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Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

Breast cancer is one of the most common types of cancer worldwide. Early detection of cancer increases the probability of recovery. This work has three contributions. The first contribution is improving the performance of support vector machine (SVM) using a recent grey wolf optimizer (GWO) for diagnosis breast cancer with efficient scaling techniques. The second contribution is proposing three efficient scaling techniques against the classical normalization technique. The last contribution is using a parallel technique which applies task distribution to improve the efficiency of GWO. The proposed sequential model is applied on two different datasets, Wisconsin diagnosis breast cancer (WDBC) dataset and Electronic Health Records (EHR). Experimental results of WDBC show that the proposed hybrid GWO-SVM model achieves 98.60% with normalization scaling. Also, using the proposed scaling techniques with the proposed GWO-SVM model gives a fast convergence and achieves accuracy rate by 99.30%. The parallel version of the proposed model achieves a speedup by 3.9 on four CPU cores. On the other hand, Experimental results of EHR show that the proposed hybrid GWO-SVM model achieves 93.26% with normalization scaling against 82.05 for SVM.

Background and objectives Around 2.6 million infants die within the first one month of life every year and India alone accounts for about one-fifth of global live births and one-fourth of neonatal deaths. Uttarakhand being a rural predominant state of India has neonatal mortality rate of 31 per 1000 live births in 2018 that is much higher than the targeted 12 deaths per 1000 live births by 2030 as per Sustainable Developmental Goal-3. The present study is being undertaken to examine Home Based Newborn Care practices of mothers in rural areas of Uttarakhand, India. Methods A community based cross-sectional study was conducted on 205 postnatal mothers who were within 42 days of delivery in Doiwala, Uttarakhand using total enumeration technique. Data were collected using reliable, structured and pretested tools comprising various aspects of home based newborn care practices. The data were analyzed using SPSS version 21. Results Delivery of most of the mothers (94.15%) took place in health centers though they never consulted obstetricians during pregnancy. While the remaining 5.85% of mothers gave birth at home with the help of local Dais and family members. Most of the babies (95.12%) were born full-term and about half of them (47.40%) were immunized with BCG, OPV and HEP-B vaccines. About 78.05% of mothers initiated breast feeding within the first hour of delivery and 88.29% of the mothers reported exclusive breastfeeding. However, the remaining 11.71% of mothers provided water, gripe water or ghutti to their babies as pre-lacteal feeds. 72.68% of mothers delayed the first bath of their baby for at least 48 h post-delivery and Kangaroo Mother Care (KMC) was practiced by 74.63% of mothers. Most of the participants (93.66%) were aware of keeping umbilical cords clean and dry, however, the remaining 6.34% of the mothers still practiced traditional methods of applying turmeric powder and ghee to the cord. Conclusion Most of the mothers were aware of hygiene maintenance and thermal protection for babies during the post-natal period. Some of the major challenges experienced by the mothers include early bathing of newborns, delayed initiation of breast feeding, cord care, avoidance of KMC, providing pre-lacteal feeds to newborns, as well as others.

While phenotypic plasticity is a critical factor contributing to tumor heterogeneity, molecular mechanisms underlying this process are largely unknown. Here we report that breast cancer cells display phenotypic diversity in response to hypoxia or normoxia microenvironments by operating a reciprocal positive feedback regulation of HPIP and HIF-1α. We show that under hypoxia, HIF-1α induces HPIP expression that establishes cell survival, and also promotes cell migration/invasion, EMT and metastatic phenotypes in breast cancer cells. Mechanistic studies revealed that HPIP interacts with SRP14, a component of signal recognition particle, and stimulates MMP9 synthesis under hypoxic stress. Whereas, in normoxia, HPIP stabilizes HIF-1α, causing the Warburg effect to support cell growth. Concurrently, mathematical modelling corroborates this reciprocal feedback loop in enabling cell-state transitions in cancer cells. Clinical data indicate that elevated levels of HPIP and HIF-1α correlate with unfavorable prognosis and shorter survival rates in breast cancer subjects. Together, this data shows a reciprocal positive feedback loop between HPIP and HIF-1α that was unknown hitherto. It unveils how the tumor microenvironment influences phenotypic plasticity that has an impact on tumor growth and metastasis and, further signifies considering this pathway as a potential therapeutic target in breast cancer.

This study proposes a new predictive segmentation method for liver tumors detection using computed tomography (CT) liver images. In the medical imaging field, the exact localization of metastasis lesions after acquisition faces persistent problems both for diagnostic aid and treatment effectiveness. Therefore, the improvement in the diagnostic process is substantially crucial in order to increase the success chance of the management and the therapeutic follow-up. The proposed procedure highlights a computerized approach based on an encoder–decoder structure in order to provide volumetric analysis of pathologic tumors. Specifically, we developed an automatic algorithm for the liver tumors defect segmentation through the Seg-Net and U-Net architectures from metastasis CT images. In this study, we collected a dataset of 200 pathologically confirmed metastasis cancer cases. A total of 8,297 CT image slices of these cases were used developing and optimizing the proposed segmentation architecture. The model was trained and validated using 170 and 30 cases or 85% and 15% of the CT image data, respectively. Study results demonstrate the strength of the proposed approach that reveals the superlative segmentation performance as evaluated using following indices including F1-score = 0.9573, Recall = 0.9520, IOU = 0.9654, Binary cross entropy = 0.0032 and p-value

Herein, we describe the case of a 20-year-old woman who presented with dysphagia of 2 months’ duration associated with vomiting, moderate abdominal pain, decreased oral intake, and significant weight loss. During the past 3 years, the patient experienced intermittent mild abdominal pain with infrequent vomiting. Endoscopy at Jordan University Hospital showed a mass in the esophagus, and endoscopic biopsies were performed. The preliminary histopathological report excluded malignancy. Two days after endoscopy, the patient presented to the emergency department complaining of severely worsening pain and total dysphagia. The pain persisted despite intravenous paracetamol administration, which was concerning for esophageal perforation; therefore, an urgent surgical intervention was performed. The mass was removed surgically, along with a para-esophageal lymph node. The final histopathological results of the endoscopic and resected specimens supported the diagnosis of pseudomyogenic hemangioendothelioma (PMHE). This is the first case reporting esophageal involvement of PMHE.

Background: Psoas abscess is a rare condition but one with potential for severe morbidity. Many factors may be implicated in the treatment outcome of the condition and efforts must be directed to identify, understand and control the factors for a better prognosis. Objective: To identify the factors associated with surgical treatment outcome of psoas muscle abscess. Methodology: This descriptive cross-sectional study was conducted upon a sample of 58 patients (chosen via non-probability, consecutive sampling) scheduled for surgical treatment for psoas muscle abscess (aged 18 to 60 years) at department of General Surgery at Liaquat University Hospital, Hyderabad & Jamshoro. All the patients underwent surgical treatment. The data was recorded via pre-structured questionnaire comprising of inquiries pertaining to socio-demographic details, presenting complaints, and factors association with surgical treatment outcome (in terms of resolution of abscess cavity). Data was analyzed via SPSS version 20. Results: Mean age of study subjects was 37.6 ± 12.5 years. Out of all 72.4% were males and 27.5% were females. Most common presentation of patients was pain in flanks, followed by fever. The commonest etiological factor was tuberculosis (TB) and consequently spinal (TB) was the most common. Resolution of abscess cavity was noted among 77.5% of the cases with a greater proportion of recovery falling in line non- tuberculous etiology. Conclusions: After careful consideration, it can be concluded that secondary psoas muscle and that with tuberculous etiology have a poorer surgical outcome, thus greater care and more effective surgical techniques may be employed to achieve complete resolution of abscess.

