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Adverse drug reactions (ADRs) and Drug-Drug interactions (DDIs) remain an important clinical problem in modern healthcare systems, particularly, with the rising complexity of therapeutics, ageing population and multi-morbidity. There is no doubt that the unpleasant impacts resulting from inaccurate or wrong dose which used in prophylaxis or treatment, will cause significant harm to the patient. Therefore, it is important to shed the light on these such cases in order to avoid further harm consequences. ADRs can be happened due to involvement of T-lymphocyte or IgE-mediated allergy. Hypersensitivity reactions have been highlighted in recent years, so, allergy test is a necessary step before taking medications that may cause hypersensitivity react ion. This article summarizes some of the key facts about ADRs and explores aspects related to their prevention, diagnosis, reporting and management in current clinical practice using strategies, procedures and tools for quality improvement to avoid any probable mistakes. The article will also illustrate the key role of healthcare practitioners in documenting and reporting the ADRs correctly.

Background: Mobile-based nursing intervention is a trial to enable children to be safe during the COVID-19 epidemic especially those children with chronic kidney disease and who have no immunity. Now days using mobile becomes a part of universal technology for improving the care of children with such conditions. This study aimed to evaluate the effect of mobile-based nursing intervention on preventive measures of COVID-19 among children suffering from chronic kidney diseases. Design: A quasi-experimental design was adopted. Sample: A purposive sample including 70 children suffering from chronic kidney diseases with predetermined criteria (receive regular kidney dialysis, have no history of previous COVID-19 or previous kidney disease complications and well-being mental health) setting: The study was conducted at the Pediatric Kidney Dialysis Unit at Sohag University Hospital. Tools for data collection: A structured questionnaire was used to collect data concerning characteristics of the studied children (pre/posttest questionnaire) as well as to assess the level of child knowledge regarding mobile intervention, preventive measures of COVID-19 and dialysis therapy, a checklist to assess reported practice as regards preventive measure of COVID-19. And Mobile-based nursing intervention which had been designed by the researchers. Results: There was a statistically significant difference towards using mobile-based nursing intervention in the area of children's knowledge and practice about COVID-19 preventive measures at post-intervention compared to pre-intervention. Conclusion: Mobile-based nursing intervention had a positive effect on improving preventive measures of COVID-19 among children suffering from chronic kidney diseases. Recommendations: apply mobile-based intervention in other pediatric kidney dialysis units and hospitals to achieve a better preventive measure of COVID- 19 among children with chronic disease.

Behcet’s disease is an autoimmune type of vasculitis presenting by attacks of oral, skin and genital ulcers, as well as ophthalmic disorders that cause blindness in 25% of affected patients. Circul...

Background The available treatment options fail to provide definitive or curative management for bruxer patients rehabilitated with implant overdentures (OD). The data regarding Botulinum toxin (BTX) injection as a management strategy for bruxism remains unclear. This randomized, single-blinded, control-group, pretest–posttest prospective trial evaluated the occlusal guard and Botox injections (BTX) effectiveness in managing sleep bruxism (SB) in subjects whose one of the edentulous arches had been restored with the implant-supported OD. Methods Forty-two patients diagnosed with definite bruxism were selected, all of which had implant-retained ODs opposing natural dentition. The participants were allocated randomly to three equal groups. Participants in group I (control group) were instructed to remove the OD at night; group II was managed with conventional occlusal stents. Those in group III were given BTX injections. New ODs were constructed for all groups, and all ball attachments were replaced with a new nylon cap. A baseline assessment (one month of OD insertion) of patient satisfaction and sleep quality was conducted, and then again at 3, 6, 9, and 12 months of treatment. Subjective sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). Patients’ satisfaction was evaluated using Temporomandibular disorders/numeric scales (TMD/NS). Prosthodontic (mechanical) complications were recorded during the follow-up period. Results Group III showed a statistically significant improvement in patient satisfaction and sleep quality compared to the other two groups at 3, 6, 9, and 12 months follow-up period (P = 0 0.001, 0.0001, 0.0013, and 0.0001 respectively). Regarding prosthodontic (mechanical) complications, the highest number of events was revealed in the control group. Conclusions BTX and occlusal appliances effectively improve patient satisfaction and sleep quality of Bruxer patients rehabilitated with single arch implant overdentures.

Documentation is reported to take up to 50% of nurses’ time per shift Training, either on-the-job or off-the-job, is the only means that may improve such lack of competencies in documentation. Aim of the study: To investigate the impact of documentation practice training program for nurses: on-the-job vs off-the-job. Design: a quasi-experimental design was used. The study was conducted at Damanhour National Medical Institute. Subjects: 210 nurses took part in this study. The questionnaire was used for data collection; the first part related to demographic characteristics, the second part: This part to assess the nurse’s knowledge gained from the training. The third part included the Audit sheet, which was intended to assess the nurse’s practice of documentation. The intervention consisted of a 2-day training in nursing documentation. Results: high statistical significances differences between studied nurses at pre, post and follow up intervention related to in the knowledge and audit scores of the nurses in the on-the-job vs off-the-job. The Mean ±SD knowledge score increased from 38.9± 9.81to 78.32, and the Mean ±SD total audit scores from 15.3± 4.8 to 39.98±8.57. Likewise, in the off-the-job group Mean ±SD knowledge score rose from 39.67± 0.21to 75.91±7.10, and the Mean ±SD total audit scores from 14.94±8.12 to 38.52±7.97. Conclusion; highly statistically significant improvement in total staff nurses’ documentation knowledge and audit level during post and follow up phase as compared with preprogram phase. Recommendations:Continuous training programs or sessions must emphasize on all aspects of nursing documentation.

