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Objectives: The democratization of diagnostics is one of the key challenges towards containing the transmission of coronavirus disease 2019 (COVID-19) around the globe. The operational complexities of existing PCR-based methods, including sample transfer to advanced central laboratories with expensive equipment, limit their use in resource-limited settings. However, with the advent of isothermal technologies, the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is possible at decentralized facilities. Methods: In this study, two recombinase-based isothermal techniques, reverse transcription recombinase polymerase amplification (RT-RPA) and reverse transcription recombinase-aided amplification (RT-RAA), were evaluated for the detection of SARS-CoV-2 in clinical samples. A total of 76 real-time reverse transcription PCR (real-time RT-PCR) confirmed COVID-19 cases and 100 negative controls were evaluated to determine the diagnostic performance of the isothermal methods. Results: This investigation revealed equally promising diagnostic accuracy of the two methods, with a sensitivity of 76.32% (95% confidence interval 65.18–85.32%) when the target genes were RdRP and ORF1ab for RT-RPA and RT-RAA, respectively; the combination of N and RdRP in RT-RPA augmented the accuracy of the assay at a sensitivity of 85.53% (95% confidence interval 75.58–92.55%). Furthermore, high specificity was observed for each of the methods, ranging from 94.00% to 98.00% (95% confidence interval 87.40–9.76%). Conclusions: Considering the diagnostic accuracies, both RT-RPA and RT-RAA appear to be suitable assays for point-of-need deployment for the detection of the pathogen, understanding its epidemiology, case management, and curbing transmission.

Background: Invasive therapies are often needed for sufferers with chronic liver diseases (CLDs). Thrombocytopenia is common hematological abnormality in CLD sufferers. In immune thrombocytopenic purpura (ITP), Helicobacter pylori (HP) infection is linked to a low platelet count, whereas HP eradication is associated to an increase in platelet count. In Egypt, the most common trigger of CLD is infection with the hepatitis C virus. In Egypt HP is common infection happens at a young age. Aim of the work: The impact of Helicobacter pylori eradication on platelet count in HCV-related CLD patients with thrombocytopenia. Patients and methods: A prospective study of 100 patients divided to HP positive and HP negative. Sufferers that checked positive for HP have been given treatment to eliminate the virus. HP eradication was evaluated using a stool test for Helicobacter pylori antigen 6 weeks following the treatment was completed. Platelet counts were used to assess the success of HP eradication after 1, 3, 6, and 9 months of follow-up. Results: HP infection prevalence among HCV patients 65% (65/100) versus 35% (35/100) HP negative. Eradication in HP positive patients after treatment were 46 patients (70.8%) and 19 patients (29.2%) not eradicate. platelets response after HP therapy there were 14 patients (21.5%) with complete response, 20 patients (30.8%) had a partial response, while 31 had no response (47.7%){12 eradicated and 19 not eradicated} Conclusion: Successfully eradicating H. pylori can have an impact on platelet recovery and platelet count maintenance in patients with chronic HCV-infected thrombocytopenia

Background: knowledge and attitude about safe motherhood practices could help not only to reduce pregnancy related health risks but also helps in improving maternal and child health. Aim: of this research was to evaluate the effectiveness of comprehensive intervention package on pregnant women's perception regarding selected aspects of safe motherhood. Design: A quasi- experimental design was utilized. Sample: A purposive sample of (154 pregnant women) (One Group Pre-test Post-test design). Setting: The research was carried out in obstetrics & gynecology outpatient clinic at Benha university hospital. Tools: Data were collected through three main tools: A self-administered questionnaire to assess women's socio-demographic characteristics and obstetrical history, maternal knowledge questionnaire, modified likert scale to assess women's attitude. Results: showed that the mean age of studied sample 22.9±6.87 years. There was improvement with a highly statistically significant difference observed in women's knowledge and attitude regarding all aspect of safe motherhood at post-intervention phase compared with pre- intervention phase (p < 0.001). A highly statistically significant positive correlation between total knowledge and total attitude regarding safe motherhood at pre-intervention phase (P≤ 0.001). While, there was a significant positive correlation between total knowledge and total attitude regarding safe motherhood at post-intervention phase (P≤ 0.05). Conclusion: The research concluded that research hypothesis is supported and the implementation of comprehensive intervention package succeeded in and had a considerable improvement in the knowledge and attitude regarding different aspects of safe motherhood among pregnant women. Recommendation: Applying educational intervention to improve women's perception about safe motherhood practices in different maternity health services to prevent further maternal and fetal mortality and morbidity

Background Hepatic ischemia reperfusion (IR) injury is considered as a main cause of liver damage and dysfunction. The l-arginine/nitric oxide pathway seems to be relevant during this process of IR. Although acute intense exercise challenges the liver with increased reactive oxygen species (ROS), regular training improves hepatic antioxidant status. Also, oxytocin (Oxy), besides its classical functions, it exhibits a potent antistress, anti-inflammatory, and antioxidant effects. This study was designed to evaluate the hepatic functional and structural changes induced by hepatic IR injury in rats and to probe the effect and potential mechanism of moderate intensity exercise training and/or Oxy, in comparison to a nitric oxide donor, l-arginine, against liver IR-induced damage. Results Compared to the sham-operated control group, the hepatic IR group displayed a significant increase in serum levels of ALT and AST, plasma levels of MDA and TNF-α, and significant decrease in plasma TAC and nitrite levels together with the worsening of liver histological picture. L-Arg, Oxy, moderate intensity exercise, and the combination of both Oxy and moderate intensity exercises ameliorated these deleterious effects that were evident by the significant decrease in serum levels of ALT and AST, significant elevation in TAC and nitrite, and significant decline in lipid peroxidation (MDA) and TNF-α, besides regression of histopathological score regarding hepatocyte necrosis, vacuolization, and nuclear pyknosis. Both the moderate intensity exercise-trained group and Oxy-treated group showed a significant decline in TNF-α and nitrite levels as compared to l-Arg-treated group. The Oxy-treated group showed statistical insignificant changes in serum levels of ALT, AST, and plasma levels of nitrite, MDA, TAC, and TNF-α as compared to moderate intensity exercise-trained group. Conclusion The combination of both moderate intensity exercise and Oxy displayed more pronounced hepatoprotection on comparison with l-Arg which could be attributed to their more prominent antioxidant and anti-inflammatory effects but not due to their NO-enhancing effect.