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of Takayasu's Arteritis. We report the case of an 11-year-old girl who presented with a tonic-clonic seizure and loss of consciousness, without fever. Imaging revealed characteristic white matter edema of the occipital and parietal lobes, in keeping with PRES. Further imaging demonstrated right renal artery stenosis and wall thickening of the abdominal aorta. The combination of hypertension, the discrepancy of blood pressure recordings between upper limbs, and imaging abnormalities of the aorta and the left renal artery led to the diagnosis of PRES secondary to Takayasu's Arteritis. Treatment with oral corticosteroids, azathioprine, amlodipine, and propranolol resulted in the complete resolution of the patient's symptoms and imaging abnormalities.

Summary Objectives Iron amino acid chelates have been developed to be used as food fortificants and therapeutic agents in the treatment of iron deficiency anemia. Purpose To compare the efficacy of Oral iron bisglycinate chelate (FeBC), lactoferrin (LF), lactoferrin with iron and iron polymaltose complex (IPC) in treatment of iron deficiency anemia (IDA). Methods: a comparative study was conducted on 120 children with IDA, they attended to outpatient clinic at Menoufia University Hospitals within a period from April to November 2019. All subjects were classified into FeBC Group (30 children received iron bisglycinate), LF Group (30 children received lactoferrin 100 mg), LF with iron Group (30 children received 30% iron saturated lactoferrin) and IPC Group (30 children received iron polymaltose complex with elemental iron of6 mg/kg/day). Serum iron, serum ferritin, transferrin saturation was investigated. Results After treatment serum iron, serum ferritin and transferrin saturation improved in FeBC group than LF group, in LF with iron group than LF group, and in IPC group than LF group. Serum ferritin improved in LF with iron group than IPC group. Side effects of drugs were higher in FeBC group than LF group, and higher in LF with iron group than FeBC group. Conclusions Adding lactoferrin to iron helps increasing iron stores more than using iron alone in treatment of iron deficiency anemia. Lactoferrin is less effective than lactoferrin with iron, iron bisglycinate chelate and iron polymaltose complex in treatment of iron deficiency anemia.

Yellow fever is a neglected hemorrhagic disease with a high case fatality rate ranging between 25% and 50% for the hospitalized patients. Yellow fever disease is caused by a zoonotic pathogen known as yellow fever virus. This RNA virus is usually transmitted by mosquitos and it is considered endemic in the tropical regions of South America and Africa. Although an effective vaccine is available for yellow fever virus, no antiviral drug is yet licensed against the disease. Thus, yellow fever virus is still representing a re-emerging threat among unvaccinated individuals in endemic regions. The NS2B-NS3 protease seems to play an important role in yellow fever virus replication cycle. As such, the NS2B-NS3 protease may represent a potential target for structure-based drug design and discovery. In this direction, computational approaches like virtual screening can be utilized to hasten the design of novel antivirals and/ or repurposing an already FDA approved drugs. In this in silico study, an FDA approved drugs library was screened against NS2B-NS3 protease crystal of yellow fever virus. Then the best hits with least energy of binding and ability of hydrogen bonding with key residues of protease active site were then selected and submitted to molecular dynamics simulation. And throughout simulation interval, only Olsalazine was able to stay in close proximity to the active site of protease crystal with least average MM-PBSA binding energy as compared to Dantrolene, Belinostat and Linezolid. This indicates that Olsalazine may have the best capacity to bind to NS2B-NS3 protease and interfere with its activity.

SMG8 (MIM *617315) is a regulatory subunit involved in nonsense-mediated mRNA decay (NMD), a cellular protective pathway that regulates mRNA transcription, transcript stability, and degrades transcripts containing premature stop codons. SMG8 binds SMG9 and SMG1 to form the SMG1C complex and inhibit the kinase activity of SMG1. Biallelic deleterious variants in SMG9 are known to cause a heart and brain malformation syndrome (HBMS; MIM #616920), whereas biallelic deleterious variants in SMG8 were recently described to cause a novel neurodevelopmental disorder (NDD) with dysmorphic facies and cataracts, now defined as Alzahrani-Kuwahara syndrome (ALKUS: MIM #619268). Only eight subjects from four families with ALKUS have been described to date. Through research reanalysis of a nondiagnostic clinical exome, we identified a subject from a fifth unrelated family with a homozygous deleterious variant in SMG8 and features consistent with ALKUS. Interestingly, the subject also had unilateral microphthalmia, a clinical feature that has been described in SMG9-related disorder. Our study expands the phenotypic spectrum of SMG8-related disorder, demonstrates an overlapping phenotype between SMG8- and SMG9-related rare disease traits, provides further evidence for the SMG8 and SMG9 protein interactions, and highlights the importance of revisiting nondiagnostic exome data to identify and affirm emerging novel genes for rare disease traits.

Background We performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well the rate of occurrence of other complications such as stroke, and upper limb ischemia. Results This was a case series study done between July 2014 and April 2020, in them all the left subclavian artery was covered to ensure a proximal safe seal zone. Routine spinal fluid drainage was done, keeping the spinal fluid pressure Conclusion By adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.

The major spliceosome mediates pre-mRNA splicing by recognizing the highly conserved sequences at the 5′ and 3′ splice sites and the branch point. More than 150 proteins participate in the splicing process and are organized in the spliceosomal A, B, and C complexes. FRA10AC1 is a peripheral protein of the spliceosomal C complex and its ortholog in the green alga facilitates recognition or interaction with splice sites. We identified biallelic pathogenic variants in FRA10AC1 in five individuals from three consanguineous families. The two unrelated Patients 1 and 2 with loss-of-function variants showed developmental delay, intellectual disability, and no speech, while three siblings with the c.494_496delAAG (p.Glu165del) variant had borderline to mild intellectual disability. All patients had microcephaly, hypoplasia or agenesis of the corpus callosum, growth retardation, and craniofacial dysmorphism. FRA10AC1 transcripts and proteins were drastically reduced or absent in fibroblasts of Patients 1 and 2. In a heterologous expression system, the p.Glu165del variant impacts intrinsic stability of FRA10AC1 but does not affect its nuclear localization. By co-immunoprecipitation, we found ectopically expressed HA-FRA10AC1 in complex with endogenous DGCR14, another component of the spliceosomal C complex, while the splice factors CHERP, NKAP, RED, and SF3B2 could not be co-immunoprecipitated. Using an in vitro splicing reporter assay, we did not obtain evidence for FRA10AC1 deficiency to suppress missplicing events caused by mutations in the highly conserved dinucleotides of 5′ and 3′ splice sites in an in vitro splicing assay in patient-derived fibroblasts. Our data highlight the importance of specific peripheral spliceosomal C complex proteins for neurodevelopment. It remains possible that FRA10AC1 may have other and/or additional cellular functions, such as coupling of transcription and splicing reactions.

