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The operating condition of a droop-based microgrid is dependent on the distributed generation (DG) droop characteristics. Both primary and secondary controls define the droop characteristic. Previous work dealing with droop-based microgrids overlooked the secondary control region boundary limits while optimizing the droop characteristics as well as the optimal selection of droop-type. This article proposes a novel problem formulation that determines the optimal droop-type as well as characteristic. Each DG is equipped with two operational control modes namely the P–f/Q–V and P–V/Q–f, one of which is optimally selected to achieve the desired operational objectives. The proposed model is formulated as a multiobjective mixed-integer nonlinear programming, which is incorporated into an optimal power flow framework and tested on a 38-bus distribution system modified to form a microgrid and optimally solved using general algebraic modeling system. A secondary control operating region is defined within which the optimal droops are constrained to maintain all possible operating conditions within the acceptable frequency and voltage limits. Furthermore, a comparative analysis is conducted where the DG droops are optimized with and without considering the proposed secondary control operating region. The dynamic performance of the proposed optimal secondary control is validated using PSCAD/EMTDC.

OBJECTIVE: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of healthcare-associated infections associated with durable ventricular assist device implant, few studies have examined inter-hospital variation and associated costs. METHODS: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n=120) were merged with post-implant 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implant and Medicare payments. RESULTS: There were 3982 infections identified among 27.8% (2,417/8,688) of patients developing an infection. The median (25(th), 75(th) percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied by hospital (range 0.0 – 35.6). Total Medicare payments from implant to 90-days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals, p

Searching for available parking spaces can be a painful experience for drivers due to driving around until finding a vacant space. This study proposes a new method to automatically detect available parking spaces. The proposed system identifies empty parking spaces using grayscale images obtained from any type of video camera. The method was found to successfully identify parking availability under different conditions and scenarios. The method was tested using real-life data and achieved a detection rate of 99.7%. This method can be applied in real-time to monitor parking availability and guide drivers to empty spaces. The method has several advantages, including simple algorithms, the use of low-quality black and white images, and simple configuration. Therefore, the system can provide enormous cost savings for locations with existing black and white surveillance cameras instead of replacing existing cameras with new high-quality cameras.

This paper proposes a new mathematical formulation for the optimal operation scheduling of a remote PV farm and a set of distributed electric vehicle charging stations (D-EVCSs), which are owned by a private entity. The proposed model is formulated to maximize the profit of the private investor through optimal electric vehicles (EVs) charging coordination and pricing mechanism. The proposed pricing mechanism aims to achieve an expected revenue by the private investor, while guaranteeing a low EVs charging price to ensure the EV owners satisfaction. The D-EVCS integrates a battery storage system (BSS) and rooftop PV for the EVs supply application. However, the rooftop PV existence is constrained to the limited footprint of the EVCS. For this reason, the investment in a remote PV farm and its impact on the expected revenue and the EVs charging price is introduced in this paper. The power generated by the remote PV farm can be transacted to the D-EVCSs using a power purchase agreement through the utility grid infrastructure. In such a case, the electricity service and distribution fees are paid to the utility grid for overseeing the PV farm power transaction. Also, the opportunity of the D-EVCSs to participate in the provision of operating reserve and demand response ancillary services is considered in the proposed model. Different case studies are evaluated to validate the effectiveness of the proposed model.

Most of the existing research focuses on electricity theft cyberattacks in the consumption domain. On the contrary, a high penetration level of distributed generators (DGs) may result in increased electricity theft cyberattacks in the distributed generation domain, which is the focus of this article. In these attacks, malicious customers can hack into the smart meters monitoring their DG units, which are usually photovoltaic, and manipulate their readings to report higher injected energy to the grid and claim more profit under feed-in tariff programs. This article proposes a data-driven approach based on machine learning to detect such thefts. We adopt an anomaly detection approach where a theft detection unit (TDU) based on a regression tree model is designed to detect suspicious data. Historical records of solar irradiance, temperature, and smart meter readings are utilized in the training stage of the detector. The probability density function of the error between the actual readings from DG meters and the predicted generation by the regression model is utilized as a metric to detect suspicious data. Several theft scenarios are used to assess the performance of the TDU. Furthermore, a comparison study with other detectors is presented to demonstrate the superiority of the proposed TDU.

Mohamed AbdAlla Salman,1 Mostafa Elshazli,1 Mohamed Shaaban,2 Mohamed Moustafa Esmat,3 Ahmed Salman,4 Heba Mahmoud Mohamed Ibrahim,4 Mohamed Tourky,5 Alaa Helal,5 Ahmed Abdelrahman Mahmoud,5 Feras Aljarad,6 Amr M Ismaeel Saadawy,7 Hossam El-Din Shaaban,8 Doaa Mansour1 1General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt; 2Damietta General Hospital, General Surgery Department, Damietta, Egypt; 3Radiology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt; 4Internal Medicine Department, Kasr Al AinyFaculty of Medicine, Cairo University, Cairo, Egypt; 5General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK; 6General Surgery Department, Lewisham and Greenwich NHS Trust, London, UK; 7Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 8Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, EgyptCorrespondence: Mohamed AbdAlla SalmanGeneral Surgery Department, Associate Professor of General Surgery, Kasr Al Ainy School of Medicine, Cairo University, Cairo, EgyptTel +00201096263434Email Mohammed.salman@kasralainy.edu.egPurpose: Long-term studies reported inadequate weight loss or weight regain after laparoscopic sleeve gastrectomy (LSG). This study investigated a possible relationship between preoperative gastric volume (GV) measured by CT volumetry and weight loss one year after LSG.Methods: This prospective study included 120 patients scheduled for LSG. 3D CT gastric volumetry was done before surgery. The weight loss in the first year was serially recorded. The primary outcome measure was the correlation between preoperative GV and postoperative weight loss after one year. The secondary outcomes were the correlation between preoperative GV and other patients’ characteristics as age and body mass index (BMI).Results: Weight and BMI decreased significantly up to 12 months. The percentage of excess weight loss (%EWL) at 6 and 12 months was significantly higher than at three months. Preoperative GV was 1021 ± 253, ranging from 397 to 1543 mL. GV was not related to sex, age, weight, height, postoperative weight, and BMI.Conclusion: Preoperative gastric volume cannot predict weight loss one year after LSG. It is not correlated with age, sex, or preoperative weight, and BMI.Keywords: correlation, gastric volume, weight loss, sleeve

