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Abstract Background People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). Methods A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021–3/31/2021) and fidelity scores (baseline: 5/1/21–7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021–3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. Results GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). Conclusion Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. Trial registration ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .

Abstract This article outlines the synthesis of two derivatives of 4-amino-5-hydrazineyl-4H-1,2,4-triazole-3-thiol for the prevention of carbon steel corrosion in 1M HCl solution. These derivatives are (Z)-3-(1-(2-(4-amino-5-mercapto-4H-1,2,4-triazol-3-yl)hydrazono)ethyl)-2H-chromen-2-one (TZ1) and 5-(2-(9H-fluoren-9-ylidene)hydrazineyl)-4-amino-4H-1,2,4-triazole-3-thiol (TZ2). Weight loss, electrochemical experiments, surface examinations, and theoretical computation are used to evaluate the effectiveness of the two compounds to be used as corrosion inhibitors. Weight loss and electrochemical studies demonstrate that these derivatives reduce the corrosion rate of carbon steel. To examine the morphology and constitution of the carbon steel surface submerged in HCl solution as well as after adding inhibitors, surface examination tests are performed. Analysis of the test solution via UV–visible spectroscopy is employed to check the possibility of complex formation between inhibitor molecules and Fe2+ ions released during the corrosion process. In order to explore their biological activity, the antibacterial activity was investigated against (E. coli and Bacillus subtilis). Finally, theoretical confirmation of the experimental findings is provided by quantum chemical (DFT) and Monte Carlo (MC) simulation studies. More adsorption sites are present in the derivatives of 4-amino-5-hydrazineyl-4H-1,2,4-triazole-3-thiol, which offer a novel perspective for developing new classes of corrosion inhibitors with substantial protective efficacy, especially at high temperatures.

Maesa indica Roxb. Sweet is a shrub known for its richness in secondary metabolites. A callus culture protocol was established to enhance its chemical profile. Sixteen elicitation culture treatments were evaluated, and we confirmed that the treatment of 200 mg/L polyethylene glycol (4000) coupled with exposure to 30 W UV irradiation for 60 min (PEG4) resulted in the highest total phenolic and total flavonoid contents, which were 4.1 and 4.9 times those of the plant ethanolic extract and 4.9 and 4.8 times those of a control sample, respectively. The phenolic compounds in the different treatments were identified qualitatively and quantitatively using the LC-ESI-MS/MS-MRM technique. Molecular docking studies of the phenolic compounds were conducted using MOE software and revealed that rutin showed the highest binding affinity toward the anti-cancer target (p38α MAPK). The cytotoxicity of the ME and PEG 4 treatment was tested against colon, breast, prostate, lung, and liver cell lines using an MTT assay. The highest cytotoxic effect of PEG4 was against prostate cancer with an IC50 value of 25.5 µg/mL. Hence, this study showed enhanced secondary metabolite accumulation and identified the phenolic compounds in the 16 treatments. The cytotoxicity assay highlighted the possible cytotoxic effect of the PEG4 treatment, and we recommend further investigations into its activity.

Abstract Background Lumbosacral plexus is a collection of nerves that converge and diverge and finally merge into terminal nerves that innervate the pelvis and lower limbs. Lumbosacral plexopathy is a clinical disease characterized by motor and sensory abnormalities that can result from damage to the lumbosacral plexus by different types of insults. Electrophysiological studies are used to demonstrate the presence of lumbosacral radiculo-plexopathy, but it is restricted owing to deep position of nerves and regional differences in muscle nerve supply. High-resolution MR neurography can simply show the precise site, size, etiology, and type of the lumbosacral radiculo-plexopathy. The aim of this study was to assess the various diseases affecting the lumbosacral plexus with their 1.5-T MR neurography imaging findings and to correlate these findings with electrophysiological studies. Results Fifty adult patients with clinical presentation of lumbosacral radiculo-plexopathy were included in this cross-sectional study. Based on clinical diagnosis, the sensitivity of electrophysiological studies in diagnosing lumbosacral radiculo-plexopathy was 80% and the sensitivity of MR neurography in diagnosing lumbosacral radiculo-plexopathy was 90%. While based on electrophysiological studies, the sensitivity of MR neurography in diagnosing lumbosacral radiculo-plexopathy was 97.5% and the specificity was 75.86%. There was a high statistically significant relation between the side affected in electrophysiological studies and the side affected in MR neurography and between the stage of the lesion in the electrophysiological studies and in MR neurography among patients (p ≤ 0.001, p ≤ 0.001) , respectively. Conclusions MR neurography of the lumbosacral plexus is a helpful non-invasive approach for the assessment of patients with inconclusive lumbar spine MR imaging because of its ability for diagnosis of neuromuscular lesions and determining their causes. Electrophysiological studies assess the nerve function and MR neurography assesses the nerve anatomy, and therefore, the correlation between electrophysiological studies and MR neurography are complementary for detection of lumbosacral radiculo-plexopathy.