Background: Although High body mass index is associated with many cardiovascular diseases including coronary artery disease. Its effect on in-hospital death in patients with acute ST-segment elevation myocardial infarction (STEMI) is still a subject of controversy. Objective: To determine the correlation between body mass index (BMI) and in-hospital mortality in those patients. Patients and Methods: In this cross-sectional study, 180 adult patients with acute STEMI were enrolled and their BMI was measured. The participants were classified according to BMI into three groups as normal, overweight, and obese. A correlation between in-hospital mortality due to STEMI and BMI was evaluated. Results: Of the total participants, 62 (34.4%) were normally weighted, 61(33.8%) were over-weighted, and 57(31.6%) were obese. There was a significant difference (p=

Zoledronate could be contributing to the development of acute kidney injury in a small number of patients. Since estimated glomerular function (eGFR) is simpler to obtain and at least as good a predictor as creatinine clearance (CrCl), it should be used in everyday practice. Zoledronate is widely used for the treatment of osteoporosis. A potential side effect is acute kidney injury (AKI). Advice from the UK Medicines and Healthcare products Regulatory Agency (MHRA) in 2019 stated that CrCl and not estimated glomerular filtration rate (eGFR) should be used and that treatment should not be given if CrCl

BACKGROUND: Efforts to control the incidence of dengue hemorrhagic fever (DHF) have been carried out intensively, however, there is no significant reduction in the number of DHF sufferers. Meanwhile, the predictive model is expected to be an early warning to anticipate the incidence of DHF. AIM: Therefore, this study aims to determine the dynamic model for predicting dengue fever incidence in Maros Regency from 2020 to 2040. METHODS: This study used the research and development (R and D) method with a dynamic systems approach. The study was conducted in Maros Regency and the data on dengue cases in Maros Regency from 2014 to 2018 were used as samples. Meanwhile, interpretive structural modeling (ISM) was used to determine policy scenarios in reducing dengue cases while the analysis of the dynamic model of dengue fever was conducted using the Powersim program. RESULTS: The critical elements of DHF prevention in the Maros Regency include the Jumantik program, 3M Plus, early warning systems, and outreach. Furthermore, the prediction of the average incidence of dengue fever from 2020 to 2040 has decreased based on dynamic model simulations by applying the Jumantik scenario (46.8%), 3M Plus (61.17%), early warning systems (74.4%), counseling (52.12%), and the combined scenario (97.87%). CONCLUSIONS: The incidence of dengue fever in the Maros Regency is prevented and controlled by the combination of the Jumantik program, 3M Plus, early warning systems, and counseling.

Aim of the work To preliminary study polymorphisms in a set of genes of relevance to methotrexate (MTX) response based on the Drug Bank database in Egyptian rheumatoid arthritis (RA) patients. Patients and methods The study included 10 consecutive adult female RA patients categorized according their response and adverse events (AEs) to MTX; patients with good response, ACR50 after 4 weeks was considered. Variant Call Format files were annotated and filtered via Drug Bank (11/9/2017) database in MTX. Accordingly, the following set of genes most related for RA MTX response were considered: SLC16A1, SLC7A11, SLC22A7, TBXAS1, PTK2B, ABCC2, ABCC4, SNORD13G, SLCO3A1, ABCC1, SLC46A1, SARM1, ABCB1, SLC19A, ATIC and SLCO1C1. Human genome DNA was assessed using Ion Ampliseq Exome Panel. Single-nucleotide variants (SNVs) and short insertions/deletions were identified Results The mean age of the patients was 39 ± 12.5 years and disease duration 9.8 ± 7.4 years. AEs were present in 4 (2 poor and 2 good responders). 6 patients showed a good response with no AEs. Of the 16 studied genes, 19 variants were revealed. 18 SNVs and one deletion were detected. The C allele of ABCB1 was dominant in 7 out of 8 good responders’ (87.5%). The G of ATIC was present in 20% with AEs and poor response. The T and G of SLCO1C1 were in 60% of good responders. Conclusion In Egyptian RA patients, there is evidence of a possible influence of a set of gene variants on the disease pathogenesis while others were related to MTX AEs and response.

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

Background: Isoprenaline (ISO) in large doses induces morphological and functional alterations in the heart leading to myocardial necrosis. It also produces excessive free radicals resulting from oxidative metabolism of catecholamine. There are increasing evidences that cardiotoxicity of ISO occurs because of generation of free radicals and oxidative stress. Objective: To investigate the protective effect of pioglitazone on the outcome of isoprenaline (ISO) induced myocardial infarct-like lesions in rats. Materials and methods: 50 male Wistar albino rats (150-200gm) were selected for this study. The rats were divided into five groups each consisted of 10 rats. This study was conducted at Department of Pharmacology, Faculty of Medicine, Al-Azhar University (Assiut). Results: Results showed that pretreatment with pioglitazone significantly decreased the activity of LDH, CK, TNF alpha, IL 6 and the levels of CTnI in serum of ISO-induced rats. Our results showed that pretreatment with pioglitazone significantly (p < 0.01) decreased the level of MDA compared with ISO alone-induced rats. Conclusion: Pioglitazone has a valuable protective role against myocardial infarction through its action as peroxisome proliferator activated receptor gamma (PPAR-γ) agonist.

الملخص: أهداف البحث: تزايد انتشار حصى الكلى في جميع أنحاء العالم في العقد الماضي، ويُعتقد أن عوامل الخطر المتعددة تُعزى إلى التغيير في نمط الحياة، والنظام الغذائي، وحتى الاحتباس الحراري. في دولة الإمارات العربية المتحدة، لم يتم عمل الكثير من البحوث لاستكشاف انتشار حصى الكلى والمعرفة عنها. تهدف هذه الدراسة إلى قياس مدى معرفة المجتمع بحصى الكلى بين البالغين في دولة الإمارات العربية المتحدة. طرق البحث: في هذه الدراسة المقطعية، تم جمع البيانات باستخدام استبانة ذاتية الإدارة تم توزيعها علىخمسة مائة و خمسة عشر مشارك (٢٠-٤٩ عاما) من أبو ظبي ودبي وعجمان والشارقة. النتائج: من بين ٥٠٠ مشارك، بلغ متوسط مجموع درجات المعرفة ٥٦.٤٪. لم يكن هناك ارتباط بين المعرفة بين أولئك الذين عانوا من حصى الكلى والذين لم يصابوا بها. كان وجود تاريخ عائلي بتشخيص حصى الكلى يزيد من خطر الإصابة بحصى الكلى بمعدل ٢.٢٧. وأظهرت النتائج أن المشاركين الذين كان لديهم علامات وأعراض وتشخيص وعلاج حصى الكلى، كان لديهم مستوى جيد من المعرفة بعد تحليل مصدر المعرفة، ولكن كان هناك مستوى ضئيل من المعرفة بخصوص العوامل الغذائية المتعلقة بحصى الكلى. كان للإنترنت ووسائل الإعلام دور أكبر بضعفين من الأطباء في تثقيف السكّان. الاستنتاجات: استطاعت هذه الدراسة أن توضح أن سكّان الإمارات على دراية ببعض الجوانب المتعلقة بحصوات الكلى ولكن على غير دراية بشأن عوامل الخطر التبعية. وهذا يسلط الضوء على أهمية تعزيز التعليم من خلال الحملات الصحية. Abstract: Objectives: The prevalence of kidney stones is increasing worldwide. Multiple risk factors are believed to contribute to the development of kidney stones such as lifestyle, diet, and global warming. In the United Arab Emirates (UAE), there has been limited research exploring the prevalence and risk factors of kidney stones. This study attempts to assess the understanding and prevalence of kidney stones among adults in the UAE. Methods: In this cross-sectional study, data were collected using a self-administered questionnaire, distributed among 515 participants (20–49 years old) from Abu Dhabi, Dubai, Ajman, and Sharjah states. IBM SPSS version 25 was used for data analysis. Results: The mean of knowledge score was 56.4% (n = 500). There was no correlation between the knowledge of those who had experienced kidney stones and those who did not. Furthermore, a family history of kidney stones increased the risk of developing stones by 2.27 times. Among participants reporting signs, symptoms, diagnosis, and the management of kidney stones, the knowledge and understanding about kidney stones was high. However, the perceptions of the same cohort about dietary precautions were limited. While analysing the sources of knowledge, the Internet and mass media were twice as important as physicians in educating the population. Conclusion: This study shows that the study cohort from the UAE population was aware of certain aspects of kidney stones but was quite naïve about its consequential risk factors. This highlights the importance of promoting education about kidney stones through health campaigns.