A multistage approach to passive islanding detection is proposed that utilizes a decision-tree-like classification algorithm. The novelty of the proposed method is centered on the way in which features are passed to subsequent stages of the decision tree (DT). Feature sets extracted using different sized time windows are passed to successive stages of the tree. This provides two important advantages: (i) cases which can be easily determined as either islanding or non-islanding events are flagged as soon as possible without waiting for the full feature set to become available (ii) because the algorithm allows for the use of different sized time windows, features are analyzed in time-scales which fit their natural patterns of temporal evolution. The proposed classifier is trained and tested using a database of feature vectors, obtained using PSCAD, which were designed to reflect a variety of commonly encountered events on an IEEE 34-bus distribution system. One of the key requirements for the proposed algorithm was that easy cases should be flagged as soon as possible; this property was confirmed by the observation that most events (79%) were detected within 10-20ms, while at the same time retaining a very high detection rate overall cases (> 99%).

As the penetration rate of flexible loads and distributed energy resources in the distribution networks increases, congestion management techniques that utilize demand-side management (DSM) have been developed. These are indirect methods that rely on information exchange between the distribution network operator, aggregators, and consumers’ meters to encourage customers to change their demand to relieve congestion. Cyber attacks against aggregators can compromise the operation of DSM-based congestion management methods, and hence, affect the security and reliability of electrical networks. In this article, the vulnerability of indirect congestion management methods to load-altering attacks is studied. An optimization algorithm is developed to determine the aggregators a cyber attacker would compromise, via minimum alteration of their load profiles, to cause congestion problems. The impact of such attacks on congestion and consumers’ electricity bill is then studied. A mitigation scheme is formulated to determine the most critical aggregators in the network. The security of these aggregators is then reinforced to mitigate such cyber attacks.

Nutraceuticals have gained immense importance in poultry science recently considering the nutritional and beneficial health effects of their constituents. Besides providing nutritional requirements to birds, nutraceuticals have beneficial pharmacological effects, for example, they help in establishing normal physiological health status, prevent diseases and thereby improve production performance. Nutraceuticals include amino acids, vitamins, minerals, enzymes, etc. which are important for preventing oxidative stress, regulating the immune response and maintaining normal physiological, biochemical and homeostatic mechanisms. Nutraceuticals help in supplying nutrients in balanced amounts for supporting the optimal growth performance in modern poultry flocks, and as a dietary supplement can reduce the use of antibiotics. The application of antibiotic growth enhancers in poultry leads to the propagation of antibiotic-resistant microbes and drug residues; therefore, they have been restricted in many countries. Thus, there is a demand for natural feed additives that lead to the same growth enhancement without affecting the health. Nutraceuticals substances have an essential role in the development of the animals’ normal physiological functions and in protecting them against infectious diseases. In this review, the uses of amino acids, vitamins and minerals as well as their mode of action in growth promotion and elevation of immune system are discussed.

Objective Infections are among the most common complications in recipients of durable left ventricular assist devices (LVAD). However, existing studies examining infections in LVAD recipients are limited is size and design. Comprehensive, systematic reviews of all types of infections occurring among recipients of contemporary LVADs have not been conducted. The goal of this scoping review was to synthesize all available evidence related to rates of infections (including location and types) in LVAD recipients. Methods In February 2019, 4,581 published studies were identified through searching five bibliographic databases: PubMed, Scopus, EMBASE, CINAHL and Web of Science Core Collection. Inclusion criteria required reporting of infectious complications among LVAD recipients receiving contemporary (HeartMate II, HeartMate 3 and HeartWare HVAD) LVADs. Study key characteristics were extracted by 2 independent reviewers and current literature described narratively. All analyses took place between Feb 2019 and Jan 2021. Results A total of 132 studies met inclusion criteria. Most studies were observational (n=118; 89.4%), single-center (n=93, 70.4%) and from the U.S. (n=88; 66.7%). Only 48 (36.3%) studies used the standardized International Society for Heart and Lung Transplantation (ISHLT) definition for reporting infections. Only 35 (26.5%) studies reported age, gender and racial distribution of their study population. Driveline infections were the most commonly reported infection type. Conclusions Most studies did not utilize standardized infection definitions or provide complete information on infection locations and types. In order to further advance the scientific rigor, published studies should (i) use standardized definitions for reporting infections and (ii) stratify rates by infection location and type.

Aim To estimate the sensitivity and specificity of topographic and tomographic corneal parameters as determined by Sirius (CSO, Florence, Italy) in discriminating keratoconus (KC) and suspect keratoconus from normal cornea. Method In this retrospective case-series study, keratoconus screening indices were measured using Sirius tomographer. Receiver operating characteristics (ROC) curves were used to determine the test's overall predictive accuracy (area under the curve) and to identify optimal cut-off points to maximize sensitivity and specificity in differentiating keratoconus and suspect keratoconus from normal corneas. Results Receiver operating characteristics (ROC) curve analyses showed high predictive accuracy for Symmetry Index back (SIb), Keratoconus Vertex front (KVf), Symmetry Index front (SIf), Keratoconus Vertex back (KVb), Apex Keratometry (Curve-Apex) and Minimum corneal Thickness (ThkMin) to distinguish keratoconus from normal (area under the curve > 0.9, all). Symmetry Index back was identified as the best diagnostic parameter for detecting suspect keratoconus with AUC of 0.86. Highest specificity to detect keratoconus and suspect keratoconus was seen for SIb, 99.87% and 84.66%, respectively. These values were associated with optimal cut-off points of 0.46 D for keratoconus and 0.12 D for suspect keratoconus. Conclusion Sirius parameters evaluated in the study were effective to differentiate keratoconus from normal corneas. However, Symmetry Index back was the index with the highest ability to detect suspect keratoconus.

