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Ahmed S Fadaly,1 Ghada Mohammed Abdellatif,2 Sameh E Saeed,1 Alaa Brik,1 Mamdouh Elsharawy,1 Ahmed Deebis,1 Rabab Mahmoud Elfwakhry,3 Dina Said Shemais1 1Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 2Department of Pediatric medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt; 3Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Dina Said Shemais, Department of cardiothoracic surgery, Zagazig University, Zagazig, 44631, Egypt, Tel +201090726390, Email drdinashemais010@gmail.comPurpose: To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group.Materials and Methods: A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival.Results: The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55± 3.57 and it was 32.61± 8.39 showing high statistically significant difference (p< 0.001). Patients in the primary closure group had earlier discharge from hospital 15.77± 4.18 than vacuum assisted group 42.61± 8.39, with high statistically significant difference (p< 0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up.Conclusion: Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.Keywords: pediatric mediastinitis, post-cardiac surgery, primary closure, vacuum-assisted closure, interrupted mattress wires

Objectives: This study aimed to determine the prognostic value of otoacoustic emissions (OAEs) in idiopathic sudden sensorineural hearing loss patients. Methods: The study included 30 subjects with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). Each patient was evaluated four times: at baseline and after one week, one month, and three months of treatment. During each visit, each patient was subjected to full audiological history, otoscopic examination, basic audiological evaluations, and transiently evoked and distortion product otoacoustic emission (TEOAEs & DEOAEs). Results: The hearing thresholds (frequency range 250–8000 Hz) and word recognition scores of patients with detectable TEOAEs and DPOAEs improved significantly, whereas no significant improvements were observed in those with no response. Conclusion: Hearing improvement is better in patients with detectable TEOAEs and DPOAEs. As a result, TEOAEs and DPOAEs are recommended as routine tests in all SSNHL patients to predict outcomes and monitor treatment as TEOAEs and DPOAEs reflect the cochlear OHCs activity.

This research deals with the study of the mineral and chemical composition and determination of firing temperature degree of two pottery vessels - the pre-dynastic era - Helwan cemetery. Helwan was one of the areas that witnessed early civilizational activity from the ancient Stone Age until the end of the ancient era in Egypt. Helwan civilization considered one of the Neolithic civilizations. In addition, is located in the Cairo governorate between present-day Helwan and the end of the Wadi Houf or its mouth. Two pottery vessels - the pre-dynastic era - Helwan cemetery in Cairo governorate was studied, examined and analyzed by various means, including: Visual Investigation - Digital Optical Light Microscope USB - Polarizing Light Microscope - X-ray diffraction analysis XRD - Differential Thermal Analysis (DTA). The examination and analysis processes considered among the important stages in the field of archaeological studies in general and pottery in particular, as they are the basis of restoration processes, through which we obtain historical data and information about the antiquity and its manufacturing techniques. The artifact can also return back to the historical period in which it was made through mineral, chemical and thermal analyzes to complete the objectives of the study. It goes back to the Archaic Era - the era of the First Dynasty and confirmed by the results of the Australian mission excavations. Mineral changes, which contribute to better treatment and maintenance steps. The various methods of examination and analysis showed very good results, as they showed the mineral and chemical composition of the ancient pottery vessels, which the restorers must know well in any of the different sites before they carry out the restoration work. Where it showed the presence of Quartz SiO2, Gehlnite Ca2AL2SiO7, Diopside MgCaSi2O6, and Wollastonite Ca.5SiO3, in addition to Calcite CaCO3 – Hematite Fe2O3 – Halite NaCl with different proportions for each sample, according to the type of clay, its chemical and mineral composition, and the conditions of burning and burial.

This study investigates the effect of Annona muricata (AM) leaf extract against irradiation-induced damage by the evaluation of hepatic tissue and the levels of oxidative and inflammatory stress in the circulation.

Ahmed Salah Abdelgalil, Ahmed Mansour Ahmed, Reham M Gamal, Mamdouh Mahmoud Elshal, Ahmed Hussein Bakeer, Ehab Hanafy Shaker Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Ahmed Salah Abdelgalil, Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, 11796, Egypt, Email ahmed.salah@nci.cu.edu.egBackground: It is critical to manage acute postoperative pain for patient satisfaction and better outcome. Erector spinae plane block (ESPB) can produce sensory blocking on both visceral and somatic levels. This study aimed to evaluate the ESPB efficacy in controlling acute postoperative pain in open nephrectomy for renal malignancies.Methods: This prospective randomized, controlled, open-label trial included 60 cases scheduled for open nephrectomy for renal malignancy under general anesthesia. Cases were assigned randomly into two equal groups. Group E administered continuous preoperative unilateral ESPB (20mL bupivacaine 0.25% bolus then 6 mL/h 0.1% for 48 hours). Group C administered intravenous (IV) patient-controlled analgesia (PCA) morphine (0.01 mg/kg/h). Postoperative analgesia was managed by morphine (3 mg IV in group E or 0.01 mg/kg bolus with a 15-min lockout in group C) to keep the visual analog scale (VAS) scores < 4.Results: Intraoperative fentanyl consumption and total morphine consumption in 1st 48 hours postoperatively were significantly lower in group E than group C (P= 0.001 and < 0.001, respectively). The time to first analgesic request was significantly longer in group E than group C (P < 0.001). VAS scores at movement and rest were significantly lower in group E than group C (P < 0.001).Conclusion: In renal malignancies, ESPB provided better analgesia with prolonged time and lower pain scores at both rest and movement compared to IV PCA following open nephrectomy.Keywords: erector spinae plane block, PCA, analgesia, nephrectomy, renal malignancy