Background: Midline cerebral structures are essential for the normal morphogenesis and function of the fetal brain. However, the diagnosis of congenital anomalies of midline cerebral structures. The Aim of The Work: This study aimed to evaluate the role of 2D versus 4D ultrasound in the diagnosis of midline structures of the fetal brain at the second trimester of pregnancy. Patients and Methods: 200 pregnant women at the second trimester [18-22 weeks] were selected. They were clinically evaluated to check the female and fetal wellbeing. Then a screening of fetal brain midline strictures had been performed by two- and four-dimensional ultrasound, aiming to discover any anomalies of the fetal brain midline structure. Both scans were compared with the postnatal transcranial ultrasound. Results: The 2D ultrasound detected no abnormality in 194 out of 200 fetuses [97.0%], and 4 cases [2.0%] had mega-cisterna magna, and 2 cases [1.0%] had encephalomylocele, which were detected by the 4 D and confirmed by postnatal transcranial ultrasound. The 4 D US discovered 2 cases [1.0%] of Dandywalker malformation, which was confirmed by postnatal transcranial US. There was a complete agreement between prenatal 4D ultrasound and postnatal transcranial ultrasound. The prenatal 2D ultrasound had a sensitivity of 75.0%, specificity of 100.0%, PPV of 100.0%, NPV of 98.7% and overall accuracy of 99.0%. Otherwise, the prenatal 4D ultrasound was 100.0% sensitive and specific. Conclusion: 4D ultrasound showed superiority in the diagnosis and confirmation of the fetal brain midline structure’s abnormalities. Also, the prenatal 4D ultrasound was 100.0% sensitive as postnatal transcranial US.

Ethanol (EtOH) intake is an important global health problem which affects many organs such as the brain, liver and stomach. The aim of the study was to examine the effect of the redox dye methylene blue (MethyB) on oxidative stress and histologic damage to the liver, gastric mucosa, and brain induced high dose ethanol (EtOH). Male rats were treated with EtOH (2 ml/rat, 96%) via intragastric route (for two consecutive days). MethyB (20 or 40 mg/kg, intraperitoneally) was given immediately after EtOH administration. The control group received saline. Rats were euthanized three hours after the last treatment. Brain and liver levels of malondialdehyde (MDA), reduced glutathione (GSH), and paraoxonase-1 (PON-1) as well as brain 5-lipoxygenase (5-LOX) and butyrylcholinesterase (BChE) were determined. Histopathological assessment of brain, liver and gastric damage was done. Results indicated that compared to saline treated animals, EtOH caused significant increase in MDA, along with decreased GSH and PON-1 activity in brain and liver. Additionally, it significantly increased 5-LOX and decreased brain BChE activity. The EtOH group showed the presence of dead and red neurons, and damage of glial cells. The liver exhibited vacuolar degeneration, apoptotic hepatocytes and foci of necrosis. The gastric mucosa showed areas of tissue damage, mucosal atrophy, and loss of normal architecture of glandular cells. The EtOH induced biochemical and histopathological alterations were alleviated after treatment with MethyB at a dose-dependent manner. These results demonstrate that MethyB is able to protect against from acute effects of EtOH on brain, liver and gastric tissue via an antioxidant action. MethyB might be of value in reducing tissue injury in acute EtOH intoxication.

Hepatocellular carcinoma is a well-known internal malignancy with increased worldwide mortality. The increased progression rate is closely associated with chronic liver diseases such as cirrhosis. Chemical carcinogens cause tumor advocacy over free radical metabolites to causes numerous biochemical and molecular changes that bring oxidative stress. In addition, inflammatory cells and its growth factor promotes the progression of liver cancer through deregulates the numerous cellular signaling pathways involved in normal cellular proliferation. Plant derived phytochemicals have a better complimentary potency to defend against a wide array of free radical mediated diseases such as cancer. More recently, we have evaluated the anticancer effect of Farnesol against DEN induced hepatocellular carcinoma in male wistar albino rats. However, the possible mechanism in which Farnesol attributes its anticancer effect against DEN induced liver cancer remains unknown. Hence in the present study, an attempt has been made to reduce the oxidative stress by appraise the antioxidant effect by Farnesol in DEN induced hepatocellular carcinoma. Elevated oxidative stress markers with concomitant decreased cellular antioxidants levels were observed in DEN induced hepatic tissues. Further, proliferating nuclei with increased proliferating cell nucleolar antigen (PCNA) and inflammatory mediator expression were observed in DEN induced rats. Oral supplementation of Farnesol to DEN induced rats significantly decrease the oxidative stress markers and increase the cellular antioxidant status. Moreover, Farnesol treatment decreases the argyrophilic nuclear organizer region and PCNA along with decreased expression of inflammatory mediators suggest that Farnesol treatment restores DEN induced hepatic abnormalities and protects liver from cancer progression.

Background: chest trauma is a common cause of mortality, major disability, and the leading cause of death from physical trauma after head and spinal cord injury. Aim: This study aimed to evaluate the effect of educational guidelines on nurses' practice level in caring patients with accidental chest trauma during emergency period. Study design: A quasi- experimental research design on one group with pre and post-test was utilized in this study. Setting: The study was conducted in the emergency department affiliated to Tanta University Emergency Hospital. Subjects: A convenience sample of all available nurses (60) who are working in emergency department(ER), and caring patients with accidental chest trauma affiliated to Tanta University Emergency Hospital, from both sex, different age and agree to participate in the study .Data collection tools:1. Nurses' demographic characteristic .2.Nurses' Observational checklist. Results: The present study revealed that there was a highly statistically significant difference between level of nurses' practice pre, post implementation of the educational guidelines. There were significant correlation between nurses educational level and their level of practice post implementation of the educational guidelines with (P value= 0.001. Conclusion: The implementation of the educational guidelines has a positive effect on nurses' practice level in caring of patients with accidental chest trauma during emergency period throughout the program phases. These findings support the research hypothesis. Recommendations: Regular continuous educational program plan about nursing care of patients with accidental chest trauma during emergency period to nurses working in emergency department at least every six months for enhancing nurses' practice to achieve high quality of care. Importance of presence of protocol related to nursing care of patients with accidental chest trauma during emergency period.

Objective: Cancer treatment using a targeted inducer of apoptosis like tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) faced the obstacle of resistance, thus providing a plus drug like Thymoquinone (TQ) could be of great interest to tackle breast cancer cells. The aim of the present work is to examine the genetic modulation impacts of the TRAIL receptors and apoptotic markers upon the combinatorial remedy of TRAIL plus TQ on human breast cancer cell lines. Methods: To achieve this rationale, the protein content-based cytotoxicity using SRB assay, as well as the genetic expressions of the TRAIL receptors (DR4 and DR5) and apoptotic markers (Bcl-2, Cas-8, and FADD) using real time qRT-PCR technique were preceded against breast cancer MCF-7 and MDA-MB-231 cancerous cell lines. Results: The current study showed that the combination therapy of TQ+TRAIL significantly inhibited the protein content-based proliferation of MDA-MB-231 cells more than MCF-7 cells. The synergistic effect of them significantly up-regulated the genetic expressions of DR4, DR5, Cas-8, and FADD genes and inhibited the genetic expression of the Bcl-2 gene in the proposed cell lines treated for 24 h. The induction of the apoptotic genes using the combined therapy was stimulated by the elevation of the reactive oxygen species (ROS); nitric oxide (NO) and malondialdehyde (MDA) levels. Conclusions: The synergistic influence between TQ which induced the DR5 and TRAIL, facilitating the connection between TRAIL and its receptors on the cancerous cell membrane. Hence, the proposed combination therapy induced the ROS-mediated apoptotic stimulus.