Abstract Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by having varying clinical presentation, severity, unpredictable course as well as outcomes. Recent disease-modifying conventional and biologic agents have enhanced rates of attaining both short- and long-term management goals, including minimization of glucocorticoid dose and use. This study was carried out to develop an up-to-date evidence-based, consensus on clinical practice guidelines for treat-to-target management of systemic lupus erythematosus in adults. Results The response rate to the online questionnaires, sent to the expert panel who participated in the three rounds, was 95.5%. At the end of round 3, a total of 14 recommendation sections were proposed for the T2T management of patients with SLE. Agreement with the recommendations (rank 7–9) ranged from 90.9–100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the proposed statements. Conclusion These recommendations provide a consensus on the treat-to-target management of patients with SLE. They provide strategies to reach optimal outcomes in common clinical scenarios, based on a combination of evidence and expert opinion.

ABSTRACT: Respiratory health problems in poultry production are frequent and knotty and thus attract the attention of farmers and researchers. The breakthrough of gene sequencing technology has revealed that healthy lungs harbor rich microbiota, whose succession and homeostasis are closely related to lung health status, suggesting a new idea to explore the mechanism of lung injury in broilers with pulmonary microbiota as the entry point. This study aimed to investigate the succession of pulmonary microbiota in healthy broilers during the growth cycle. Fixed and molecular samples were collected from the lungs of healthy broilers at 1, 3, 14, 21, 28, and 42 d of age. Lung tissue morphology was observed by hematoxylin and eosin staining, and the changes in the composition and diversity of pulmonary microbiota were analyzed using 16S rRNA gene sequencing. The results showed that lung index peaked at 3 d, then decreased with age. No significant change was observed in the α diversity of pulmonary microbiota, while the β diversity changed regularly with age during the broilers’ growth cycle. The relative abundance of dominant bacteria of Firmicutes and their subordinate Lactobacillus increased with age, while the abundance of Proteobacteria decreased with age. The correlation analysis between the abundance of differential bacteria and predicted function showed that dominant bacteria of Firmicutes, Proteobacteria and Lactobacillus were significantly correlated with most functional abundance, indicating that they may involve in lung functional development and physiological activities of broilers. Collectively, these findings suggest that the lung has been colonized with abundant microbiota in broilers when they were just hatched, and their composition changed regularly with day age. The dominant bacteria, Firmicutes, Proteobacteria, and Lactobacillus, play crucial roles in lung function development and physiological activities. It paves the way for further research on the mechanism of pulmonary microbiota-mediated lung injury in broilers.

Heavy metals contamination of water is a serious and complex environmental problem due to rapid industrialization, bioaccumulation and non-degradability. Therefore, the reuse of agricultural waste in the process of purifying water from pollutants is an attractive and promising method. Almost inexpensive materials are used to purify water, thus achieving the desired economic and environmental goal. In this study banana peel (BP) was used before and after modification by 0.1M sulphuric acid (H2SO4) to enhance the removal of Zinc Zn(II), Lead Pb(II) and Nickel Ni(II). The effect of various parameters was studied Such as pH, contact time, adsorbent dosage and initial metal ion concentration at 5 ppm. All these parameters were studied in batch experiments for a comparative study. The removal percentage was found to be 84% Zn (II),78%Pb (II) and 72% Ni (II) before modification and 92% Zn (II) , 94% Pb (II) and 96% Ni (II) after modification at initial concentration of 5 ppm. The data obtained from sorption isotherms were described with Langmuir and Freundlich isotherm models but were found to be well fitted for the Langmuir model. The correlation coefficient values R2 for Langmuir were at the range (0.996-0.999) while that for Freundlich were at the range (0.912-0.972). The rate of adsorption follows Pseudo-second-order kinetics. This work proved the high banana peels efficiency as an adsorbent agent for heavy metals removal from aqueous solutions.

Abstract Background Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring. Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 19 recommendation items, categorized into 11 sections to address the main LN categories, were obtained. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 90.5 to 100%. The phrasing of all 19 clinical standards identified by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion These recommendations provide an updated consensus on the pharmacological treatment of lupus nephritis and strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Abstract Background Nephritis is known to be one of the most serious complications of lupus and a strong predictor of poor outcome. This study was carried out aiming at setting up an up-to-date recommendation for the management of women living with lupus nephritis and planning for a family throughout conception, pregnancy, and the postpartum period. Ten key clinical questions were identified by the scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. The literature review team performed a systematic review to summarise evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for women living with lupus nephritis (LN) and planning for a family. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-Based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 20 recommendation items, categorised into 10 domains to address the main LN with pregnancy categories, were obtained. The percentage of those who agreed with the recommendations (rank 7–9) ranged from 88.5 to 100%. On the phrasing of all the clinical standards defined by the scientific committee, a consensus was reached (i.e., 75% of respondents strongly agreed or agreed). An algorithm for the management of LN with pregnancy has been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of LN with pregnancy and strategies to reach optimal outcomes for both the mother and newborn in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient’s situation.