We present a case of indolent neurolymphomatosis in a 55-year-old male patient with worsening pain and weakness in his right leg over the past few months. The patient has a past medical history of type II diabetes mellitus, four-year history of worsening left foot drop, left lower limb pain and weakness attributed to diabetic amyotrophy, and back pain. The new right-sided symptoms prompted further imaging which revealed a left sciatic nerve mass which was biopsied. Initial biopsy results were inconclusive. 18F-FDG PET/CT revealed the full extent of this patient's disease and helped plan for a more representative biopsy site, which finally established a diagnosis of diffuse large B-cell lymphoma involving the lumbosacral nerve roots. The patient underwent a course of chemotherapy. 18F-FDG PET/CT was ordered again at the end of treatment showing partial response to therapy. He underwent radiation therapy to the site of residual disease, with complete metabolic response of lesions on follow up PET CT.

May-Thurner syndrome commonly presents with left leg swelling. Right-sided venous compression syndromes are rare. We report a 49-year-old gentleman who presented with right lower extremity swelling after leg trauma. He was found to have right distal common iliac vein compression by the overlying right internal iliac artery. He was treated with an endovascular approach with balloon venoplasty and stenting. This is a unique presentation of May-Thurner syndrome variation affecting the right lower extremity with limited description in the literature.

Background Transcatheter aortic valve replacement (TAVR) procedural success relies heavily on volumetric reconstruction imaging, particularly ECG-gated multi-detector row computed tomography. We postulated that single examination using fast low-angle shot (FLASH) dual source CT scanning (DS-CTA) could provide lower dose than ECG-gated CTA while maintaining the image quality. Methods In this single-centre cohort study, all patients who underwent ECG-gated and FLASH DS-CTA were evaluated. Volumetric reconstructions were performed for both ECG-gated and FLASH DS-CTA to obtain nonsagittal views of the structures. ECG-gated cardiac CT was obtained to evaluate the aortic annular size while FLASH DS-CTA was obtained to examine the aortic and iliac vasculature as part of TAVR imaging protocol. We evaluated measures of aortic annulus, coronaries and sinus of Valsalva using ECG-gated and FLASH DS-CTA scanning protocols. Image quality assessments were performed using aortic root region-of-interest signal-to-noise ratio. Results A total of 130 patients (mean age 81.5 ± 9.2 years, 46.2% female, and 99.2% white) underwent both ECG-gated CT and FLASH DS-CTA. There were excellent correlations between aortic annular area (R2 = 0.934) and aortic annular perimeter (R2 = 0.923) measured by the two protocols. Only 2 (1.5%) patients had >10% difference between aortic annular measurements by ECG-gated and FLASH DS-CTA, while none of the patients had a >10% difference between aortic annular perimeter measured by ECG-gated and FLASH DS-CT scans. There was no significant difference in signal-to-noise ratio between the two methods (mean difference 13.4; 95% CI −2.1–28.8, p = 0.09). There was significantly lower radiation dose for FLASH DS-CTA than ECG-gated CT scan (mean dose-length product difference 404.38; 95% CI 328.9–479.87, p Conclusion Overall, FLASH DS-CTA and ECG-gated CT scans provided comparable image quality and aortic annular dimensions for pre-TAVR evaluation. DS-CTA additionally provided the necessary angiographic imaging of the aorta and peripheral access vessels while still maintaining a lower radiation dose. We propose that a single non-ECG gated FLASH DS-CTA could be utilized to provide all the necessary pre-TAVR imaging information without a gated CT scan.

Background. Hereditary hemorrhagic telangiectasia (HHT) also known as Osler–Weber–Rendu syndrome is a rare autosomal dominant disorder, which results in vascular dysplasia affecting mainly visceral and mucocutaneous organs. Case Presentation. A 65-year-old woman with a 12-year history of recurrent spontaneous epistaxis presented with shortness of breath, easy fatigability, and bilateral lower limb edema. Her family history was significant for definite hereditary hemorrhagic telangiectasia in first-degree relatives. During the previous 15 days, she has experienced three episodes of recurrent nasal bleeding. She has a background of chronic mitral regurgitation. Physical examination revealed telangiectases in her tongue, lower lip, and hand in addition to signs of congestive heart failure. The patient met 3\4 Curacao criteria and had a definite HHT. Her laboratory workup revealed a hemoglobin count of 5.4 g/dl. Echocardiography revealed a left systolic ejection fraction of 51% with left atrial dilatation and severe mitral regurgitation. Chest X-ray showed features of cardiomegaly and pulmonary edema. The abdominal ultrasonography showed enlarged liver size with homogenous texture and congested hepatic veins without features of hepatic AVMs. She was treated with intravenous frusemide, iron supplement, tranexamic acid, blood transfusion, and nasal packing. Conclusions. HTT usually passes unnoticed in Sudan. The rarity of HHT, difficulties in affording diagnostic imaging studies, and low clinical suspicion among doctors are important contributing factors. Anemia resulting from recurrent epistaxis might have an influential role in precipitating acute heart failure in those with chronic rheumatic valvular disease.