Background The annual incidence of the intracranial dissecting aneurysms is about 1 to 1.5 per 100,000. This is a well-known cause of stroke and subarachnoid hemorrhage in young and middle-aged patients (Santos-Franco et al. in Neurosurg Rev, 2008. https://doi.org/10.1007/s10143-008-0124-x). Various surgical and endovascular treatment methods have been proposed for intracranial dissecting aneurysms. All treatment methods aim to reduce the blood flow in the dissected region. Deconstructive techniques sacrifice the parent artery, whereas reconstructive techniques aim to maintain a parent artery (Stéphanie et al. in Lancet Neurol 14(6):640–654, 2015. https://doi.org/10.1016/S1474-4422(15)00009-5). Due to its dissecting nature, wall friability can make surgical clipping difficult and even risky. On the other hand, recanalization after coiling alone is almost certain. Therefore, deconstructive modalities of treatment like trapping or parent vessel occlusion, performed either surgically or endovascularly, have predominated for managing those lesions, usually with good results. Nevertheless, in absence of efficient collateral pathways, the deconstructive technique carries an ischemic risk. In situations in which parent artery preservation is mandatory, the use of stent-assisted techniques may be the most appropriate choice (de Barros Faria et al. in Am J Neuroradiol 32(11):2192–2195, 2011. https://doi.org/10.3174/ajnr.A2671). However, the usage of stent with recently ruptured aneurysms is always perplexing due to the necessity of dual antiplatelet administration. Hence the management of dissecting aneurysms remain challenging. Results Between January 2017 and July 2019, 19 patients presenting with intracranial dissecting aneurysms were referred to our department for endovascular treatment. Among the nineteen patients, 11 cases were treated by parent artery occlusion representing 57.9% of the cases, and 7 cases (36.8%) were treated by artery preserving technique, and only one case (5.3%) was treated by combination of parent artery occlusion and artery preserving technique. One week after the intervention 26.3% of patients had no disability (mRS = 0), 47.4% had no significant disability (mRS = 1), 15.8% had slight disability (mRS = 2) and 10.5% had moderate to severe disability (mRS = 3–4). After three months we found an overall improvement of the clinical outcome, as 57.9% of patients had no disability (mRS = 0), 26.3% had no significant disability (mRS = 1) and 15.8% had mild disability (mRS = 2). Finally, after six months reassessment with angiography showed that 89.5% of patients had stable aneurysmal occlusion, and 10.5% had recurrence of aneurysm. Conclusions Both endovascular approaches, whether parent artery occlusion or artery preserving technique showed favorable outcome which indicates the safety and efficacy of both approaches if selected properly according to the morphology of the aneurysm.

OBJECTIVES We assessed the relation between clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) and absence of residual disease, in women diagnosed with cervical cancer (CC) and adenocarcinoma in situ (AIS). MATERIALS METHODS Data were collected from 92 women diagnosed with CC and AIS who were positive to HR-HPV and had a repeat cervical HPV test 3-12 weeks after LLETZ (in which CC/AIS were diagnosed) and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV after LLETZ. RESULTS The HR-HPV results after the LLETZ operation were negative in 40 women and positive in 52 women. The HR-HPV-negative group included a significantly higher incidence of AIS: 14 (35%) vs 5 (9.6%, p < .006).In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among 34 women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p < .0005). The positive predictive value for absence of residual cancer, with clearance of HR-HPV after LLETZ, was 95%. CONCLUSIONS Clearance of HR-HPV from the cervix a short time after LLETZ has a high association with the absence of residual cancer in the final outcome, either in the pathology or the follow-up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

Fetal brain arrest is an extremely rare genetic disorder that was described in few patients and encompasses very unique findings of underdeveloped cerebral hemispheres in association with collapsed skull bones. Based on the recurrence among sibs, an autosomal recessive mode of inheritance was proposed; however, no causative gene was identified so far. Here, we report the identification of biallelic variants in the WDR81 gene in two unrelated families (4 patients) with fetal brain arrest including the originally described family and an additional new family. Two homozygous variants were identified: a new missense (c.1157 T > C, p.Val386Ala) and a previously described frameshift variant, c.4668_4669delAG (p.Gly1557AspfsTer16). We assessed the expression of WDR81 at the protein level by western blot analysis using primary skin fibroblast cultures established from the patient with the missense variant and noticed that WDR81 expression was significantly reduced in comparison to normal control confirming the pathogenicity of this variant. Our findings confirm the involvement of WDR81 in the pathogenesis of fetal brain arrest syndrome and suggest that fetal brain arrest represents the severe end of the spectrum phenotypes caused by pathogenic variants in WDR81. In addition, we reviewed the clinical and molecular data on WDR81-related disorders and phenotype/genotype correlations.

Background: Obesity is the single most burdensome lifestyle disease, which has reached epidemic proportions. This study aimed to examine the eating behavior patterns and beliefs in a group of adolescents living in the United Arab Emirates (UAE). Procedure: A questionnaire was administered to adolescents (aged 11 and 18 years) attending outpatients' clinics at governmental health facilities. Informed consent was obtained, and the questionnaire was available in English or Arabic languages. Results: In all, 36 adolescent subjects participated in our study with 12 males and 24 females. UAE nationals constituted 72% of our participants and 28% were of other ethnic backgrounds; 75% were overweight to obese with 17% normal and 8% underweight. The majority of patients were healthy with only 6 patients suffering chronic medical diseases. We uncovered that in less than half of our cohort, the decision to eat came directly from the individuals themselves, but it was more influenced by their families. Food consumption was largely in response to physical hunger with the sensation perceived in the upper abdomen by one-third and the remainder localizing it to various other areas. Excessive caloric intake with frequent meals and snacks was also reported. Our study subjects decided what to consume mainly based on what appeared appetizing, followed by availability and cravings and to a lesser extent based on health recommendations. Excessive speed of food ingestion was self-reported in the majority of participants. Moreover, almost half of the adolescents were unable to turn down food offerings from their close family members and over one-fourth were unable to refuse food from other persons. Common symptoms reported included dysphoric mood, disordered sleep, decreased energy and concentration difficulties as well as low self-esteem. Conclusion: Our study uncovered certain eating behaviors in the cohort of adolescents, which may be important in promoting weight gain. These included misconceived hunger signals, excessive frequency, amount and speed of food consumption as well as more focus on food taste, inattentiveness to cravings and a strong social influence on food intake decisions. The findings of our study aim to shed some light on the eating patterns among adolescents and encourage research to investigate eating behaviors on an expanded scale evaluating ethnic, gender and age-related differences.

Sleep-disordered breathing (SDB) is highly prevalent in adults and leads to significant cardiovascular and neurologic sequelae. Intermittent hypoxia during sleep is a direct consequence of SDB. Administration of nocturnal supplemental oxygen (NSO) has been used as a therapeutic alternative to positive airway pressure (PAP) in SDB. NSO significantly improves oxygen saturation in OSA but is inferior to PAP in terms of reducing apnea severity and may prolong the duration of obstructive apneas. The effect of NSO on daytime sleepiness remains unclear, but NSO may improve physical function-related quality of life in OSA. Its effects on BP reduction remain inconclusive. The effects of NSO vs PAP in OSA with comorbid COPD (overlap syndrome) are unknown. NSO is effective in reducing central sleep apnea related to congestive heart failure; however, its impact on mortality and cardiovascular clinical outcomes are being investigated in an ongoing clinical trial. In conclusion, studies are inconclusive or limited regarding clinical outcomes with oxygen therapy compared with sham or PAP therapy in patients with OSA and overlap syndrome. Oxygen does mitigate central sleep apnea. This review examines the crucial knowledge gaps and suggests future research priorities to clarify the effects of optimal dose and duration of NSO, alone or in combination with PAP, on cardiovascular, sleep, and cognitive outcomes.