Abstract Background Combined ilioinguinal-iliohypogastric (IIN/IHN) block and transverse abdominis plane (TAP) block are used under ultrasound (USG) visualization for postoperative pain control in patients undergoing inguinal hernia repair surgery. This study compares USG-guided TAP versus IIN/IHN block for post-operative analgesia efficacy in adults undergoing inguinal hernia surgery, among 100 patients randomized into group A received TAP block by using levobupivacaine 0.5% 25 ml and group B received IIN+IHN blocks by using levobupivacaine 0.5% 10 ml before induction of general anesthesia. Results The mean duration (in minutes) to require rescue analgesia was found to be 1003.2 ± 99.6 (min) in group A and 1317 ± 69 (min) in group B. In a comparison of these two values the difference in the meantime to rescue analgesic requirement was statistically significant (p

Objective: Primary care physicians are the first means of access to further healthcare services and act as a doorkeeper for different specialties at the secondary and tertiary levels; thus, communication skills are one of the most vital skills to be taught to residents in the family medicine specialty. This study aimed to evaluate the communication skills of family medicine residents in Oman from the perspective of their patients. Methods: This cross-sectional study was performed at the Family Medicine and Public Health Clinic of Sultan Qaboos University Hospital as well as various Ministry of Health training health centers in Muscat, Oman. An Arabic version of the validated 14-item Communication Assessment Tool (CAT) was used to evaluate patients’ perceptions regarding the communication skills of family medicine residents at the end of their consultation. Data were collected between September 2020 and May 2021 from 602 patients who received care or interacted with 60 residents from the Oman Medical Specialty Board (OMSB) Family Medicine Residency Program at different residency levels. Results: The mean percentage of CAT items rated as excellent was 73.8±32.6%. The item “Treated me with respect” was most commonly rated as excellent (84.2%), whilst the item “Involved me in decisions as much as I wanted” was least frequently rated as excellent (62.0%). Various factors were found to significantly affect CAT rating, including residency level, type of clinic, number of times seeing the same resident, and the patient’s education level. In contrast, other factors such as time of consultation, the gender of either the resident or the patient, and the nationality of the patient did not affect CAT rating. Conclusion: Some areas of weakness especially with the item “encouraged me to ask questions” and involved me in decisions as much as I wanted” identified in the communication skills of OMSB family medicine residents. These findings are comparable with those reported by similar studies worldwide.

Maesa indica Roxb. Sweet is a shrub known for its richness in secondary metabolites. A callus culture protocol was established to enhance its chemical profile. Sixteen elicitation culture treatments were evaluated, and we confirmed that the treatment of 200 mg/L polyethylene glycol (4000) coupled with exposure to 30 W UV irradiation for 60 min (PEG4) resulted in the highest total phenolic and total flavonoid contents, which were 4.1 and 4.9 times those of the plant ethanolic extract and 4.9 and 4.8 times those of a control sample, respectively. The phenolic compounds in the different treatments were identified qualitatively and quantitatively using the LC-ESI-MS/MS-MRM technique. Molecular docking studies of the phenolic compounds were conducted using MOE software and revealed that rutin showed the highest binding affinity toward the anti-cancer target (p38α MAPK). The cytotoxicity of the ME and PEG 4 treatment was tested against colon, breast, prostate, lung, and liver cell lines using an MTT assay. The highest cytotoxic effect of PEG4 was against prostate cancer with an IC50 value of 25.5 µg/mL. Hence, this study showed enhanced secondary metabolite accumulation and identified the phenolic compounds in the 16 treatments. The cytotoxicity assay highlighted the possible cytotoxic effect of the PEG4 treatment, and we recommend further investigations into its activity. [ABSTRACT FROM AUTHOR]

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Abstract Background Depression and anxiety are non-motor symptoms of Parkinson’s disease (PD) that are often overlooked and underrated. This study aimed to highlight the frequency and risk factors of depression and anxiety among subjects with PD. Methods Sixty-four patients with PD who were diagnosed according to United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria and 50 sex- and age-matched healthy control subjects are evaluated for depression and anxiety. PD severity and staging were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale. Depression and anxiety were diagnosed using DSM-IV TR criteria and scored using Hamilton Depression and Hamilton Anxiety Rating Scales (HAM-D and HAM-A). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess impact of depression and anxiety on quality of life. Results 31.25% of patients with PD had depression while 40.6% of patients had anxiety disorder. Depression was higher in females and patients with history of depression and low socioeconomic status (SES). Anxiety was common in young patients and those who had history of anxiety. Overlap between depression and anxiety was recorded in 23.4%. Total UPDRS and Hoehn and Yahr scale accounted for 33.4% of variance for depression. Total UPDRS and earlier age of onset accounted for 39% of variance for anxiety. Advanced disease stage and severity were independent predictors for depression while disease severity and younger age of onset were the main predictors for anxiety. Depression and anxiety have a negative impact on the overall quality of life of PD patients especially on physical and psychosocial domains. Conclusion Depression and anxiety are relatively common in PD. Female gender, low SES, and history of depression were the main risk factors for developing depression. Young age and history of anxiety were risk factors for anxiety. Both had negative impact on quality of life.