Muslimah N Alsulami,1 Majed H Wakid,2 Mohammed Al-matary,3 Rewaida Abdel-Gaber,4 Wafa Abdullah I Al-Megrin,5 Areej O Bakhraibah,1 Abdullah D Alanazi,6 Hatem A Elshabrawy,7 Asmaa M El-Kady8 1Department of Biology, College of Science, University of Jeddah, Jeddah, 21493, Saudi Arabia; 2Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 4Department of Zoology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia; 5Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 6Department of Biological Sciences, Faculty of Science and Humanities, Shaqra University, Ad-Dawadimi, 11911, Saudi Arabia; 7Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX, 77304, USA; 8Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, 83523, EgyptCorrespondence: Asmaa M El-Kady; Hatem A Elshabrawy, Email Asmaa.elkady@med.svu.edu.eg; hatem.elshabrawy@shsu.eduBackground: In Saudi Arabia, more than US$ 0.2 million annual losses are caused by liver condemnations due to fascioliasis. Data obtained from the genetic characterization of Fasciola population sheds light on parasite transmission which could eventually help in development of effective parasite control measures. So, the aim of this study was to investigate the genetic diversity of Fasciola spp. isolated from cattle in Saudi Arabia by sequence analyses of COI gene.Materials and Methods: A total of 325 cows slaughtered at the central municipal abattoir in Jeddah city, Jeddah Province, Saudi Arabia were examined for fascioliasis in the period from 1st of June to 1st of July 2020. DNA was extracted from adult Fasciola worms and used for PCR and DNA sequence using a primer pair targeting COI gene. Analysis of the obtained sequences was done using BLAST search and phylogenetic analysis.Results: Bovine fascioliasis was diagnosed in 18 out of 325 cattle (5.5%). Forty-eight flukes were extracted from infected animals and DNA was successfully amplified from all flukes. Overall 12 different DNA sequences were obtained. BLAST search showed that all obtained sequences were F. hepatica and had > 97% similarity with F. hepatica isolates from Tanzania, Europe and Iran. Phylogenetic analysis of the obtained sequences showed that Fasciola isolates from the current study were clustered in one subclade closely related to isolates from North and South Africa and Italy.Conclusion: Reports on the molecular characterization of Fasciola spp. in Saudi Arabia are limited. In the current study, our findings showed that F. hepatica was the only Fasciola species parasitizing cattle in Jeddah city, Saudi Arabia. Further studies using a large number of samples from different localities in Saudi Arabia are needed to provide data that will help the development of control measures against fascioliasis.Keywords: fascioliasis, cattle, PCR, COI, Saudi Arabia

Asmaa M El-Kady,1 Fahad M Aldakheel,2 Khaled S Allemailem,3 Ahmad Almatroudi,3 Reem Dbas Alharbi,3 Hamad Al Hamed,4 Muslimah Alsulami,5 Wafa A Alshehri,5 Saeed El-Ashram,6 Eugene Kreys,7 Khalil Mohamed,8 Wafa Abdullah I Al-Megrin,9 Hatem A Elshabrawy10 1Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia; 3Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia; 4Department of Laboratory and Blood Bank, King Fahd Specialist Hospital, Buraydah, 52211, Saudi Arabia; 5Department of Biology, College of Science, University of Jeddah, Jeddah, 21959, Saudi Arabia; 6Faculty of Science, Kafrelsheikh University, Kafr El-Sheikh, 33516, Egypt; 7Department of Clinical & Administrative Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA, 95757, USA; 8Department of Epidemiology, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia; 9Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh, 11671, Saudi Arabia; 10Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX, 77304, USACorrespondence: Asmaa M El-Kady; Hatem A Elshabrawy, Email Asmaa.elkady@med.svu.edu.eg; hatem.elshabrawy@shsu.eduBackground: A good understanding of the possible risk factors for coronavirus disease 19 (COVID‐19) severity could help clinicians in identifying patients who need prioritized treatment to prevent disease progression and adverse outcome. In the present study, we aimed to correlate clinical and laboratory characteristics of hospitalized COVID-19 patients to disease outcome in Saudi Arabia.Materials and Methods: The present study included 199 COVID-19 patients admitted to King Fahd Specialist Hospital, Buraydah, Qassim, Saudi Arabia, from April to December 2020. Patients were followed-up until discharge either for recovery or death. Demographic data, clinical data and laboratory results were retrieved from electronic patient records.Results: Critical COVID-19 cases showed higher mean of age and higher prevalence of co-morbid conditions. Fifty-five patients died during the observation period. Risk factors for in hospital death for COVID 19 patients were leukocytosis (OR 1.89, 95% CI 1.008– 3.548, p = 0.081), lymphocytopenia (OR 2.152, 95% CI 1.079– 4.295, p = 0.020), neutrophilia (OR 1.839, 95% CI 0.951– 3.55, p = 0.047), thrombocytopenia (OR 2.152, 95% CI 0.852– 5.430, p = 0.085), liver injury (OR 2.689, 95% CI 1.373– 4.944, p = 0.003), acute kidney injury (OR 1.248, 95% CI 0.631– 2.467 p = 0.319), pancreatic injury (OR 1.973, 95% CI 0.939– 4.144, p = 0.056) and high D dimer (OR 2.635, 95% CI 0.747– 9.287, p = 0.091).Conclusion: Clinical and laboratory data of COVID-19 patients may help understanding the pathogenesis of the disease and subsequently improve of the outcome of patients by determination of the associated risk factors and recognition of high risk group who are more liable for complications and in hospital death. The present study put an eye on some parameters (laboratory and clinical) that should be alarming signs that the patient is at high risk bad prognosis.Keywords: clinical, outcomes, prognosis, COVID-19, Saudi Arabia