Background: COVID-19 is an infectious illness caused by a newly discovered corona virus now called severe acute respiratory syndrome. Nurses are providing front line care for patients with COVID-19 that require hospitalization. So, studying of nurses’ knowledge of the COVID-19, risk perception, preventive behaviors and emotional regulation is necessary since COVID-19 is currently spreading in hospitals and all over the world. Aim: assess nurses' knowledge, risk perception, preventive behaviors and emotional regulation regarding COVID-19. Design: A descriptive exploratory research design was used to achieve the aim of this study. Settings: This study was conducted at seven isolation hospitals in seven Egyptian governorates. Study subjects: a purposive sample of 140 nurses working in isolation hospitals in Egypt Governorates. Tools: Nurses’ demographic characteristics assessment questionnaire, nurses’ self-administered assessment questionnaire, nurses' preventive behavior assessment tool, nurses’ risk perception assessment tool and nurses’ emotional regulation scale. Results: more than two thirds of nurses were females; the majority of the nurses had satisfactory level of knowledge regarding COVID-19. Concerning preventive behavior, the majority of nurses had good preventive behavior regarding COVID-19, while more than one third of nurses had poor level of risk perception. Regarding emotional regulation more than two thirds of nurses had good level of emotional regulation. Conclusion: The majority of the nurses had satisfactory levels of knowledge, good level of preventive behavior and risk perception of dealing with COVID-19 patients, and they also have good levels of emotional regulation, which are reflected positively in dealing and caring COVID-19 patients in isolation hospitals. Recommendations: Infection control courses should be implemented for all the nurses working in isolation hospitals before dealing with COVID 19 patients. Providing emotional and psychological support for nurses should be done to increase the emotional regulation

PURPOSE To investigate the long-term effect of scleral buckling on corneal biomechanics and the effect of change of scleral properties on intraocular pressure (IOP) measurements. METHODS This is a prospective case series, patients with rhegmatogenous retinal detachment prepared for scleral buckling were included. Goldmann applanation tonometry was used to measure IOP (GAT IOP). Ocular Response Analyzer (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), goldmann-corrected IOP (IOPg), and corneal-compensated IOP (IOPcc) preoperatively, and 1, 3, and 6 months postoperatively. RESULTS Thirty-three eyes included in the final analysis, with an average age 38.4 ± 16.2 years. CH and CRF decreased significantly at first, third, sixth months post-scleral buckling; however, this effect decreased with time as follows; preoperative: 8.9 ± 1.5 and 8.5 ± 2.1, first month: 6.8 ± 1.6 and 7.1 ± 1.8 (P value = 0.00, 0.002), third month: 7.8 ± 1.5 and 7.6 ± 1.6 (P value = 0.001, 0.008), and sixth month: 7.7 ± 1.3 and 7.6 ± 1.7 (P value = 0.002, 0.055). IOP cc was 19.3 ± 3.6, 17.1 ± 4, and 17.6 ± 2.9 at 1, 3, and 6 months, and these readings were significantly higher than GAT (13.6 ± 7.6, 12.4 ± 5.1, and 12.1 ± 2.9, P values = 0.00) and IOPg (14.9 ± 3.6, 13.5 ± 4.1, and 13.9 ± 3.5, P values = 0.00). The change in CH at each visit is correlated with the difference between the IOPcc and GAT measurements. CONCLUSION The conventional Goldmann applanation tonometry underestimates post buckle IOP measurements due corneal biomechanics changes. ORA might be an alternative and accurate method of measurement; however, further investigation is warranted.

BACKGROUND: Low levels of scholarly achievement, poverty, and geographical isolation are all known to be linked to early marriage. AIM: This study aimed at identifying the most credible and the best-suited communication channels (CCs) to reach rural communities for motivating them to reduce child and adolescent marriage. METHODS: This study was a community-based cross-sectional systematic formative research. The study targeted 1000 wives who were ever married women in childbearing period aged 15–49 years and their husbands in 21 rural village units of two governorates of Upper Egypt through questionnaires. Decisions concerning the choice of the best-suited CCs were based on their reach, frequency, managerial feasibility, and effectiveness. The investigated CCs included: modern social media (search browser engine/Facebook group and/or twitter/YouTube or messaging through WhatsApp or any mobile app), traditional mass media (T.V/Radio/Reading), and interpersonal communication (talk with religious leaders/partners/friends/doctors/health promoters). Comparisons between different CCs were done using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A vast majority of the surveyed wives (96.6%) were married at an age ranging from 15 to 24 years. The spread of social media through smartphones was limited to only one-third of wives and their husbands through mainly searching on YouTube (31.7% of wives and 27.8% of husbands). Television was the most accessible means of mass media for both wives and husbands (72.5% and 63.3%, respectively). The most credible and the best-suited CCs methods for wives were talking with the health promotors and doctors with 2 times significantly higher (OR = 2.0, CI = 1.7–2.4 for each one) than that with the search on YouTube and 3 times significantly higher (OR = 3.1, CI = 2.5–3.7 and OR = 3.1, CI = 2.6–3.8, respectively) than that for social media using browser engine. For husbands, the odds of the most credible and the best-suited CCs methods were more than 1½ times higher for the talk with the health promotors than the search on You Tube (OR = 1.6, CI = 1.3–2.0) or the search using browser engine (OR = 1.6, CI = 1.3–1.9), Whereas the odds were one and a third higher for the talk with the doctor than the search on You Tube (OR = 1.3, CI = 1.1–1.6) or the search using browser engine (OR = 1.6, CI= 1.1–1.6). Significant difference was detected in favor of the traditional media as the most credible source of information only for wives’ intention to postpone their children early marriage. CONCLUSIONS: Despite the availability of recent social media worldwide, rural communities with high illiteracy have limited access to the internet and limited availability of smartphones. Interpersonal communication is considered their most effective CCs for achieving equity in reducing child marriage. It seems vital during the implementation of any strategies toward reproductive health to use not only the media broadcasts, but also to rely on the channels that are most credible and suitable for the targeted communication to support meeting the unmet need.