Abstract Background Intolerance to MTX is the most common cause of non-compliance that leads to poor disease control. Treatment is usually discontinued due to intolerance which interferes with compliance of the patient to long-term treatment. Caffeine causes most of its biological effects via antagonizing all types of adenosine receptors (ARs). Our aim was to investigate the effect of caffeine intake on reducing symptoms of MTX intolerance in patients with RA. Methods Ninety patients were diagnosed as RA with MTX intolerance divided into 2 groups. Sixty patients were prescribed caffeine or dark chocolate. Control group included 30 patients who will continue MTX regimen without addition of any extra caffeine. Results Group A (caffeine group): There was no statistically significant difference between patients and controls at the start of the study. There was statistically significant decrease in methotrexate intolerance severity score (MISS) all over the study period (P = 0.001), and also MISS was statistically significantly lower in each follow-up time when compared with time 0 (P = 0.001). Group B (control group): There was statistically significant increase in MISS all over the study period (P = 0.017); also, MISS was statistically significantly higher in follow-up time 2 and time 3 when compared with time 0 (P = 0.033). We found that after 3 months, 80% of group A patients showed complete relief, 6.7% showed partial relief, 10% showed minimal relief, and 3.3% got worse. Conclusion Adding caffeine to management regimen can reduce the symptoms of MTX intolerance in RA patients. Caffeine relieved the symptoms of MTX intolerance in 80% of RA patients after 3 months of adding caffeine to management regimen.

Abstract Background Post-stroke depression (PSD) has worse functional outcomes and quality of life. Despite the extensive literature on this topic, there is no agreement on the frequency or risk factors for post-stroke depression. Objectives To establish the frequency and risk factors of post-stroke depression and its impact on quality of life. Patients and methods One hundred three stroke patients were recruited from the out-patient clinic of Qena University Hospital who satisfied the WHO definition for stroke, together with a control group of 50 age- and sex-matched healthy volunteers. A complete history, neurological examination, and CT brain were obtained for each patient. DSM-IV TR criteria were used for diagnosis of depressive disorders which was scored with the Hamilton depression rating scale (HAM-D); Barthel Index (BI), and quality of life were also measured. Results Thirty-eight (36.9%) stroke patients had PSD which was significantly higher than in the normal population (control group 12%). Statistically significant risk factors for PSD included low educational level, low socioeconomic status, smoking, and post-stroke functional impairment. Post-stroke depression has an impact on quality of life. Conclusion Post-stroke depression is a relatively common complication of stroke and can affect the quality of life. Low educational level and socioeconomic status, as well as smoking and functional impairments, were considered as risk factors for the occurrence of post-stroke depression. Early detection of predictors of post-stroke depression may improve the outcome of stroke and prevent the psychiatric consequences.

Background: Maxillofacial trauma has the potential to cause disfigurement and loss of function. It can be fatal by causing severe bleeding or interference with the airway. Objectives: The objectives of this study were to assess the etiology, site, timing, age, and gender predilection of maxillofacial trauma in a sample of Sudanese patients. Materials and Methods: This was a prospective descriptive-analytical hospital-based study. The records of 96 trauma patients who attended Khartoum Dental Teaching Hospital from February to April 2017 were investigated for the following information: the etiology of the trauma, site of the fracture, time of the injury as well as the patients’ age and gender. Data were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY USA). Results: During the study period, 96 patients with 204 fractures were treated. 82.3% of the patients were males. The age group between 13 and 23 years showed the highest rate of incidence of maxillofacial trauma. The most common cause of the trauma was assault (36.5%) in males and falls in females (47.1%). Dentoalveolar fractures were the most common site of fractures (25.6%) followed by condylar fractures (14%). The majority of the injuries (34.4%) took place during the day between 1 pm and 6 pm. Conclusions: Causes and patterns of maxillofacial trauma vary greatly from one region to another. This can remarkably aid in raising public awareness and establishing specific prevention and treatment programs.

Information and communication technologies are witnessing tremendous developments in today's world. Which allowed many institutions and departments to adopt ICT in their administrative work. This research discusses the designing of an Electronic Archiving System Based on the Computer Network by using (Visual C #.NET) language and the development of a central database by using (SQL Server 2008). The Ninewa Health bureau has been chosen as a model for completion of the study. To address the problem of the traditional reality experienced by the institutions and departments of the state in Iraq, based on the limited use of information technology, while electronic archiving systems that have become the basic method in the institutions of developed countries. This system works on converting paper documents and attachments into an electronic format, and saving them in the database within indexed records according to the document number or book. The system also provides an integrated tool for the managing mail, and workflow, as well as the preparation of reports, and great flexibility in the management of system database (backup, update of administrative units as per the applicable structure of the bureau concerned), managing user accounts and granting them access permission. The study has showed that the electronic archiving system has a positive impact in the fields of administrative works, through facilitating the process of archiving and saving of documents and official correspondence book to provide office spaces consumed in the storage of paper files. As well as reduce the time and effort spent in the search for files. and the ease of exchanging documents through a local network by the adoption of the (client / server) model to connect the sections of the bureau with each other for integrated with the electronic archiving system. The study aims to strengthen the role of archiving to launch the e-government project by improving and simplifying official transactions procedures. Last but not least the research dealt with a theoretical framework on the archiving (concept, components, types), as well as the practical aspect of the analysis and design of the system and explain how it works. Finally, this research succeed in designing the system, and the system has been tested on real data represented by models of books and official documents in the bureau of Health Nineveh..