Background and Aim: The reports from the Ministry of Agriculture and Fisheries suggest that camels suffer less compared to goats, sheep, and cows from a number of common infectious diseases in Oman. However, there is no immunological evidence to substantiate this claim. This present study is, therefore, an attempt to study the immunological responses of camels, goats, sheep, and cows by comparing their oxidative respiratory burst of peripheral blood leukocytes (PBLs) as a marker of innate immunity occurring during phagocytosis and the mitogenic responses of their peripheral blood mononuclear leukocytes (PBMLs) as a marker of their adaptive immune response. Materials and Methods: Ten female adult animals (n = 10) were selected from each species (goats, sheep, and cows). The goats, sheep, and cows were maintained at the Agricultural Experiment Station, while camels were kept at the Royal Camel Corps (RCC). Blood samples were collected from the jugular vein in 7 mL of heparin and ethylenediaminetetraacetic acid vacutainer tubes. The oxidative respiratory burst of PBLs was measured using a chemiluminescence (CL) assay. Reactants consisted of 75 μL of whole blood diluted (1:50), 75 μL of luminol/isoluminol, and 75 μL of zymosan opsonized with non-heat inactivated serum/heat-inactivated serum or non-opsonized zymosan. CL responses were measured as relative light units and expressed as the mean count per minute and peak CL values. The mitogenic response of PBMLs to concanavalin A (Con-A), phytohemagglutinin (PHA), and pokeweed mitogen (PWM) was tested using a WST-8 assay and read spectrophotometrically at 450 nm. Results: The present findings showed that camel PBLs generate significantly higher CL responses, both intracellularly as well as extracellularly, with zymosan opsonized with autologous serum. Camel PBLs demonstrated a significantly higher (p = 0.001) response when stimulated with zymosan opsonized with heat-inactivated serum compared to those of goat, sheep, and cow lymphocytes from camels exhibited significantly higher (p = 0.001) stimulation indices (SI) with Con-A, PHA, and PWM. Conclusion: The present study suggests that camels are capable of mounting both superior innate as well as adaptive immune responses and provide immunological evidence supporting the belief of some authors, who have proposed that camels are less susceptible to a number of common infectious diseases than other domesticated ruminants.

This research was devoted to the creation of a protection system for electric motors used in industry and transport, based on modern and traditional sensors. In the course of operation, the malfunctions of electric motors have been investigated and it was found that the accident modes occur mainly due to exceeding the permissible values of the current, voltage and temperature parameters. Modern sensors of current, voltage, and temperature have been compared and the most effective ones were selected for use in electric motors. Based on reasoning from these sensors, a protection system for a low-power electric motor has been developed in the laboratory. In addition, in the Multisim application software package, a simulation of the operation of the protection system at different voltage and current values was performed, and a circuit of the sensor control unit and the power source for powering the protection system was constructed. It has been proposed to apply such a multi-parametric complex protection system for electric motors, especially in transport.

Aim. To determine the optimal extraction frequency of green tea leaves with 60 % ethanol by the antioxidant method. Materials and methods. Chun Myn green tea leaves were the object of the study, the raw material was collected in Anhui province (China) from March to April. Dry green tea leaves were standardized according to the European Pharmacopeia 9.0. Spectrophotometry was used to quantify biologically active substances. The antioxidant activity was determined by the potentiometric method. Potentiometric measurements were performed on a HANNA 2550 pH meter (Germany) with a combined platinum EZDO 50 PO electrode (Taiwan). A UV-1000 spectrophotometer (China) was used to measure the optical density. Results and discussion. The total content of phenolic compounds was 9.60 ± 0.17, 1.30 ± 0.03 and 0.12 ± 0.002 %, catechins – 9.20 ± 0.18, 1.20 ± 0.02 and 0.07 ± 0.002 %, flavonoids – 0.27 ± 0.005, 0.04 ± 0.001, 0.005 ± 0.001, hydroxycinnamic acids – 0.49 ± 0.01, 0.07 ± 0.002 and 0.007 ± 0.001 %, dry residue – 10.75 ± 0.11, 1.59 ± 0.02 and 0.15 ± 0.002 %, the antioxidant activity was 474.08 ± 9.48, 67.70 ± 1.35 and 7.01 ± 0.14 mmol-equiv mdry res(-1) for the first, second and third extraction, respectively. According to the results obtained, the optimal number of extractions of the raw material with 60 % ethanol was found to be two. Conclusions. The dynamic of extractions of biologically active substances of green tea leaves has been studied by triple extraction of the raw material to find the optimal extraction frequency; for the first time, a method for determining the extraction frequency based on the antioxidant activity of the extracts has been developed and proposed. It has been found that the optimal extraction rate is 2 times. The results obtained will be used in the further production of herbal medicines, dietary supplements, and cosmetic products with a green tea extract.