Background: The goal of This study is to determine best corrected visual acuity after catract surgery complicated with capsular rupture and vitreous loss.Methods: This study included 40 subjects had cataract surgeries their ages range from 50 to 65 years divided into 2 groups . The first group included 20 patient whose cataract surgery had no complications ,8 cases(40%) had ECCE and 12 cases(60%) had Phaco,Thier age had mean average +_58.10 and standerd division 4.29. The second group included 20 patient whose cataract surgery complicated with capsular rupture and vitreous loss, 8cases (40%) had ECCE and 12 cases (60%) had phaco,Thier age had mean average +- 58.20 and standerd division 3.69. By measuring BCVA 8 weeks after surgery the BCVA at phaco group the uncomplicated cases had mean +- 0.40 and SD +-0.12 ,the complicated cases had mean +- 0.22 and SD +-0.14.The p value is 0.003 . AT the EXTRA cases ,the uncomplicated cases with mean +|- 0.48 SD +|- 0.29 and the complicated cases had mean +- 0.21 SD +- 0.06 . The p value is 0.033.Results: It was found that BCVA at patients with PCR and vitreous loss is less than other patients whose cataract surgery had no complication .KeyWords:Capsular rupture, vitrous loss, Visual acuity

Background: The interactions between hepatitis C Virus (HCV) and the host immune system have a major role in HCV pathogenesis. Objective: To estimate complement C3 and C4 serum levels in patients with chronic HCV patients and to correlate its levels with response to directly acting anti-viral agents (DAAs) in those patients. Patients and methods: The study included 80 individuals classified into two groups: Group (I): 40 patients with chronic HCV infection, Group (II): Control group which included 40 healthy individuals. Measurement of the level of complement C3 and C4 has done by nephelometry immunoassay before and after treatment with DAAs. Results: All patients with chronic HCV infection in group (I) showed significant reduction in serum levels of complement C3 and C4 compared to the control group (II). Moreover, those patients who treated with DAAs showed significantly higher levels of C3 and C4 when compared to chronic HCV patients before treatment with DAAs. Conclusion: Serum levels of complement C3 and C4 serum may be used in the follow up of the course of the disease and may be used as a predictor for the response to treatment with DAAs.

Background: Endometrial carcinoma (EC) is second common gynecological cancer worldwide. It represents 2.83% of female genital malignancy and 72.37% of uterine corpus malignancy according to Egyptian National Cancer Institute (NCI). Distinction between endometrial atypical hyperplasia (EAH) and EC has been controversial, with clinical impact. Objective: Investigate immunohistochemical expression of Annexin A2 (ANXA2) in EC versus endometrial proliferative lesions and correlation with available clinicopathological parameters. Materials and Methods: This retrospective study included formalin-fixed, paraffin-embedded blocks of 66 specimens of endometrial tissue divided into four groups: EC, EAH, endometrial hyperplasia (EH) without atypia and proliferative endometrium. Immunohistochemical staining by ANXA2 antibody was done. Evaluation by semi- quantitative scores followed by correlation of results with clinicopathological data was applied. Results: Annexin A2 was positive in all cases without significant variations between groups. Analysis using ROC curve revealed that immunohistochemical expression of ANXA2 has weak power in differentiating type I- EC from EAH. Correlation between ANXA2 expression and clinicopathological parameters in type I- EC showed a significant negative association between ANXA2 immuno-reactivity score (IRS) and maximum tumor dimension (P=0.03). On other hand, in type II- EC, there was a significant positive linear correlation between ANXA2 H-score and both maximum tumor dimension (P= 0.02) and apoptotic count (P=0.008). Conclusion: Annexin A2 is essential for development of endometrial tissue beside carrying good features in type I- EC by its association with small tumor size. In type II- EC, ANXA2 has two opposing effects; increased tumor maximum dimension and apoptosis. Net result is in favor of increase tumor burden.

Background: Black Raspberry has a wide range of pharmacological and therapeutic aspects including anti-inflammatory and antioxidant activities. Moreover, the effect of Black Raspberry has been studied in many cancers such as human cervical, esophageal and colorectal cancer and showed cytotoxic and anti-proliferative effects against these types of cancer. Aim: To identify the possible anti-cancer effect of Black Raspberry on Oral Squamous Cell Carcinoma cell line. Material and methods: Human tongue squamous cell carcinoma cell line was divided into 3 groups: one control group, second group treated with Black Raspberry, and the third group treated with Doxorubicin, each of the two treatments was applied for 24, 48, 72 hours, respectively. Then, cellular viability was measured using Microculture Tetrazolium assay, cell cycle analysis was done using Flow Cytometry and eventually, apoptotic activity was evaluated using Enzyme-linked Immunosorbent assay. Results: Black Raspberry succeeded to decrease the percentage of viable and proliferating cells with increasing time. On the other hand, it increased the percentage of apoptotic cells and levels of caspase-3. Conclusion: Black Raspberry has a potential cytotoxic effect on oral squamous cell carcinoma cell line in a dose and time dependent manner, and exerts this action through induction of apoptosis, and its action is comparable to Doxorubicin action.

Background: Malnutrition in children is common globally and may result in both short-and long-term irreversible negative health outcomes. Conventional indices fall short of portraying the full consequence of under-nutrition in the population. Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) is another nutritional assessment tool which was created to solve this dilemma. Aims of Study: This study was designed to detect any deviation of nutritional status of children from 2-5 years in outpatient clinic of rural and urban areas using conventional indices (weight for age, height for age and BMI), and the newly developed STAMP. Patients and Methods: This cross-sectional study was conducted on 135 children aged 2-5 years attended the outpa-tient clinics in three hospitals, Bulaq El-Dakrur General Hospital (urban area), Al-Badrashin Central Hospital and Al-Wahat Al-Bahariya Hospital (rural areas), in Egypt. Weight and height measurements were obtained. Z-scores were cal-culated for weight-for-age (WAZ), height-for-age (HAZ) and BMI. World Health Organization growth charts were used to define underweight, stunted and obese patients and STAMP score was used to assess the risk for nutritional derangements. Dietary recall was also obtained and analyzed. Results: Children were classified as per the conventional indices and STAMP. The prevalence of normal weight, height and BMI were 80%, 59.2% and 37.7% respectively. The prevalence of marginal underweight, marginal stunting and overweight were 17%, 27.4%, and 34% respectively and the prevalence of underweight, stunting and obese were 2.9%, 11.8%, and 28.1% respectively. As per STAMP, 57% of children were at low risk, 17.7% were at intermediate risk and 25.1 % were at high risk of malnutrition. Concerning the difference between urban and rural areas, the prevalence of underweight and stunting in urban district were 0.00% and 6.7% respectively, and in rural district were 4.4% and 14.4% respectively. Conclusion: STAMP offers a valid screening tool for the detection of malnutrition and malnutrition risk in pediatric primary health care setting. It met the requirements of a nutrition screening tool in being quick and easy to use.