Objective: The study aims to clarify the sensitivity of the CTU, and if is it coast effective and time effective to be used as first and the one-stop shop imaging modality for the diagnosis of the different ureteric diseases. Patients and methods: 400 patients with different urinary tract complaints (hematuria and/or renal colic) did triphasic CTU examinations, for diagnosis of suspected obstructive or traumatic ureteric uropathy from January 2014 to October 2016. These patients were filtered from a larger number of patients – who were presented with urinary tract complaints by plain KUB X ray and US, which showed no explaining kidneys or urinary bladder pathology. Results: Ureteric duplication was detected in 5 (1.25%) patients, ectopic ureter in one patient (0.25%), UPJ stricture in 4 patients (1%), PUJ vascular impression in 2 patients (0.5%), ureteric calculus in 103 patients (25.75%), pyogenic ureteritis in 8 patients (2%), ureteritis cystica in one patient (0.25%) TCC in 3 patients (0.75%), PRPF in one patient (0.025%) and Trauma in one patient (0.025%). Conclusion: CTU is very sensitive tool of imaging and could be confidently considered the one-stop shop imaging tool for accurate diagnosis of the different ureteric lesions.

Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD. [ABSTRACT FROM AUTHOR]

Solid Oxide Cells (SOCs) are poised to serve as economically vital, high-efficiency energy conversion devices. But certain critical issues persist in their current stage of development, including system aging during high temperature operation, or reduced performance at low temperature running. To tackle these challenges and drive the advancement of SOC technology, nanocomposite electrodes have emerged as a promising and revolutionary solution to provide high performance and durability at the same time. Persistent efforts have been dedicated to the development of novel nanocomposite electrodes and unraveling the underlying working mechanisms of nanostructured heterogeneous electrodes. These advancements are fueled by the remarkable enhancements that nanocomposites offer, not only in terms of ionic and/or electronic conductivity but also in electrocatalytic activity and stability for SOC. Both experimental results and theoretical calculations validate these enhancements, making nanocomposites an attractive avenue for exploration. To summarize the recent advancements and provide a forward-looking insight regarding this field in this review, we (1) start with an overview of the progress in the development of nano-scaled composite electrodes, encompassing both oxygen ion conducting and proton conducting systems, (2) then highlight the unique attributes of nanocomposite electrodes in the enhancement of the SOC performance, (3) delve into the various techniques used to fabricate nanocomposite electrodes with precise control over their composition, structure, and morphology, and (4) finally acknowledge these remaining obstacles and take a critical look at the hurdles that need to be overcome. Alongside identifying these challenges, we propose potential strategies and research directions to address them effectively. By bridging the gap between current research progress and future possibilities, we aspire to inspire further exploration and innovation in electrochemical energy conversion systems. [ABSTRACT FROM AUTHOR]

Background: Salivary glands swellings are frequently encountered in the dental clinic. Their causes include but not limited to neoplasm, infection, stone, and inflammation. Sublingual salivary gland enlargements are commonly caused by ranula, while neoplasms rarely occur and if found they tend to be malignant. Another cause is idiopathic hyperplasia of the sublingual gland (IHSG), which is characterized as asymptomatic swelling of unknown cause, protrude from the mouth floor with normal appearance of the overlying mucosa. The one factor found to be associated with these enlargements is the absence of mandibular posterior teeth. Although IHSG is a relatively frequent condition, to the authors’ knowledge only a few related studies were found in the literature. Case description: A 61 years old male patient presented with a complaint of a swelling at the floor of the mouth. It was painless, asymptomatic and noticed by the patient for two years with unremarkable size changes. Examination revealed a lobulated swelling, mobile, non-ulcerated, sessile and arising from the left sublingual gland. No lymphadenopathy was observed. The left side of the mandible presented with missing molars. Panoramic radiographs examination was unremarkable. Contrast-enhanced CT scan showed asymmetric hypodensity at the mouth floor, just lateral to the left geniohyoid muscle. With ranula as a tentative diagnosis, we planned to perform marsupialization and the procedure carried out under local anesthesia. Exposure of the tissue revealed a lobulated mass, mimics the appearance and texture of typical salivary gland tissue. An incisional biopsy was obtained. Microscopic examination of the tissue revealed a normal appearing mucous and serous salivary glandular lobules while part of the specimen was characterized by the presence of fibrosis and inflammation with preservation of the main ductal structure. On follow-up appointments, the swelling was asymptomatic without changes. After correlation between the histopathological and the clinical presentation, a decision made to keep the patient with no intervention unless symptoms arise or swelling progress then surgical excision is indicated. Clinical implication: The present case was reported to highlight a variation in sublingual gland swellings. Recognition of such cases is vital to avoid unnecessary investigations and misdiagnosis or invasive surgical approaches.