Fresh water is a scarce resource that is slowly renewable, so water management is very important to achieve the sustainability of architecture and urbanization through the medium and long term. Recently, environmental assessment systems have been given attention and development by many countries globally and regionally, and thus assessment systems have spread to help the architect achieve a sustainable environment and implementing green building practices. This can be implemented by adopting each system strategies such as energy, water, materials...etc. Since the scarcity of fresh water is a global issue, this paper aims to identify clear strategies of water efficiency and how to preserve it to obtain the best strategies that can be used to improve water efficiency inside buildings in Egypt. To attain this aim, The study follows a clear theoretical methodology in which the issue of water is recognized globally and its impact on architecture as well as water efficiency during the life cycle of the building. Then, a comparative analytical study was conducted for water efficiency between the local GPRS 2018 assessment system against the two global assessment systems LEED BD&CV1.4 and Green Star design & as built V1.3. The study concluded with an applied example by applying the strategies of water efficiency in GPRS2018, to clarify strengths and weaknesses points.

Background: Chest injury was found to cause death in 20%–25% of multiple trauma patients. Thoracic trauma is, therefore, important in the overall management of multiple injury patients and may require a longer stay in the Intensive Care Unit (ICU) and use of mechanical ventilation. Methods: This prospective randomized clinical study was in Emergency Intensive Care, Tanta University Hospitals. For, 88 adult patients with blunt chest injury. Patients were enrolled in this study aged ≥18 years old classified into two equal groups: Group I (Non-Invasive Mechanical Ventilation group) = 44 patient: Patients in this group received BIPAP. Group II (Control group=44 patient: Patients in this group have received high flow O2 by mask O2 without use of non-invasive mechanical ventilation. Data of collection were: the demographic data, Frequent arterial blood gas analysis of all patients every 6 hrs. Respiratory rate, Arterial blood pressure, Heart rate were recorded: every 6 h. All Patients receive analgesia. Evaluate outcome: a-Primary outcome. Tracheal intubation, duration of ventilation. b-Secondary outcome. Mortality, ICU length stay. And Chest Trauma Scoring System. Results: Ten patients (22%) were intubated and mechanically ventilated in group I (BiPAP). with mean value of duration of ventilation 34.4 hrs. But at group II 16 patients (36%) were intubated and mechanically ventilated with mean value of duration of ventilation 34.12 hrs. ICU stay at group I (BiPAP) was statistically decrease of number of days when compared to group II (control). 6 days at group I and 12 days at group II. In this study no case of mortality was recorded with non-invasive ventilation, although three mortality cases were recorded with the control group. Conclusion: This study recommends the pre-emptive use of Non-Invasive Ventilation in the treatment for blunt chest injury in patients at risk for respiratory failure. Success of Non-Invasive Ventilation depends on improvement of hypercarbia and hypoxemia in patients impending respiratory failure due to reversible cause as blunt chest trauma with the expectation of a good outcome and avoidance of intubation.

The effect of several essential oils, plant extracts and packaging materials on oxidative stability of virgin olive oil during different storage times was investigated. The formation of free radicals, changing of color, development of rancid odor and taste are formed as a result of the oxidation of stored oils due to the effect of oxygen and light in the environment depending on the properties of the packaging materials used. As the storage time progressed, viscosity, color, free fatty acid, peroxide and K232 values were increased. The highest increase in K270 value was found in the first month whereas the value of p-anisidine was found to be maximum in the second and third months of storage. The highest acidity (1.91%) and discoloration were observed in the samples stored in the glass-pet bottle while the highest viscosity (99.80 mPa s), peroxide (12.00 meq O2/kg), K232 (0.73) and K270 (0.11) values are found in the samples stored in the tin. The highest free fatty acid values of samples stored in glass bottles, PET bottles and tin were detected in olive oils added rosemary. The peroxide values of the samples stored in glass and pet bottles decreased at 1st month and increased as the storage process progressed.

A lot of people have to live near power lines, and there is strong evidence that electric fields around power lines may cause cancer as well as many other symptoms that humans can directly observe, such as poor short-term memory, chronic fatigue, depression, nausea, and rashes. Hence, it is necessary to mitigate these fields to acceptable values to protect such groups. There are already many conventional compensation techniques in electric field mitigation may be useful in areas where the space is available however in residence with high civil density other techniques should be introduced. In the present paper, the self-compensation using voltage unbalance will be introduced. The main concept of the research is that the electric field resulting from three-phase voltages is negligible as the separations among phases are too small. However, in Overhead Transmission Lines the separations among conductors are determined based on the breakdown strength of air and cannot be changed widely. On the other hand, this concept could be applied electrically not mechanically in overhead power lines by controlling the three-phase voltages to make it as if it were located as near as possible to each other, resulting in a lower electric field. Genetic Algorithm (GA) is used to find the desired voltage unbalance achieving the electric field as minimum as possible in the residence area. The proposed algorithm is applied to 11 kV line and the results show that the electric field is reduced to about 82% under the safe limit, which is considered a very good percentage compared to other techniques.

The optimal sizing of a hybrid energy system may be a difficult undertaking problem, because of the huge number of structure settings and the irregular nature of solar radiation and wind power sources. This issue has a place with the classification of combinatorial enhancement, and its solution dependent on the classical technique may be a waste of time. This paper proposes a Genetic Algorithm (GA) methodology to find the optimal sizing of a hybrid Photovoltaic, Wind Turbine, Battery Storage, and Diesel Generators (PV/WT/BA/DG) energy system based on the number of PV modules, the number of wind turbines, the number of batteries, the number of diesel generators, the slope angle of PV panel and a hub height of wind turbine as the design parameters and study its effect on the Levelized Cost of Energy (LCOE). The proposed method aims to minimize the LCOE with high reliability of load supplying by increasing the design variables gradually. The proposed method will be tested at different sites with various metrological data to ensure its robustness. The results show that the LCOE decreases as the design parameters increase, also that the average wind-speed is inversely proportional to the LCOE of the site under study.