Background: In patients with cirrhosis, spontaneous bacterial peritonitis is the most common bacterial infection. This research aims at studying the ascititc fluid Micro RNA-155 as a possible biomarker in spontaneous peritonitis. Method: 187 liver cirrhosis and ascites were chosen, 97 SBP patients and 90 SBP patients, all patients had historical history, thorough and local examination, comprehensive investigations, abdominal ultrasonography, diagnostic abdominal paracentesis and Micro RNA-155 evaluation. Results: in SBP, the average value of TLC, Polymorphene, and RNA-155 was considerably greater than non SBP, but in the SBP group the average value of ascetic albumin, glucose, and protein was considerably lower than in the non-SBP group. For MiR-155, the optimal balance of sensitivity and specificity was 0.022 for ROC as a marker with sensitivity 60 percent and specificity 62.0 percent and surface area under curve 0.639. No statistically significant link exists among SBP patients among Micro RNA-155 with TLC, polymorphs, MELD score and Child Pugh score values. Conclusion; Although MiR-155 was increased in the ascetic fluid of SBP patients, and is a predictor for SBP development, it cannot be employed as diagnostic marker in the SBP, according to this research.

Background Anomalous aortic origin of the left coronary artery (AAOCLA) with an extended transseptal course behind the right ventricular outflow tract (RVOT) is a rare variant that poses challenges not addressed by current surgical techniques. We utilized a novel transconal approach in 7 consecutive patients. Methods A retrospective review was made of a prospectively collected database for consecutive patients undergoing transconal unroofing of transseptal AAOLCA. Surgical repair entails transection of the RVOT, unroofing the septal course of the AAOLCA, followed by RVOT extension with a rectangular strip of autologous pericardium. Preoperative characteristics, operative details, and postoperative course were abstracted. Results All 7 patients identified were symptomatic. Median age was 48 years (range, 12 to 62). The AAOLCA with transseptal course was confirmed by computed tomography angiography. Three patients had provocative testing demonstrating anterolateral ischemia. Four patients underwent cardiac catheterization with intravascular ultrasound and indexed fractional flow reserve, confirming flow-limiting lesion. Importantly, 3 patients had negative provocative noninvasive testing for ischemia. Median postoperative hospital length of stay was 6 days (range, 4 to 12). No mortality or major complications occurred during a median follow-up of 0.75 years. Postoperative evaluation demonstrated anatomically patent unroofed AAOLCA with improved indexed fractional flow reserve compared with preoperative (0.59 ± 0.16 vs 0.90 ± 0.03, P = .05). Conclusions Complete unroofing of AAOLCA with transseptal course repaired with posterior extension of RVOT is an effective technique with excellent early outcome. Multimodality provocative testing is critical to evaluate these lesions as individual studies may be misleading. Intravascular ultrasound with indexed fractional flow reserve is clinically useful to confirm the hemodynamic significance of specific lesions.

Background: Diagnosis of toxoplasmosis relies mainly on determination of IgG and IgM using ELISA.However, inter-laboratory evaluation of performance of many commercial kits gave unsatisfactoryagreements. Merging the innovative use of quantum dots nanobeads (QDNBs) immunoassay may yieldhigher sensitivity and specificity than the conventional used methods.Objective: The present study aims to evaluate the performance of QDNBs based immunoassay inserodiagnosis of human toxoplasmosis.Subjects and Methods: The study included 175 subjects divided into three categories; 122 patientswith clinical manifestations suggestive of toxoplasmosis; 32 patients proved positive for other parasiticinfections, and 21 healthy control subjects. In comparison to Sabin Feldman dye test (SFDT), as a goldstandard test, serum samples were examined in an immunoassay utilizing QDNBs for detection of T. gondiispecific IgG and IgM antibodies.Results: Compared to SFDT, combined QDNBs-IgG/IgM immunoassay exhibited sensitivity of 95.4%,specificity of 98.9%, positive predictive value (PPV) of 98.8%, and negative predictive value (NPV) of95.6%, with relative agreement, validity, and accuracy of almost 97%.Conclusion: It was concluded that QDNBs-based immunoassay improves the performance of ELISAparticularly sensitivity as well as shorten the assay time.

The aim of this review was to present various topics related to lactose intolerance with special attention given to the role of fermented foods and probiotics in alleviating gastrointestinal symptoms. Lactose intolerance is a common digestive problem in which the human body is unable to digest lactose, known as milk sugar. Lactose intolerance can either be hereditary or a consequence of intestinal diseases. Recent work has demonstrated that fermented dairy products and probiotics can modify the metabolic activities of colonic microbiota and may alleviate the symptoms of lactose intolerance. We suggest that, lactose free dairy products could be recommended as alternatives for the alleviation of lactose intolerance and for the promotion of human health and wellness.

Fatema S Shaikh,1 Nahier Aldhafferi,1 Areej Buker,1 Abdullah Alqahtani,1 Subhodeep Dey,2 Saema Abdulhamid,1 Dalal Ali Mahaii AlBuhairi,1 Raha Saud Abdulaziz Alkabour,1 Waad Sami O Atiyah,1 Sara Bachar Chrouf,1 Abdussalam Alshehri,3 Sunday Olusanya Olatunji,1 Abdullah M Almuhaideb,1 Mohammed S Alshahrani,4 Yousof AlMunsour,1 Vahitha B Abdul-Salam5 1College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia; 2Indian Institute of Management – Calcutta, Kolkata, India; 3Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia; 4College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia; 5Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UKCorrespondence: Fatema S Shaikh Tel +966-5591660024Email fsshaikh@iau.edu.saPurpose: The first novel coronavirus disease-19 (COVID-19) case in the Kingdom of Saudi Arabia (KSA) was reported in Qatif in March 2020 with continual increase in infection and mortality rates since then. In this study, we aim to determine risk factors which effect severity and mortality rates in a cohort of hospitalized COVID-19 patients in KSA.Method: We reviewed medical records of hospitalized patients with confirmed COVID-19 positive results via reverse-transcriptase-polymerase-chain-reaction (RT-PCR) tests at Prince Mohammed Bin Abdulaziz Hospital, Riyadh between May and August 2020. Data were obtained for patient’s demography, body mass index (BMI), and comorbidities. Additional data on patients that required intensive care unit (ICU) admission and clinical outcomes were recorded and analyzed with Python Pandas.Results: A total of 565 COVID-19 positive patients were inducted in the study out of which, 63 (11.1%) patients died while 101 (17.9%) patients required ICU admission. Disease incidences were significantly higher in males and non-Saudi nationals. Patients with cardiovascular, respiratory, and renal diseases displayed significantly higher association with ICU admissions (p< 0.001) while mortality rates were significantly higher in COVID-19 patients with cardiovascular, respiratory, renal and neurological diseases. Univariate cox proportional hazards regression model showed that COVID-19 positive patients requiring ICU admission [Hazard’s ratio, HR=4.2 95% confidence interval, CI 2.5– 7.2); p< 0.001] with preexisting cardiovascular [HR=4.1 (CI 2.5– 6.7); p< 0.001] or respiratory [HR=4.0 (CI 2.0– 8.1); p=0.010] diseases were at significantly higher risk for mortality among the positive patients. There were no significant differences in mortality rates or ICU admissions among males and females, and across different age groups, BMIs and nationalities. Hospitalized patients with cardiovascular comorbidity had the highest risk of death (HR=2.9, CI 1.7– 5.0; p=0.020).Conclusion: Independent risk factors for critical outcomes among COVID-19 in KSA include cardiovascular, respiratory and renal comorbidities.Keywords: COVID-19, SARS-CoV-2, mortality rate, comorbidities, risk factors, KSA