Background The prevalence of hepatitis C (HCV) infection among the patients on hemodialysis (HD) varies from country to country and from one center to another in the same country. Despite the existence of guidelines for the infection control program, Egypt is one of the countries with high HCV prevalence. In Egypt, the prevalence of HCV among hemodialysis patients in 2015 survey was 50.7%. This study aimed to evaluate the prevalence and seroconversion rate of hepatitis C infection and the risk factors for seroconversion in our community hemodialysis units. Results The prevalence of HCV was 34.8% among hemodialysis patients. The seroconversion rate was 13.2%. The positive history of blood transfusion and the frequency of blood transfusion, in addition to the handling by medical staff to equipment and blood products and the number of inserted temporary dialysis catheters, were found to be significant risk factors for seroconversion. Conclusion We concluded that there is a high prevalence of HCV infection in the dialysis units of our community and a relatively high seroconversion rate among hemodialysis patients.

Background According to the World Health Organization, two billion people will attain the age of 60 years or more by 2050. Ageing is a major risk factor for a number of neurodegenerative disorders, which currently possess challenge to the global health status, carrying economic and social consequences. Therefore, attention has been dedicated towards the development of neuroprotective agents derived from natural sources. Honeybee products, such as honey, bee pollen, bee bread, propolis, royal jelly, beeswax, and bee venom have been used for therapeutic purposes since ancient times in Egypt, Greece, and China. Despite the emergence of modern medicine, bee products remain clinically relevant owing to their potential as anti-inflammatory, anti-oxidant, and neuroprotective agents. Scope and approach This review demonstrates the potential of bee products against neurological disorders in the light of the current literature. Key findings and conclusions Bee products and individual isolated components have enormous therapeutic potential for multiple neurological disorders. The different studies show overall neuroprotective and nerve-tonic characteristics of bee products, mainly due to their anti-oxidant, anti-inflammatory and anti-apoptotic features. However, some limitations such as allergic reactions and the cytotoxic effect of some bee products warrant a special care in its development as drug leads in future studies.

This paper introduces a time efficient deep learning-based solution to the traveling salesman problem with time window (TSPTW). Our goal is to reduce the total tour length traveled by -*the agent without violating any time limitations. This will aid in decreasing the time required to supply any type of service, as well as lowering the emissions produced by automobiles, allowing our planet to recover from air pollution emissions. The proposed model is a variation of the pointer networks that has a better ability to encode the TSPTW problems. The model proposed in this paper is inspired from our previous work that introduces a hybrid context encoder and a multi attention decoder. The hybrid encoder primarily comprises the transformer encoder and the graph encoder; these encoders encode the feature vector before passing it to the attention decoder layer. The decoder consists of transformer context and graph context as well. The output attentions from the two decoders are aggregated and used to select the following step in the trip. To the best of our knowledge, our network is the first neural model that will be able to solve medium-size TSPTW problems. Moreover, we conducted sensitivity analysis to explore how the model performance changes as the time window width in the training and testing data changes. The experimental work shows that our proposed model outperforms the state-of-the-art model for TSPTW of sizes 20, 50 and 100 nodes/cities. We expect that our model will become state-of-the-art methodology for solving the TSPTW problems.

Background: Lung Ultrasound (LUS) has important role in diagnosis of different lung diseases so it can be used in diagnosis and early detection of Ventilator-Associated Pneu-monia (VAP).Aim of Study: Our aim is to evaluate the sensitivity and the specificity of lung ultrasound for early diagnosis of ventilator-associated pneumonia compared to chest X-ray.Patients and Methods: This study was carried out on 100 patients divided into two Groups (A & B), each one included 50 adult male and female patients with suspected VAP. In Group A (LUS), we searched for lung ultrasound findings as subpleural consolidation, lobar consolidation, and dynamic arborescent/linear air bronchogram while in Group B (CXR), we searched for chest X-ray findings as lung infiltrates and air bronchogram. In both groups, Endotracheal Aspirates (EA) was collected for direct gram stain examination (EAgram) and culture (EAquant). LUS findings were analyzed in scores as the clinical-LUS score (Ventilator-associated Pneumonia Lung Ultrasound Score [VPLUS]) which was calculated as follows: ³2 areas with subpleural consolidations, 1 point; ³1 area with dynamic arborescent/linear air bronchogram, 2 points; and purulent EA, 1 point. Positive direct gram stain examination (EAgram) or positive culture (EAquant) which had 2 points were added to VPLUS to be VPLUS EAgram and VPLUS EAquant.Results: The sensitivity and the specificity of lung ultra-sound findings in Group A (LUS) were higher than chest X-ray findings Group B (CXR) as presence of ultrasound signs in Group A (LUS) (lobar/hemilobar consolidations, dynamic air bronchogram, subpleural consolidations) separate or combined gave us sensitivity 97%, lobar or hemilobar consol-idations had sensitivity 94%, presence of dynamic air bron-chogram or subpleural consolidations gave us sensitivity 94%, VPLUS-EAquant ³3 gave us sensitivity 94%. The best spe-cificity was found also in Group A as (air bronchogram + subpleural consolidations + positive culture or positive gram stain examination) gave us the highest specificity 100%, combination of (dynamic air bronchogram and subpleural consolidations) gave us high specificity 94%, combination of (lobar/hemilobar consolidations, dynamic air bronchogram and subpleural consolidations) gave us also high specificity 94%, (VPLUS-EAquant ³4, VPLUS-EAgram ³4 and VPLUS ³3) had specificity 94%. On the other hand, signs of chest X-ray in Group B had lower sensitivity and specificity com-pared to lung ultrasound in Group A as chest X-ray infiltrates gave us sensitivity 53%, specificity 25%, air bronchogram had sensitivity 33%, specificity 40%, presence of (chest X-ray infiltraes, air bronchogram) separate or combined gave us sensitivity 57%, specificity 25%.Conclusion: The sensitivity and specificity of lung ultra-sound were higher than chest xray, so lung ultrasound is better than chest X-ray for early diagnosis of VAP.