Obesity is an independent risk factor for cardiovascular diseases. Coronary artery calcium (CAC) is a direct measure of coronary atherosclerosis. The study investigated the effect of bariatric surgery on CAC scores in people with severe obesity subjected to laparoscopic sleeve gastrectomy (LSG). This prospective study included 129 people with severe obesity in two groups; the LSG group (n=74) subjected to surgery and the diet group (n=55), managed by a diet regimen and lifestyle modification. Cardiovascular risk was assessed by Framingham risk score (FRS) and coronary calcium score (CCS) measured by computed tomography initially and after 3 years. The two groups had a comparable CAD risk before treatment according to FRS or CCS. After treatment, CCS improved significantly in the LSG group (p=0.008) but not in the diet group (p=0.149). There was no correlation between FRS and CCS (r=0.005, p=0.952). Treatment resulted in significant weight reduction and improved fasting blood glucose and lipid profile in the two groups. The change of weight, blood glucose, and HDL, and remission of diabetes mellitus (DM) were significantly higher in the LSG group compared to the diet group. LSG may reduce the risk of developing future cardiovascular comorbidities evidenced by reducing CAC scores. Significant weight reduction and improvement of cardiovascular risk factors may recommend LSG as a cardioprotective procedure in people with severe obesity.

This research aimed to investigate the prospected desirable influences of sowing date, planting density, and soil enrichment with humic acid (HA) on the growth and uptake of macro and micronutrients and their implications on the productivity of sunflower plants grown in dry, saline, and nutrient-deficient environment. Two field trials were conducted in two seasons (2018 and 2019) by planting the sunflower plants on two dates, one early (on May 5) and the other late (on May 30) under three planting densities of 95.2 (high), 71.4 (medium), and 57.1 (low) thousand plants ha−1 and soil enrichment with three rates of HA [0 (HA0), 24 (HA24), and 48 kg ha−1 (HA48)]. Early sowing date with soil HA48 under low planting density was the best combination for optimizing sunflower’s growth, while early sowing date with HA48 under high planting density was best for the macro and micronutrient contents of shoots and seeds, as well as seed, oil (OY), and protein yields. With the application of automatic linear modeling analysis, seed yield, oil%, stem diameter, harvest index, shoot dry weight, plant height, and seed yield plant−1 were selected as the characteristics most contributing to OY in predicting stressed sunflower’s OY. Due to the ever-climate changes, choosing an appropriate sowing date, as a non-monetary practice, and optimal planting density with adequate anti-stress (e.g., HA) substance to enrich the low-fertile saline soils is the safest effective way to maintain global food security and sustainable agricultural development in dry environments.

Smartphones became ubiquitous and are used by so many people, at least to know the driving directions to their destination. Smartphones come with rich embedded sensors (e.g., GPS, accelerometer, and camera) as well as built-in radios (e.g., Bluetooth, Wi-Fi, and Cellular), which both enable users to gather data and distribute it among people at any time or location. These features have come up with the mobile crowdsensing (MCS) development which can be used in a wide range of applications. In this paper, we introduce a complete mobile crowdsensing framework for road surface condition detection. Various modules have been addressed such as task management, data fusion, reputation scoring, incentive awarding, security and privacy, as well as discussing popular techniques and algorithms utilized in the proposed MCS framework modules. A prototype of the crowd sensing application is designed which is related to our framework. The proposed framework considers the data quality and trustiness between the users and the server as well.

Background/Aims: Peptic ulcer bleeding is the most common cause of upper gastrointestinal tract bleeding. Platelet-rich plasma (PRP) enhances tissue repair, and is therefore used in various medical treatments. A combination of mechanical or electrothermal hemostasis has been recommended for upper gastrointestinal tract bleeding treatment. This study evaluated the additive efficacy of PRP in bleeding peptic ulcer hemostasis and recovery.Methods: Eighty patients with peptic ulcer bleeding were initially treated by hemoclipping, and were randomly chosen for either additional PRP (n=40) or additional epinephrine (n=40) injections. Both groups were compared with regard to achieving hemostasis and the frequency of complications.Results: Hemostasis was immediately achieved in both groups. Two patients (5%) in the PRP group and 8 (20%) patients in the epinephrine group experienced rebleeding after 15.9±2.8 and 12.3±3.7 days, respectively. They were managed by PRP injection in addition to proton pump inhibitor infusion. Hemoglobin was substantially increased in the PRP-treated group with full recovery occurring in 60.5% compared to 31.3% of patients in the epinephrine group (p=0.001). There was no recurrent bleeding in the PRP group, but 4/32 (12.5%) patients in the epinephrine group exhibited rebleeding.Conclusions: PRP showed additional benefit in reducing peptic ulcer bleeding with no reported significant complications. Clinical trial (NCT03733171).

Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.

AimsThere is little information on the impact of COVID-19 on breast pathologists. This survey assessed the effect of the COVID-19 pandemic on UK and Ireland-based breast pathologists to optimise working environments and ensure preparedness for potential future pandemics.MethodsA 35-question survey during the first wave of COVID-19 infections in the UK including questions on workload, working practices, professional development, training, health and safety and well-being was distributed to consultant breast pathologists and responses collected anonymously.ResultsThere were 135 responses from breast pathologists based in the UK and Ireland. Most participants (75.6%) stated that their workload had decreased and their productivity dropped. 86/135 (63.7%) were given the option of working from home and 36% of those who did reported improved efficiency. Multidisciplinary team meetings largely moved to virtual platforms (77.8%) with fewer members present (41.5%). Online education, including webinars and courses, was utilised by 92.6%. 16.3% of pathologists reported shortages of masks, visors or gowns as the the most common health and safety concern. COVID-19 had a significant negative impact on the physical and mental health of 33.3% of respondents. A small number of pathologists (10.4%) were redeployed and/or retrained.ConclusionThe UK and Ireland breast pathologists adapted to the rapid change and maintained service delivery despite the significant impact of the pandemic on their working practices and mental health. It is important to apply flexible working patterns and environments that improve productivity and well-being. The changes suggested should be considered for long-term shaping of breast pathology services.

Background : : Despite the adherence to medications, the control of the modifiable key risk factor—intraocular pressure (IOP)—for the progression of primary open-angle glaucoma (POAG) in diabetics is usually difficult; hence, many glaucoma patients try other alternative therapeutic options. Objectives: This randomized controlled study investigated the short-term IOP response to the combined effects of transcutaneous electrical nerve stimulation over acupoint (Acu-TENS) and yoga ocular exercise in type 2 diabetics with POAG. Methods : : Eighty diabetics with bilateral POAG, ages ≥ 50 years, IOP > 21 mmHg in both eyes, and a body mass index below 30 kg/m2 were included in this trial. The patients were randomly assigned to group A (n = 40; this group received 20 minutes of yoga ocular exercise followed by 20 minutes of active Acu-TENS over bilateral BL 61 and BL 62 acupoints) and group B (n = 40; this group received the same protocol as group A but with a placebo Acu-TENS). The repeated measurement of IOP were recorded before, immediately after, 30 minutes, and 60 minutes after the sessions. Results : : The repeated measures analysis of variance revealed a greater significant decline of IOP in group A than group B in both eyes at the consecutive intervals of time measurements. Conclusion : : According to this short-term observation, the addition of Acu-TENS to yoga ocular exercise could reduce the high IOP in diabetic patients with POAG, but further longterm trials are needed.