This study analyzes the general disease characteristics, impact of enzyme replacement therapy (ERT), and overall survival (OS) of 156 Egyptian patients with Gaucher disease (GD) enrolled on hormone replacement from 1998 to 2017. The mean age at diagnosis was 32.46±12.68 months. Anemia was noted at diagnosis in 50%, thrombocytopenia in 30.7%, severe splenomegaly in 58.7%, severe hepatomegaly in 11.9%, and skeletal findings were detected in 24.3% of the patients. The most prevalent GD type was type 3 (54.5%). Twenty-two of type 3 patients had no neurological manifestations at diagnosis, and 12 developed variable central nervous system manifestations during follow-up. The most common neurological features were limited eye movements, oculomotor apraxia, and squint. Of the 60 patients for whom genotypes were obtained, homozygous L444P was the most common (n=35/60, 58.3%). Treatment with ERT (imiglucerase) revealed significant improvements in blood indices, organ volumes, and growth parameters (P

There was no significant increase in platelet count in transfused and not transfused patients, meaning that platelet transfusion had no longer benefit in reduction of clinical or severe bleeding or improvement in platelet count recovery

BACKGROUND Neuromata developed after major extremity amputation can cause pain, limit the use of prosthetics, and negatively affect the quality of life. The frequency of postamputation neuroma varies widely. The objective of this study was to determine the incidence of patients who developed symptomatic neuromata after lower-limb amputation through a systematic review and meta-analysis. METHODS A systematic review of the literature was performed on 4 major databases. Studies that reported the incidence of symptomatic neuroma in lower-limb amputees were included. A meta-analysis was performed to calculate the pooled incidence of neuromata. RESULTS Thirteen studies consisting of 1329 patients were included in this meta-analysis. The reported incidence of patients who developed symptomatic neuromata ranged between 4% and 49%. The median duration of follow-up was 8.6 years (interquartile range, 2.0-17.4 years). The pooled percentage (95% confidence interval [CI]) of lower-limb amputees who developed symptomatic neuromata was 19% (12%-29%). In studies with a duration of follow-up at least 3 years, the pooled percentage (95% CI) of lower-limb amputees who developed symptomatic neuromata was 30% (22%-40%). In studies with a follow-up period of fewer than 3 years, the pooled percentage (95% CI) of neuroma incidence was 3% (2%-6%). CONCLUSIONS In summary, the overall incidence of patients who developed symptomatic neuromata was 19% or approximately 1 in 5 lower-limb amputees. Symptomatic neuromata are more commonly diagnosed when the follow-up period is longer than 3 years. These findings suggest that neuroma after amputation might be underestimated in studies with a short duration of follow-up.

Protein arginine N-methyltransferase 7 (PRMT7) encodes an arginine methyltransferase central to a number of fundamental biological processes, mutations in which result in an autosomal recessive developmental disorder characterized by short stature, brachydactyly, intellectual developmental disability and seizures (SBIDDS). To date, fewer than 15 patients with biallelic mutations in PRMT7 have been documented. Here we report brothers from a consanguineous Iraqi family presenting with a developmental disorder characterized by global developmental delay, shortened stature, facial dysmorphisms, brachydactyly, and kidney dysfunction. In both affected brothers, whole genome sequencing (WGS) identified a novel homozygous substitution in PRMT7 (ENST00000339507.5), c.1097 G > A (p.Cys366Tyr), considered to account for the majority of the phenotypic presentation. Rare compound heterozygous mutations in the dysplasia-associated perlecan-encoding HSPG2 gene (ENST00000374695.3) were also found (c.10721-2dupA, p.Ser71Asn and c.212 G > A), potentially accounting for the kidney dysfunction. In addition to expanding the known mutational spectrum of variably expressive PRMT7 mutations alongside potential digenic inheritance with HSPG2, this report underlines the diagnostic utility of a WGS-guided analysis in the detection of rare genetic disorders.

Floating knee injury is uncommon yet challenging problem. The situation is more complicated by presence of infection, open comminuted fractures, and late presentation. The aim of this study was to evaluate the closed reduction techniques by circular external fixation in a single stage to treat patients having infected neglected floating knee injuries. This retrospective study included 19 patients with a mean age of 34.4 years. The average duration from trauma to surgery was 51.1 days. All patients had at least one infected open fracture. According to Fraser’s classification, ten injuries were type I, one case was type IIa, four were type IIb, and four were type IIc. Patients were treated by closed reduction techniques using the Ilizarov principles. Orthoplastic procedures were done in four cases in the same surgical setting. Closed reduction and union were achieved in all cases with control of infection in 17 cases. The follow-up period averaged 41 months. The mean knee flexion was 97.4°. The complications included 5° extension lag (two cases), malunion (three cases), refracture (two cases), and DVT (four cases). The bone results were excellent (12 cases), good (5 cases), and poor (2 cases). The functional results were excellent (two cases), good (seven cases), acceptable (seven cases), and poor (three cases). Closed reduction techniques using a circular frame provided a valid treatment option for infected neglected floating knee injuries in one stage without bone grafting. However, the high rate of complications and the diminished knee range of motion should be considered.

Background: Organophosphates are highly toxic compounds for human beings. Organophosphate compounds (OPCs) poisoning by unintentional or suicidal ingestion is associated with high morbidity and mortality, particularly in developing countries. Aim of the study: Assessing the prognostic value of red cell distribution width (RDW) and white blood cells (WBCs), hemoglobin and platelet count on severity and outcome in patients with acute organophosphate poisoning in conjunction with clinical signs using the Peradeniya Organophosphorus Poisoning (POP) score. This is in addition to evaluation and comparison between RDW with pseudo choline esterase (PChE) level as early OPCs poisoning predictor. Methods: A prospective cross-sectional study was done on 100 acutely OPCs intoxicated patients admitted to Poison Control Center Ain Shams University Hospitals (PCC-ASUHs) from June 2019 till December 2019. All cases were clinically evaluated. RDW was done on admission and after 24 hours while WBCs, hemoglobin, platelets, PChE level and arterial blood gases (ABG) were estimated immediately after admission prior to treatment. Results: High RDW values indicated poor prognosis. There was a highly significant correlation between RDW values and the need for mechanical ventilation (MV). There was a significant correlation between high WBCs count, severity of OPCs poisoning and the need for MV. Lower mean pH, higher mean PCO2, lower mean HCO3, lower mean PChE levels, and higher mean WBCs count were noted in patients on MV compared to patients without MV. Conclusion: RDW values on admission can be a reliable predictor of severity and outcome in contrast to PChE levels which showed nonsignificant correlation with severity. Additionally, there was a significant correlation between WBCs with the need of MV. RDW on admission can predict the need for mechanical ventilation with sensitivity (58.97%), specificity (83.61%) at cutoff value more than 14.4. RDW on admission had a sensitivity of 75% and specificity of 73.75% with a cut-off value of 14.3 in predicting mortality in patients with OPCs poisoning. Recommendations: RDW is a simple parameter that could be used in assessing the prognosis of acute organophosphorus poisoning. WBCs count could also be used in those patients to predict the need of MV.