Introduction: Diabetes is one of the most common chronic diseases that impact quality of life and its management must go beyond glycemic control to include quality of life. Objectives: The aim of this study is to evaluate the relationship between quality of life and glycemic control in type 2 diabetic patients attending Abu Khalifa family medicine center in Ismailia. Methods: A cross sectional study was conducted to assess quality of life in 151 adult patients with type 2 diabetes attending Abu-Khalifa family medicine center. SES (socioeconomic status) scale and SF-36 questionnaire were interviewed to all patients who were also tested for HbA1c. Data analysis was applied to identify the relationship between quality of life and glycemic control ,presented by HbA1c, and other significant predictors of quality of life with significant limit of P

Prevalence of Staphylococcus aureus mastitis in buffaloes was fundamentally aimed in the current work using culturing procedures and PCR Assay. Field therapeutic trial with follow-up for 10 consecutive weeks post therapy was carried out with monitoring of shedding pattern of Staphylococcus aureus. Three hundred and eighty buffaloes of different lactation seasons were examined in Sohag Governorate. Prevalence of clinically and subclinically infected buffaloes was 10.52% and 26.84%, respectively. Epizootiologically, prevalence of clinically and subclinically infected animals with mastitis in the 2nd, 3rd, and 4th lactation seasons was 12.00% and 32.00%; 20.83% and 41.67%; and 22.73% and 36.36%, respectively. Thereafter the trend of mastitis was significantly declined by increasing the numbers of lactation season. Over the 9th lactation season, there were no signs of mastitis. Bacteriologically, Staphylococcus aureus was the predominant pathogen followed by Streptococcus agalactiae and Escherichia coli. Staphylococcus aureus were sensitive to amoxicillin, enrofloxacin and ciprofloxacin but 50 % of the tested strains were resistant to penicillin and oxytetracycline. A Field therapeutic trial with synulox (Amoxicillin plus Clavulanic acid) with anti-inflammatory and supportive drugs was carried out in 10 diseased buffaloes (3 clinical and 7 subclinical). Three clinical and three subclinical forms were culled due to failure of therapy. Four cases of subclinical mastitis were apparently successfully treated. Shedding pattern of Staphylococcus aureus during the therapeutic period was weekly monitored and revealed that shedding was intermittent. In conclusion, Staphylococcus aureus is an outstanding notoriousness mastitogen and its early detection considers a crucial goal in control. PCR is a valuable test for detection of mastitogens than culture techniques but it is still precious practically.

Background Idiopathic pulmonary fibrosis (IPF) is a specific fibrosing form of interstitial pneumonia that is chronic, progressive and of an unknown etiology. IPF was initially considered to be an inflammation-driven disorder. Therefore, early treatment is aimed to eliminate or suppress the inflammatory process. Pirfenidone is the first antifibrotic drug used in the treatment of IPF. The approval of pirfenidone in 2008 gave us the hope for a new era in the treatment of this aggressive disease. Aim The aim of the study is to assess the efficiency and safety of pirfenidone in a group of patients with IPF. Patients and methods This study included 40 adult patients with IPF. Patients were divided into two groups. Group A included 20 patients who accepted to start pirfenidone treatment. There were 13 females and seven males. Their mean age was 57.1±8.19 years. Group B included 20 sex-matched (13 females and seven males) and age-matched (57.25±8.05 years) patients starting conventional treatment for IPF (systemic steroids and azathioprine). Results Mean decline in predicted forced vital capacity was −0.89±14.55% for group A and −5.48±10.89% for group B, with no statistical significant. Oxygen saturation improved slightly in group A, but with no statistical significant differences between two groups (P>0.05). There was progression of the disease according to high-resolution computed tomography in 60% in group A and 70% in group B, stationary in 30% in group A and 30% in group B, whereas only 10% in group A showed regression of the disease. Conclusion Pirfenidone improved distance walked in 6-min walk test and exercise oxygen saturation in patients with IPF, improved PaO2 in treatment group after 3 months therapy, and has good effect on radiological presentation of patients with IPF compared with steroids with azathioprine.

With the advancement of isothermal nucleic acid amplification techniques, detection of the pathogenic DNA in clinical samples at point-of-need is no longer a dream. The newly developed recombinase polymerase amplification (RPA) assay incorporated in a suitcase laboratory has shown promising diagnostic efficacy over real-time PCR in detection of leishmania DNA from clinical samples. For broader application of this point-of-need system, we undertook a current multi-country diagnostic evaluation study towards establishing this technique in different endemic settings which would be beneficial for the ongoing elimination programs for leishmaniasis. For this study purpose, clinical samples from confirmed visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL) patients were subjected to both real-time PCR and RPA assay in Bangladesh, India, and Nepal. Further skin samples from confirmed cutaneous leishmaniasis (CL) patients were also included from Sri Lanka. A total of 450 clinical samples from VL patients, 429 from PKDL patients, 47 from CL patients, and 322 from endemic healthy/healthy controls were under investigation to determine the diagnostic efficacy of RPA assay in comparison to real-time PCR. A comparative sensitivity of both methods was found where real-time PCR and RPA assay showed 96.86% (95% CI: 94.45–98.42) and 88.85% (95% CI: 85.08–91.96) sensitivity respectively in the diagnosis of VL cases. This new isothermal method also exhibited promising diagnostic sensitivity (93.50%) for PKDL cases, when a skin sample was used. Due to variation in the sequence of target amplicons, RPA assay showed comparatively lower sensitivity (55.32%) than that of real-time PCR in Sri Lanka for the diagnosis of CL cases. Except for India, the assay presented absolute specificity in the rest of the sites. Excellent concordance between the two molecular methods towards detection of leishmania DNA in clinical samples substantiates the application of RPA assay incorporated in a suitcase laboratory for point-of-need diagnosis of VL and PKDL in low resource endemic settings. However, further improvisation of the method is necessary for diagnosis of CL.