The performance of solar trough collectors can be enhanced by optimizing the mirror profile. Accordingly, a method for optimizing the trough mirror profile is introduced in the present work. This method aims at enhancing the amount of reflected solar irradiance onto the receiver tube. Optimum profiles “Opt1” and “Opt2” were obtained by implementing multi-objective multi-dimensional optimization. Results show that the “Opt1” profile enhances the overall efficiency of the trough collector by 8.2% compared to an original parabolic trough collector (PTC). This performance improvement was also recorded at different trough angles. The trough depth was reduced by up to 89% for the “Opt1” profile. Therefore, analysis of the wind loads was performed for the PTC and the optimized profiles. This analysis shows that the “Opt1” and “Opt2” profiles have higher wind loads compared to the PTC whenever the wind is blowing across the trough backside. The “Opt1” profile and the PTC have the same wind loads at the local solar noon. The “Opt1” profile has lower wind loads compared to “Opt2” and the PTC whenever the wind is facing the trough front side. Accordingly, adding shields on the backside of the trough is recommended for investigation in a future work.

OBJECTIVES Insulin is a high-risk medication, and its dosing depends on the individualized clinical and nutritional needs of each patient. Our hospital implemented an insulin dose calculator (IDC) imbedded in the electronic medical record with the goal of decreasing average wait times in inpatient insulin ordering and administration. In this study, we evaluated whether implementation of an IDC decreased the average wait time for insulin administration for hospitalized pediatric patients. METHODS This pre- and postintervention cohort study measured wait times between point-of-care glucose testing and insulin administration. Patients admitted to the inpatient pediatric services who were treated with subcutaneous insulin during the study period were included. Additionally, nurses completed satisfaction surveys on the insulin administration process at our hospital pre- and post-IDC implementation. Descriptive statistics, χ2, Fisher’s exact test, and Student t tests were used to compare groups. Statistical process control charts were used to analyze data trends. RESULTS The preintervention cohort included 79 insulin doses for admitted pediatric patients. The postimplementation cohort included 128 insulin doses ordered via the IDC. Post-IDC implementation, the average wait time between point-of-care glucose testing and insulin administration decreased from 37 to 25 minutes (P < .05). The statistical process control chart revealed a 5-month run below the established mean after implementation of the IDC. Before IDC implementation, 15.6% of nurses expressed satisfaction in the insulin-dosing process compared with 69.2% postimplementation (P < .05). CONCLUSIONS Implementation of an IDC reduced the average wait time in ordering and administration of rapid-acting insulin and improved nursing satisfaction with the process.

Aim of the work: To evaluate resistin level in systemic lupus erythematosus (SLE) patients and to assess the relationship with insulin resistance, disease characteristics, inflammatory markers and carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis. Patients and methods: Thirty adult SLE patients and twenty age and sex-matched control were enrolled. All patients were subjected to history taking, clinical examination and assessment of anthropometric measurements. Laboratory investigations included serum resistin, measures of insulin resistance, highly sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and lipid profile. Carotid duplex was performed for measurement of CIMT. SLE disease activity index (SLEDAI-2k) and damage index were evaluated. Results: The 30 patients were 23 (76.7%) females and 7 (23.3%) males (F:M 3.3:1) with a mean age of 30.9 ± 7.9 years. The disease duration was 4.8 ± 1.8 years. The mean serum resistin in patients was 7.7 ± 2.9 ng/dl and in control was 8.5 ± 5.1 ng/dl (p = 0.8). The ESR and hs-CRP were significantly increased (p

Background Therapeutic interventions for hepatocellular carcinoma (HCC) particularly in patients with advanced liver disease may lead to more aggravation of clinical and biochemical parameters of liver functions. We aimed to assess the utilization of easily applied variables which evaluate residual hepatic reserve to predict liability for complications and hepatic decompensation in cirrhotic patients with ablated HCC particularly when these patients were exposed to specific medical treatment such as DAAs and systemic therapy for HCC such as sorafenib. This study included 3 groups with HCC. Group 1: patients with ablated HCC and Child-Turcotte-Pugh (CTP) class A, who received Sofosbuvir (SOF)-based treatment (n = 250), group 2: HCC patients CTP (A), managed with sorafenib after transarterial chemoembolization (TACE) (n = 250) and group 3 as a control group of non-cirrhotic patients (n = 176). Evaluation for all patients was done by routine laboratory investigations including liver and kidney functions, complete blood count, platelet indices and plasma ammonia, upper gastrointestinal (GI) endoscopy and estimation of liver volume by ultrasound and liver stiffness (LS) by Fibroscan. Results Unfavorable outcome and increased incidence of complications during DAAs were independently associated with severity of thrombocytopenia (p = 0.001) at a cut-off 78,000/μl, LS > 20 kPa (p = 0.001), liver volume < 500 ml (p = 0.002), and gamma globulin levels > 4 gm/dl (p = 0.004). In the sorafenib group, unfavorable outcome and complications were independently associated with PDW/MPV ratio > 2.74 (p = 0.001), level of ammonia > 87 μg/dl (p = 0.001), LS > 25 kPa (p = 0.001), and liver volume < 490 ml (p = 0.001). Conclusion Non-invasive parameters of residual hepatic reserve are promising tools to guide therapy and avoid further complications in patients with liver cirrhosis and ablated HCC.