A new selective molecular imprinted polymer (MIP) was synthesized for the electrochemical sensing of aminophylline (AMI). The MIP was fabricated via the co-polymerization of different monomers (acrylamide and methacrylic acid) around the template (AMI) in the presence of a cross-linker (ethylene glycol dimethacrylate) and an initiator (potassium persulfate). The prepared polymers were characterized by CHN elemental analysis, Fourier-transform infrared spectroscopy, atomic force microscopy, and scanning electron microscopy. For electrochemical applications, a voltammetric sensor was constructed by dropping MIP on the glassy carbon electrode surface after modification with the graphene oxide. Electrochemical determinations were achieved using differential pulse voltammetry (DPV), which indicated a wide range (3.7 × 10-11-1 × 10-3 M) of AMI and a low detection limit (2.1 × 10-12 M). Alternatively, MIP was immobilized on a plasticized PVC membrane and deposited as one layer on the GCE to fabricate the potentiometric sensor. In the same context, a potentiometric sensor was constructed and exhibited a linear calibration curve in the concentration range of 2.6 × 10-9 M to 3.1 × 10-3 M, with a detection limit of 1.5 × 10-10 M. Additionally, the developed methods displayed great selectivity for AMI compared to other competing molecules, high repeatability, and stability. In addition, the proposed methods were successfully applied for AMI detection in pharmaceutical drugs with recovery values (98.2-99.6%). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to check the sensitivity of multiple newly developed 3T MRI breast sequences using CAD software, in pre-sampling diagnosis of breast cancer, in an attempt to minimize unnecessary invasive sampling or surgical procedures. Patients and methods: This was a prospective study, included 120 female patients, presented with debatable or malignancy suspected mammo-sonographic results. The study protocol was approved by the ethics committee in Al-Mana General Hospital. Results: 36 patients’ tumors were reported as benign and 84 were reported as malignant. Biopsy approved 33 tumors as benign and 87 as malignant tumors. These results gave indices of 93.1% sensitivity and 90.9% specificity. Conclusion: 3T MRI breast with CAD is very sensitive imaging tool, that can help to avoid unnecessary invasive procedures.

Background The optimal renal replacement therapy for elderly patients is unclear, and literature is evolving in this regard. For elderly individuals who progress to CKD5, hemodialysis is often a valuable treatment option. Although hemodialysis is a life-sustaining therapy and extends life, it may also create, increase, or prolong suffering in selected subgroups of geriatric patients. In our current study we focused on elderly diabetic patients above 65 years, as they constitute the more vulnerable subgroup, having multiple comorbid conditions. The primary objective was to study the patient′s survival and the association with different comorbidities. Patients and methods We conducted a retrospective analysis of 48 type 2 diabetic patients aged above 65 years. We reviewed their survival data and comorbid conditions - namely, vascular, cognitive, and autonomy. Results and Conclusion The mortality rate was 7.5% per year with significant association with prior cerebrovascular accident, cognitive impairment, and lost autonomy.

The aim of this study is to evaluate the value of high resolution CT scan (HRCT) in diagnosis and management of congenital hearing loss. Patients and methods: This is a prospective study including 60 patients, 24 males and 36 females aged from 1 to 7 years, who were presented by unilateral or bilateral congenital conductive (CHL) or/and sensorineural hearing loss (SNHL). All patients were evaluated by HRCT scan with post-processing multiplanar reconstruction (MPR). Only three Results: External auditory canal atresia (EACA) was diagnosed in 10 patients, while both EACA and middle ear anomalies were diagnosed in another 6 patients. Variable inner ear anomalies were diagnosed in the patients with SNHL. One patient with SNHL had cochlear nerve aplasia that was missed by HRCT and was diagnosed by MRI, in addition to the CT diagnosed vestibulocochlear anomalies. Conclusion: Although HRCT scan can be used as a solitary diagnostic imaging tool for diagnosis of pure CHL, combined CT and MRI examination is crucial for preoperative evaluation of SNHL patients.

The behaviors of the fresh and mechanical properties of self-compacting concrete (SCC) are different from those of normal concrete mix. Previous research has investigated the benefits of this concrete mix by incorporating different constituent materials. The current research aims to develop a steel fiber reinforcement (SFR)‒SCC mixture and to study the effectiveness of different cement replacement materials (CRMs) on the fresh and mechanical properties of the SFR‒SCC mixtures. CRMs have been used to replace cement content, and the use of different water/cement ratios may lower the cost of CRMs, which include microwave-incinerated rice husk ash, silica fume, and fly ash. Fresh behavior, such as flow and filling ability and capacity segregation, was examined by a special test in SCC on the basis of their specifications. Moreover, compressive and splitting tensile strength tests were determined to simulate the hardened behavior for the concrete specimens. Experimental findings showed that, the V-funnel and L-box were within the accepted range for SCC. Tensile and flexural strength increases upon the use of 10% silica fume were found when compared with other groups; the ideal percentage of steel fiber that should be combined in this hybrid was 2% of the total weight of the binder. Overall, steel fibers generated a heightened compressive and splitting tensile strength in the self-compacting concrete mixes.