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

Aim: Aim is to depict suggestive urine and stool parameters in asymptomatic suspected contact children living with COVID-19 infected adults. These parameters will facilitate identifying children who deserve the confirmatory diagnosis of COVID-19 by PCR test. Methods: Study was conducted in the National Hepatology and Tropical Medicine Research institute (NHTMRI) Cairo, Egypt. It included 66 mild COVID-19 adult patients (group1) and their 82 asymptomatic contact children (group 2). Results: In group 1, both C reactive protein (CRP) and D-dimer levels were significantly high. C reactive protein was significantly positively correlated with urinary microalbumin> 30, albumin/ creatinine ratio and urine pus >10 cells / HPF and significantly negatively correlated with vitamin C. D-dimer was significantly negatively correlated with vitamin C. In group 2, CRP and D-dimer were significantly negatively correlated with urine specific gravity (SG), urinary vitamin C. CRP was significantly negatively correlated with stool pus > 10 cells/ HPF, while D-dimer was significantly positively correlated with stool occult blood. Receiver Operating Curve (ROC) analysis revealed that urine SG showed the highest area under the curve (AUC); 0.859, 0.96, sensitivity of 100%, 100% and specificity of 71.8%, 77.8% with reference to D-dimer and CRP; respectively. Conclusions: In contact children of adult COVID-19 proved infection, urine SG, stool occult blood and stool pus > 10 cells/ HPF can be feasible tool for suspected COVID-19 infection, based on its results COVID-19 PCR request can be an imperative option to confirm the diagnosis; particularly in developing countries where detection of COVID -19 by PCR is not readily feasible.

Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti-Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10).Conclusion This study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.

Azza GA Farag,1 Hesham N Khaled,1 Mostafa A Hammam,1 Mustafa Elsayed Elshaib,2 Nermin Reda Tayel,3 Sahar Elsoudy Ibrahim Hommos,4 Eman Masoud Abd El Gayed5 1Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt; 2Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt; 3Department of Molecular Diagnostics and Therapeutics, Genetic Engineering Biotechnology Research Institute, Sadat City, Egypt; 4Dermatology Department, Elsherouk General Hospital, Cairo, Egypt; 5Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Shibin El Kom, EgyptCorrespondence: Azza GA FaragDermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shibin El Kom 32511, EgyptTel +20 109 778 7204Fax +20 2482 226 454Email azzagaber92@yahoo.comBackground: Keloids represent chronic fibroproliferative skin disorders in which there is deposition of extracellular components, especially type 1 collagen, fibronectin and elastin, in excessive amounts. NEDD4 is associated with fibrosis found in abnormal wound healing through increased fibroblast proliferation and regulation of type 1 collagen expression. The exact etiology of keloid formation is undefined, but the role of genetic factors was demonstrated.Objective: To investigate the polymorphism of the NEDD4 gene rs8032158 in a sample of Egyptian patients who have keloids.Methods: The current case–control study was conducted in 160 unrelated subjects; 100 keloid patients and 60 ages and sex coincided with apparently healthy controls. All subjects underwent a complete history, and weight and length were measured to calculate body mass index (BMI). The Vancouver Scar Scale (VSS) was used to assess keloid severity. An analysis of the polymorphism of the NEDD4 gene rs8032158 T/C was performed using taqman allelic discrimination (real-time PCR).Results: The rs8032158 CC genotype was observed significantly in keloid patients and increased the risk of keloid development by approximately 2 times (p = 0.003, OR = 1.80). The C allele significantly increased the risk of keloid development by approximately 2 times (P = 0.002, OR = 2.08). The carriers of the CC genotype were significantly associated with severe keloid form and with the highest VSS values.Conclusion: The polymorphism of the NEDD4 gene rs8032158 could participate in the formation of keloids in the Egyptian population. The NEDD4 rs8032158 CC genotype may have a role in keloid severity.Keywords: NEDD4, keloid, gene polymorphism

Wiam Elshami, Mohamed M Abuzaid, H O Tekin Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Wiam Elshami Email welshami@sharjah.ac.aePurpose: This study assessed the effectiveness of breast and eye shielding and measured the radiation dose to radiosensitive tissues (eyes and breasts) due to scatter radiation during cervical spine X-ray radiography examinations.Methods: Using an anthropomorphic phantom, the scattered radiation dose was measured before and after the placement of the lead shield over the eyes and breasts in the anteroposterior (AP) and left lateral projection. A regression formula was utilized to determine the exposure. Mean values and standard deviation of breasts and eyes doses were calculated. The paired two sample t-test was used to compare the recorded dose before and after shielding placement.Results: Radiation shielding of eyes and breasts during AP cervical spine X-ray decreased radiation dose to the breasts by 99.9% and to the left and right eye by 91% and 89%, respectively. For the left lateral cervical spine X-ray, the radiation dose decreased by 26% and 31% for the left and right eye, respectively, and by 23% and 99% for the left and right breast, respectively. A significant difference was noted comparing the dose before and after the implementing shielding on the eye and breast.Conclusion: According to the results presented, the dose is significantly reduced, especially considering that they are not in the area of interest but are exposed to scatter radiation.Keywords: radiation exposure, radiation dose, radiation protection, ALARA, radiography