Background: Laparoscopy is a diagnostic and surgical procedure used in all surgical disciplines. The rationale for DTI, without prior pneumoperitoneum, is based on the difficulty of grasping and lifting the abdomen after it is distended with gas and the fact that the VN accounts for many complications. It was noted that complications of laparoscopic surgery are mostly entry-related and independent of the complexity of surgery. DTI without pneumoperitoneum was reported to be associated with minimal complications and preferred by some laparoscopic surgeons. Objective: The study aimed to evaluate the patients who will undergo a DTI for laparoscopy, focusing attention on feasibility, safety, benefits and risks of DTI. We also want to discuss some technical aspects, such as the site of the trocar insertion. Patients and Methods: A prospective cohort study had been carried out in El-Galaa Teaching Hospital during the period between August 2015 and December 2019.Three hundred gynecological patients admitted for either scheduled or emergency laparoscopy. The following methods were done: Direct trocar insertion during laparoscopy had been the standard entry for all selected cases without prior pneumoperitoneum. The entry had been performed at the umbilical level. Results: successful pneumoperitoneum was established in 100% patients irrespective of previous surgery, BMI, parity. Mean time to induce pneumoperitoneum was 100.6±19.27 seconds in all patients. 10 patients had a minor omental injury as there was 10 (3.3%) omental adhesions to anterior abdominal wall due to previous surgery. These injuries were very small and managed by laparoscopy. Conclusion: DTI is a very safe and reliable technique for creation of pneumoperitoneum, and should be used routinely instead of closed Veress needle technique.

Background: Escherichia coli is a common causative of blood stream infection having potentials to produce significant morbidity and mortality. This organism also has the ability to develop resistance against antimicrobial agents. Knowing its epidemiology, risk factors and antimicrobial resistance patterns can help preventing and managing bacteremia caused by this organism. Materials and methods: This was across sectional observational study carried out from February 2017 to February 2018 on 64 blood culture positive Escherichia coli infected patients admitted in Medicine inpatient of a medical college hospital. Age, sex, mode of acquisition of infection, history of prior empiric antibiotic treatment, duration of hospital stay, development of complication were observed and noted. Antibiotic susceptibility test for all isolates was performed by Kirby-Bauer disc diffusion method. Predesigned semi-structured data collection from was used and collected data were analyzed manually and expressed in descriptive statistical terms. Results: Of the 64 enrolled patients, 47(73.43%) were female. Average age of affection was 53.48±20.65 years and increased incidence rates (51.56%) was observed at age >60 years. Infection was communityacquired in 35.84% cases and urinary tract infection was the most frequent (46.3) risk factor. More than eighty seven percent of samples showed resistance to at least one antimicrobial agent and resistance to multiple drugs was associated with complications. Conclusion: Escherichia coli bacteremia has high incidence rates for antimicrobial resistance and mortality. Continuous surveillance and antibiotic susceptibility pattern monitoring is essential to develop regional antibiotic therapy protocols.

Background: In certain places, tuberculosis (TB) and diabetes mellitus (DM) are strongly linked as frequent comorbidities and might be termed epidemics combined. Objective: The present work aimed to detect relationship between type 1 DM (T1DM) and latent TB. Patients and Methods: This comparative cross-sectional study was conducted over the period from October 2019 to October 2020. It included 81 cases had type 1 DM and 81 healthy children as control group. This study was conducted at Zagazig University Pediatric Hospital. All patients were subjected to the following: Full history taking, full general examination, and investigation (Tuberculin test and chest X ray). Results: In the current study, 42% were male and (58%) were female. In the present work, there was no statistically significant difference between cases group and controls group regarding anthropometric measurements. This study showed that, the percentage of positive tuberculin test was higher among cases group than controls group (32.1%, 7.4%) p value< 0.001. OR estimate for DM on risk of TB was 5.9 (95% CI 2.27 to 15.33). Conclusion: There was no statistically significant difference between diabetic group and control group regarding sex, age, weight, and height. There was no statistically significant difference between diabetic and control group regarding contact with patient with TB and passive smoking. The percentage of positive tuberculin test was higher among diabetic group than control group.

Patients with shoulder pain commonly present to a general practitioner and/or in the orthopedic department. In some instances, pain in the shoulder region can indicate serious underlying pathology. This article describes an elderly smoker presenting with progressively worsening shoulder pain not conforming to musculoskeletal, neuropathic or mechanical type pain and with poor response to conventional pain management protocols. Evaluation with meticulous history, physical signs, chest imaging findings, and histopathology confirmed the diagnosis of a rare clinical condition the Pancoast tumor.

Iron status may influence the outcome of infertile women under the intracytoplasmic sperm injection (ICSI) technique of in vitro fertilization (IVF). The aim of this study is to evaluate iron status and ceruloplasmin ferroxidase activity in the follicular fluid (FF) and their association with IVF outcomes. The study enrolled fertile women with male cause infertility (n=25), infertile women with polycystic ovary syndrome (PCOS; n=21), infertile women with low AMH level (n=26), and women with unexplained infertility (UI; n=27), all undergoing IVF/ICSI. On the day of oocyte suction, the selection of FF samples was accomplished. Iron, ferritin, and transferrin levels, as well as ceruloplasmin (CP) ferroxidase activity, were measured in the FF. In the PCOS group, iron showed significantly higher level (P

Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10–12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF’s multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071 (registration date: September 12, 2019) Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01031-w.

Background Male sex reversal syndrome is a rare genetic cause of male infertility with an overall incidence of 1/20,000–1/100,000 males. There is mismatching between the genetic make-up and the apparent clinical features. The clinical presentation of such cases is variable ranging from ambiguous genitalia at birth, failed puberty, up to normal male phenotype with infertility and hypogonadism. The exact molecular and genetic bases of this syndrome are still unclear. Most of the recorded cases were SRY positive (i.e. representing 80–90% of all cases), and they showed translocated SRY gene on the Y chromosome. Moreover, fewer cases of male sex reversal (46, XX) were SRY negative. Case presentation Herby, we report a rare case of a 35-year-old infertile male patient who presented with azoospermia, hypergonadotropic hypogonadism, and abnormal classical (46, XX) karyotype, as well as negative FISH for SRY gene. He had a previous negative biopsy and was asking for redoing micro-TESE, whoever he was discouraged as chances to find sperm is eventually nil, and instead, he was prescribed testosterone replacement therapy to correct hypogonadism. Conclusion Therefore, any case of non-obstructive azoospermia should be offered genetic testing trying to exclude non-treatable cases and for genetic counseling.

Background: Cervical cancer affects all aspects of a patient’s life, including sexualfunctioning and intimacy. Sexuality is one of the indicators of quality of life; it influencesthoughts, feelings, actions, social integration, and therefore, physical and mental health. Thepresent study aimed to evaluate the impact of protocol of nursing intervention on sexualdysfunction among women with cervical cancer. An intervention study design wasconducted in out-patient clinic in the oncology unit at Beni-suef university Hospital. Apurposive sample of 70 women was included in the study. A quasi-experimental (prepost) study design was used. Data was collected through four types of tools structuredinterviewing questionnaire sheet, female sexual function index, female sexual distress scaleand body image scale. In addition to Supportive material (educational booklet) was given towomen. Results: There were high statistical significant differences in the women's totalscore of knowledge about cervical cancer, total scores of female sexual function index,female sexual distress scale and body image scale at post intervention in which the womenhad higher score at post intervention p (< 0.001). Conclusion: Educational booklet provedto have a positive effect on knowledge and sexual function of women with cervical cancer.Recommendations: Multidisciplinary collaboration approach for addressing sexualproblems related to cervical cancer, preparing health classes for cervical cancer womenregarding sexual dysfunction with cervical cancer and further research about nurse'sperception and practices regarding sexual dysfunction with cervical cancer.