Introduction: Lower extremity varicose vein is a common disease. Sclerotherapy can be used to treat truncal varices of the superficial venous system. This involves injecting a sclerosant intraluminally in order to cause fibrosis and eventual obliteration of the vein. Objective: To demonstrate the efficacy and safety of foam sclerotherapy in the treatment of great saphenous reflux measured against patient clinical examination and duplex scanning. Materials and methods: Fifty legs with varicose veins due to incompetent great saphenous vein were treated with ultrasound guided sclerosing foam prepared according to the Tessari method by mixing 3% polidocanol solution (Aethoxysclerol) with air using 2 disposable syringes and a three way tap producing high-quality micro-foam. Clinical examination and duplex scanning before and after the treatment with a mean follow up of 6 months were done to every patient. Results: An average of 10 ml of foam was required to close incompetent Great saphenous veins as defined by a reflux of more than 0.5 s documented by duplex scan. At the 6th month of follow up, patients felt that their legs were treated successfully with resolution of symptoms and complete resolution in 96%. Conclusion: Foam sclerotherapy is a safe and effective therapy in treating varicose veins with high patient satisfaction and improvement in quality of life. KEYWORDS: Varicose veins, Foam sclerotherapy, Duplex ultrasound imaging, Treatment outcome, Complications

Background: To examine the impact of aging on the response of rats to pentylenetetrazole (PTZ)-induction of epilepsy and the possible role of oxidative stress and nuclear factor erythroid 2-related factor 2 (Nrf2)/ heme oxygenase (HO)-1 pathway in this response. Methods: Forty male albino rats were equally allocated into 4 groups; 1) Young control (YC) group, aged 8-12 weeks, 2) Old control (OC) group, aged 24 months, 3) PTZ-Young group: young rats received PTZ (50 mg/Kg, i.p. every other day) for 2 weeks and 4) PTZ-Old group: as group 3 but rats were old. The seizure score stage and latency to the first jerk were recorded in rats. Redox state markers in brain tissues including malondialdehyde (MDA), catalase and total antioxidant capacity (TAC) were evaluated. Also, the expression of Nrf2 and HO-1 genes were measured in the brain tissues. Results: Old rats showed an early and a significant rise in the seizure score with PTZ administration and a significant drop in the seizure latency compared to young rats (P <0.01). Also, old rats showed a significantly higher MDA concentration and a significantly lower TAC and catalase activity than young rats (P <0.01). Moreover, the expression of Nrf2 and HO-1 was significantly lowered in old rats compared to young rats with PTZ administration (P < 0.01). Conclusions: Aging increases the vulnerability of rats to PTZ-induced epilepsy. An effect might come down to the up-regulation of oxidative stress and the down regulation of antioxidant pathways including Nrf2 and HO-1. [ABSTRACT FROM AUTHOR]

Nowadays, conjugated microporous polymers (CMPs) of the donor‐acceptor (D‐A) type show excellent photocatalytic performance in water splitting due to their efficient isolation of light‐induced excitons. The key to this activity lies in the appropriate selection of electron donor and acceptor units. In this paper, we synthesized three D‐A carbazole‐based CMPs and investigated the influence of planarity, electronic structure, crystallinity, and surface area on their photocatalytic efficiency in hydrogen evolution from water. Our CMPs have excellent light collection ability, fast separation rates, and minimal recombination rates for the electron/hole pairs, so an excellent hydrogen evolution rate (HER) was achieved by water reduction. Moreover, the most efficient semiconductor Cz‐4Py CMP, which had the lowest dihedral angle, more suitable LUMO level, semi‐crystalline nature, and largest surface area, showed the best HER up to 8813 μmol g−1 h−1 under visible light with an apparent quantum yield (AQY) of 4.51 % at λ=420 nm. While the HERs for Cz‐4TPT and Cz‐4TzTz CMPs with higher dihedral angle, amorphous nature, and lower surface area were 1702 and 1541 μmol g−1 h−1, respectively. The efficiencies obtained exceed those of many polymeric materials reported for photocatalytic H2O reduction. This work confirms the importance of the molecular design of CMP photocatalysts to optimize their performance in hydrogen release by water dissociation. [ABSTRACT FROM AUTHOR]

Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin. Results. Wheezy infants with silent reflux and wheezy infants with typical GERD symptoms but normal MII-pH had significantly higher BAL pepsin compared to healthy control (45.3 ± 8.6 and 42.8 ± 8 versus 29 ± 2.6, P