Abstract Background Epidemiological studies suggested that determinants for antibiotic resistance have originated in aquaculture. Recently, the integrated agriculture-aquaculture system has been implemented, where fish are raised in ponds that receive agriculture drainage water. The present study aims to investigate the occurrence of β-lactamase and carbapenemase-producing Enterobacteriaceae in the integrated agriculture-aquaculture and the consequent public health implication. Methods Samples were collected from fish, fishpond water inlets, tap water, outlet water, and workers at sites of integrated agriculture-aquacultures. Samples were also taken from inhabitants of the aquaculture surrounding areas. All samples were cultured on MacConkey agar, the Enterobacteriaceae isolates were tested for susceptibility to cephalosporins and carbapenems, and screened for bla CTX-M-15, bla SHV, bla OXA-1, bla TEM, bla PER-1, bla KPC, bla OXA-48, and bla NDM. Strains having similar resistance phenotype and genotype were examined for the presence of Incompatible (Inc) plasmids. Results A major proportion of the Enterobacteriaceae isolates were resistant to cephalosporins and carbapenems. Among the 66 isolates from fish, 34 were resistant to both cephalosporin and carbapenem groups, 26 to carbapenems alone, and 4 to cephalosporins alone. Of the 15 isolates from fishpond water inlets, 8 showed resistance to both groups, 1 to carbapenems alone, and 5 to cephalosporins alone. Out of the 33 isolates from tap water, 17 were resistant to both groups, and 16 to cephalosporins alone. Similarly, of the 16 outlet water isolates, 10 were resistant to both groups, and 6 to cephalosporins alone. Furthermore, of the 30 examined workers, 15 carried Enterobacteriaceae resistant strains, 10 to both groups, and 5 to cephalosporins alone. Similar strains were isolated from the inhabitants of the aquaculture surrounding areas. Irrespective of source of samples, strains resistant to all examined antibiotics, carried predominantly the carbapenemase gene bla KPC either alone or with the β-lactamase genes (bla CTX-M-15, bla SHV, bla TEM, and bla PER-1). The isolates from fish, water, and workers harboured a wide-range of multi-drug-resistance Inc. plasmids, which were similar among all isolates. Conclusion The present findings suggest transmission of the resistance genes among Enterobacteriaceae strains from different sources. This reiterates the need for control strategies that focus on humans, animals, water, and sewage systems to solve the antibiotic resistance problem.

Kristin Lang, 1– 3 Rami A ElShafie, 1– 3 Sati Akbaba, 1– 3 Ronald Koschny, 4 Nina Bougatf, 1– 3, 5 Denise Bernhardt, 1– 3, 5 Stefan E Welte, 1– 3, 5 Sebastian Adeberg, 1– 3, 5 Matthias Häfner, 1– 3, 5 Steffen Kargus, 6 Peter K Plinkert, 7 Jürgen Debus, 1– 3, 5, 8 Stefan Rieken 1– 3, 5, 8 1Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany; 2Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany; 3National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany; 4Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany; 5Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany; 6Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany; 7Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany; 8Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, GermanyCorrespondence: Kristin LangDepartment of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, GermanyTel +49-6221-56-8202Fax +49-6221-56-5353Email Kristin.Lang@med.uni-heidelberg.deBackground and aim: The primary aim of our study was to evaluate percutaneous endoscopic gastrostomy (PEG) tube placement depending on body weight and body mass index in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). A secondary aim was to evaluate the course of weight change following PEG placement.Methods: We retrospectively reviewed the medical records of 186 patients with HNC undergoing radiotherapy (RT) or chemoradiotherapy (CRT) at our institution between January 2010 and August 2017. Initial weight and nutritional intake were analyzed prior to RT initiation and then followed throughout treatment until completion. Based on these data, the indication of PEG placement was determined. Medical records were also reviewed to analyze PEG-related acute toxicities.Results: A total of 186 patients met inclusion criteria. Patients were most commonly male (n=123, 66.1%) with squamous cell carcinoma (n=164, 88.2%). Patients who had dysphagia prior to treatment initiation as well as patients with a BMI 2 needed PEG placement earlier during the treatment course. Low-grade toxicities related to PEG insertion were observed in 10.7% patients, with peristomal pain and redness adjacent to the PEG tube insertion site being most common. High-grade toxicities, such as peritonitis and organ injury, were found in 4.9% of patients.Conclusion: Underweight patients and those with preexisting dysphagia should be closely screened during RT for weight loss and decreased oral intake. For weight loss greater than 4.5% during the treatment of HNC, early PEG-tube placement should be considered. Further prospective studies are needed to confirm these findings, and delineate a scoring system for timing of PEG use (prophylactic vs reactive) as well as assess the quality of life in patients with HNC who receive PEG placement.Keywords: head and neck cancer, radiotherapy, PEG placement, body mass index, toxicity