Background: Head and neck cancer represents one of the most common cancer types. Numerous riskfactors are implicated in the development of HNSCC. In our study we aimed to investigate the changes thatoccur in the oral mucosa of cannabis smokers and compare them to cigarette smokers and non-smokers.Methods: Three groups of subjects were included in our study (33 in each group); cannabis and cigarettesmokers, cigarette smokers and non-smokers. The biopsies were examined by routine H&E techniques andimmunohistochemical expression of p53.Conclusion: The present work demonstrated evident dysplastic and pre-dysplastic changes in H&E stainedsections. The changes were detected histologically in both smoker groups. These changes were morepronounced in cannabis smokers’ group than cigarette smokers’ group. Moreover, p53 immunostaining washigher for cigarette smokers’ group than cannabis smokers’ group. It is evident that cigarette smoking andcannabis smoking results in field changes in the oral mucosa which are detectable in tissue sections. Thesechanges, such as hyperplasia and dysplasia are more detectable in H&E sections of cannabis smokers thancigarette smokers. However, positive p53 immunoexpression was lower in cannabis smokers than cigarettesmokers.

Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). The assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 min at 42 &deg, C. The RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Comparing the developed assay with commercial multiplex real-time PCR, the assay demonstrated 94% and 95% sensitivity for T. pallidum and H. ducreyi, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication efforts by ensuring reliable diagnosis, to enable monitoring of program success and planning of follow-up interventions at the community level.

Mass Media is the 3rd largest emerging industry of Pakistan. It involves so many decision making in regard to selection of shows, anchors, lighting and technical equipment. The problem becomes ambiguous as most of the channel owners are investors and seldom know about the complications and technicalities of this industry. Solutions given by fuzzy structures in different areas has provoked us to find their applications in the nexus of Mass Media. In this paper, we will present two problems which harnesses fuzzy soft set techniques and algorithm to come in to play for solving mass media decision making problem.

With the growing success of controlling malaria in Sub-Saharan Africa, the incidence of fever due to malaria is in decline, whereas the proportion of patients with non-malaria febrile illness (NMFI) is increasing. Clinical diagnosis of NMFI is hampered by unspecific symptoms, but early diagnosis is a key factor for both better patient care and disease control. The aim of this study was to determine the arboviral aetiologies of NMFI in low resource settings, using a mobile laboratory based on recombinase polymerase amplification (RPA) assays. The panel of tests for this study was expanded to five arboviruses: dengue virus (DENV), zika virus (ZIKV), yellow fever virus (YFV), chikungunya virus (CHIKV), and rift valley fever virus (RVFV). One hundred and four children aged between one month and 115 months were enrolled and screened. Three of the 104 blood samples of children

Background: Traumatic acute subdural hematoma remains one of the most lethal of all head injuries patients with Acute Subdural Hematomas (ASDHs) having higher mortality and lower functional recovery rates compared with those of other head-injured patients.Decompressive Craniectomy (DC) for management of ASDH with accompanying brain edema and midline shift has become one of the standard guidelines in many centers. DC remains to be the standard of surgical modality for patients with poor clinical status.Subcutaneous preservation of autologous bone flap is an inexpensive option that preserves the viability of the bone flap, resulting in good cosmetic results and the very low infection rate.Aim of Study: To compare results of (ASDHs) managed with DC with consequent subcutaneous bone flap insertion in the abdominal wall vs subcutaneous hinged flail placement in the craniectomy site.Patients and Methods: A retrospective review of 61 patients with (ASDHs) operated at the Department of Neuro-surgery, Cairo University and Beni Souf University Hospital during the period from Jan. 2012 – Dec. 2015. Patients were divided into:Group (A): 31 patients operated upon with subcutaneous abdominal bone flap insertion, (22 males and 9 females) median age was 42 years. On admission there were 19 patients with Glasgow Coma Score (GCS) below 8, and 12 patients with GCS 8 or above 8.Group (B): 30 patients operated upon with subcutaneous hinged flail bone flap replacement in the craniectomy site, (22 males and 8 females) median age 44 years. On admission there were 18 patients with GCS blew 8, and 12 patients with GCS 8 or above 8.Early surgical evacuation, dural fenestration, intensive care management to monitor intra cranial pressure and follow-up CT brain were done for all patients.Results: Group (A) 14 patients died in the hospital, 4 survived with unfavorable outcome (vegetative state), and 13 survived with favorable outcome.Group (B) 17 patients died in the hospital, 4 survived with unfavorable outcome (vegetative state), and 9 survived with favorable outcome.Conclusion: Analysis of the obtained data reveals that subcutaneous abdominal bone flap insertion shows a statisti-cally significant better prognosis as compared to subcutaneous hinged flail bone flap replacement at the craniectomy site which may be due to better decompression of the brain and allowing for more roomfor expansion.

Background: The best management of lower calyceal stones remains debatable. Small lower calyceal stones are usually managed with SWL, RIRS or PNL.Aim of Study: This study aims to assess the safety, efficacy and complications of minimally invasive percutaneous neph-rolithotomy (mini PNL) in lower calyceal stones.Patients and Methods: Patients with lower calyceal radio-opaque unilateral stones £2cm were enrolled and underwent mini PNL between February 2014 and January 2016 using a semi rigid ureteroscope through a 16Fr sheath and holmium laser lithotripsy. Patients were considered stone free when no stones or residuals