Introduction Hodgkin lymphoma is a highly curable lymphoproliferative malignancy with an overall relative survival rate of 87.4%. It is characterized by multinucleated Reed–Sternberg cells which are mostly derived from B cells in the germinal center. Case report We present a case of a 40-year-old gentleman with acquired immunodeficiency syndrome who presented with Stage 4b Hodgkin lymphoma complicated with fulminant hepatic failure and direct hyperbilirubinemia. The initial presentation of Hodgkin lymphoma as cholestatic jaundice is extremely rare. Management and outcome Though the survival rate with chemotherapy is high, the fulminant hepatic failure made the situation challenging with the use of chemotherapeutic regimens that require hepatic excretion. He received dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen [doxorubicin 12.5 mg (6.75 mg/m2), bleomycin 18 units (10 units/m2), vinblastine 3 mg (1.5 mg/m2), dacarbazine 380 mg (190 mg/m2)] as well as bictegravir/emtricitabine/tenofovir alafenamide since admission for treatment of human immunodeficiency virus and hepatitis B. He started responding with the first cycle of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen with bilirubin levels trended down and normalized as well as his clinical condition improved. He received the full dose of adriamycin-bleomycin-vinblastine-dacarbazine on day 15. Discussion Our case report emphasizes that the early usage of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen can restore hepatic function and can achieve improvement in hepatic function allowing the delivery of full-dose chemotherapy.

Bladder cancer is a major health problem. The limitations of poor sensitivity of cytology and the invasiveness of cystoscopy have generated interest in other non-invasive tools to monitor tumor recurrence. The measurement of survivin can aid the early diagnosis of bladder cancer, determine prognosis, and predict treatment outcomes. Its combination with other biomarkers as caspase-3 in this study may enhance prognostication and prediction of treatment response in bladder cancer, as well as tumor recurrence. The present study included 51 prospective consecutive patients undergoing transurethral resection of a bladder tumor (TURBT) for suspected bladder cancer. Immunohistochemical (IHC) staining and scoring for survivin and caspase-3 were done and then correlated with available clinical parameters. Seven patients had no cancer diagnosis, and none of them had positive immunoreactivity. Forty-four patients had bladder cancer, and expression of survivin and caspase-3 was present in 42 (95.5%) and 10 (22.7%) cases, respectively. There was no statistically significant correlation between recurrence and either survivin or caspase-3 expression. Survivin and/ or caspase-3 is not recommended as a part of the workup for bladder cancer, as their clinical applicability is very doubtful.

This study conducts numerical and experimental analyses to study the parameters affecting deep drawing of symmetric low-depth products, such as die geometry, punch movement, and cushioning. The methodology proposed in this paper is applied on the deep drawing of a frying pan manufactured out of AL99.9%. The finite element model (FE-model) is developed using LS-Dyna© and an experiment is carried out to validate the FE-model. The numerical and experimental results have shown minor deviation of 3.5% and 0.92% for maximum pressing load and maximum thickness, respectively. The validated FE-model is then employed to study the parameters affecting the maximum pressing load and maximum thinning. It is proved that the cushion stiffness and the initial blank thickness have the major influence, while the punch speed shows an insignificant impact. The results are justified and hence the FE-model proves to be reliable for further analyses.

Kaposi sarcoma (KS) was first described by Moritz Kaposi as a vascular tumor that mainly involves the skin but can affect any organ system. It is typically an acquired immunodeficiency syndrome defining illness but has emerged as a neoplasm also seen in patients on immunosuppressive therapy. Few KS cases have been reported in the literature associated with inflammatory bowel diseases. We report the case of a 39-year-old male with well-controlled human immunodeficiency virus (HIV) and ulcerative colitis (UC) who presented to the hospital with new skin lesions shortly after the initiation of vedolizumab to treat his refractory UC. Immunohistochemistry of the skin lesions was consistent with Kaposi's sarcoma secondary to human herpesvirus-8. This is a rare case of iatrogenic KS in a well-controlled HIV patient secondary to immunosuppressive therapy.

The authors aimed to evaluate sedation characteristics, as well as cardiorespiratory effects, of propofol, dexmedetomidine, and ketofol used for conscious sedation during transesophageal echocardiography (TEE).Prospective double-blind randomized study.Tanta University hospitals.Seventy-five participants with left-to-right shunt requiring diagnostic TEE interventions. Patients were randomized into three groups-P, Dex, and K-to receive propofol, dexmedetomidine, or ketofol, respectively.Time to reach targeted sedation level, duration of the procedure, recovery time, hemodynamic parameters, incidence of oxygen desaturation90%, as well as the cardiologist's satisfaction were recorded. The time onset and offset of sedation, duration of TEE procedure, and the need for rescue propofol were significantly less in the P and K groups compared with group Dex (p value 0.000*, 0.003*, 0.000*, and 0.000* and effect size 0.39, 0.15, 0.21, and 0.34, respectively). Mean arterial pressure, heart rate, and cardiac output significantly decreased in groups P and Dex compared with either baseline or group K. Hypoxic events were more manifest in group P; whereas group K had better cardiologist's satisfaction than the other two groups.In the TEE settings, the three agents were capable of attaining the targeted sedation levels , with propofol and ketofol having a faster onset and recovery times compared with dexmedetomidine. Even though dexmedetomidine and ketofol provided a more stable respiratory profile than propofol, ketofol was favorable in providing fewer hemodynamic alterations with better satisfaction scores than both propofol and dexmedetomidine.

The increase of resistant bacteria puts a huge pressure on the antimicrobials in current use. Antimicrobial resistance (AMR) results from antibiotic misuse and abuse over many years and is a global financial burden. New polices must be developed for the use of antimicrobials and to continue research efforts to mitigate AMR. It is essential to target the most harmful bacteria and concentrate on their mechanisms of resistance to develop successful antimicrobials. Essential oils (EOs) are occur naturally in plants and have long been used as antimicrobials, but most have not been researched. This review explores EOs as alternative antimicrobials, investigating their ability to decrease or inhibit biofilm formation, and assess their ability to contribute to AMR control. Low concentrations of EOs can inhibit Gram-positive and Gram-negative pathogenic bacteria. Some EOs have demonstrated strong anti-biofilm activities. If EOs are successful against biofilm formation, particularly in bacteria developing AMR, they could be incorporated into new antimicrobials. Therefore, there is a need to investigate these EOs’ potential, particularly for surface disinfection, and against bacteria from food, clinical and non-clinical environments.

