion criteria were included. They examined awareness, applications, challenges and strengths of Mobile-Health applications. All studies showed some evidence that mHealth intervention had a positive impact on increasing the coverage and use of COVID-19 vaccine. Bad awareness of people was strongly associated with declines in vaccination intent. The use of mobile applications has made a great revolution in tracking and data gathering about vaccination status. The main limitations were reporting bias and malfunctioning of mobile applications. The main strengths were getting real-time data, improving surveillance, using geographic mapping to monitor populations. Conclusion: Growing usage of smartphone and internet penetration in African countries opens the door to mHealth applications such as health literacy, vaccine supply and control, disease monitoring and intervention, and virtual consultations with health professionals around the world.

The genetics of relapsed pediatric acute myeloid leukemia (AML) has yet to be comprehensively defined. Here, we present the spectrum of genomic alterations in 136 relapsed pediatric AMLs. We identified recurrent exon 13 tandem duplications (TD) in upstream binding transcription factor (UBTF) in 9% of relapsed AML cases. UBTF-TD AMLs commonly have normal karyotype or trisomy 8 with cooccurring WT1 mutations or FLT3-ITD but not other known oncogenic fusions. These UBTF-TD events are stable during disease progression and are present in the founding clone. In addition, we observed that UBTF-TD AMLs account for approximately 4% of all de novo pediatric AMLs, are less common in adults, and are associated with poor outcomes and MRD positivity. Expression of UBTF-TD in primary hematopoietic cells is sufficient to enhance serial clonogenic activity and to drive a similar transcriptional program to UBTF-TD AMLs. Collectively, these clinical, genomic, and functional data establish UBTF-TD as a new recurrent mutation in AML. Significance: We defined the spectrum of mutations in relapsed pediatric AML and identified UBTF-TDs as a new recurrent genetic alteration. These duplications are more common in children and define a group of AMLs with intermediate-risk cytogenetic abnormalities, FLT3-ITD and WT1 alterations, and are associated with poor outcomes. See related commentary by Hasserjian and Nardi, p. 173. This article is highlighted in the In This Issue feature, p. 171.

Neuroblastoma (NBL) is a highly malignant embryonal tumor that originates from the primordial neural crest cells. NBL is the most common tumor in infants and the most common extracranial solid tumor in children. The tumor is more commonly diagnosed in children of 1-4 years of age. NBL is characterized by enigmatic clinical behavior that ranges from spontaneous regression to an aggressive clinical course leading to frequent relapses and death. Based on the likelihood of progression and relapse, the International Neuroblastoma Risk Group classification system categorized NBL into very low risk, low risk, intermediate risk, and high risk (HR) groups. HR NBL is defined based on the patient's age (> 18 months), disease metastasis, tumor histology, and MYCN gene amplification. HR NBL is diagnosed in nearly 40% of patients, mainly those > 18 months of age, and is associated with aggressive clinical behavior. Treatment strategies involve the use of intensive chemotherapy (CTR), surgical resection, high dose CTR with hematopoietic stem cell support, radiotherapy, biotherapy, and immunotherapy with Anti-ganglioside 2 monoclonal antibodies. Although HR NBL is now better characterized and aggressive multimodal therapy is applied, the outcomes of treatment are still poor, with overall survival and event-free survival of approximately 40% and 30% at 3-years, respectively. The short and long-term side effects of therapy are tremendous. HR NBL carries a high mortality rate accounting for nearly 15% of pediatric cancer deaths. However, most mortalities are attributed to the high frequency of disease relapse (50%) and disease reactiveness to therapy (20%). Newer treatment strategies are therefore urgently needed. Recent discoveries in the field of biology and molecular genetics of NBL have led to the identification of several targets that can improve the treatment results. In this review, we discuss the different aspects of the epidemiology, biology, clinical presentations, diagnosis, and treatment of HR NBL, in addition to the recent developments in the management of the disease.

To evaluated obesity-related morbidity prevalence among overweight/obese children and adolescents in Saudi Arabia, adiposity indicators and insulin resistance as obesity-related morbidity predictors.We enrolled 318 overweight/obese children attending a Pediatric Endocrinology Clinic at King Abdulaziz University Hospital, Saudi Arabia, aged 2-20 years in this retrospective cross-sectional study from September 2019 to March 2021. All children had nutritional obesity, and their body mass index (BMI) standard deviation score was higher than one standard deviation score above the mean for their age and gender. Clinical adiposity indices including BMI, waist circumference (WC), waist-hip ratio (WHR), and bioimpedance analysis (BIA) of body composition were assessed. Biochemical testing of insulin resistance through homeostasis model assessment for insulin resistance and fasting insulin was performed, along with receiver operating curve analysis to obtain optimal cut-off points for obesity-related morbidity.Obesity related morbidity was found in 61.9%, whereas insulin resistance was detected among 64.7% of the patients. Body mass index standard deviation score, WC, BAI of body composition-derived body fat, homeostasis model assessment for insulin resistance, and fasting insulin are significant obesity-related morbidity predictors, and the cut-off points were established.Obesity-related morbidity is widely prevalent among obese children and insulin resistance is a key factor in its prediction. Clinical adiposity indices, given their accuracy and practicability, are important predictors of obesity-related morbidity.