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Doaa Abdallah El-Naggar,1 Laila Mohammed Ahmad El-Zalabany,1 Doaa Abdelhalim Shahin,2 Afaf Mahmoud Attia,1 Shaaban Abdelfattah El-Mosallamy1 1Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Dakahliya, Egypt; 2Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Dakahliya, EgyptCorrespondence: Doaa Abdallah El-Naggar, Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Tel +20 1063433525, Dakahliya, Egypt, Email dr_doaaelnaggar@yahoo.comBackground: Chloroxylenol (para-chloro-meta-xylenol, PCMX) is claimed to be highly harmful both to humans and the environment. Toxic effects of PCMX on testicular functions are scarcely discussed in the literature.Aim of Study: To study testicular toxic effects of PCMX on male Sprague-Dawley rats.Materials and Methods: Forty animals were randomly distributed into three groups: negative control (G I), vehicle group (G II) and PCMX group (G III). PCMX group was subdivided into three subgroups: GIIIa: received PCMX 100 mg/kg, GIIIb: received PCMX 200 mg/kg and G IIIc: received PCMX 500 mg/kg. Hormonal assay included assessment of serum testosterone and estradiol levels. Histopathological examination of testicular tissue, analysis of cellular viability, necrosis and apoptosis in testicular tissue by flow cytometry, analysis of cellular DNA content and phases of cell cycle analysis by flow cytometry were also performed.Results: Rats in the groups exposed to PCMX (G IIIa, G IIIb and G IIIc) had significantly lower estradiol and testosterone levels in comparison to control groups (G I and GII). Histopathological examination of testicular tissue of PCMX-exposed rats showed irregular crossly sectioned seminiferous tubules with their lumina containing scanty spermatids and spermatozoa. G IIIc animals showed eosinophilic proteinaceous material and vacuolated and necrotic interstitial cells of Leydig. Rats in PCMX-exposed groups (G IIIa, G IIIb and G IIIc) showed significantly lower testicular tissue viability in comparison to control groups (G I and G II). Rats in PCMX-exposed groups (G IIIa, G IIIb and G IIIc) showed significantly lower percentage of cells in the G0/G1 phase in comparison to control groups (G I and G II).Conclusion: Rats exposed to PCMX had significant reduction in testosterone and estradiol levels with marked histopathological alterations affecting testicular tissues. These effects are dose-dependent.Keywords: chloroxylenol toxicity, testicular toxicity, cell cycle, semen analysis

Purpose – This research aimed to study the impact of compensation on employee retention and turnover intentions among healthcare employees. The study also tested the mediation role of job satisfaction in the relationship. Design/methodology/approach – In the present study, self-administrated questionnaires were distributed among 600 doctors working in public hospitals of Pakistan, following stratified sampling. The data analysis was conducted through SPSS and smart-PLS. Findings – Results of the present study supported all the hypotheses (H1–H7), such as the significant relationship of compensation with employee retention and turnover intentions. Results further confirmed the mediation effect of job satisfaction between compensation and employee retention as well as compensation and turnover intentions. Practical implications – This study is useful for policymakers and organizational managers since the study provides guidelines on employee retention and high turnover intentions and how these factors are influenced by improved compensation. Originality/value – This study sheds light on the relationship of compensation together with employee retention and turnover intentions through the mediating role of job satisfaction in healthcare context, which was overlooked in the existing literature.

Purpose: This study investigates the relationship of human resource management practices with employee engagement, in hospitality industry. This study also explores the mediation role of psychological involvement in the relationship. Methodology: The data utilized in this study was obtained from a sample of 380 employees working in the hospitality industry of Pakistan, via purposive sampling techniques. While the data of present study was analysed through structural equation modeling using smart-PLS 4. Findings: Results of the present study confirms that there exists a significantly positive relationship between human resource management practices and employee engagement. Results also confirmed that psychological involvement significantly mediates the relationship of human resource management practices and employee engagement. Implications: With this present study emphasizes the significance of implementing efficient human resource management strategies to promote employee engagement, while also suggesting that psychological participation plays a substantial role in this process. Through an in-depth understanding of the fundamental mechanisms through which human resource management practices exert influence on employee engagement, hospitality companies can formulate strategies aimed at augmenting employee well-being and performance. Additionally, the study clearly addresses shortcomings and provides recommendations as well.

Purpose – This study aims to examine the impact of workplace safety (WPS) on employee retention (ER) in the health-care sector in Azad Jammu and Kashmir (AJ&K), Pakistan. At the same time, a mediation relationship through job satisfaction (JS) and employee loyalty (EL) was also tested. Design/methodology/approach – Structured questionnaires were used to collect the data from 300 doctors, using purposive sampling technique analysed using partial least squares (Smart-PLS 3). Findings – This study’s findings supported all hypotheses, such as WPS has a significant positive relationship with ER. In addition, a mediation relationship between JS and EL was also confirmed. Furthermore, a serial mediation effect of JS and EL between WPS and ER was also confirmed in this study. Research limitations/implications – This study might not fit organisations from other regions due to regional norms. In the future, this study’s model may be tested on other regions and segments of the health-care sector, such as nurses, management staff and support staff. Practical implications – The present study is unique because it is based on a newly formulated framework, WPS → JS → EL → ER, under the social exchange theory, which has not been tested before. Social implications – In a safe environment, doctors will feel relaxed, stay longer and provide better services; resultantly, patients will get better treatment. Originality/value – This study tested the sequential mediation effect through JS and EL for the first time in ER, which was missing previously, to the best of the authors’ knowledge. This will add more insights to the safety-retention literature in health-care settings. Furthermore, this study is also the first attempt to explore the relationship between WPS and ER in the health-care sector in AJ&K.