Background: The SARS-CoV-2 Omicron spread fast globally and became the predominant variant in many countries. Resumption of public regular life activities, including in-person schooling, presented parents with new sources of worry. Thus, it is important to study parental worry about the Omicron variant, willingness to vaccinate their children, and knowledge about school-based COVID-19 precautionary measures. Methods: A national, cross-sectional, pilot-validated online questionnaire targeting parents in the Kingdom of Saudi Arabia (KSA) was distributed between 31 December 2021, and 7 January 2022. The survey included sociodemographic, COVID-19 infection data, parental and children vaccination status, attitudes towards booster vaccine, parents’ Omicron-related perceptions and worries, and attitude towards in-person schooling. Results: A total of 1340 participants completed the survey, most (65.3%) of whom were mothers. Of the parents, 96.3% either received two or three doses of the COVID-19 vaccine. Only 32.1% of the parents were willing to vaccinate their young children (5–11 years of age). In relation to their children 12–18 years of age, 48% had already had them vaccinated, 31% were planning to vaccinate them, and 42.8% were willing to administer a booster dose. Only 16% were more worried about the Omicron variant compared to the Delta variant. Residents of western KSA were more worried about Omicron compared to Delta. Parents worried about the Omicron variant and male participants were significantly less aware of school-based COVID-19 precautionary measures. Parents with post-graduate degrees and those having more children were significantly more inclined to send their children to school even if COVID-19 outbreaks could occur in schools, while parents who were more worried about the Omicron variant and were more committed to infection prevention measures were significantly less inclined to do so. Conclusions: Overall, parents had lower worry levels about the Omicron variant compared to the Delta variant. They had a higher willingness to vaccinate their older children compared to the younger ones. In addition, our cohort of parents showed high willingness to send their children to schools and trusted the school-based preventative measures. These findings can inform policy makers when considering school related decisions during the current or future public health crises.

Background: Theileria annulata is a tick-borne protozoan parasite responsible for bovine theileriosis, a disease that impacts cattle population in many developing countries. Development and deployment of effective control strategies, based on vaccine or therapy, should consider the extent of diversity of the parasite and its population structure in different endemic areas. In this study, we examined T. annulata in Pakistan and carried out a comparative analysis with similar data garneted in other areas, to provide further information on the level of parasite diversity and parasite genetic structure in different endemic areas. Methods: The present study examined a set of 10 microsatellites/minisatellites and analyzed the genetic structure of T. annulata in cattle breeds from Pakistan (Indian sub-continent) and compared these with those in Oman (Middle East), Tunisia (Africa), and Turkey (Europe). Result: A high level of genetic diversity was observed among T. annulata detected in cattle from Pakistan, comparable to that in Oman, Tunisia, and Turkey. The genotypes of T. annulata in these four countries form genetically distinct groups that are geographically sub-structured. The T. annulata population in Oman overlapped with that in the Indian Subcontinent (Pakistan) and that in Africa (Tunisia). Conclusions: The T. annulata parasite in Pakistan is highly diverse, and genetically differentiated. This pattern accords well and complements that seen among T. annulata representing the global endemic site. The parasite population in the Arabian Peninsula overlapped with that in the Indian-Subcontinent (India) and that in Africa (Tunisia), which shared some genotypes with that in the Near East and Europe (Turkey). This suggests some level of parasite gene flow, indicative of limited movement between neighboring countries.

Aim: To compare the role of chest US and bedside plain chest radiography in the evaluation of intensive care patients having pleural effusion and pneumothorax. Chest computed tomography has been used as an ideal standard. Patients and methods: Sixty critically ill patients with chest troubles and positive CT, were be studied with chest US and bedside CXR .Two pathologic abnormalities were be evaluated: pneumothorax and pleural effusion. Each hemithorax had been examined for the existence or absence of each pathology. All patients had been assessed by clinical examination of chest, full clinical history, laboratory assessment. All patients who had pleural effusion underwent US guided FNAC. Results: One hundred twenty hemithoraces had been investigated by the three imaging techniques. The sensitivity, specificity and diagnostic accuracy of bedside CXR were 54.5, 96 and 83.3% for pneumothorax and 76.2, 70.6 and 75% for pleural effusion, respectively. The corresponding values for chest US were 85.7, 97.9 and 95.2% for pneumothorax and 100, 100, and 100% for pleural effusion, respectively. Conclusions: In evaluation of ICU patients with pleural effusion and pneumothorax, chest US is the first bedside tool with high diagnostic performance. These chest conditions are urgent especially in seriously ill patients, as both need US guided drainage. Chest US has many advantages, including non invasive examination in multiple planes, free of radiation hazard, less expensive, real-time, high sensitivity and diagnostic accuracy in chest lesions detection. Lung ultrasound is being exclusive than bedside chest X-ray and equal to chest CT in diagnosing pleural effusion and pneumothorax.

Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure developed for the care of patients with short-term respiratory and/or cardiac issues (MacLaren et al., 2011). ECMO patients must be monitored twenty-four hours a day by an ECMO-trained multidisciplinary team. The trained healthcare professional needs to watch over fifty variables and rapidly intervene to assess and resolve any given emergency. Hence hands on training is very important for ECMO professionals to develop rapid and correct actions upon different scenarios. Simulation based training (SBT) offers ECMO practitioners an opportunity to develop the skills needed for the initiation of the ECMO procedure and the care of ECMO patients without exposing patients to undue risks (Al Disi et al., 2018). For ECMO to work, cannulation is required to reroute the blood flow to the machine rather than the lung and/or heart. Cannulation is the insertion of a cannula through the blood vessels. In collaboration with Hamad Medical Corporation (HMC), the main healthcare provider in Qatar, the aim of this project is to develop an effective, economical realistic, user-friendly, low-cost, and a multi-functional high-fidelity cannulation simulation mannequin. Keywords: Extracorporeal Membrane Oxygenation, ECMO, Medical training, Cannulation, Healthcare

A country’s economy has a special role in a country’s defense. The organization of the national defense is carried out not only through the development of national armed forces, but also by increasing the sustainability of the economic activity for provision of the State and population demands during war. For this reason, development of the economic potential, taking necessary measures for preparation and sustainability of labor, material and financial resources are one of the significant issues and studying the conceptual, legal and economic issues related to the duties of the economy in the organization of state defense in Azerbaijan is very crucial.

Self-mutilation is the deliberate direct injuring of body tissue, often done without suicidal intention. Genital self-mutilation is a very rare event and self-harm of the penis, especially in the genital system is exceedingly rare. Generally, this kind of behavior is related to psychotic disorders but can sometimes be seen in non-psychotic people due to bizarre autoerotic acts, a desire for to change sex or religious beliefs that view sexual intercourse as a sin. Our case was the reported genital self-mutilation as a result of the bizarre sexual arousal of a young man who is employed as an architect.

Epstein-Barr virus (EBV) is a human herpes virus that infects over 90% of the world’s population and is linked to development of cancer. In immune-competent individuals, EBV infection is mitigated by a highly efficient virus-specific memory T-cell response. Risk of EBV-driven cancers increases with immune suppression (IS). EBV-seronegative recipients of solid organ transplants are at high risk of developing post-transplant lymphoproliferative disease (PTLD) due to iatrogenic IS. While reducing the level of IS may improve EBV-specific immunity and regression of PTLD, patients are at high risk for allograft rejection and need for immune-chemotherapy. Strategies to prevent PTLD in this vulnerable patient population represents an unmet need. We have previously shown that BZLF1-specific cytotoxic T-cell (CTL) expansion following reduced IS correlated with immune-mediated PTLD regression and improved patient survival. We have developed a vaccine to bolster EBV-specific immunity to the BZLF1 protein and show that co-culture of dendritic cells (DCs) loaded with a αDEC205-BZLF1 fusion protein with peripheral blood mononuclear cells (PMBCs) leads to expansion and increased cytotoxic activity of central-effector memory CTLs against EBV-transformed B-cells. Human–murine chimeric Hu-PBL-SCID mice were vaccinated with DCs loaded with αDEC205-BZLF1 or control to assess prevention of fatal human EBV lymphoproliferative disease. Despite a profoundly immunosuppressive environment, vaccination with αDEC205-BZLF1 stimulated clonal expansion of antigen-specific T-cells that produced abundant IFNγ and significantly prolonged survival. These results support preclinical and clinical development of vaccine approaches using BZLF1 as an immunogen to harness adaptive cellular responses and prevent PTLD in vulnerable patient populations.

Objective: Pregnant people pose some challenge to the intensivists and their management is clinically important in the intensive care unit (ICU). Thrombotic events and pulmonary embolism (PE) is one of the most important causes of maternal morbidity and mortality. The aim of this study is to evaluate the incidence, diagnostic approaches, therapeutic interventions, intensive care management and outcome of parturient admitted to obstetric intensive care which were suspected to have PE. Materials and Methods: In this study, all pregnant or postpartum women with the sign or symptoms of PE which admitted to obstetric ICU of Alzahra teaching hospital during 5 years were reviewed. Demographic data, clinical signs or symptoms, diagnostic approaches, patient management and final outcome of the patients were collected, noted and analyzed. Results: Totally 200 parturient with the suspicion to have PE were admitted to ICU during 5 years. Mean age, weight and height of patients were 26.61 ± 4.28 years, 75.24 ± 3.06 kg and 157.87±7.89 cm, respectively. 136 (68%) patients were assessed carefully with imaging techniques and pulmonary emboli PE was ruled out in 124 (62%) patients whose CT was normal and 76 (38%) revealed unilateral (59 patients) or bilateral (8 patients) PE. Mean admission time was 7 days and overall mortality was 2.6% (2 patients). Conclusion: PE is an important cause of pregnancy-related mortality and morbidity and can mimic many other clinical conditions. However, high index of suspicion, accurate diagnostic approaches and timely prophylaxis and therapy can prevent maternal mortality.