Background Premature ventricular contraction (PVC) is considered one of the most common arrhythmias in clinical practice. The aetiology of PVC is still unclear, however increased sympathetic activity, electrolyte misbalance and cardiomyopathies are considered the main causes of PVCs. In this study we were trying to find out whether there was any association between PVC burden and elevated left ventricular (LV) filling pressure. Methods A total of 100 patients (age: 58.6 ± 7.5 years, 52 males) with frequent PVCs observed on 24-hour Holter monitoring (> 1%) and normal LV ejection fraction (LVEF) (> 50% on echocardiography) were enrolled. Clinical characteristics and echocardiographic parameters, including E/E' to assess LV filling pressure of the patients, were compared with those of an age- and gender-matched control group (n = 100, age: 57.4 ± 7.5 years, 50 males). Results Mean E' was significantly higher in the controls (7.9 ± 3.1 cm/s) than the cases (6.4 ± 1.9 cm/s) (p = 0.010) while mean E/E' was significantly higher in the cases (12.5 ± 5.3) than the controls (10.9 ± 5.7) (p = 0.044), reflecting significantly different LV diastolic function. However LVEF by M-mode and biplane imaging showed no significant difference between the groups. Conclusion Patients with frequent PVCs were associated with high LV filling pressure, which was significantly different from LV filling pressure in the control group.

A novel method to improve the robustness of steel end plate connections is presented in this paper. Existing commonly adopted techniques alter the stiffness of the beam or the end plate to improve the connection’s robustness. In this study, the robustness is enhanced by improving the contribution of the bolts to the rotational capacity of connections, the higher the bolts’ elongation, the higher the rotational capacity that can be achieved. However, the brittleness of the bolt material, combined with its small length, results in negligible elongation. Alternatively, the load path between the end plate and the bolts can be interrupted with a ductile element to achieve the required elongation. This can be achieved by inserting a steel sleeve with a designated length, thickness, and wall curvature between the end plate and the washer. The proposed sleeve should be designed so that its ultimate capacity is less than the force in the bolt at failure, accordingly, the sleeve develops a severe bending deformation before the failure of any connection components. Using a validated finite element model, end plate connections with various parameters are numerically investigated to understand the performance of the sleeve device. The proposed system substantially enhances the rotational capacity of the connections, ranging between 1.37 and 2.46 times that of the standard connection. It is also concluded that the sleeved connections exhibit a consistent elastic response with the standard connections, indicating the proposed system is compatible with codified elastic design approaches without modification. Furthermore, for a specific connection, various ductile responses can be achieved without altering the connection capacity nor configuration.

This research focuses on to identify the relationship between supply chain management practices (supplier relationship, supply chain complexity, information sharing, information quality, logistics and strategic location) with perceived organization performance through the mediating role of supply chain performance (supply chain integration, supply chain flexibility and supplier performance) in oil and gas companies in Egypt. Then the relationship between the three variables will be tested and examined. Literature and prior studies related to this field are reviewed to construct the research hypotheses, which state that there is a significant relationship between Supply Chain Management and Supply Chain Performance, there is a significant relationship between Supply Chain Performance and Perceived Organizational Performance, and there is a significant relationship between Supply Chain Management and Perceived Organizational Performance. These hypotheses will be tested throughout the research study. Primary data is collected from supply chain employees in 61 companies of the petroleum agency in Egypt using a quantitative approach (Questionnaire). The data collected is analyzed and then the results of the analysis and findings are demonstrated by the end of the research with some recommendations to Egyptian SMEs to enhance their Perceived Organizational Performance.

Background: Many women all around the world use the Cu T 380A for contraception as it is cheap and effective way for contraception. Menorrhagia is the most common cause of removal of the intra uterine contraceptive device (IUCD) and it is a very annoying side effect for IUCD users. Finding a way to avoid such a complaint is important to find a proper way for contraception. Objective: To prove the correlation between the Cu IUCD-induced menorrhagia and the findings of the transvaginal Doppler ultrasound. Patients and Method: It was a prospective cross-sectional study and it was conducted on eighty four women who were referred to the family planning clinic of Zagazig University Hospital and Zagazig General Hospital for Cu T-380A IUCD insertion. The study was conducted in the period from 1/1/2019 to 30/7/2019. Then, all specimen had been classified into 2 groups:Group 1 (n =37): with menorrhagia, and group 2 (n = 47) without menorrhagia. Results: Uterine artery pulsatility index (PI) and resistance index (RI) after one month of insertion were significantly lower than at time of insertion among women with IUCD-induced menorrhagia. Endometrial thickness after one month of insertion was significantly higher than at time of insertion among women with IUCD-induced menorrhagia. PI and RI at time of insertion were significantly lower in women with IUD-induced menorrhagia than in those using IUD with normal menstrual bleeding. Uterine artery PI ≤ 1.99 and RI ≤ 0.82 have been associated with menorrhagia at time of insertion. Conclusions: The transvaginal Doppler ultrasound is very helpful in prediction of menorrhagia among IUCD users.

Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and

Resume Introduction L’insuffisance renale aigue est l’un des criteres du paludisme grave avec une incidence variee. Nos objectifs sont de determiner la prevalence de l’insuffisance renale aigue associee au paludisme et rapporter les caracteristiques des patients avec l’evolution des cas. Patients et methode Il s’agit d’une etude descriptive retrospective de 5 ans, menee du 1er janvier 2015 au 31 decembre 2019 dans le service des maladies infectieuses du Centre hospitalier universitaire de Befelatanana Antananarivo. Parmi 379 patients diagnostiques, 103 patients, soit 27,18 %, presentant une insuffisance renale aigue associee etaient inclus. Nous avons utilise les criteres du groupe Kidney Disease Improving Global Outcomes pour definir l’insuffisance renale aigue. Resultats La prevalence de l’insuffisance renale aigue etait de 27,18 %. L’âge moyen des patients etait de 34,92 ans et le sex-ratio etait de 3,68. Le Plasmodium falciparum etait l’agent causal dans 98,06 % des cas, suivi par le Plasmodium vivax. La diurese etait conservee dans 69,86 % des cas. L’ictere etait le principal signe de gravite associe (49,51 %). La creatininemie moyenne etait de 466,93 μmol/L. L’evolution etait favorable sous antipaludeen et la rehydratation. La dialyse etait requise dans 25,24 % des cas. Treize patients etaient decedes, soit un taux de 12,62 %, parmi lesquels 8 patients (61,54 %) avaient presente des criteres de dialyse mais n’avaient pas ete epures pour des raisons economiques. Conclusion L’insuffisance renale aigue est une complication frequente du paludisme. Elle est responsable d’une mortalite non negligeable malgre l’amelioration des soins dans la lutte contre le paludisme.

Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication.

The aim of the study was to add to the literature new data regarding the evaluation of surgical fixation of challenging unstable paediatric pelvic fractures, radiologically and clinically besides recording any complications through the follow-up period. Prospective study was conducted at our hospital between 2012 and 2017 where 21 patients less than 16 years with unstable fracture pelvis were surgically fixed. The method of fixation varied between the external percutaneous fixation and internal fixation. The Infix system was used in for anterior ring fixation in some cases. Patients were evaluated radiologically and functionally using the functional independence measure questionnaire (FIM) and the modified Merle d'Aubigne and Postel (MDP) score. Twelve males and 9 females were fixed with mean age of 12.5 years. Motorcar accident was the main mode of trauma. Nine patients had fracture pelvis Tile’s type B and 12 had Tile’s type C injuries. All fractures united by 8 weeks. No patients suffered from pelvic asymmetry or leg length discrepancy at a mean follow-up of 2 years. The mean of FIM was 122.5 and the mean of MDP score was 16.2. Displaced unstable pelvic fractures in children need a systematic evaluation of the injury pattern. These serious fractures should be referred for anterior ± posterior ring stabilization. Promising clinical outcomes with surgical fixation can be reached with a low rate of complications. Further large-scale studies should be conducted for the calling literature.

Background: Contrast-induced acute kidney injury (CI-AKI), is an important complication of percutaneous coronary intervention (PCI). We aimed to study the role of serum midkine (MK) as an early biomarker of CI-AKI. Methods: We conducted a prospective observational cohort study. It includes 100 chronic kidney disease (CKD) patients with an estimated glomerular filtration rate (eGFR)

Background: In the 21st century, the majority of trache-ostomies are now inserted by the intensivists in the intensive care unit (ICU). It is one of the most frequent procedures performed in critically ill patients. It has been advocated for those requiring prolonged mechanical ventilation because it facilitates weaning by decreasing the work of breathing, decreases the requirement for sedation and may allow for earlier patient mobilization, feeding and physical and occu-pational therapy. Aim of Study: To evaluate ultrasound guided percutaneous tracheostomy and conventional tracheostomy in critically ill patients regarding effect on outcome (weaning from mechanical ventilation and ICU stay), duration of the technique, success rate and to evaluate incidence of perioperative, early and late complications. Patients and Methods: Our study is a randomized con-trolled clinical trial conducted on 40 critically ill patients admitted to the Intensive Care Unit at Ain Shams University Hospitals, from the period from September 2020 until March 2021 they were intubated and mechanically ventilated and required elective percutaneous dilatational tracheotomy. Results: US-guided group showed fewer procedural com-plications compared to conventional group. We had faced procedural complications in conventional group in form of 2 (10%) of patients suffer from hypoxemia, Pneumothorax, decannulation and post. Tracheal wall injury. 3 (15%) of patients had transient hypotension and false passage. And 5 (25%) cases of perforation of ETT cuff during insertion, one case (5%) of subcutaneous emphysema and 7 (35%) cases of minor bleeding compered to three cases of minor bleeding in US-guided group, one case of decannulation and three case of transient hypotension. No early complications were detected in both study groups; except one case of tube obstruction or displacement in conventional group. According to late com-plications our analysis illustrates decrease in late complication in US-guided group 2 (10%) versus 4 (20%) in conventional group. In US-guided group only two cases of Stoma site infection resolved by antibiotic and local care. In conventional group there were two case of Tracheoesophageal fistula, one case of Stoma site infection and one case of Tracheoinnominate fistula. Conclusion: Percutaneous dilatational tracheostomy could be a safer procedure when performed by using peri- and preoperative US assistance. The use of US guidance for percutaneous dilatational tracheostomy could reduce the complication rates of the procedure. The ultrasound-guided percutaneous dilatational tracheostomy seems to reduce the late and early complications when compared to the anatomical landmark guided Percutaneous dilatational tracheostomy. Pre-procedural US-guided percutaneous dilatational tracheostomy can be considered as a reliable tool to increase safety and improve outcomes of elective tracheostomy.