The aim of this study is to provide a holistic review of the fight against COVID-19 in developing countries, particularly Malaysia. Specifically, the study aims to determine how facilities management delivery in public hospitals can be improved to ensure readiness in handling COVID-19 cases. We conducted a review of the literature and reliable media updates on COVID-19 and services management. A critical synthesis of COVID-19 information was conducted to scrutinise the technical aspects and highlight how facilities management can be improved to ensure hospital readiness in managing COVID-19 cases. The data and information used in the present study were collected up to the time of writing this paper, which leaves a room for further studies. Nonetheless, this study’s recommendations are useful for understanding the present and future pandemics. This study is a first attempt to summarise the data on facilities management in relation to the COVID-19 pandemic in the Malaysian context. The study’s findings are suitable for the developing countries in managing healthcare management practices in the fight against COVID-19. This study aims to highlight current issues in order to provide a more objective assessment of facilities management to ensure hospital readiness in handling COVID-19 cases.

The present study investigates the impact of human capital capacity, human capital knowledge, and human capital skills on organisational performance in the hospitality industry. This study also investigates the moderating role of innovative leadership in the relationship of human capital capacity, human capital knowledge, and human capital skills with organisational performance. Data was collected through survey questionnaires from 356 managers working in small and middle-level hotels located in the four districts of Saudi Arabia. The present study used convenience sampling, and the data analysis method was partial least square structural equation modelling. Results of this study demonstrate that human capital capacity, human capital knowledge and human capital skills have a significant positive relationship with organizational performance. Results also confirmed a moderation effect of innovative leadership between human capital knowledge and organizational performance. However, the moderation effect of innovative leadership between human capital capacity and human capital skills with organizational performance was not confirmed. Finally, the theoretical contribution, practical implications and future commendations are also discussed.

Background: The incidence of cancer and the prevalence of metabolic disease and metabolic dysfunction-associated steatotic liver disease is increasing in young adults. However, updated global data on metabolic dysfunction-associated steatohepatitis (MASH)-associated primary liver cancer (PLC) in young adults remains scarce., Methods: This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years rates from MASH-associated PLC in young adults (15-49 y)., Results: In 2021, there were 4300 incidence cases, 3550 deaths, and 179,340 disability-adjusted life years from MASH-associated PLC in young adults. Among various etiologies of PLC in young adults, only MASH-associated PLC had increased incidence rates (annual percent change: +0.26, 95% CI: 0.16%-0.35%), with the Eastern Mediterranean region having the largest observed increase (annual percent change: 1.46%, 95% CI: 1.40%-1.51%). In 2021, MASH-associated PLC in young adults made up 6% (+1% from 2000) incident cases, 6% (+2% from 2000) deaths, and 6% (+2% from 2000) disability-adjusted life years of all PLC in this age group. Over half of the countries exhibited an increase in age-standardized incidence rate from MASH-associated PLC in young adults from 2000 to 2021., Conclusions: The incidence of MASH-associated PLC in young adults is significantly increasing, signaling likely future increases in PLC incidence among older adults as this cohort ages. This trend necessitates urgent strategies worldwide to mitigate the epidemics of MASH-associated PLC in young adults., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)

Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce., Methods: This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex., Results: There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (annual percent change [APC], +0.46; 95% confidence interval [CI], 0.33%-0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (APC, 0.24%; 95% CI, 0.06%-0.42%), whereas they remained stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC, 2.09%; 95% CI, 2.02%-2.16%), age-standardized death rate (APC, 1.96%; 95% CI, 1.69%-2.23%), and age-standardized DALYs (APC, 1.96%; 95% CI, 1.63%-2.30%) from MASH-associated PLC., Conclusions: Over the past 2 decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Unconventional resources, such as heavy oil, are increasingly being explored and exploited due to the declining availability of conventional petroleum resources. Heavy crude oil poses challenges in production, transportation, and refining, due to its high viscosity, low API gravity, and elevated sulfur and metal content. Improving the quality of heavy oil can be achieved through the application of steam injection, which lowers the oil's viscosity and enhances its flow. However, steam injection alone falls short of meeting the growing demand for higher-quality petroleum products. Catalytic upgrading is therefore being investigated as a viable solution to improve heavy oil quality. This study experimentally investigates the application of two novel catalysts, namely copper-substituted zinc ferrite (ZCFO) synthesized via the sol-gel combustion method and a graphene oxide-based nanocomposite (GO-ZCFO) with different ratios, for catalyzing aquathermolysis reactions in the steam injection process, with the aim of enhancing the in-situ upgrading of heavy oil. These catalysts underwent characterization using X-ray powder diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), and Transmission Electron Microscopy (TEM). Their catalytic performance was assessed utilizing a high-pressure/high-temperature reactor (300 ml), with a comprehensive analysis of the changes in the physical and chemical properties of the heavy oil before and after upgrading. This analysis included measurements of sulfur content, SARA fractions, viscosity, API gravity, and Gas Chromatography (GC) of saturated hydrocarbons and evolved gases. All upgrading experiments, including both catalytic and non-catalytic aquathermolysis processes, were conducted under a reaction time of 6 h, a reaction temperature of 320 °C, and high pressure (86-112 bar). The results indicated that the introduction of the proposed catalysts as additives into the upgrading system resulted in a significant reduction in sulfur content. This, in turn, led to a decrease in resin and asphaltene content, an increase in the content of saturated hydrocarbon, particularly low-molecular-weight alkanes, and ultimately, a reduction in viscosity along with higher API gravity of the crude oil. GO-ZCFO with a weight ratio (50:50) exhibited the best catalytic performance. The heavy crude oil, upgraded with this 50:50 ratio, exhibited significant enhancements, including a 29.26% reduction in sulfur content, a 21.27% decrease in resin content, a 37.60% decrease in asphaltene content, a 46.92% increase in saturated hydrocarbon content, a 66.48% reduction in viscosity, and a 25.49% increase in API gravity. In comparison, the oil upgraded through non-catalytic aquathermolysis showed only marginal improvements, with slight reductions in sulfur content by 5.41%, resin content by 3.60%, asphaltene content by 11.36%, viscosity by 17.89%, and inconsiderable increases in saturated hydrocarbon content by 9.9% and API gravity by 3.02%. The GO-ZCFO, with its high catalytic activity, stands as a promising catalyst that contributes to improving the in-situ upgrading and thermal conversion of heavy crude oil., (© 2024. The Author(s).)

Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality globally. Most patients present with late diagnosis, leading to poor prognosis. This narrative review explores novel biomarkers for early HCC detection. We conducted a comprehensive literature review analyzing protein, circulating nucleic acid, metabolite, and quantitative proteomics-based biomarkers, evaluating the advantages and limitations of each approach. While established markers like alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin, and AFP-L3 remain relevant, promising candidates include circulating tumor DNA, microRNAs, long noncoding RNAs, extracellular vesicle, and metabolomic biomarkers. Multi-biomarker panels like the GALAD score, Oncoguard, and Helio liver test show promise for improved diagnostic accuracy. Non-invasive approaches like urine and gut microbiome analysis are also emerging possibilities. Integrating these novel biomarkers with current screening protocols holds significant potential for earlier HCC detection and improved patient outcomes. Future research should explore multi-biomarker panels, omics technologies, and artificial intelligence to further enhance early HCC diagnosis and management.

Objectives: To evaluate anchorage loss after en masse retraction in bimaxillary dentoalveolar protrusion patients using friction vs frictionless mechanics., Materials and Methods: Thirty patients with bimaxillary dentoalveolar protrusion needing extraction of upper first premolars and en masse retraction with maximum anchorage were included in this two-arm, parallel, single-center, single-blinded randomized clinical trial with a 1:1 allocation ratio using fully sealed opaque envelopes. Friction group retraction utilized elastomeric power chain between miniscrews and hooks crimped mesial to upper canines on 17 × 25 stainless steel archwire. Frictionless group used customized T-loop springs loading upper first molars indirectly anchored to miniscrews. Activation was every 4 weeks until full retraction. The primary outcome assessed was anchorage loss evaluated at cusp tip and root apex of the first molar. First molar rotation, incisor tip and torque, and root resorption of anterior teeth were evaluated on digital models and cone beam computed tomography taken before and after space closure., Results: Anchorage loss at crown of first molar was significantly more in frictionless group by 2.1 mm (95% CI = -0.4 to 3.5), (P = .014), while there was no significant difference in anchorage loss at root apex between groups. Significant mesial in molar rotation of 6.672° (95% CI = 12.2-21.2), (P = 0.02) was greater in the frictionless group. Both groups showed comparable tip, torque, and root resorption values. No severe harms were reported. There was mild gingival overgrowth and inflammation in the frictionless group due to T-loop irritation., Conclusions: Extra anchorage considerations are needed during en masse retraction when frictionless mechanics is implemented as higher anchorage loss and molar rotation were detected. No difference in tip, torque, and root resorption was observed., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Introduction This study focuses on the management of primary aneurysmal bone cysts (ABCs) through comprehensive curettage, hydrogen peroxide lavage, and non-vascularized strut fibular grafting. Methods The research encompassed 20 cases, predominantly males (80%), with an average age of 11.35 years. Patient assessment involved thorough history-taking, clinical examinations, and radiological evaluations, including plain radiographs, CT scans, and MRI. The study evaluated healing, bone consolidation, and complications, with patients assessed using the Musculoskeletal Tumor Society (MSTS) upper limb score. Results and discussion The results demonstrated a mean MSTS score of 91.55%, indicating favorable outcomes compared to prior studies. The utilization of non-vascularized autogenous fibular grafts offered effective mechanical stabilization and facilitated an early return to normal function, even prior to complete cavity filling. Our research underscores the efficacy of this treatment approach for primary ABC, particularly in achieving satisfactory functional outcomes. Moreover, the findings contribute to the understanding of optimal management strategies for ABC, considering factors such as patient age, lesion location, vascularity, and size. Conclusion The study advocates for the adoption of thorough curettage, hydrogen peroxide lavage, and non-vascularized strut fibular grafting as a reliable treatment modality for primary ABC. This approach highlights its potential to enhance patient outcomes and functional recovery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ismail et al.)

Background Vertical shear (VS) pelvic ring injuries present a unique challenge due to their inherent vertical and rotational instability and the risk of massive bleeding. VS injuries may result from either bony or ligamentous injury. The goal in the treatment of VS fractures of the pelvis is to achieve and maintain an accurate reduction of the displaced hemipelvis. Aim of the study This study aimed to compare the results of the treatment of VS fractures pelvis by using iliosacral (IS) screws versus lumbopelvic fixation (LPF). Methodology This retrospective study was carried out on 40 patients with VS fracture pelvis injuries at El Hadara University Hospital, Alexandria, Egypt, from January 2020 to December 2020. Twenty of them were treated by an IS screw, and the other 20 were treated by LPF. Then, both groups were followed up for six months with regard to union rate, metal failure, and clinical outcomes. Results The EQ-5D showed a significant improvement in LPF more than the IS screw group in the five items of the score. Moreover, the total EQ-5D index showed a significant increase in the LPF group more than the IS screw group (p < 0.05). The incidence of neurological complication was found in four cases in the IS screw group, while no cases were found in the LPF group. The infection was found in six patients in the IS screw group and only three cases in the LPF group. The malunion was found in two cases in the IS screw group and no cases in the LPF group. The neurological change and the incidence of infection were significantly higher in the IS screw group than in the LPF group (p < 0.05). Conclusion Our results demonstrate reliable maintenance of reduction and acceptable complication rates with a minimally invasive LPF for VS fractured pelvis. The benefits of minimally invasive LPF may be offset by increased elective reoperations for the removal of instrumentation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ashour et al.)