Left ventricular thrombus typically occurs in patients with impaired left ventricular function such as aneurysm, dilated cardiomyopathy, or post-myocardial infarction. Untreated HIV infection is known to increase the risk of venous thromboembolism and cardiovascular disease. However, the pathophysiology remains uncertain; some studies have proposed chronic inflammation as the underlying etiology. Nonetheless, left ventricular thrombus is extremely rare among persons living with HIV with no known underlying cardiac disease. Herein, we report an unusual case of a 55-year-old homeless and heterosexual male with past medical history of HIV, who has mildly reduced left ventricular function and a nonmobile, medium size left ventricular thrombus. Patient was initially treated with therapeutic dose of enoxaparin, and subsequently developed acute embolic occlusion of right femoral artery that lead to an above knee amputation. To our knowledge, left ventricular thromboembolism complicated with acute embolic ischemia in persons living with HIV is extremely rare. The presenting case will definitely add to the current body of knowledge and will raise awareness among physicians, in recognizing the rare association between HIV and arterial thromboembolism.

Failure to rescue (FTR), defined as death after a complication, is recognized as a principal driver of variation in mortality among hospitals. We evaluated FTR as a quality metric in patients who received durable left ventricular assist devices (LVADs) using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support.Data on 13,617 patients who received primary durable LVADs from April 2012 to October 2017 at 131 hospitals that performed at least 20 implants were analyzed from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Rates of major complications and FTR were compared across risk-adjusted in-hospital mortality terciles (low, medium, high) and hospital volume. Logistic regression was used to estimate expected FTR rates on the basis of patient factors for each major complication.The overall unadjusted in-hospital mortality rate was 6.96%. Risk-adjusted in-hospital mortality rates varied 3.1-fold across terciles (low, 3.3%; high, 10.3%; P trend.001). Rates of major complications varied 1.1-fold (low, 34.0%; high, 38.8%; P .0001). Among patients with a major complication, 854 died in-hospital for an FTR rate of 17.7%, with 2.8-fold variation across mortality terciles (low, 8.5%; high, 23.9%; P .0001). FTR rates were highest for renal dysfunction requiring dialysis (45.3%) and stroke (36.5%). Higher average annual LVAD volume was associated with higher rates of major complications (10 per year, 26.7%; 10-20 per year, 34.0%; 20-30 per year, 34.0%;30 per year, 40.1%; P trend.0001) whereas hospitals implanting10 per year had the highest FTR rate (10 per year, 23.5%; 10-20 per year, 16.5%; 20-30 per year, 17.0%;30 per year, 17.9%; P = .03).FTR might serve as an important quality metric for durable LVAD implant procedures, and identifying strategies for successful rescue after complications might reduce hospital variations in mortality.

Male breast cancer (MBC) is rare, accounting for less than 1% of all breast cancer but the incidence has increased worldwide. Risk factors include increased longevity, obesity, testicular diseases and tumours, and germline mutations of BRCA2. BRCA2 carriers have 80 times the risk of the general population. Men generally present with breast cancer at an older age compared with women. Histologically, MBC is often of grade 2, hormone receptor positive, HER2 negative, and no special type carcinoma although in situ and invasive papillary carcinomas are common. Reporting and staging are similar to female breast cancer. Metastatic lesions to the male breast do occur and should be differentiated from primary carcinomas. Until recently, MBC was thought to be similar to the usual ER positive post-menopausal female counterpart. However, advances in MBC research and trials have highlighted significant differences between the two. This review provides an up to date overview of the biology, genetics, and histology of MBC with comparison to female breast cancers and differential diagnosis from histological mimics.

Japanese quail originated from the wildlife environment and was first domesticated in Japan in 1595. Japanese quail has widely distributed in various parts of the world. This bird is characterized by its rapid growth rate, high rate of egg production, much lower space requirements, small size, good reproductive potential, short life cycle, resistance to diseases, early sexual maturity (from 39 to 50 days), better laying ability and shorter time of hatching compared with the different species of poultry. All these characteristics rendered it an excellent laboratory animal and a good economical animal protein source (for both egg and meat). Thermal stress was found to be the major limiting variable in poultry production, directly influencing bird welfare conditions. Previous research showed that heat stress in the production environment, induced by high ambient temperatures, may have a direct detrimental effect on welfare, meat quality, carcass characteristics, productivity, egg mass and egg quality. Furthermore, heat stress directly decreases quails' reproductive performance. As tiny, ground-dwelling birds, quail may appear unable to handle extreme temperatures, yet they have methods of fighting the heat. This review will help in developing and strengthening the core of the quail-based poultry sector. In addition, it provides aggregate information on the characteristics of the quail bird as a production unit in poultry farms as well as being an animal model for laboratory experiments. Also, this review provided deep insight into the domestication process and the impact of heat stress on production characteristics, which altered the domestic or Japanese quail substantially.

In this study, which is the first of its kind in the gulf region, eye doses of interventional cardiologists and nurses were measured using active dosimeters for left and right eyes, in 60 percutaneous coronary interventions in three main hospitals in Kuwait. The dose given in terms of Hp(0.07) per procedure when ceiling suspended screens were used by main operators ranged from 18.5 to 30.3 µSv for the left eye and from 12.6 to 23.6 µSv for the right eye. Taking into account typical staff workload, the results show that the dose limit of 20 mSv/year to the eyes can be exceeded for interventional cardiologists in some situations, which demonstrates the need of using additional effective radiation protection tools, e.g. protective eye spectacles, in addition to the regular and proper use of ceiling suspended screens. With indications of increase in workload, the need for availability of a dedicated active dosimeter for the regular monitoring of eye doses is emphasized.

There was a need to develop accurate and effective methods for assessing pain in birds in general and in chickens in particular, as chicks are laboratory animals that are easily raised and dealt with, as well as having neurological components to interact and respond to pain the same as in mammals. Birds have physiological and/or behavioral signs of pain. The physiological signs of pain include the change in heart rate, respiratory rate, and blood pressure, and the flapping of the wing. The behavioral signs of pain that extend from the withdrawal response, calling, and the flapping of the wing. This article focused on the methods of pain assessment in birds in the published literature that varying according to the type of stimulus. However, this review offers information on pain assessment approaches and associated behavior, which can enhance specialists’ Understanding of the pain causes and, thus, we can evaluate the analgesic drugs for pain in chicks.