Background: Patients with depressed skull fractures overlying the superior sagittal sinus (SSS) present an ongoing challenge. Many surgeons would opt for a conservative man-agement of these cases if there was no associated deficit to avoid risky sinus surgery. A variable percentage of patients presenting with such fractures suffer from SSS occlusion resulting in Benign Intracranial Hypertension (BIH).Aim of Study: We aim to evaluate SSS patency, evaluate intracranial tension and evaluate options for management in patients with simple depressed skull fractures overlying posterior 2/3 of SSS and not surgically indicated.Patient and Methods: Prospective study of cases which admitted to Cairo University Hospitals, and Bani sueif Uni-versity Hospital, Department of Neurosurgery, Accidents and Emergency between Jan. 2014 and December 2015.Patients with simple and compound depressed skull frac-tures overlying the SSS and not indicated for surgery, with no other intracranial abnormality, with a Glasgow Coma Scores (GCS) of 12 or better were admitted to the study. Patients underwent Magnetic Resonance Venography (MRV) to determine SSS patency on admission, they were clinically followed up using Computerized Tomography (CT) and repeat MRV when needed. Patients underwent serial lumbar manom-etry, and were given medical treatment in the form of aceta-zolamide, furosemide plus low molecular weight heparin and anti platelets. Patients were then assessed and evaluated to be admitted for LP shunt surgery and followed-up.Results: A total of 12 cases were included in the study, 7 patients had complete SSS occlusion and 5 cases has nar-rowing with patent SSS. The 5 cases with incomplete SSS occlusion had a stable course with only one case (20%) developing elevated intracranial pressure (ICP) not responding to medications and requiring LP shunt. Of the 7 patients with complete occlusion, 100% developed elevated ICP not re-sponding to medical treatment, and all required LP Shunt insertion, 5 patients developed multiple contusions due to anticoagulant therapy on top of SSS occlusion, with discon-tinuation of anticoagulants and deterioration of conscious level, 8 patients had LP surgery and showed a stable improving post operative course, 2 patients had restored SSS patency on repeat MRV.Conclusion: Management of depressed skull fractures overlying the SSS remains controversial, patients with partial occlusion have a better prognosis, patients with complete occlusion can improve with best medical treatment. LP shunt is recommended for all cases of SSS occlusion.

Background: Low back pain is common and originates in the Sacroiliac (SI) joint in 15%-30% of cases. Traditional SI joint disruption/de generative sacroiliitis treatments include non operative care or open SI joint fusion.Aim of Study: We aim to evaluate and compare the use-fulness, side effects and complication of use platelet Rich Plasma (PRP) versus the more commonly used local steroid injection in treatment of sacroiliitis.Patient and Methods: These study include 18 patient were divided into two group:•Group (A): 30 patients received image guided local inter-articular steroid injection of 2ml methylprednisolone (Depo-Medrol) plus 1ml lidocaine.•Group (B): 16 patients received image guided local interar-ticular injection of 3ml PRP plus 0.5ml lidocaine.The median follow-up 6-12 weeks, evaluating improve-ment, the need for repeat injection and complication. The extent of pain improvement was evaluated using the visual analogue pain scale (VAS).Result: Group (A) 24 patient (80%) had complete resolving of symptom while 8 patient in Group (B) had resolution (50%).Group (A) had one case of sever painful injection site, one case with supreficial infection and two cases who com-plained of systemic effects of steroids including hiccups and elevated blood sugar levels that improved after one week, while Group (B) had two cases with acute aching pain follow-ing the injection and improved the following three days and one case where the procedure had to be redone under CT guidance.Conclusion: Local steroid for treatment of sacroiliitis more effective in management when compare two local PRP injection but the complication rate is higher and there is more risk in certain groups who do not tolerate steroids like diabetics, hypertensive and old age.PRP administration is inferior to steroid in management of sacroiliitis in terms of immediate pain relief but is much safer, has less complication and can be repeated safely.

Background: Cirrhosis often is a silent disease Clinical symptoms at presentation may include jaundice of the eyes or skin, pruritus, gastrointestinal bleeding, coagulopathy, increasing abdominal girth, and mental status changes. Pruritus may be the presenting symptom, arising years before any other classic clinical and laboratory markers of hepatic dysfunction. This study examines the clinical, laboratory and histopathological changes in the skins of cirrhotic patients with pruritus in comparison with cirrhotic patients without pruritus and healthy control skins . Patients and Methods: To evaluate clinical, laboratory and histopathological changes in cirrhotic patients with pruritus, cirrhotic patients without pruritus and corresponding healthy (control). skin biopsies (20 specimens each) using hematoxylin and eosin stain and to study mast cell density using gimesa stain. Results: In the skin biopsy specimens of the cirrhotic patients with pruritus we found several histological changes including: epidermal hyperplasia (acanthosis) ,vascular ectasia(dilated dermal blood vessels), hypertrophied dermal nerve endings, mixed inflammatory cellular infilterate and lymphocytic vasculopathy (swelling of the endothelial cell lining of the blood vessels without fibrinoid necrosis, leucocytoclasia or extravasation of red blood cells). Evaluation of mast cell count in Gimesa stained skin sections revealed an increased numbers of these cells in the group of cirrhotic patients with pruritus ( N=5-10). The cells noted in perivascular, perineural and interstitial distribution (between collagen bundles). Conclusions: We report, for the first time, some histopathologial changes in the skins of cirrhotic patients with pruritus in comparison with cirrhotic patients without pruritus and healthy control skins .

Background:Hepatic pruritus is a very common symptom among different chronic liver diseases, particularly in those related to cholestasis. Its prevalence is variable among liver diseases, ranging from 5% in chronic hepatitis C virus infection to 70% in primary biliary cirrhosis. Its etiopathogenesis remains poorly understood.Nerve growth factor (NGF) is a member of neurotrophins. many studies clearly demonstrate their role in pruritus. Nerve growth factor (NGF) is overexpressed in prurigonodularis and its therapeutic administration is pruritogenic. In atopic dermatitis, NGF is released by keratinocytes, mast cells and fibroblasts and plasma levels of NGF are also elevated and correlate with disease activity.This study examines the hypothesis that expression of NGF protein is altered in cirrhotic patients with pruritus. Patients and Methods: To test our hypothesis, we examined the expression patterns of NGF protein in cirrhotic patients with pruritus, cirrhotic patients without pruritus and corresponding healthy (control). skin biopsies (20 specimens each) were evaluated using immunoperoxidase staining techniques. Results: We found variations between the skins of cirrhotic patients with and without pruritus and healthy skin. In healthy skin, the expression of NGF protein was strong (basal cell keratinocytes), moderate (spinouslayer), and weak or abscent (granular cell layer). In contrast, marked expression of NGF protein was observed in all layers of skin (total NGF epidermis and dermis) incirrhotic patients with pruritus in comparison with cirrhotic patients without pruritus and healthy control and this was statistically significant. NGF protein expression was strong (basal cell keratinocytes), moderate (spinous layer), and weak or abscent (granular cell layer). The expression of NGF protein was strong in the adnexal structures. Conclusions: We report, for the first time, increased expression of NGF protein in the epidermal keratinocytes of cirrhotic patients with pruritus skin. Our findings suggest possible roles for this protienin pathophysiology of hepatic pruritus. The clinical ramifications of these observations mandate further investigations.