Objective: To evaluate the role of transvaginal power Doppler sonography in differentiation between benign and malignant endometrial conditions in women with postmenopausal bleeding. Setting: OB/GYN Dept., Suzan Mubarak University Hospital and Radiology Dept., Minia University Hospital, Minia University, Minia, Egypt. Study design: Prospective observational study. Patients: Eighty patients with postmenopausal bleeding. Intervention(s): Grey scale transvaginal sonography, power Doppler study of the endometrium and endometrial-myometrial interface, and office hysteroscopy and the final diagnosis by histopathological examination of hysteroscopic guided biopsy. Results: Endometrial power Doppler signals were positive in 69 out of the eighty patients (86.25%): 8 cases showed multiple vessel pattern -A- (10%); 19 cases with single vessel pattern -B- (23.75%); 42 cases with scattered vessel pattern -C- (52.5%) while in the remaining 11 cases (13.75%), no power Doppler signals were detected. The hysteroscopic findings were endometrial polyp in 16 cases (20%), atrophic endometrium in 14 cases (17.5%), hyperplasic endometrium in 32 cases (40%), submucus fibroid in 6 cases (7.5%), cervical polyp in 3 cases (3.75%) and suspicious endometrium for malignancy in 8 cases (10%). Hysteroscopy was more accurate in cases with intra-cavitary masses (polyps and submucous fibroids) than power Doppler, but power Doppler had a more predictive value for malignant endometrium. Conclusion: Power Doppler blood flow mapping of the endometrium in women with postmenopausal bleeding is useful to discriminate carcinoma from other endometrial pathologies.

Solid oxide cell electrodes need to display a wide range of combined properties, for example, electronic and ionic conductivities, catalytic activity, chemical compatibility with other parts, thermal expansion match, phase stability, and tolerance to foreign species/contaminants. It is extremely challenging for a single material to meet all these features required. Surface decoration is a remarkably adaptive strategy to provide needed features to the electrodes by introducing functioning materials through various target‐guided methods. This review provides an overview of typical and novel techniques to create surface decoration on the electrodes to abruptly improve the drawbacks of the electrodes of solid oxide cells, including performance enhancement, stability of long‐term operation, and tolerance to poisoning foreign species. It starts with the introduction of surface decoration experimental procedure, proceeds to crucial characterization methods that are particularly effective in identifying the properties of the surface coating, continues with target‐oriented practice in terms of surface decoration materials choice and microstructure manipulation, and ends with the explorations of functioning mechanisms for the resultant behavior. With hope, the review will spark more novel utilizations of surface decoration practice to promote the technical status of the solid oxide cells for widespread commercialization in the future. [ABSTRACT FROM AUTHOR]

An Inertially Stabilized Platform (ISP) is used when certain sensors are meant to be stable around a required orientation regardless of any movements of the carrier platform. ISPs are essential for vision-guided flying vehicles to stabilize the equipped seeker attached to the guided vehicle body for efficient target tracking and guidance. This work aims to design a suitable and robust controller for an ISP that can mitigate the disturbances and noise expected when attached to a guided vehicle seeker system. The ISP system is modeled, designed, and implemented. To overcome system uncertainties, external disturbances, and coupling, an efficient controller is to be designed to meet stability and performance requirements. In this research, a decoupled dynamic modelling of a two-axis ISP while accounting for system uncertainties is introduced. In addition to that, a combined fuzzy-PID controller is designed. To evaluate the proposed system's performance, a series of experiments based on two axes and transformations between two frames are carried out. The proposed controllers are compared to traditional PID controllers. The simulation and laboratory tests show the high performance achieved by the proposed combined fuzzy-PID controller for the designed ISP, where better robustness, transient response, and steady-state error are obtained when compared to the conventional controllers. [ABSTRACT FROM AUTHOR]

Land is a vital component of nature around the world and is essential for humans, terrestrial plants, and animals. However, urbanization is growing worldwide and the groundwater quality in urban areas is declining due to rapid development, industrialization, and pollution. Hence, it is important to determine the hydrogeochemistry and changes concerning land use and land cover (LULC). This study was conducted to investigate the hydrogeochemical mechanism of Sargodha, one of Pakistan's fastest-growing cities, during 2015 and 2021 under two different LULC indices named normalized difference vegetation index (NDVI) and normalized difference built-up index (NDBI). Forty-eight groundwater samples were collected in 2015 and 2021 to assess groundwater quality for domestic use and irrigation. The Piper diagram revealed that (Ca2++Mg2+–HCO3−+CO32−) and (Na++K+–SO42−+Cl−) were the main components of hydrogeochemistry in both years. The Gibbs plot and silicate weathering of groundwater samples indicated that rock dominance and silicate weathering played a major role in aquifers. Additionally, the results showed that 4% of the groundwater in 2015 and 21% of the groundwater samples in 2021 were unfit for human consumption. However, 37% and 40% of samples were considered not fit for irrigation in 2015 and 2021, respectively. The LULC, NDVI, and NDBI clearly revealed higher urban areas in 2021 compared to 2015. The relationship between groundwater parameters and land use land cover indices (NDVI and NDBI) explained that none had a major relationship. The non-carcinogenic risk showed health quotient HQ < 1, indicating no severe health risk due to nitrate (NO3−) exposure in the city. The current study suggests conducting future investigations considering a larger scale to recommend efficient management strategies, urbanization planning, and ensuring safe irrigation and drinking water to prevent groundwater pollution. [ABSTRACT FROM AUTHOR]