Thin films of semiconductor Se80Ge20-xAgx (x = 0, 3, 6, 9, 12 and 15 at.%) were deposited by the thermal evaporation technology. Through optical and electrical characterization, the influence of the Ag ratio on the photoelectric parameters of Se–Ge thin film was studied. The X-ray diffraction pattern showed the amorphous nature of the deposited films as well as the polycrystalline state when the films were annealed at the maximum crystallization temperature (415 K), which was determined by the first derivative of the resistivity curve with respect to temperature. The crystallization kinetics of the film was extracted from the electrical analysis by measuring the change in resistivity with temperature. The electrical results of the thin film showed three regions; namely, amorphous, extended (crystalline) and hopping. In the extended and hopping states, the activation energy and pre-exponential factors were calculated. The optical constants, extinction coefficient and refractive index were calculated using the transmittance and reflectance of the grown Se80Ge20-xAgx films. The energy gaps of the films were estimated in the strong absorption regions. The changes in the bandgap energy of the film by thermal annealing can help to produce materials with acceptable band gaps for use as absorber layers in solar cell applications. Also, the results provide microscopic insights and studies on the structure, electr-othermal and optical properties of Ag metal-doped GeSe as a back contact of solar cells.

In seeking to improve traffic congestion and safety on roads and highways, there has been an increased interest in intelligent transportation systems (ITS). The emerging visible light communication (VLC) technology is a new candidate to enable wireless access in ITS. The purpose of this study is to present a comprehensive review of the current studies related to VLC. Since VLC facilitates illumination and data communication simultaneously, it reduces energy consumption significantly. Additionally, VLC is immune to electromagnetic interference, provides high data security, and utilizes unregulated visible light spectrum, showing promise as a potentially cheaper alternative to existing radio frequency (RF) based technology. Moreover, recent advances in semiconductor materials and solid-state technologies have enabled the development of efficient light-emitting diodes (LEDs) and laser diodes (LDs) which are used as transmitters in a VLC system. Although 10 s of Gbits/s data rate has been demonstrated in indoor VLC links, successful implementation of it in outdoor environments requires further research to overcome the challenges presented by environmental factors, unwanted lights, non-line of sight communication, directional radiation pattern, frequent fragmentation, and so on. Besides, in recent years, semiconductor LDs have been garnering more attention since they can transmit more data over longer distances due to their high quantum efficiency and modulation bandwidth compared to LEDs. As a result, urban planners, policy-makers, transportation engineers, and vehicle manufacturers are considering LD-based VLC to facilitate vehicle-to-vehicle and vehicle-to-infrastructure communication. Thus, this paper reviews and compares the most recent developments in VLC technologies, identifies their benefits and potential use in ITS applications, discusses the probable barriers for their implementation in our existing transportation infrastructure, and suggests future research directions and recommendations to overcome these challenges.

In the current century, the development of medicine and molecular biotechnology led to successful containment and even eradication of some human pathogens, especially in developed countries. However, some pathogens have evolved, resulting in the emergence of other infectious diseases in developed countries. Human socioeconomic activities and the advancement of technology and transportation have led to the quick movement of humans to different parts of the world. There is a significant concern that this movement enhances the distribution of pathogens, making it difficult to contain, as witnessed with the global spread of the 2009 influenza pandemic within only 3 months and the 2014 Ebola outbreak, which spread in various West African countries within 8 months. Natural products obtained from plant sources can be identified as the next-generation antibacterial and antiviral alternatives. In developed countries, 80% of the population depends on traditional medicine for their primary healthcare issues, according to the World Health Organization (WHO). Relatedly, India is one of the highest producing countries for medicinal herbs. It is considered an international botanical garden. Therefore, the focus of this current review was on the importance of using plants to treat bacterial and viral diseases due to the many advantages of these plants.

The telecommunication sector has been developed rapidly and with large amounts of data obtained as a result of increasing in the number of subscribers, modern techniques, data-based applications, and services. As well as better awareness of customer requirements and excellent quality that meets their satisfaction. This satisfaction raises rivalry between firms to maintain the quality of their services and upgrade them. These data can be helpfully extracted for analysis and used for predicting churners. Researchers around the world have conducted important research to understand the uses of Data mining (DM) that can be used to predict customers' churn. This paper supplies a review of nearly 73 recent journalistic articles starting in 2003 to introduce the different DM techniques used in many customerbased churning models. It epitomizes the present literature in the field of communications by highlighting the impact of service quality on customer satisfaction, detecting churners in the telecoms industry, in addition to the sample size used, the churn variables used and the results of various DM technologies. Eventually, the most common techniques for predicting telecommunication churning such as classification, regression analysis, and clustering are included, thus presenting a roadmap for new researchers to build new churn management models.

Low caloric diet can reduce liver volume; however, there is no consensus regarding preoperative weight reduction before bariatric surgery. This study evaluates the effect of preoperative very-lowcalorie diet (VLCD) in patients undergoing laparoscopic sleeve gastrectomy (LSG). This prospective study included patients scheduled for LSG stratified into two groups, Diet Group (n = 183) who followed a preoperative VLCD regimen for three weeks and underwent assessment of the liver lobes span before and after regimen, and Control Group (n = 138) who underwent sonographic assessment once before surgery and were operated upon without diet. The outcome measures were the impact of preoperative diet on the liver span, intraoperative complications, anthropometric factors affecting the liver span. Diet regimen resulted in a significant reduction of the right and left lobes. The percentage of the reduction of the left lobe span was significantly higher than that of the right lobe (p

Lack of conal rotation and conal malseptation is a characteristic anatomical feature for TOF which lead to dextroposed position of aorta and significant RVOT narrowing. The quantitative assessment of these anatomical features using modern cardiac imaging modality has been rarely discussed in the literature. All TOF scanned had in our center from 2013 till 2019 were included. The angle of aortic root rotation was recorded by measuring the angle between a line connecting the midpoint of the non-coronary sinus to the anterior commissure and another line along the interatrial septum. Rotation angles were correlated with proximal main pulmonary artery (MPA) size indexed to BSA. 287 TOF patients were included, 258 patients (91%) had TOF with pulmonary stenosis (TOF-PS) including 138 male (54%), median age 2 years (2 months–40 years), and 29 patients (9%) had TOF with pulmonary atresia (TOF-PA) including 17 male (59%), median age 5 years (1 m-33 years). The whole cases demonstrated clockwise rotation of the aortic root. The mean rotation angle in TOF-PS group was 52.6 ± 20.9° and in TOF-PA group was 64.9 ± 13.9°. Proximal MPA diameter was 11.1 ± 5.9 mm/m2. There was a significant negative correlation between aortic root rotation angle and proximal MPA diameter (r = − 0.262, P = 0.000). The rotation angle of aortic root was significantly higher in TOF-PA compared to TOF-PS (64.9 ± 13.9° vs. 52.6 ± 20.9°, P = 0.001, respectively). MSCT provide a quantitative measurement methodology of conal malseptation and its effect in TOF patients. There is a clockwise rotation angle of the aortic root in TOF patients that correlates negatively with proximal MPA size. TOF-PA have a larger rotation angle of aortic root.