The inflammatory bowel disease (IBD) nurse specialitis plays a key role in the management of IBD patients who undergoing biological therapy. Aim: Assess the effect of educational program about biological therapy on nurses' performance in caring of patient with IBD and its activity grade. Subjects and methods: All nurses (40) in the Tropical Medicine and Gastroenterology department and outpatient clinic at Assiut University Hospitals, in addition to a sample of 80 IBD patients (forty patient with crohn's disease and another forty patient with ulcerative colitis) who underwent biological therapy, all were assessed before and after the implementation the nursing educational program. Tools: Tool 1: Structured questionnaire to assess nurses` demographic data and knowledge about biological therapy, Tool 2: observation checklist for nurses` practice. Tool3: Patient disease activity scales, and Nursing educational program about biological therapy administration. Results: It found that a highly statistically significant improvement in nurses' knowledge & practice scores after implementing the nursing educational program P

Chemotherapy causes many acute side effects. Video games distraction is a method that helps in relieving adverse corollaries. Aim: To investigate the effect of video games on the adverse corollaries of chemotherapy at pediatric oncology patients. Design: A quasi-experimental research design was utilized. Subjects: - A convenient sample of 100 children suffering from cancer undergoing chemotherapy was equally assigned into two groups the video games group (50 children) and the control group (50 children). Setting: the study was applied at the pediatric department at the Oncology Institute at Sohag City and Sohag University Hospital. Tools: Two tools were used (1) demographic characteristics tool and (2) Rhodes Index of Nausea and Vomiting Likert scale. Results: Regarding items of Rhodes index of nausea &vomiting scale, it was found that all pediatric oncology patients (100%) in the video games group had no nausea compared to slightly more than three quarters in the control group. Conclusion: Pediatric oncology patients undergoing chemotherapy who received video games had experienced lower intensity of nausea and vomiting compared to children in the control group. Recommendations: Pediatric nurses should involve video game in routine care among pediatric oncology patients undergoing chemotherapy to reduce and manage side effects of chemotherapy.

Introduction: Mammography is the most used breast screening tool and was proven to reduce breast-cancer-associated mortality. The estimated sensitivity of mammography varies between 77% and 95%; however, sensitivity could be 26% lower in dense breasts than in entirely fatty breasts. The ability to represent the complex 3D breast architecture and early changes in anatomical structures in a 2D view is the biggest challenge for mammography. In Digital Breast Tomosynthesis (DBT), tomographic images are reconstructed from multiple projections acquired from different angles. This technique allows the generation of 3D data, reduction of tissue overlap and allows better evaluation of masses, architectural distortion, and asymmetries compared with conventional two-dimensional mammographic images.Objective: To evaluate the impact of Digital Breast Tomosynthesis on BIRADS categorization of mammographic non-mass findings.Methods: Prospective cohort for 180 women with mammographic non-mass findings who presented to Alexandria University Radio diagnosis Department either for screening or diagnostic purposes between July 2019 and August 2020 with mean age 51.44 ± 10.67 . Digital breast tomosynthesis and ultrasound was done for all patients. Lesions were evaluated on DM; DBT alone then combined DBT & DM. Comparison of results according to changes in BIRADS, diagnostic performance using histopathology as gold standard.Results: 208 non-mass findings were detected by conventional mammography (104 asymmetry, 35 architectural distortion, 69 micro calcifications), Tomosynthesis reduced the BIRADS 3 count by 32%, upgraded the count of BIRADS 4 lesions by 11.4% while upgraded the BIRADS 2 by 18.9% with consequent improvement of sensitivity and specificity, PPV, NPV and accuracy to 96%, 95%, 94%,97%, and 95.6%.Conclusion: Combined FFDM and DBT improved the diagnostic performance in evaluation of non-mass findings and proper BIRADS categorization.

Background Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. Patients with a recent transient ischemic attack (TIA) or stroke and severe stenosis (70 to 99% of the diameter of a major intracranial artery) are at particularly high risk for recurrent stroke in the territory of the stenotic artery (approximately 23% at 1 year) despite medical treatment. Therefore, alternative therapies are urgently needed for these patients. Objective To determine the efficacy and safety of angioplasty with stenting in medically refractory ICAS and to compare its effectiveness with optimal medical treatment. Subjects and methods Fifty patients with symptomatic ICAS despite medical treatment (i.e, recurrent stroke or TIA) were enrolled and equally randomized in a prospective study where twenty-five patients underwent angioplasty with stenting and twenty-five patients received optimal medical treatment. Clinical assessment with NIHSS and mRS were done at 0, 3, and 6 months, and transracial Doppler (TCD) assessment of ICAS was done at 0 and 3 months after treatment. Results The interventional group had a better clinical outcome with mean NIHSS scores (5.2 ± 4.2, 4.43 ± 4.28 and 3.9 ± 4.7) at baseline, 3 and 6 months, respectively, in comparison to the medical group with mean NIHSS (4.5 ± 4.2, 11.42 ± 6.3, and 8.5 ± 5.1) and better functional outcome with mean mRS scores (1.3 ± 0.96, 1.2 ± 1.13, and 1.0 ± 1.13) at baseline, 3 and 6 months, respectively, in comparison to the medical group (0.84 ± 0.75, 2.28 ± 1.2, and 2 ± 1.24). TCD assessment of ICAS showed a marked reduction of the percentage of stenosis on 3 months of follow-up among the interventional groups (only 5.6% had > 70% stenosis) in comparison to the medical group (85.7% had > 70% stenosis). Recurrent ischemic events on 6 months of follow-up were 16% among interventional groups in comparison to 84% among medical groups. The mortality rate was 8% among interventional groups due to subarachnoid hemorrhages (SAH) related to procedure in comparison to 28% among medical groups secondary to ischemic events. The intraoperative success rate was 96% with the failure of stent deployment in 1 patient due to the tortuous anatomy of vessels. Early post interventional complication rate, i.e, SAH was 8%. Late post interventional restenosis and occlusion rates were 8% on 3 months of follow-up. Conclusion Endovascular stenting of medically refractory ICAS is more efficacious and effective with better clinical and functional outcomes than optimal medical treatment; however, its safety is still debatable. Trial registration Done at ClinicalTrials.gov. Trial ID (NCT Number) NCT04393025.