Background: Aspiration thrombectomy has gained popularity in patients with massive and sub-massive pulmonary embolism (PE) and having contraindications to thrombolysis., Methods: A meta-analysis was conducted including studies on aspiration thrombectomy in patients with high-risk and intermediate-risk PE. The pooled odds ratio for efficacy parameters, including change in heart rate, blood pressure and right ventricle/left ventricle (RV/LV) ratio, and safety parameters including major bleeding and stroke, was calculated using a random effects model., Results: The meta-analysis of 24 selected studies revealed that intermediate and high-risk pulmonary embolism (PE) patients demonstrated significant improvements: modified Miller score odds ratio of 10.60, mean pulmonary artery pressure reduction by 0.04 mm Hg, and an overall all-cause mortality odds ratio of 0.10. Considerable heterogeneity was observed in various outcomes., Conclusion: Aspiration thrombectomy has success rates in both high-risk and intermediate-risk PE, however, procedural risks, including bleeding, must be anticipated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Aim: Molecular-targeted agents such as lenvatinib and sorafenib have been approved to treat hepatocellular carcinoma (HCC). However, the choice between these two agents in the primary treatment for advanced HCC is still under debate with conflicting results. We sought to evaluate the efficacy of lenvatinib and sorafenib in patients with HCC., Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until February 10, 2023. The primary outcome of this meta-analysis was overall survival (OS). The secondary outcomes were progression-free survival (PFS), time to progression, objective response rate (ORR), and disease control rate (DCR)., Results: A total of 13 studies with 3705 patients (1635 on lenvatinib and 2070 on sorafenib) were included in our analysis. The mean age of the patients in both groups was comparable (66.81 vs 65.9 years). Pooled analysis of primary outcomes showed that, compared with sorafenib, lenvatinib was associated with significantly better OS in patients treated with these drugs (HR 0.82, 95% CI: 0.69-0.97, P  = 0.02). Pooled analysis also showed that PFS (HR 0.67, 95% CI: 0.57-0.78, P  < 0.00001) and time to progression (HR 0.49, 95% CI: 0.31-0.79; P  = 0.004) were significantly better in the lenvatinib group compared to the sorafenib group. It also showed that the lenvatinib group had significantly better ORR (odds ratio [OR] 5.43, 95% CI: 3.71-7.97; P  < 0.00001) and DCR (OR 2.35, 95% CI: 1.75-3.16; P  < 00001) than the sorafenib group., Conclusion: Our study shows that lenvatinib is superior to sorafenib regarding OS and PFS in patients with advanced HCC., (© 2023 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background/aim: As the clinical differentiation between epileptic seizures, psychogenic non-epileptic seizures (PNES), and syncope depends mainly on a detailed report of the event, which may not be available, an objective assessment of a potential biochemical analysis is needed. We aimed to investigate whether serum creatine kinase (CK) could be used to differentiate epileptic seizure from PNES and syncope and to assess the strength of evidence present., Methods: We directed a retrospective cohort study coupled with a systematic review and meta-analysis of studies that measured CK in patients with epilepsy, PNES, syncope, and healthy controls., Results: The cohort study, which traced 202 patients, showed that the CK level was significantly higher 48 h after the event in the epilepsy group versus patients with syncope (p < 0.01) Along with 1086 patients obtained through a database search for meta-analysis, CK level compared to different types of seizures from PNES was higher in epileptic seizure patients with a mean difference of 568.966 mIU/ml (95% CI 166.864, 971.067). The subgroup analysis of CK showed that it was higher in GTCS compared to syncope with a mean difference of 125.39 mIU/ml (95% CI 45.25, 205.52)., Discussion: Increased serum levels of CK have been associated mainly with epileptic seizures in relation to non-epileptic events. However, further studies would try to explore the variation in measurements and any other potential diagnostic marker., Conclusion: The cohort study shows that the CK level in epilepsy seizures is higher after 48 h from the event compared to syncope. Moreover, the meta-analysis results show the present diagnostic utility of CK and its importance to be used in accordance with a detailed report of the event., (© 2023. Deutsche Gesellschaft für Neurologie e.V.)

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction; however, their effects among patients with preserved ejection fraction have been debatable., Objective: We aim to evaluate the SGLT2 inhibitor effect among patients with heart failure with reduced ejection fraction, including DELIVER and EMPEROR-Preserved trials., Methods: We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 30th, 2022. Statistical analysis was performed by calculating hazard ratio (HR) using the random effect model with a 95% confidence interval (CI) and probability value (P). Statistical significance was met if 95% CI does not cross numeric "1" and P < .05., Results: Six studies with a total of 15,989 total patients were included in the final analysis. The mean age of patients enrolled in SGLT2 inhibitors and placebo was 69.13 and 69.37 years, respectively. The median follow-up duration was 2.24 years. SGLT2 inhibitors reduced composite cardiovascular mortality or first hospitalization for heart failure (HR, 0.80 [95% CI: 0.74-0.87], P < .001, I2 = 0%), heart failure hospitalization (HR, 0.74 [95% CI: 0.67-0.82], P < .001, I2 = 0%) compared with placebo. However, all-cause mortality (HR, 0.97 [95% CI: 0.89-1.06], P = .54, I2 = 0%) and cardiovascular mortality (HR, 0.96 [95% CI: 0.82-1.13), P = .66, I2 = 35.09%] were comparable between both groups., Conclusion: Our study finding shows that SGLT2 inhibitors significantly reduced the risk of first HF hospitalization or cardiovascular death and HF hospitalization; however, all-cause mortality was comparable between the groups., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Familial Mediterranean fever is a hereditary autoinflammatory disease affecting mainly Arabs, Turks, Armenians, and Jews with genotype-phenotype heterogeneity, presenting as recurrent episodes of fever along with polyserositis and rash. To date, more than 370 mutations in the MEFV gene have been recognized to cause the disease., Methods: We conducted a retrospective cohort study involving 124 patients in Hebron, Palestine, diagnosed with FMF at the Al-Ahli, and Palestinian Red Crescent Society (PRCS) Hospitals., Results: The median age of diagnosis was five years, presenting as abdominal pain (76.6%), fever (67.7%), joint pain and arthritis. Regarding MEFV gene mutations, we had 62 patients (50%) with heterozygous genotypes, 40 patients (32.3%) with homozygous phenotypes, 21 patients (16.9%) with compound heterozygous genotypes, and one was a missing state. Regarding variant frequencies, M694V was the most common one (43.4%), followed by E148Q (15.6%), V726A (5.7%), A744S (4.1%), and R202Q (4.1%). Positive family history was detected in 59 patients (54.6%), and there was no significant difference in zygosity regarding characteristics, consanguinity, and family history., Conclusions: We affirm in this study of 124 children with FMF, abdominal pain, followed by fever, joint pain and arthritis were the main manifestations. Further, M694V, E148Q, V726A, A744S, and R202Q were the most frequent mutations, and carrying the M649V mutations is associated with a predisposition to other comorbidities. We believe that this study gives a pervasive overview of FMF in Palestinian patients. Looking forward, future studies on a larger number of patients could precisely highlight the genotype-phenotype association among FMF patients., Competing Interests: All authors declare no conflict of interest., (© 2023 The Mediterranean Journal of Rheumatology (MJR).)