Background and objectives With global efforts to develop and deliver a COVID-19 vaccine rapidly, vaccine hesitancy stands as a barrier to these efforts. We aimed to estimate the proportion of Syrian adult population intending to be vaccinated against COVID-19 and, principally, to assess the demographic and attitudinal factors associated with it in order to approach suitable solutions. Methods An anonymous online questionnaire was conducted between 23rd December 2020 and 5th January 2021 in various provinces in Syria. A total of 3402 adults were sampled to reflect the population demographic factors. Attitudinal factors included Covid-19 fears, risks, and beliefs on the origin. Vaccination hesitancy and knowledge were also measured. The intention to get vaccinated against COVID-19 was the primary endpoint. Results According to their statements, 1222 participants (35.92%) will consent to get vaccinated against COVID-19. Our findings indicate that male gender, younger age, rural residence, not having children, smoking, fear about COVID-19, individual perceived severity, believing in the natural origin of the coronavirus, and high vaccination knowledge were positive predictors of embracing COVID-19 vaccine when it is available. Conclusion COVID-19 vaccine acceptance rate is considerably poor across Syrian population compared to populations in developed countries. Vaccine hesitancy is closely bound to the fear of side effects and doubts about vaccine efficacy. Factors such as conspiracy beliefs and myths about the vaccine lower vaccine uptake. Thus, interventional educational campaigns are increasingly required to overcome misinformation and avert low vaccination acceptance rates.

Background There is solid evidence that olfactory dysfunction (OD) can present in COVID-19 patients. Anosmia can be the only presentation or can be accompanied by other symptoms of COVID-19. Multiple cross-sectional studies have demonstrated that the incidence rate of olfactory dysfunction is high in COVID-19 patients with good prognosis. The aim of our study is to investigate the presence of OD with the radiologic and laboratory findings among COVID-19 positive patients. Results There was statistical significance in clinical severity between anosmia and non-anosmia group (P value 0.000) denoting that anosmia sign mostly occur in mild COVID. Also, there was significance in D dimer between two groups (P value 0.044) denoting that D dimer could be a sign of clinical severity and it is usually not elevated in anosmia. All anosmia group had normal CT chest denoting that it is a mild form of COVID-19. Conclusions Olfactory dysfunction (OD) is an imminent sign of COVID-19 patient, which can be presented as a sole symptom or with other symptoms. As anosmia could be the sole clinical presentation of COVID-19 patients without any other significant signs and so otolaryngologists should be aware of this presentation in COVID-19 diagnosis.

Background: Deep vein thrombosis (DVT) is a major complication and preventable cause of morbidity and mortality among patients in the intensive care unit (ICU). The incidence of deep vein thrombosis in neurological ICU presumed to be higher reporting an incidence of 18 to 50%. A nursing protocol that improves nurses’ use of preventive measures for deep vein thrombosis is paramount. Aim: This study aimed to investigate the effect of nursing care protocol on deep vein thrombosis occurrence among critically neurological patients.Subjects and Method: Design: A quasi-experimental research design was used.Setting: study conducted at neurosurgery intensive care unit and neurological department in Mansoura University HospitalSubjects:a purposive sample of 60 patients (30 protocol patients group and 30 control group) participated in the study.. Routine care was applied to the control group while the protocol group received deep vein thrombosis care according to the protocol. Tools: data were collected using two tools; DVT Assessment Status Tool and DVT Incidence Monitoring Tool. Results: 26% of studied patients in the control group developed DVT compared with 3% in the protocol group. A significant difference existed between the two groups after implementing the nursing protocol concerning exercise, elastic stock, and pneumatic compression (P

Background: People experiencing or perceived to have a mental illness often subject to stigma from many sources which can be automatically internalized and result in internalized stigma. Aim: This study aimedat assessing the levels of internalized stigma and explores relation between demographic, clinical data, and internalized stigma among psychiatric inpatients in Minia governorate. Research Design: A descriptive correlational research design was used in this study. Study subjects and setting: 50 psychiatric inpatients at Minia Hospital for Mental Health and Addiction Treatment in New Minia City were included in the study. Tools: Socio-demographic and clinical data questionnaire and Internalized Stigma of Mental Illness Scale were used. Results: More than half (60%) of the studied patients were males, near to one third (30%) had schizophrenia, less than two thirds (60%) of them had a moderate level of internalized stigma, while 26% of them had high level of internalized stigma and only 14% of them had low level of internalized stigma. Conclusion: There were no statistically significant differences between internalized stigma levels and all sociodemographic and clinical data of the patients except for occupation and duration of hospitalization. Recommendations: Designing and implementing psycho-educational programs for psychiatric mentally ill patients to decrease internalized stigma are needed.

The effect of bariatric surgery on postoperative thyroid function remains incompletely understood. In this study, we aimed to evaluate the changes in thyroid functions after gastric sleeve operation for morbidly obese Egyptian patients. This was a prospective study that recruited 128 patients who underwent sleeve gastrectomy through the period from December 2016 to April 2020. We measured thyroid-stimulating hormone (TSH), free thyroxin (FT4), and free triiodothyronine. Subclinical hypothyroidism was defined by a TSH level > 4.5 mIU/L but a normal FT4 level. All patients were followed for 12 months after the procedure. Preoperatively, 30 (23.4%) patients had subclinical hypothyroidism. The prevalence of subclinical hypothyroidism decreased significantly to reach 7.8% at the end of follow-up (p

This paper proposes an adaptive Time-Bound Attribute-Based Encryption Scheme (TB-ABE). TB-ABE is a fine-grained data access control scheme that maintains a secure data exchange environment between ...