Bee venom (BV) is a typical toxin secreted by stingers of honeybee workers. BV and BV therapy have long been attractive to different cultures, with extensive studies during recent decades. Nowadays, BV is applied to combat several skin diseases, such as atopic dermatitis, acne vulgaris, alopecia, vitiligo, and psoriasis. BV is used extensively in topical preparations as cosmetics and used as dressing for wound healing, as well as in facemasks. Nevertheless, the safety of BV as a therapeutic choice has always been a concern due to the immune system reaction in some people due to BV use. The documented unfavorable impact is explained by the fact that the skin reactions to BV might expand to excessive immunological responses, including anaphylaxis, that typically resolve over numerous days. This review aims to address bee venom therapeutic uses in skin cosmetics.

In this study, which extended from May 2014 to December 2015, histopathologic techniques made on both ovaries and uteri of 83 slaughtered she-donkeys. Histopathologically, variable ovarian abnormalities were recorded including follicular cyst, paraovarian cyst, granulosa cell tumor, cavernous hemangioma, oophoritis and ovarian hematoma. In correlation to these abnormalities, the uterine examination revealed variable degrees and types of pathological alterations; some of which were relied on these ovarian abnormalities and others were not

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in Egypt and worldwide. Gene expression profiling classifies DLBCL into: germinal center B cell-like (GCB) and non germinal center B cell-like (non-GCB) DLBCL. Hans' algorithm has high concordance with gene expression profiling results. Regulatory T cells (Tregs) represent important modulators for the interaction between lymphoma cells and host microenvironment. FOXP3 is a popular single marker for Tregs. There is little information about the possible role of Tregs in high-grade lymphoma such as DLBCL. This study aims to assess the prognostic impact of FOXP3+ Tregs in DLBCL. The study was carried out on 70 archival cases (61 de novo DLBCL and 9 reactive follicular hyperplasia cases). DLBCL cases were classified into GCB and non-GCB groups using Hans' algorithm. All studied cases are subjected to FOXP3 immunostaining. Density of FOXP3+ Tregs was higher in reactive cases compared with DLBCL (P=0.000). In DLBCL cases, FOXP3 expression was associated with free spleen (P=0.02), early stage (P=0.05), centroblastic variant (P=0.003), and absence of necrosis (P=0.05). In germinal cases, density of FOXP3 was significantly higher in cases with good PS (P=0.02), very good and good revised international prognostic index (P=0.002), and low-risk age-adjusted international prognostic index >60 (P=0.01). Non germinal DLBCL cases with negative FOXP3 were significantly associated with splenic involvement (P=0.005). DLBCL cases with high FOXP3 have longer survival (P=0.03). T cells in the background of DLBCL may play a role in modulation of tumor progression. Their presence is associated with favorable prognostic parameters in DLBCL.

Acne is a longstanding inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles by Propionibacterium acne [1]. Apelin is a newely discovered adipocytokine secreted by white adipose tissue and couples with the APJ receptor with the highest affinity. Apelin and the APJ receptor are found in pancreatic islet cells and found to have a role in energy metabolism. Many researches show that apelin has a role in glucose homeostasis regulation, insulin secretion, and increasing insulin sensitivity [2].The aim of the work was to evaluate the serum level of Apelin-13 in patients with acne vulgaris .Serum apelin was measured in 40 patients with moderate to severe acne vulgaris and 30 healthy controls using enzyme-linked immunosorbent assay (ELISA). Serumlevels of apelin13 in patients with acne vulgaris was found to be higher than in healthy controls (p value

Carbonic anhydrase IX (CAIX) is an enzyme whose expression is very limited in normal tissues and it is highly expressed in various cancers. Therefore, inhibition of CAIX is considered as a promising therapeutic target for the treatment of solid tumors where hypoxic environment has developed. The aim of the current work is to evaluate the immunohistochemical (IHC) expression of CAIX in breast cancer (BC) of Egyptian patients and to investigate the associations of CAIX expression with the standard clinicopathologic features, IHC subtypes of BC, and overall survival. This retrospective study was conducted on 56 archival cases of Egyptian BC patients. Fifty-one of 56 cases (91.1%) showed positive expression of CAIX with cytoplasmic localization, whereas 5 cases (8.9%) showed negative expression. CAIX IHC overexpression is significantly associated with advanced stage and presence of coagulative tumor cell necrosis (P=0.03 and 0.02, respectively). Multivariate analysis revealed Ki67 labeling index and CAIX H-score grouping (P=0.03 and 0.02, respectively) as independent prognostic factors affecting BC patients' overall survival. We concluded that CAIX could play a role in the progression of the studied BC cases. CAIX is a good candidate for target therapy.

BackgroundChronic spontaneous urticaria (CSU) is a distressing disease with a high negative impact on patients’ quality of life. Autoimmunity plays a role in the pathophysiology of the disease in a large proportion of patients. An immunomodulatory and tolerance-enhancing effect was described for act

Purpose: Locally advanced breast cancer (LABC) is a heterogeneous entity that remains a clinical challenge. Anthracycline-based neoadjuvant chemotherapy has emerged as the standard of care for those patients. However, it is associated with serious side effects including cardiotoxicity. This study aimed to evaluate the prognostic and predictive role of topoisomerase IIα (TOP2α) and tissue inhibitor of metalloproteinases 1 (TIMP-1) in Egyptian LABC patients after anthracycline-based neoadjuvant chemotherapy. Materials and Methods: This retrospective study was conducted on 84 LABC cases. Immunohistochemical expression of TOP2α and TIMP-1 was evaluated in pretreatment needle core biopsies. Results were correlated with clinicopathlogic parameters, response to neoadjuvant chemotherapy in postoperative specimens, disease-free survival and overall survival (OS). Results: Positive TOP2α expression was detected in 57/84 (67.9%) cases. It was significantly associated with good response to chemotherapy in breast (P=0.048) and lymph node (P=0.06) as well as prolonged OS (P=0.04). It tended to be the most independent prognostic factor for OS (P=0.06). Positive TIMP-1 expression was detected in 48/84 (57.1%) cases. It was significantly associated with poor response to chemotherapy in breast (P=0.02). The 2T profile (TOP2α+ and TIMP-1−) was significantly associated with good response to chemotherapy in breast (P=0.006). Conclusion: TOP2α and TIMP-1 are important predictive and prognostic factors in LABC patients who received anthracycline-based chemotherapy.