The safety and clinical outcomes of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) among patients with solid organ transplants is not well understood. This study aimed to evaluate the clinical outcomes of TAVR and SAVR among patients with a history of solid organ transplantation. We performed a systematic literature search of databases for relevant articles from inception until May 1st, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a P-value of <0.05 was considered statistically significant. A total of 3240 studies were identified of which 3 studies with a total of 2960 patients were included in the final analysis. For solid organ transplants patients, the odds of in-hospital mortality (OR 0.37, 95% CI 0.20-0.71, P < 0.001), 30-day mortality (OR 0.51, 95% CI 0.35-0.74, P < 0.001), acute kidney injury (OR 0.45, 95% CI 0.35-0.59, P < 0.001), and bleeding (OR 0.35, 95% CI 0.27-0.46, P < 0.001) were significantly lower in patients undergoing TAVR compared to SAVR. In contrast, the odds of pacemaker implantation (OR 2.60, 95% CI 0.36-18.90, P = 0.34), postprocedural stroke (OR 0.36, 95% CI 0.13-1.03, P = 0.06) were similar between both groups of patients. Length of hospital stay was significantly lower in TAVR compared to SAVR patients (SMD -0.82, 95% CI -0.95 to -0.70, P < 0.001). In solid organ transplant patients, TAVR appeared to be a safe procedure with fewer postprocedure complications, shorter length of hospital stay, and lower in hospital mortality compared with SAVR., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Over time, oil consumption has increased along with a continuous demand for petroleum products that require finding ways to increase hydrocarbon production more economically and effectively. So, enhanced oil recovery technologies are believed to be very promising and will serve as a key to meeting the future energy demand. This paper aims to introduce an innovative method to boost the EOR by using two novel types of surfactants synthesized from sulfonamide derivatives. Types I and II surfactants were analyzed using Fourier transform infrared spectroscopy, and their characterization was further performed using 1 H NMR and 13 C NMR spectroscopy. Additionally, the evaluation of these surfactants included interfacial tension measurements at concentrations up to 0.9 wt %. The combination of types I and II surfactants with alkaline (NaOH) was also investigated by the measurements of interfacial tension. A series of coreflood and sandpack tests under high-salinity conditions were carried out to assess the effects of a surfactant alone and alkaline-surfactant as a combination on improving oil recovery. The rock wettability was evaluated using relative permeability saturation curves, and the oil displacement efficiency was determined using fractional flow curves. The coreflood results demonstrated that alkaline-surfactant flooding with the chemical formula 0.2 wt % surfactant type II plus 0.5 wt % NaOH achieved a higher oil recovery of 74% OOIP compared to surfactant flooding with the chemical formula 0.5 wt % surfactant type II (64% OOIP) and waterflooding (saline solution with a 35,000 ppm salinity: 48% OOIP). Moreover, the experimental results showed that under both core and sandpack flood conditions, there was a noticeable reduction in oil-water interfacial tension, a change in rock wettability to more water-wet, and higher efficiency of oil displacement when alkaline was added to the surfactant. Based on current research, the alkaline-surfactant formulation is strongly recommended for chemical flooding because of its high efficacy and relatively low cost., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Background: Hydrocephalus is commonly associated with Chiari malformation (CM) particularly CM type II. The traditional treatment of hydrocephalus in these patients has been cerebrospinal fluid diversion by shunts. Endoscopic third ventriculostomy (ETV) has emerged as an alternative procedure in these patients., Purpose: Assessment of the clinical and radiological outcomes of ETV in the management of hydrocephalus in children with CM II., Methods: This is a prospective study conducted on 18 patients with CM II associated with hydrocephalus admitted to Cairo University hospitals between January 2020 and June 2021. These patients had been managed surgically by ETV. Clinical outcome was assessed based on improvement of manifestations of increased intracranial pressure while radiological outcome was based on the findings of postoperative computed tomography. In cases with early failure, serial lumbar puncture (LP) was performed for 2 days., Results: ETV was performed as a secondary procedure in 4 cases. The overall success rate of the procedure was 72%, and its success rate as a secondary procedure was 100%. Serial LP was effective in decreasing early failure in 44.4% of cases. Radiological regression of hydrocephalic changes was detected in 50% of the cases., Conclusion: ETV is an efficient and safe procedure in the treatment of hydrocephalus in children with Chiari malformation II, particularly when performed as a secondary procedure. Serial LP following the procedure increases the success rate in patients with early failure., (© 2023. The Author(s).)