The COVID-19 pandemic caught the world unprepared, with containment measures impacting both global supply chains and agri-commodity flows. The public health crisis raised some urgent questions: “how can fish and other aquatic foods and supply chains be prioritized as health-related interventions to avert both a malnutrition crisis and gender inequality?” Furthermore, “what are the integrated responses, investment opportunities, and governance mechanisms to effectively address the pandemic?” As “super foods,” diets of fish and aquatic foods provide animal-source protein, omega-3 fatty acids, and micronutrients, including both vitamins and minerals, necessary for both the ill and the healthy. The affordability and accessibility of fish could address food and nutrition security needs under lockdown and border closures, boost immune systems, and increase commodity trade. This analytical piece focuses on the continent of Africa, where malnutrition is pervasive, but also where local aquatic food supplies can be utilised during lockdowns and border closures. The paper provides governance insights on national budget support programs and portfolio restructuring to strengthen local aquatic foods production systems to meet dietary needs. Furthermore, the authors advocate for a coordinated multi-sectoral intervention across several well-being domains in the immediate and medium-term involving various partnerships. These integrated responses will mutually limit the contagion while providing support to functional fish value chains for healthy diets, livelihoods, cross-border trade, and long-term macroeconomic recovery.

Purpose There are several important strategic projects in the field of renewable energy in Egypt. Benban project is considered as one of the largest solar generation facilities in the world, which aims to increase clean energy produced, provide electricity needs for citizens and help to increase the volume of Egypt's electricity exports. The purpose of this paper is to explore the most important drivers and barriers that affect the implementation of green supply chain management (GSCM) practices in the field of solar energy production. Design/methodology/approach It is an exploratory research that conducts a case study about solar energy companies operating in Benban, south Egypt. It adopts a mixed approach; qualitative and quantitative research strategy to test the relationship between dependent and independent variables through a survey. Findings This research concluded that normative drivers involving stakeholder pressure are of the greatest drivers of GSCM practice, while external barriers including lack of government regulations and government support, poor supplier commitment, customers’ unawareness of sustainable green products, lack of markets receiving and manufacturing recycled materials, lack of renewal or technological innovation in markets and lack of human resources or expertise in market are among the biggest barriers to GSCM implementation. Research limitations/implications The researchers collected 30 responses during the field survey, which is a nonrandom sample that does not allow generalization. In addition, samples are only from companies in the solar energy sector only. Originality/value As there is a need for research that addresses sustainability practices and solutions in developing countries, especially in Egypt, this paper theoretically contributes to literature by proposing a conceptual framework that identifies the drivers and barriers of GSCM from the existing literature, then investigates and measures their impact on the implementation of GSCM on an Egyptian case study. As regards the practical contribution, this research is a trial to experimentally test the importance of top management’s role in motivating and training employees to improve the brand image of their company and making them aware of the benefits of the successful GSCM implementation.

Background Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice. Methods The study was undertaken in Qatar’s publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported. Results A total 81,569 individuals were included (18–29 years 2.4%; 30–39 years 11.7%; 40–49 years 25.4%; 50–59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%). Conclusions In Qatar’s primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence.

Background: Now a day, social network sites among students become most common. There are different and more advancing types of social network sites and have greater impact on the way the people use of it and have remained major public health issues throughout the whole world. The aim of the study was to evaluate the effect of an educational program on knowledge and uses of social network of students on faculty of nursing at Tanta University. Subjects and Method: A quasi-experimental research design was utilized in this study and it was carried out at Faculty of Nursing, Tanta University. Subjects: The total studied sample was 79 students. Tools of the study: Two tools were used for data collection; tool I: Structured interview schedule consisted of three parts. Tool II: uses of social network sites, this tool was taken and adapted from the instrument developed by Gupta and Bashir in 2018. Results: Total knowledge and uses scores were significantly improved from preprogram to three months after program application for the studied sample, where the mean of total knowledge score increased from 9.25 pre program to 13.39 three months post program and the mean of total uses score increased from 31.47 pre program to 38.54 three months post program Conclusion: The levels of knowledge and uses of the studied sample toward social network were improved after implementation of the educational program. Recommendation: Conducting lectures, workshops and campaigns to raise awareness about correct and accurate information of social network sites and its uses among other students and all community groups.

Background: Colorectal cancers (CRC) are one of the major causes of cancer-related deaths worldwide. Laparoscopic colectomies have many advantages in short-term outcomes in comparison with open colectomies and recently have a long-term oncologic validation. Objectives: This work aimed to compare the short- and medium-term outcomes of TLC and LPCC for CRC at the beginning of the learning curve of laparoscopic colectomy. Materials and Methods: A randomized prospective study has been conducted from November 2018 to November 2020 on 30 patients with CRC were randomized to the total laparoscopic colectomy (TLC) group (15 patients) or laparoscopic-planned conversion colectomy LPCC group (15 patients). The primary outcomes were operative time, intra-operative blood loss, postoperative pain, hospital stay, and the secondary outcomes were early postoperative complications (anastomotic leak, pelvic nerve injuries), tumour recurrence, port-site metastasis, and hernia.Results: There were statistically significant differences in the operative time (244± 40.9min vs. 322 ± 57 min; P