Surfactant is the principle treatment of respiratory distress syndrome, but the ideal method of its administration remains controversial. The intubation, surfactant administration and extubation (InSurE) method is proven to work but is invasive. The objective of this systematic review is to evaluate the efficacy and safety of the modalities of surfactant administration.We searched MEDLINE, EMBASE and CENTRAL (inception to December 2015) for randomized trials comparing new modalities with InSurE method. The primary outcome was mortality and development of bronchopulmonary dysplasia (BPD).We screened 1837 citations and identified five unique trials were included; all were of unclear risk of bias. Four trials (400 infants) compared endotracheal catheters with InSurE, and one trial (70 infants) compared laryngeal masks (LMA) with InSurE. There was no significant difference between using endotracheal catheters compared with InSurE regarding infant mortality (risk ratio 1.05, 95% CI 0.57-1.94, 4 trials, 400 patients, p 0.87, I(2) 0%) or BPD (risk ratio 0.73, 95% CI 0.43-1.21, 4 trials, 400 patients, p 0.22, I(2) 0%). Adverse events were under-reported.The use of endotracheal catheters may provide comparable results to the InSurE method. There is limited evidence on the comparative efficacy of LMA.

Background: Alopecia is one of the most important hair follicle (HF) disorders, which is divided into scarring (cicatricial) and nonscarring (noncicatricial) types. Objective: The aim of this study is to investigate the expression of stem cell (SC) markers such as cytokeratin (CK) 17 and CK19 in scarring and nonscarring alopecia. Materials and Methods: Thirty patients with scalp alopecia (15 with scarring alopecia and 15 without) together with ten healthy volunteers were included in this study. Biopsies were taken from all participants and stained for CK17 and CK19 using immunohistochemistry. Results: There was a statistically significant difference between the nonscarring group and the control group with regard to CK17 expression in the outer layers of the HFs (P = 0.00) and CK19 staining of the inner layers of the HFs (P = 0.008). There was a statistically significant difference between the scarring and the control groups regarding CK17 expression in the outer (P = 0.00) and the inner layers (P = 0.00) of the HFs and CK19 expression in the inner layers of the HFs (P = 0.00). CK17 expression in the outer layers (P = 0.02) and the inner layers of the HFs (P = 0.00) together with CK19 expression in the inner layers of the HFs (P = 0.00) showed statistically significant differences between scarring and nonscarring alopecia groups. Conclusions: The presence of SC markers (CK17 and CK19) in the HFs was affected in both scarring and nonscarring alopecia, but the defect in scarring alopecia is more evident than that of nonscarring alopecia. The persistence of SC markers in some types of scarring alopecia could give a hope for the recovery of these lesions. Further studies are recommended to clarify the benefit from using HF SCs in the treatment of alopecia.

We developed a mobile laboratory for molecular detection of viral hemorrhagic fever viruses for an African team that tested its function during several outbreaks. This was the first team deployed onsite during the Ebola outbreak in West Africa 2014–2016., Background A mobile laboratory transportable on commercial flights was developed to enable local response to viral hemorrhagic fever outbreaks. Methods The development progressed from use of mobile real-time reverse-transcription polymerase chain reaction to mobile real-time recombinase polymerase amplification. In this study, we describe various stages of the mobile laboratory development. Results A brief overview of mobile laboratory deployments, which culminated in the first on-site detection of Ebola virus disease (EVD) in March 2014, and their successful use in a campaign to roll back EVD cases in Conakry in the West Africa Ebola virus outbreak are described. Conclusions The developed mobile laboratory successfully enabled local teams to perform rapid disgnostic testing for viral hemorrhagic fever.

Background The emergence of different viral infections during the last decades like dengue, West Nile, SARS, chikungunya, MERS-CoV, Ebola, Zika and Yellow Fever raised some questions on quickness and reliability of laboratory diagnostic tests for verification of suspected cases. Since sampling of blood requires medically trained personal and comprises some risks for the patient as well as for the health care personal, the sampling by non-invasive methods (e.g. saliva and/ or urine) might be a very valuable alternative for investigating a diseased patient. Main body To analyse the usefulness of alternative non­invasive samples for the diagnosis of emerging infectious viral diseases, a literature search was performed on PubMed for alternative sampling for these viral infections. In total, 711 papers of potential relevance were found, of which we have included 128 in this review. Conclusions Considering the experience using non-invasive sampling for the diagnostic of emerging viral diseases, it seems important to perform an investigation using alternative samples for routine diagnostics. Moreover, during an outbreak situation, evaluation of appropriate sampling and further processing for laboratory analysis on various diagnostic platforms are very crucial. This will help to achieve optimal diagnostic results for a good and reliable case identification. Open-Access-Publikationsfonds 2018

Introduction: A broken instrument within the root canal is a panic problem which one should never wish to occur during routine endodontic therapy. However, the decision regarding how to manage this problem is complex. Therefore, the clinician must evaluate carefully the options of treatment; retrieving the instrument; bypassing the instrument; or leaving the fractured instrument in the canal as part of the final root canal filling. Objective: The objective of this study is to compare the sealing ability of three obturation techniques over apically broken nickel-titanium (Ni-Ti) ProTaper file. Materials and methods: Forty eight extracted human single-rooted mandibular premolars were prepared using ProTaper files (PT) and subjected to breakage of 3mm from F5 tip at the apical one third of the canal. The canals were randomly divided into three groups of 12 teeth each according to type of obturation technique; E&Q plus obturation, using a Thermafil obturator, or lateral compaction technique. The remaining 12 teeth served as positive controls which contained canals with apically broken files only without any type of obturation. Apical leakage was assessed by the dye penetration method in which all teeth were immersed in 2% methylene blue dye for 48 hours. Then the specimens were longitudinally split into two halves. Linear dye penetration was measured in millimeters under a stereomicroscope for each specimen. Statistical analysis of the results was performed using Kruskal-Wallis and post hoc tests. Results: The results showed no statistically significant difference in apical leakage between the three obturation techniques used over apically broken F5 files. Conclusions: All obturation techniques used over apically broken PT files played a significant role in the sealing ability