The world is gradually moving toward a severe energy crisis, with an ever-increasing demand for energy overstepping its supply. Therefore, the energy crisis in the world has shed important light on the need for enhanced oil recovery to provide an affordable energy supply. Inaccurate reservoir characterization may lead to the failure of enhanced oil recovery projects. Thus, the accurate establishment of reservoir characterization techniques is required to successfully plan and execute the enhanced oil recovery projects. The main objective of this research is to obtain an accurate approach that can be used to estimate rock types, flow zone indicators, permeability, tortuosity, and irreducible water saturation for uncored wells based on electrical rock properties that were obtained from only logging tools. The new technique is obtained by modifying the Resistivity Zone Index (RZI) equation that was presented by Shahat et al. by taking the tortuosity factor into consideration. When true formation resistivity ( R t ) and inverse porosity (1/Φ) are correlated on a log-log scale, unit slope parallel straight lines are produced, where each line represents a distinct electrical flow unit (EFU). Each line's intercept with the y -axis at 1/Φ = 1 yields a unique parameter specified as the Electrical Tortuosity Index (ETI). The proposed approach was validated successfully by testing it on log data from 21 logged wells and comparing it to the Amaefule technique, which was applied to 1135 core samples taken from the same reservoir. Electrical Tortuosity Index (ETI) values show marked accuracy for representing reservoir compared with Flow Zone Indicator (FZI) values obtained by the Amaefule technique and Resistivity Zone Index (RZI) values obtained by the Shahat et al. technique, with correlation coefficients of determination ( R 2 ) values equal to 0.98 and 0.99, respectively. Hence, by using the new technique, the Flow Zone Indicator, permeability, tortuosity, and irreducible water saturation were estimated and then compared with the obtained results from the core analysis, which showed a great match with the R 2 -values of 0.98, 0.96, 0.98, and 0.99, respectively., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Ischemic heart disease (IHD) is a pressing public health concern with high prevalence, mortality, and morbidity. Although the value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as markers of the acute coronary syndrome are well recognized, there is a paucity of data deciphering their role in screening for stable ischemic heart disease (SIHD) in the presence of type 2 diabetes mellitus (T2DM). The present study investigates the value of NLR and PLR as markers of SIHD in T2DM. We evaluated the predictive value of NLR and PLR for SIHD by comparing T2DM patients having angiographically proven SIHD to T2DM patients without IHD at different cutoff levels by evaluating the area under the curve (AUC) obtained from receiver-operating-characteristic analysis. Raised NLR and PLR were significantly associated with SIHD ( P < .001 for each). On performing AUC-receiver-operating-characteristic analysis, NLR of > 2.39 and PLR of > 68.80 were associated with the highest prevalence of SIHD (NLR, AUC: 0.652 [0.605-0.699]; CI: 95%; P < .001, PLR, AUC: 0.623 [0.575-0.671] CI: 95%; P < .001). The sensitivities and specificities for these cutoff values were 50% and 73% for NLR and 73% and 46% for PLR, respectively. NLR and PLR were significantly higher in SIHD compared to those without; however, these markers had limited predictive potential in the setting of T2DM., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: We aimed to evaluate the use of intravenous levetiracetam as the first-line treatment of neonatal seizures compared with phenobarbital., Methods: The study was conducted on 104 neonates (0-28 days) with clinical seizures after inclusion criteria. They were assigned in equal ratio into 2 groups; 1 included neonates who received phenobarbitone, and the other included neonates who received levetiracetam. Neonates were loaded with 20 mg/kg of intravenous drug-A (phenobarbitone) or drug-B (levetiracetam). In persistent seizures, a second loading dose of the same drug was given. Crossover to other drugs occurred if seizures persisted after the second dose of the same drug. The proportion of neonates who achieved cessation of seizures following the first or second loading dose of either drug-A or drug-B (PB or LEV) was the main outcome measure provided that they remained free of seizure for the following 24 hours., Results: After 1 or 2 doses of Levetiracatam or Phenobarbitone, clinical seizures stopped (and remained seizure-free for 24 hours) in 41 (78.84%) and 34 (65.38%) patients, respectively ( P  = .01). Neonates in the LEV group showed better seizure control than neonates in the PB group (RR = 0.57; 95% CI (0.17, 0.80). We did not report any adverse drug reactions in the LEV group. However, 12 (23.07%) neonates developed adverse drug reactions in the PB Group., Conclusion: Levetiracetam is considered an effective and safe drug as a first-line AED in neonatal seizures., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

A high-performance immobilized bacterial strain coated with magnetic iron oxide nanoparticles was used for Basic Blue 41 azo dye (BB 41 dye) decolorization. To create the coated bacterial strain, Raoultella Ornithinolytica sp. was isolated and identified under the accession number KT213695, then coated with manufactured magnetic iron oxide nanoparticles. SEM and SEM-EDX were used to characterize the coated bacteria and validate its morphological structure formation. The coated Raoultella Ornithinolytica sp. A1 (coated A1) generated a 95.20% decolorization for BB 41 dye at 1600 ppm starting concentration with an optimal dose of coated A1 5 mL/L, pH 8, under static conditions for 24 h at 37 °C. Continuous batch cycles were used, with BB 41 dye (1600 ppm) added every 24 h four times, to achieve a high decolorization efficiency of 80.14%. Furthermore, the metabolites of BB 41 dye biodegradation were investigated by gas chromatographic-mass spectrum analysis (GC-MS) and showed a less toxic effect on the bioindicator Artemia salina. Additionally, 5 mL/L of coated A1 demonstrated the highest decolorization rate (47.2%) when applied to a real wastewater sample after 96 h with a consequent reduction in COD from 592 to 494 ppm., (© 2022. The Author(s).)

Chemical flooding using a polymer and/or surfactant has been widely applied in oilfields worldwide for enhanced oil recovery. Chemical adsorption in reservoirs has a significant effect on the rock permeability and wettability and hence can affect the overall oil production. In this work, two chemicals, namely, the xanthan gum (XG) biopolymer and sodium dodecylbenzenesulfonate (SDBS) anionic surfactant, were used individually as displacement fluids. The amount of chemical adsorption on the rock surface and the residual resistance factor (permeability reduction) were calculated throughout the flooding experiments using an unconsolidated sandstone (SS) pack model. The effects of the injected chemicals' concentration and reservoir salinity on adsorption capacity have been examined. Additionally, the effect of the addition of nanosilica particles (NSPs) to the injected fluid on the rock adsorption was also investigated. The results showed that the amount of XG and SDBS adsorption on the rock surface increased, albeit to a different extent, by increasing the chemical concentration at the applied salinities (0, 3.5, 5, and 10%) of the displacement fluids. Also, the permeability reduction increased with the increase in XG and SDBS concentrations; however, permeability reduction due to SDBS flooding was lower than that of XG in SS. The use of NSPs as a coinjectant to the XG and SDBS displacement fluids increased the adsorption on the SS rock. A plausible mechanism for the adsorption of the XG/NSP and SDBS/NSP blends on the SS surface was proposed. A density function theory calculation was employed to establish a relation between the adsorptivity of NSPs on SDBS and XG and the total energy and dipole moment of the molecules., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Introduction: Although aortic valve replacement in severe symptomatic Aortic Stenosis (AS) are clearly outlined, the role of surgical intervention in asymptomatic severe AS remains unclear with limited evidence. The aim of our meta-analysis is to evaluate the efficacy and safety of early surgical aortic valve repair compared to conservative management., Methods: A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant., Results: A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. At a median followup of 4.1 years, here were significantly lower odds of all-cause mortality [OR = 0.30 (95 %CI:0.17-0.53), p < 0.0001], cardiovascular mortality [OR = 0.35 (95 %CI:(0.17-0.72), p = 0.005], and sudden cardiac death (OR = 0.36 (95 %CI: 0.15-0.89), p = 0.03) among early surgery group compared with conservative care. There was no significant difference between incidence of major bleeding, clinical thromboembolic events, hospitalization due to heart failure, stroke and myocardial infarction between the conservative care groups and early surgery., Conclusion: Among asymptomatic patients with AS, early surgery shows better outcomes in reducing all-cause mortality and cardiovascular mortality compared with conservative management approaches., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V.)