Sittana Elshafie,1,2 Saad J Taj-Aldeen2,3 1Qatar Orthopedic and Sports Medicine Hospital, Aspetar, Doha, Qatar; 2Weill Cornell Medicine-Qatar, 3Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar Background: Streptococcus pneumoniae is the leading cause of meningitis and sepsis. The aim of the study was to analyze the distribution, vaccine serotype coverage, and antibiotic resistance of S. pneumoniae serotypes isolated from patients with invasive diseases, after the introduction of pneumococcal 7-valent conjugated vaccine (PCV-7). Methods: A total of 134 isolates were collected from blood and cerebrospinal fluid specimens at Hamad Hospital during the period from 2005 to 2009. Isolate serotyping was done using the Quellung reaction. The prevaccination period was considered before 2005. Results: The most common serotypes for all age groups were 3 (12.70%), 14 (11.90%), 1 (11.90%), 19A (9.00%), 9V (5.20%), 23F (5.20%), and 19F (4.50%). Coverage rates for infant

The derivatives of isatin have already been reported to show a variety of biological activities. However, there has been no report on solvatochromic effect of isatin derivatives so far, and that could be of interest to study and relate to their electronic structure, as a part of the characterisation of these compounds. Linear solvation energy relationships (LSER) were used to analyze solvent influence on the UV absorption maxima shifts of investigated isatin derivatives, i.e. isatin based Schiff bases, by using Kamlet-Taft model. Linear free energy relationships (LFER) were applied to the substituent-induced NMR chemical shifts (SCS) using SSP (single substituent parameter). The obtained correlations together with theoretical calculations gave insight into the influence of the molecular conformation on the transmission of substituent effects, as well as on solute/solvent interactions. The molecular electrostatic potential (MEP) surface map was plotted over the optimized geometry of the molecules in order to visualize electron density distribution and explain origin of solvent/solute interactions. [Projekat Ministarstva nauke Republike Srbije, br. 172013]

SARS-CoV-2 has affected people from all age groups, races and ethnicities. Given that many infected individuals are asymptomatic, they transmit the disease to others unknowingly, which has resulted in the spread of infection at an alarming rate. This review aims to provide an overview of the pathophysiology, preventive measures to reduce the disease spread, therapies currently in use, an update on vaccine development and opportunities for vaccine delivery. The World Health Organization has advised several precautions including social distancing, hand washing and the use of PPE including gloves and face masks for minimizing the spread of SARS-CoV-2 infection. At present, several antiviral therapies previously approved for other infections are being repositioned to study their efficacy against SARS-CoV-2. In addition, some medicines (i.e., remdesivir, chloroquine, hydroxychloroquine) have received emergency use authorisation from the FDA. Plasma therapy has also been authorised for emergency use for the treatment of COVID-19 on a smaller scale. However, no vaccine has been approved so far against this virus. Nevertheless, several potential vaccine targets have been reported, and development of different types of vaccines including DNA, mRNA, viral vector, inactivated, subunit and vaccine-like particles is in process. It is concluded that a suitable candidate delivered through an advanced drug delivery approach would effectively boost the immune system against this coronavirus.

The hybrid hydrogen storage method consists of the combination of both solid-state metal hydrides and gas hydrogen storage. This method is regarded as a promising trade-off solution between the already developed high-pressure storage reservoir, utilized in the automobile industry, and solid-state storage through the formation of metal hydrides. Therefore, it is possible to lower the hydrogen pressure and to increase the hydrogen volumetric density. In this work, we design a non-stoichiometric AB2 C14-Laves alloy composed of (Ti0.9Zr0.1)1.25Cr0.85Mn1.1Mo0.05. This alloy is synthesized by arc-melting, and the thermodynamic and kinetic behaviors are evaluated in a high-pressure Sieverts apparatus. Proper thermodynamic parameters are obtained in the range of temperature and pressure from 3 to 85 °C and from 15 to 500 bar: ΔHabs. = 22 ± 1 kJ/mol H2, ΔSabs. = 107 ± 2 J/K mol H2, and ΔHdes. = 24 ± 1 kJ/mol H2, ΔSdes. = 110 ± 3 J/K mol H2. The addition of 10 wt.% of expanded natural graphite (ENG) allows the improvement of the heat transfer properties, showing a reversible capacity of about 1.5 wt.%, cycling stability and hydrogenation/dehydrogenation times between 25 to 70 s. The feasibility for the utilization of the designed material in a high-pressure tank is also evaluated, considering practical design parameters.

The original article [1] incorrectly presents final author, Eugene H. Johnson’s name incorrectly whereby middle initial, ‘H.’ is mistakenly presented as a Family Name.

Infertility has become a common occurrence in males. Oxidant stress has become one of the most common causes of infertility. X-irradiation, or exposure to environmental toxicants and the physical conditions of varicocele and cryptorchidism have been demonstrated to increase testicular oxidative stress. The resultant oxidant stress may lead to an increase in germ cell apoptosis and subsequent hypospermatogenesis. This may result in changes in the dynamics of testicular microvascular blood flow, endocrine signaling, and germ cell apoptosis. Oxidative stress, therefore, becomes a major and the most probable finding associated with male infertility. This raises a possibility of application of antioxidant therapy that could help alleviate the reduced spermatogenesis.