Background and Aims: The COVID-19 pandemic and the resultant change in sedentary behaviors have had immense health, economic, and social implications globally. As governments worldwide imposed lockdowns and curfews, the amount of time spent indoors greatly increased. This lead to a dramatic change in physical activity (PA) levels and profound consequences on daily routines. Our study aimed to investigate patterns of PA during the COVID-19 pandemic among adults residing in Saudi Arabia., Methods: This cross-sectional survey-based study aimed to investigate patterns of PA during the COVID-19 pandemic among adults residing in Saudi Arabia. The International Physical Activity Questionnaire was utilized to measure participants' PA levels between April 2021 and May 2021. Participants were then classified into three groups according to their PA level, and their PA levels and sedentary behaviors were analyzed., Results: We surveyed 463 participants, 315 (68%) of which were female and 134 (32%) of which were male with a median age of 23 (interquartile range, 21-35) years. Moderate-to-high PA was reported by 257 (55.7%) of the participants. There was a significant decrease in PA during the COVID-19 pandemic and resultant lockdowns among the participants ( p  = 0.04), with higher rates of sedentary behavior among males than females ( p  = 0.14)., Conclusions: The decline in PA is a profound challenge of the COVID-19 pandemic that needs to be addressed by health practitioners and policymakers. Our study highlights the decline in PA levels seen during the COVID-19 pandemic and the importance of promotional programs and interventions to increase PA among the Saudi Arabian population without compromising the essential health restrictions and social distancing., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

This study investigated the effect of phytic acid (IP6) in different concentrations and application times on microtensile bond strength (µTBS) and interfacial integrity of universal adhesive to deep dentin. Flat deep dentin surfaces of 48 human molars were either etched with 37% phosphoric acid (PA) for 15 sec (control); or received no acid treatment and universal adhesive was applied directly in a self-etch mode (SE); or divided according to IP6 concentration (C) into two main groups: C1, 0.5%, and C2, 1%. Specimens of IP6 groups were further subdivided into three subgroups according to application time of IP6 (T) where; T1, 15 sec; T2, 30 sec and T3, 60 sec. Single Bond Universal Adhesive was then applied and resin composite blocks were built-up. Forty Specimens were then sectioned to produce resin/dentin beams that were used for µTBS testing using a universal testing machine. The remaining eight specimens were sectioned into slabs that were immersed into ammonical silver nitrate solution and nanoleakage was observed using a field emission scanning electron microscope (FE-SEM). The results showed that the application of IP6 in 0.5% and 1% produced significantly higher µTBS and less nanoleakage compared to PA and SE groups. Also, the application of IP6 for 60 sec recorded the highest µTBS and the lowest nanoleakage followed by 30 sec, and 15 sec respectively. Therefore, conditioning of deep dentin with IP6 enhances µTBS and interfacial integrity of universal adhesive to deep dentin in comparison to PA etching or using the universal adhesive in SE mode.

The present work-study the decreasing fluoride ions toxicity on the rat heart via loading them on the chitosan nanoparticles (Cs NPs) surface to form the biologically compatible composite (Cs@NaF). The obtained nanocomposite was characterized by different techniques such as field emission scanning electron microscopy (FEG-SEM), zeta potential, and x-ray diffraction (XRD). The biochemical parameters in the albino rats perform, where twenty-eight male adult Sprague Dawley rats (average body weight of 150 ± 10 g) were obtained from the Faculty of Agriculture, Alexandria University, then acclimatized for two weeks before the experiment and divided into four groups in galvanized wire cages at room temperature (22-25 °C) with a 12-h photoperiod and fed a well-balanced commercial diet. The blood samples were obtained from the vena cava of the rat heart via estimation of the troponin T, Lactate dehydrogenase, and creatine phosphokinase. Also, immunoglobulins (IgA, IgM, and IgG) and hematological measurements have been performed on the rat heart. To express all of the data, the mean and standard error of the mean are utilized by (ANOVA), followed by Tukey's multiple comparison test. The modified chitosan with fluoride decreases the toxicity of fluoride via improving the rat heart function due to the presence of Cs NPs helped to mitigate some of the negative effects of fluoride therapy., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Precise prediction of pore pressure and fracture pressure is a crucial aspect of petroleum engineering. The awareness of both fracture pressure and pore pressure is essential to control the well. It helps in the elimination of the problems related to drilling, waterflooding project, and hydraulic fracturing job such as fluid loss, kick, differential sticking, and blowout. Avoiding these problems enhances the performance and reduces the cost of operation. Several researchers proposed many models for predicting pore and fracture pressures using well log information, rock strength properties, or drilling data. However, some of these models are limited to one type of lithology such as clean and compacted shale formation, applicable only for the pressure generated by under compaction, and some of them cannot be used in unloading formations. Recently, artificial intelligence techniques showed a great performance in petroleum engineering applications. Hence, in this paper, two artificial neural network models are developed to estimate both pore pressure and fracture pressure through the use of 2820 data sets obtained from drilling data in mixed lithologies of sandstone, carbonate, and shale. The proposed artificial neural network (ANN) models achieved accurate estimation of pore and fracture pressures, where the coefficients of determination ( R 2 ) for pore and fracture pressures are 0.974 and 0.998, respectively. Another data set from the Middle East was used to validate the developed models. The models estimated the pore and fracture pressures with high R 2 values of 0.90 and 0.99, respectively. This work demonstrates the validity and reliability of the developed models to calculate pore and fracture pressures from real-time surface drilling parameters by considering the formation type to overcome the limitation of previous models., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Background: COVID-19 is an illness caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory healthcare workers (LHCWs) are at highest risk for COVID-19 infection due to direct exposure to COVID-19 patients and/or infected samples., Objectives: Our primary objective in this study was to evaluate SARS-CoV-2 Ab testing as a screening tool for detecting COVID-19 infection among asymptomatic LHCWs. Our secondary aims were to establish the relationship between exposure to COVID-19 infection and subsequent asymptomatic disease and working in different areas of the laboratory., Method: The detection of SARS-CoV-2 antibodies was done by different methods (rapid testing, electrochemiluminescence, and chemiluminescent microparticle immunoassay). The study included 199 asymptomatic LHCWs at Assiut University Hospital, Egypt, from different laboratory areas including molecular biology, microbiology, parasitology, and outpatient clinic laboratories in addition to LHCWs involved in automation, phlebotomy, rotating physicians, and those working in the sample receiving area., Results: The incidence of SARS-CoV-2 antibodies by rapid testing and immunoassay among asymptomatic LHCWs was 29.6% and 24.4%. Laboratory phlebotomists (55.6%) were most likely to be exposed to positive patients and samples, followed by those working in the sample receiving area (32%), LHCWs in the automation area (29.6%), rotating doctors (28.6%), and LHCWs in the diagnostic molecular biology laboratory (15.4%). The sensitivities of the rapid test and SARS-CoV-2 total antibody were 94.1% and 92%, whereas the specificities were 92.6% and 91%., Conclusion: Rapid serological testing is an effective screening method for the detection of SARS-CoV-2 infection among asymptomatic LHCWs and the identification of the groups of workers who have a significantly higher seroprevalence than the rest of the laboratory population., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Azza M. Ezz Eldin et al.)

Objective: Post-COVID-19 syndrome appears to be a multi-organ illness with a broad spectrum of manifestations, occurring after even mild acute illness. Limited data currently available has suggested that vitamin D deficiency may play a role in COVID-19 cases. However, to our knowledge, no study has examined the frequency of vitamin D deficiency in post-COVID-19 cases and its effect on the symptom severity. The aim of this study is to both screen the frequency of vitamin D deficiency in post-COVID-19 syndrome patients and to study its relation to persistent symptoms., Patients and Methods: A cross-sectional, single-center study was conducted involving all cases attending post-COVID-19 follow-up clinic from November 2020 to May 2021. Complete history, clinical examination, and laboratory analysis [kidney functions, serum calcium, C-reactive protein, serum ferritin, Serum 25-(OH) vitamin D] was done as well as HRCT chest., Results: The study included 219 post-COVID-19 cases, 84% had deficient vitamin D levels (< 20 ng/dL); 11.4% had insufficient level (20-30 ng/dL) and only 4.9 % reported normal level. There was no link between levels of vitamin D with either the acute or post-COVID-19 symptoms in the studied groups., Conclusions: Despite the prevalence of vitamin D deficiency among the study population, no association was observed between the levels of vitamin D and post-COVID-19 symptoms. It appears that post-COVID-19 syndrome pathophysiology involves a more complex interaction with the immune system. Dedicated clinical trials are advised to better study vitamin D levels and the related disease severity in COVID-19 patients.

There are limited studies evaluating the correlation between the presence of signet ring carcinoma and tumor response to neoadjuvant therapy in the rectum. Hereby, we aimed to report for the first time our experience from Upper Egypt through assessing the predictive role of signet ring cell component (SRCC) in the response to preoperative chemoradiotherapy (PCRT) and the impact of histological types (SRCC versus other types) on survival. This retrospective study analysed the medical records of 195 patients with locally advanced rectal cancer treated from 2011, to 2018. Patients were divided into two groups according to histological types: SRCC group and non SRCC group. All patients received PCRT followed by surgery. SRCC group was associated with significant higher rate of complete clinical response (cCR) and pathologic complete response (pCR) (83.3% and 88.9% respectively) as compared to non SRCC group (9.0% and 10.2% respectively); P <0.0001. Fifteen cases (93.8%) who were diagnosed by magnetic resonance tumor regression grade (mrTRG) and diffusion weighted imaging (DWI) as cCR after PCRT, also achieved pCR, in contrast to 88.9% of cases without SRCC. Signet ring histology was the only predictor of pCR in multivariate analysis ( P =0.027). There was no statistically significant difference between both histological groups as regard to survival. SRCC is an important predictor of pCR and assessing their response to PCRT using mrTRG and DWI showed high sensitivity for the detection of cCR, making them good candidates for watch-and-wait approach. Histological types did not significantly affect the survival outcome., Competing Interests: None., (AJCR Copyright © 2022.)

Cigarette smoking appears to have adverse effects of male reproductivity. The interplay between zinc and cadmium presumably plays a role in mediating toxic effects of smoking. This work was conducted to study serum and seminal plasma zinc and cadmium level in smokers compared to non-smokers. Seventy males were included: 35 smokers (group I) (smoking ˃20 cigarettes/day with mild smoking index <400) and 35 age-matched non-smokers (group II). Semen analysis was performed according to the WHO laboratory manual 2010. Atomic absorption spectrophotometer was used to detect zinc and cadmium amounts in both blood plasma and semen of any groups. Smoker group showed significantly lower sperm density, motility (P=0.001), and sperm viability (P=0.002) and higher abnormally formed sperms. Seminal zinc level was significantly lower in smokers (P=0.038).There was significant negative correlation between seminal zinc and smoking index and significant positive correlation between seminal zinc levels and sperm motility (P=0.008) and viability percentage (P=0.001). Seminal cadmium level was significantly higher in smoker (P=0.022). Significant positive correlation between seminal cadmium and both age and smoking index (P=0.003) and significant negative correlation between seminal cadmium and sperm density (P=0.005), motility (P=0.047), and viability (P=0.039). Seminal zinc level was negatively correlated to seminal cadmium level (P=0.020). Smoking has deleterious effects on semen quality hence fertility through several toxicants and chemicals. Reduced zinc levels and elevated cadmium levels were evident in smokers which have significant role in the adverse effects on the semen parameters., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)